As a nomad at sea, you may face unique challenges in accessing medical care. You may be far from a major port, and even if you are in a port, you may not be familiar with the local healthcare system. Having a well-stocked medical kit and knowing how to handle common injuries and illnesses at sea is essential. However, there are a number of resources available to help you get the medical care you need, no matter where you are in the world.
**This article will explore various aspects of medical care and preventative measures for sailing nomads, including how to handle medical emergencies, what to include in a well-stocked medical kit, and resources for medical and travelers’ insurance.
Lurking Fears When You Live or Travel Abroad
Yesterday as I walked alone in Puerto Penasco, I came across 3 dogs in a dirt alley, one of which lunged at me several times and would probably have bitten me had the dog’s owner not stepped in. In my mind swirled three things at once: 1) “dogs here are usually so friendly—what’s going on?” 2) “if he bites me, will the other two dogs join in?” 3) “if he bites me—we’re done in the boat yard because I’ll have to head home for care.”
Mexico dogs, in particular, do not typically lunge and bark when someone passes by their neighborhood. In fact, Baja dogs, as we like to call them, are so friendly that I’ve said when we’re done cruising that I’d love to come back here just to take one (a stray) home.
However, the reality is that when you live abroad, you know that roaming dogs carry an abundance of diseases: rabies, intestinal parasites, scabies, ringworm. The list goes on.
In countries like Mexico where there is an overpopulation of animals and limited resources for vaccinating the animals, then the fear of being bitten is real. And it would require all sorts of follow-up care, like a tetnus shot, weeks of antibiotics, and post-exposure treatment consisting of rabies’ vaccinations.
Medical Emergencies at Sea
Even though Kevin and I are working right now in a boatyard close enough to the U.S. that we simply would have driven home if there was a problem, a medical emergency at sea is even scarier. Off shore, many boaters would simply use their VHF radio to contact the nearest coast guard station or navy. Or a satellite phone would enable crew members aboard to call a medical emergency number.
In U.S. waters, the coast guard will dispatch a rescue vessel to the boat’s location. The rescue vessel will have medical professionals on board who can provide emergency treatment.
And if the condition is serious, the person may be evacuated to a hospital on shore. The best medical advice we have heard when there is an emergency at sea: take seasickness medications right away. With so much going on and the possibility of unpleasant ocean conditions, even if you are not prone to getting seasick like us, the advice is to take the meds anyway.
Luckily for us, we have not had this kind of emergency, but we have tried to prepare for emergency situations on board. For instance, we have two well-stocked medical kits on board.
First Aid Kit Essentials
The following list of items should be in a kit or bag separate from a ditch kit (the waterproof bag loaded with essential items in case you must abandon your boat.)
Item | Quantity |
Adhesive bandages | 20 |
Sterile gauze pads | Plenty |
Assorted box of surgical sutures | 1 |
Adhesive tape | 1 roll |
Waterproof tape | 2 rolls |
Antibiotic ointment | 1 tube |
Antiseptic wipes | 10 |
Pain relievers | Plenty |
Scissors | 1 pair |
Tweezers | 1 pair |
First aid forceps (clamp) | 1 |
Thermometer | 1 |
Latex gloves | 4 pairs |
First aid manual (search for and download for free a marine medicine guide) | 1 |
Stethoscope | 1 |
It is important to check your first aid kit regularly and replace any expired items. Additionally, after I was hospitalized in La Paz our first year of cruising, we added the following items:
- A full bottle of antibiotics (Mexican pharmacies sell 100 tablet bottles)
- Fleet enemas
- IV fluid (a bag)
- Blood pressure cuff
- Seasickness meds
- Hydrocortisone cream
- And because we know of so many cruisers who have had kidney stones: Stone Breaker tablets (lemonade powder also helps as the acidity in lemonade helps break up stones.)
Non-Emergency Medical Care
If you are experiencing a non-emergency medical condition, such as a cold or flu, you may be able to get care from a telemedicine provider. Telemedicine providers can provide medical care remotely using video conferencing and other technology.
And if you need to see a doctor on shore, you can contact your travel insurance company for assistance. Your travel insurance company can help you find a doctor who is in your network and who can speak your language. You may also be able to find a doctor on your own by searching online or asking other nomads or cruisers for recommendations.
Paying for Medical Care
The cost of medical care can vary depending on the country where you are and the type of care you need. If you have travel insurance (see good resources below), your insurance company may cover the cost of your medical care. However, it is important to check with your insurance company in advance to make sure that your policy covers medical care at sea.
If you do not have travel insurance, you will need to pay for your medical care out of pocket. The cost of medical care can be expensive, so it is important to have a financial plan in place. You may also want to consider purchasing medical evacuation insurance (see below), which can cover the cost of transporting you to a hospital on shore in the event of a medical emergency.
Paying for Care: Anecdote in Mexico
Stories abound in Mexico of how cheap emergency and hospital care is. As I mention in my article “The Realities of Living and Working on a Boat,” I found myself in a research hospital in La Paz, Mexico, after I could not go to the bathroom. My entire system shut down. I will generally avoid the hospital at all costs, but I finally consulted the local cruisers’ guide and found a hospital in town.
I spent 8 hours with an umbrella of young men (the oldest male doctor was 25 years of age) hovered above my hips as they tried to get a catheter in me. That’s four doctors, one IV fluid bag, an enema, an Xray, and four catheters. The staff waved goodbye to us. When Kevin insisted on paying, the hospital staff kind of looked around in confusion. And then one nice man told Kevin to go to the cashier’s office. The bill was $90 U.S. dollars.
The other details of this story—the missing bathroom knob on the only bathroom in my “ward,” the missing toilet seat, the lack of an IV bag hook which forced me to hold the bag while trying not to fall into the toilet after my enema, the lack of sink soap at the end of that adventure, the bloody cotton ball on the Xray room floor. The fun went on.
But believe me when I say how lucky I felt that I wasn’t in the middle of the ocean as I realized my body would not function. This experience was a wake-up call for me to handle my body and my stress levels differently with our cruising lifestyle. It also allowed me to re-assess our level of preparedness on the boat.
Tips for Accessing Medical Care at Sea
Here are some additional preventative care measures:
- Take a medical refresher course, like a CPR course, and repeat the course as recommended. Youtube videos on how to do CPR or wilderness first aid courses can also help cruisers stay up-to-date. And now it is possible to buy an at-home defibrillator (albeit, pricey) in case of a cardiac arrest on board.
- Register with a telemedicine provider. This will allow you to access medical care remotely, even if you are far from a major port (see “resources” below).
- Keep your medical records up to date. This will help medical professionals to provide you with the best possible care. When you do have to go to the hospital, make sure to have your passport and other important paperwork.
- If you have it, make sure your travel insurance policy covers medical care at sea.
- Have a financial plan in place to cover the cost of medical care.
- Consider purchasing medical evacuation insurance. We know of a sailor who used this insurance to airlift his wife from a hospital in La Paz, Mexico, to San Diego after she fell and hit her head onboard.
Resources and Preparation for Sailing Nomads
Here are some resources that can be helpful for nomads at sea who need medical care:
- International Maritime Organization (IMO): The IMO provides a number of resources for seafarers, including information on medical care and medical emergencies.
- Divers Alert Network (DAN): DAN is a non-profit organization that provides medical assistance to divers and other people who are injured or sick at sea. They offer a 24/7 emergency hotline. And they also offer traveler’s insurance.
- Nomad Insurance: World Nomads Insurance provides comprehensive travel insurance for nomads and other people who live and work abroad. I received a quote for me and Kevin for a 6-month period in Mexico, and the standard price for both of us was under $1000. The coverage included equipment losses, emergency care, emergency evacuation, trip cancellation due to sickness or injury, and more.
- Global Rescue: Global Rescue is a company that provides medical assistance and evacuation services to travelers. Their transport rules are straightforward and flexible, as well. For instance, if you can fly commercially to a site rather than get airlifted, they handle the rest of the logistics in getting you care.
Follow the Girl Scout Rule: Be Prepared!
By following the tips above, the sailing nomad can be prepared. Having a plan in place, an awareness of available resources, and the ability to be proactive in seeking medical care if needed can make all the difference when you live and work abroad.
**Disclaimer: I am not a medical professional. This article is written based on my own experiences and knowledge of resources available. Please comment in the article below if you have other suggestions—I welcome them!
About The Author
For your first aid kit, add two of each size Israeli Trauma Bandages, two CAT Tourniquets, and a bottle of Lidocaine with syringes. Also add a couple tubes of Crazy Glue and a package (100) steri strips. Giving yourself sutures without Lidocaine is really not fun at all.
Thanks for the tips! We do have Lidocaine cream, but these are great suggestions since cuts on board are so common.