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FINDING A DOCTOR OVERSEAS

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A worry that haunts many or even most foreign-bound travelers is the possibility of becoming seriously ill or suffering a bad accident while away. In an emergency, where do you find a doctor - especially in places where much of the medical care may not be up to American standards?

In Asia a couple of decades ago, I foolishly traipsed about for several days in sandals because they were cooler than shoes. Soon a thong wore a blister on one of my toes, and it became infected while I was staying in Kuala Lumpur, the capital of Malaysia. Overnight my foot swelled to what seemed double its natural size, and the throbbing pain was excruciating. Obviously I needed a doctor, and right away.My solution in a distant land where I was a stranger was to call the U.S. embassy, where a sympathetic consular officer gave me the name of a British-trained doctor whom embassy personnel regularly consulted and recommended highly. Citing the embassy as a reference, I got an immediate appointment and satisfactory treatment. The swelling took about two days to go away, and on those days you could have seen me hopping about Kuala Lumpur as I tried to keep to a busy sightseeing schedule.

On a trip a few years back to Buzios, Brazil, a somewhat remote beach resort a half-day's drive north of Rio de Janeiro, my wife, who is normally quite healthy, developed a sudden gynecological problem for which she needed quick medical advice. But where do you find a doctor in a small village? We turned to our innkeeper, who spoke English, for help. As it happened, her family doctor was away for the day. So she led us to the public clinic, where about two dozen villagers of varying ages were lined up beneath a tree waiting for the clinic to open. It was the best we could do.

Chatting with acquaintances in the crowd, the innkeeper easily got their agreement to let my wife go to the head of the line, and they waved the visitor forward with hospitable smiles. The doctor was all smiles too, but he spoke very little English. So our innkeeper joined the consultation as translator. The clinic was spartanly furnished, and it must have possessed only very limited medical equipment because the doctor had to postpone his examination for an hour while he sterilized some of the instruments he needed. Not surprisingly, my wife was uneasy about the quality of care. But the doctor's reassurances calmed her, and she left the clinic pleased with his help.

I cite these experiences as a reminder - to myself as well as other travelers - that medical emergencies of the most unexpected sort can strike anyone at any time. And sometimes finding adequate medical care is simply a matter of good luck. So, before going abroad, you should give some thought to your health history and, depending on your destination, what you might do if you suddenly became ill or were injured.

Fortunately, in recent years numerous services have sprung up providing varying types of medical assistance to Americans abroad that go well beyond such traditional sources of help as the American embassy or consulate or your hotel. For example:

- Credit card companies - including American Express and gold-level Visa and MasterCard - maintain 24-hour hot lines that card holders can contact to get a referral to the nearest English-speaking doctor or recommended hospital. The staff members at these numbers may be much more accessible, and helpful, than embassy personnel.

- Other organizations - and at least one guidebook - have compiled lists of qualified doctors in most countries of the world. Among them, the highly regarded International Association of Medical Assistance for Travelers has put together a 72-page directory of English-speaking doctors around the world, and it is available at no cost - although a donation is welcomed. With such a list in hand, you can make an appointment before leaving home for any medical care you think you might need while abroad.

- Travel assistance (or insurance) companies offer various types of medical coverage for the length of your trip, including air evacuation home. Health insurance for your trip can be critical if your regular coverage is limited only to the United States. Consider evacuation insurance seriously if you are headed for a country where medical facilities are known to be primitive. A flight home from Eastern Europe on a stretcher can cost as much as $30,000 aboard a commercial airliner; a private medical jet could cost $80,000. An official at one assistance company tells the horror story of a New York man who had to take a second mortgage on his home to fly his daughter back from Moscow, where she had been struck and seriously injured by a hit-and-run driver.

- And some firms have developed differing ways to speed your medical history to emergency room doctors if, in the worst-case scenario, you arrive unconscious and in immediate need of help. Typically, they provide 24-hour access to your medical, dental and eye-care records. If you break your glasses on a trip and don't have a spare, you or the optician at your destination can order up your prescription in minutes.