Almost Fearless

How to Survive Surgery Abroad… Alone

On September 24th, 2015, nerves overcame me while awaiting my landlord. My apartment was empty, and all that I owned in the world – nine boxes, a duffle bag, and a 25L carry-on backpack – were crammed into my best friend’s SUV. Nomad day had arrived. Time to return the keys and become home-free.

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Excited? Yes. But mostly, I was terrified. I was a week from being 42 and had decided to forego all roof-over-my-head security. In fact, I’d never travelled abroad as an adult, and going nomad scared me to bits. With rent in my hometown Vancouver so expensive, I had to go all-in on the nomad life to travel, the biggest decision of my life.

Out of the many things terrifying me on key-returning day, needing surgery abroad never hit my radar.

So, in February, 2017, when I was 9,300 kilometres from Vancouver, alone, with doctors saying I needed an emergency hysterectomy, terror struck.

How does one get major surgery alone in Albania? Home of one of the world’s oldest and hardest-to-learn languages, and which, not long ago, was as isolated as North Korea?

And for a hysterectomy? Oof! My mother had one; it was how they found the cancer that killed her six months later. So, not only did I need solo surgery in the “old world,” but I had to wrestle ghosts, too.

Then there’s the hysterectomy recovery, which involves not lifting more than five pounds. For weeks! Are you kidding me? Alone? On the other side of the world? My duffle weighs 50 pounds, for crying out loud.

These were only the start of the fears flashing through my mind when I learned I had to go under the knife.

Feel the Fear… Yada, Yada, Yada

Traveling the world solo has made me tough, but I bawled in that consult room. Fear took over for a while.

Upon getting home, I remembered my go-to motto: “In the face of fear, make a plan.”

I’m not ashamed that I got scared. Fear is the natural reaction to most obstacles, and it’s okay to feel it, because it’s our survival instinct kicking in. Daily, people survive fear and grow stronger. They plan for contingencies and they move through fear.

Not everyone believes in the value of a plan, but when trapped at home in a foreign country, recovering from major surgery, a plan might save your life. It’s not called “major” surgery for kicks, you know.

The Backstory

In December, 2016, I landed in Greece, and so began the first signs of my health’s impending downward spiral. That first night, I bled heavily. My period persisted for weeks over a beautiful-but-stormy Christmas on a Greek Island. Five weeks later, in Athens, the bleeding escalated even more. I visited a pharmacy for management drugs, but pharmacists urged me to go to a hospital.

This was the day before my travels to Morocco were to begin and I was apprehensive of experiencing Moroccan medicine’s handling of female health.

So, to Athens’ maternity hospital I went. After seven hours of waiting and testing in a peeling, crumbling, dim ER room, came a verdict. Endometrial ablation required. Outpatient procedure, max of four to six days’ recovery, for the low price of €200. It’d cost less to pay out of pocket and return to Athens than to cancel my flight and lodgings in Morocco, so I asked the docs for management drugs, and was prescribed progesterone to abate bleeding. Back to traveling I went.

Three weeks into Morocco, things became dire. I lost a pint of blood over eight hours. I’ve never been so scared. I ate that progesterone like it was a box of Tic Tacs. Then I came across a Guardian UK report entitled, “People Who Should Live Are Dying: Inside Greece’s Medical Meltdown.” Suddenly, my return to Greece seemed ill-considered. My would-be procedure was exactly the kind that could go from easy to infected, and then what?

Bound for Albania

So, I investigated surgery options and costs for everywhere from Scotland and Hungary to Croatia and Italy. I searched for “American-style” healthcare services, and Google went in overdrive. Most hospitals answered emails in English, some even had live English chat help. And then Albania appeared. Upon further research, it appeared to have a reputable, affordable private care system with one of the lowest costs of living in Europe.

The Albanian private American-style hospital wouldn’t quote me on specific procedures, insisting I needed testing with their gynecologists to ascertain a treatment plan. Eventually, I relented and booked a consultation. I’d trust my instinct and the €39 gynecologist consult fee, which seemed like a bargain to me.

Originally, I stupidly planned to land in the capital, Tirana, on a Thursday night, spend the weekend exploring and visit the doctor Monday. Soon, my naïve idiocy struck me. What if my situation was more serious? I lost a pint of blood in eight hours! I might need weeks in Tirana for recovery! I rescheduled. Within 14 hours of my plane’s touchdown, I was at the hospital.

Good call, too. The Greeks were wrong. Forget ablation, the uterus had to go.

In 1999, my mother had fibroids that turned malign and killed her. Her scenario was one in 1,000, but my relation to her put me in the “high-risk” category. My new doctors, upon learning this, insisted on the hysterectomy. They wanted to operate at 8 a.m. the next morning. In fact, so insistent were they, that when I said I couldn’t afford the €3,000, they demanded hospital administration reduce the costs by 50% so I could get the procedure.

The Recovery Challenge

Recommending surgery less than 24 hours later obviously meant my status was serious. But recovery would need weeks of lifting barely anything. How would I get by in a foreign country with no help, no support, no lifting, limited walking and no delivery services?

What was the point of life-threatening major surgery if I couldn’t have a safe recovery?

The surgery went on ice until Monday morning, buying me 2.5 days to prepare.

Immediately, I emailed my AirBNB hosts to extend my booking as long as I could, giving me four weeks total. Later, I’d find another place. I asked if they could help me arrange check-in care with nursing experience. In a bizarre fluke, it turned out my apartment manager’s mother-in-law had been a recovery nurse in Greece for over two decades. We arranged for her to come by daily, twice, if needed, for check-in, prescription purchasing, and grocery delivery. As for money, meh, why discuss such things? Her help eventually cost just $50 for seven short visits, more than three full days’ wages for most Albanians.

And so, I had confronted and resolved my biggest concerns within three hours of agreeing to surgery, but then I made a detailed plan.

The Plan That Saw Me Through

Food, Food, Food!

The grocery store featured prominently that weekend, and I stocked up on anything that wouldn’t spoil in that first month; Tetra Pak milk, eggs, dairy, bread for the freezer, snacks and other staples. Before spending money foolishly, I Googled for best foods to eat after abdominal surgery. Soup was a winner, so I made three kinds of soup and “souped-up” the freezer with these frozen in portions.

Luckily, my AirBNB was an oft-travelling banker’s home loaded with cooking supplies, since he loved to eat, so cooking was easy and rewarding. I chalk it up to cosmic good fortune that, out of 18 months of travel, his apartment was the best cooking set-up I’ve had, but I would recommend anyone to investigate this more deeply before booking.

Tips: If seeking lodging for surgical recovery, read suite reviews in detail to see what people say about cooking supplies. Also, create a “kitchen kit” with utensils and tools, like a good knife, spatula and whatever else you consider essential. Remember, you’ll need to check this in luggage as it can’t be carry-on.

Choosing a Location

Because this was all about the hospital, I first arranged the hospital before booking an AirBNB. Then I compared the AirBNB map with Google maps, ensuring I picked a well-stocked, comfortable apartment close to the hospital, so I could afford cab fares there and back.

I also used Google maps to zoom in and see what was nearby. Streetview revealed tons of green grocers, markets, eateries and bakeries, all within three blocks. With a light-weight (1/2-pound) backpack, I’d soon be able to carry four to five pounds on my back, plus four to five pounds in-hand, while I regained my independence.

Before surgery, I took an introductory walk around the neighbourhood. I made note of the closest cafés and veggie shops and bakeries, and even found a well-hidden produce and mini-market stop in an alley 60 feet from my back door!

My only planning fail was in forgetting that countries like Mexico and Albania often have unreliable power. What on Earth would I have done if I had to leave the building in a power outage? I was on the ninth floor! Luckily that never happened.

Tips: Be brutally clear with your landlord about your surgical recovery limitations. They cannot just wave it off and go “Oh, it’ll be fine.” If being brutally clear scares the landlord off, then you’re doing yourself a favor. Let them know you need X, Y, and Z a maximum of X-meters away. (The rest of the world uses meters, not feet/miles. A web distance converter will ensure you can give them an accurate understanding of distance.)

Elevators are fantastic, but not in a power outage. Also, just because there’s an elevator doesn’t
mean there are no steps leading to the entrance or the elevator itself. Ask if there are any steps at all, as steps may be verboten in your recovery.

Know Who to Call

With private hospitals, customer service is a big deal. Administration knew I spoke only English and was travelling alone and staff were concerned about helping me. I requested cell numbers for two English-speaking administrative staff, in case anything went badly after I returned home, and sent an initial text and a photo of myself for my contact ID, so they’d know who I was if I contacted them later. (In fact, this helped me weeks after the surgery when my insurance company insisted on having all post-surgery documents, and my concierge Romeo helped me through texts and emails, sending me everything I needed.)

Later, I programmed my AirBNB hosts’ number into my phone, putting it in my “favourites,” so I’d have fast access.

Like in many poorer countries, Albania’s capital lacks a building address system, and explaining where I was in an emergency might literally be life or death. I had an agreement with my hosts that I could reach out if needing to summon medical intervention.

Finally, I realized my life might depend on my cell phone. I bought the largest data plan I could, five gigabytes for 30 days, guaranteeing coverage if WiFi died and giving me recovery time before topping up data coverage again.

Tips: Take a spare battery charger to the hospital, because annoying the nurses with things like “plug my phone in, please” is uncool. I use a 16,000 mAH charger that can recharge my phone completely at least four times, and this proved infinitely useful in the hospital and upon returning home, when I discovered how much it sucked to bend over for any reason, let alone mess around with plug outlets close to the floor.

Using Social Media and Smartphones for Good

On Facebook, I was blunt about what was going down. I told my public network about the surgery I needed, what time it would occur, when I would check in and where I was.

They offered me crazy support and shared a ton of information I hadn’t considered, giving me good questions to ask my medical staff.

To that end, I also downloaded the Albanian dictionary for offline use in Google Translate. “Translate” may get a lot of things wrong, but it gets enough right that I consider it a critical app in my travels – and in a hospital too.

For fun, in post-surgery, I used Instagram to keep myself amused, doing a “Captive in Albania” photo-series from my 9th-floor apartment, using a zoom lens, which became very popular with my network. This also ensured I got up and stood quite a bit in those early post-surgery days, which is critical for good recovery.

Tips: Create a Facebook list that includes the people you love and trust the most, like your Aunt Betty, brother Dave and anyone else you can be brutally open with, or just create a “custom” update where you add specific people you want to share your real status with, and only they will see it. But be aware, the next time you post, it defaults to the last setting, so make sure you’ve got the right visibility settings on anything you post.

Other Little-Big Things

Cash is king in Albania. With the Albanian mafia alive and well, I wouldn’t give anyone my credit card or banking card in any situation. Knowing I had no idea what might come up in the next few weeks, I visited ATMs to stock up on all the cash I could possibly need for my first three weeks after surgery, then hid it at home so the cleaner wouldn’t find it.

I envisioned life after surgery. Logistics mattered. I wanted to avoid bending down to lower shelves to rummage for things like cookware and such, so I put anything I might need at waist-level for my first days at home. Drugs were put by my bed, and other necessities placed on the kitchen table, counter, or waist-level in the bathroom, since those were my primary living zones. I even rearranged furniture, such as pushing a nice armchair up to a window with a city view for reading. Totally overkill, but I cleaned that window, too, so I could enjoy my view as much as possible.

I also compared the beds in the apartment. I found the master bed would be too low for standing up from after abdominal surgery. Conversely, the smaller-but-higher “extra bed” was firmer for back support and easier to get out of, plus closer to the kitchen and bathroom.

On the day before surgery, I also did laundry, so I’d be fine for a week to 10 days.
And the final thing I did before leaving for surgery was to clip my toenails, since I knew it might be over a month before I could bend over enough to do that again. (And it was five weeks!)

Tips: Don’t wait until the last day before surgery to get cash out of the bank, as most countries have a daily maximum withdrawal you’ll need to exceed. This way, you can return two days in a row and double up.

Ensure you have lots of toilet paper, skin cream, and other basics before the big day. Your skin will dry out in the hospital, and it’ll be nice to lather up. Keep in mind you may need things like laxatives, mild sleeping pills and other drugs that may be expensive, so “more is better” in this case.

Finally, Breathe

Surgical recovery is largely about being able to rest, relax, eat healthy and sleep. It’s also about being bored and being patient enough to enjoy the boredom. The surgery’s hard, but it’s also the easiest part, because we’re so inclined to want to Do All The Things, especially if we’re in a foreign country and everything’s beautiful out that window. But embrace the boredom. Trust in your preparations. Make lists of anything you realize you’ve overlooked. If you’ve got food, a safe place to be and a good bed, those are the most critical factors in surviving surgery abroad. It can be lonely and scary, but I’m proof that a little planning and a lot of patience can mean a successful recovery and a new lease on life.

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Steffani Cameron

Steffani Cameron is a journalist born and raised in Vancouver, Canada. After overcoming a serious scooter crash, brain trauma, and debt, she went "full nomad" at age 42, in 2015, and plans to keep going until at least 2020.

18 comments

  • Biggest tip: travel insurance. A good policy would either get you back “home” if you were stable or coordinate all care, pay most expense etc. Don’t leave home without travel insurance. It can save your life.

    • Except she doesn’t have a home.. so like many people who live overseas we have to figure out how to get care abroad. A travel policy would fly her back but not rent an apartment for her… right?

    • I have travel insurance. I would have likely not had the surgery considered urgent in Canada, where care standards have fallen dramatically.

      Plus, because I saw a hospital for a related issue and went away for a month, I was deemed “unemergent” by the insurers because any follow up must occur within two weeks.

      Trust me, I’ve got myself covered by insurance in three directions yet none of it applied.

      • Finally, I understand. I never ‘got it’ why you didn’t go back to friends or family in Canada. You may no longer have a uterus, but WOW woman, you’ve got GUTS! Thank you so much for your candid sharing of that gutsy medical adventure! This post can help sooo many people, some too scared to intentionally go overseas for medical treatment they can’t get or can’t afford at home.

        • Hahah, Cherie! Thanks on the guts comment. I left a comment for Holly below that will explain even more in-depth why Canada was never a consideration for me.

          I had a woman from Canada tell me she opted for a Caesarean in Zimbabwe in a private hospital and never thought twice about it. She said it was pretty amazing how well she was treated and felt that it far exceeded what she would have had in Vancouver.

          My aunt had a bowel resection in Mexico after a near-fatal blockage, and her BC doctor told her, that had it happened in BC, she’d have been on a colostomy bag the rest of her life.

          Our care isn’t what we want to believe it is.

  • This is excellent, Steffani. You have helped others feel less scared by it all. Your practical nature shines out of this post and, I know, saved you a multitude of post-op issues. Well done!
    Julie

  • I don’t live abroad or need surgery, but I read every word of this because it is so interesting and well written. I love your motto “in the face of fear, make a plan.” Your approach was very practical and offered great advice.

  • “In the face of fear, make a plan” I really like that. It speaks to my anticipatory anxiety.

    I also agree that the Canadian health care situation is extremely bad. If you were here you might have had to wait hours in ER because there are no family doctors. Then weeks to see a surgeon and then longer to schedule in surgery. You waited 2.5 days.

    Cheers

    • And I only waited 2.5 days out of choice! I could’ve been under the knife 18 hours later, if I wanted.

      My decision to stay and pay for the surgery was also largely informed by the fact that my mother’s fibroids surgery was scheduled more than 4 months later in 1999; she only got bumped up when a superstitious Chinese woman cancelled hers for Chinese New Year. Otherwise my mother would’ve been dead by the time her date came along, the cancer was progressing so far.

      If I had been scheduled 4 months later upon returning to Canada, and rented a similar apartment with a kitchen close to a hospital, I’d have been paying $12,000 for rent alone. Not including the $1500 of flights.

      Then there’s food. In Albania, I paid 50 cents a kilo for spinach ($3+ in Vancouver), $2.75/kilo of cherry tomatoes ($10 in Van), $1 per kilo of potatoes ($6 in Van). Cabs for $2.50 up to 3 kilometres. Buses for 20 cents.

      My total costs with surgery, rent, prescriptions, drop-in nursing, and commuting were about $5,000 for 6 weeks.

      So…

  • Steffani, you have such an ease in your writing style that even though I felt your ‘fear’ you also made me feel your ‘zen’…you are an amazing woman. Your resourcefulness is admirable! Thank you for writing this article because in doing so you have written a guide for many to follow. Blessings, Julie

    • Hey, thank you so much, Julie. I’m laughing at the Zen thing, because I’m so not. I had a serious head trauma in 2004 that has left me with chronic mild anxiety, and I’ve just learned to do what I can to mitigate it. I think survival instincts are half natural and half learned. With the right steps, we can face most things in life. 🙂

  • I faced a very similar circumstance when I was a digital nomad in Austria this past winter. I got a blood clot in my ankle and had to find my way around language barriers and general helplessness from being ill and alone in a foreign country. You faced your problem so bravely!

    http://www.nynomads.com
    Living sustainably on $100/week in NYC

  • Thank you so much for this. I have had oral surgery twice in Tijuana at a clinic I’ve been to for years (a huge savings even when I had dental insurance.) The clinic is attached to a hotel and with drugs in my system, I was escorted upstairs to my room to sleep. I was otherwise alone but less than 100 miles from home. I imagine that major surgery may be part of my future one day and will be looking at having that done overseas. I have taken strength from hearing about your process. #Binder

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