I’ve traveled a fair bit in my life, most especially in the days before kids, and each adventure I’ve had has required advance preparations. For my upcoming trip to India, that preparation included a visit to the travel clinic to figure out what vaccines (and other medications) I would need to travel to India.
Boston, fortunately, has a number of helpful travel clinics, which are specialized medical offices that are staffed with infectious disease professionals. These doctors and nurses are well versed in the steps that need to be taken to stay healthy when traveling in countries with different infrastructure, climates, and endemic diseases.
Upon my arrival to the clinic, which was located in one of Boston’s many teaching hospitals, I completed a questionnaire that asked about destination, travel dates, and duration of stay. The doctor also needed to know what environment I’d be in (rural versus urban) and the purpose of my trip. After a brief wait (there is always a wait at the doctor’s office!), I met with the doctor who, based upon the information I provided and my answers to additional questions, recommended a number of medicines and vaccines, including the typhoid vaccine and malaria prophylaxis. He also gave me a tetanus booster since I couldn’t remember the last time I had received one, though I was confident it hadn’t been within the last 10 years, and a flu shot. He wrote me a prescription for two different antibiotics in case I get a GI bug while in India, and he sent me off with tips for eating and drinking while in country (e.g., avoid ice and raw food and don’t drink the water, among other tips).
The travel clinic appointment was fairly straightforward. What was trickier was the health insurance related to the appointment and prescriptions. My health insurance doesn’t cover travel-related vaccinations, so whether or not any of my clinic visit, since it related to the vaccinations, will be covered is uncertain. The guidelines were unclear, so I’m crossing my fingers that it means it’s covered. The typhoid vaccine was not covered, and, for that, I paid the $71 cost out-of-pocket (with reimbursement pending from my employer since this is a work trip). I explained to my health insurance company’s representative that the cost of hospitalizing me if I contracted typhoid would far exceed the costs of the vaccine, but there wasn’t anything they could do. The plan guidelines are not flexible. Surprisingly, even though there’s no malaria in New England, that prescription was covered, along with the antibiotics. Each plan is different, of course, so if you’re planning to visit a travel clinic, it’s best to contact your health insurance company with coverage inquiries.
What’s more amazing—and heart wrenching—is that for the poor and uninsured, such expenses—any medical expenses—are burdensome. I take for granted that I can pay these costs and not think twice about the money: it’s more important to stay healthy than it is to worry about the lack of coverage. I imagine I’d feel differently if the vaccine had been more than $71. Perhaps. I did read up on typhoid, and after doing so, I would have forked over even more money to avoid contracting it.
I felt similarly about the malaria medicine. When the doctor showed me a map of India to illustrate how extensive malaria was, the entire country was highlighted. His solution was to write me a prescription and provide instructions for taking the drug so I’d stay healthy. How many people in India can afford the same medications? And, have such easy access? I hope to learn more about these inequities during my trip.