Arranging International Travel Dialysis

I’ve decided to try another trip to China, as part of a business trip.  My last effort ended badly, when I tripped on slippery tiles on a Hong Kong footpath and fell on my fistula.  It scared the hell out of Julie and me, thinking I had a life-threatening injury in a foreign country, at risk of bleeding to death where I fell.  Luckily we were already on the way to a hospital around the corner for dialysis, and more luckily, they found I had bruised but not ruptured the fistula.  All was well, but the doctor suggested we delay our trip to Beijing.  We cut the trip short and came home.

Well, here it is, almost 2 years later and Julie and I are ready to line up again.  This time, we plan to go to both China and Europe for a few weeks in April/May.  We will start with a direct flight from Melbourne to Beijing, stay about 5 days, and then fly to London to do some work and catch up with our No. 2 son.  We will probably stay there for about 12 days travelling to Gloucester in the Cotswolds and perhaps Oxford, then Stockholm, back to London and home.

Here’s how we plan and schedule the dialysis I need at each stop.

Arranging dialysis from a distance is like getting a dentist appointment.  The closer the appointment, the less likely you can get one.  So the Number 1 Rule is to start booking early.

Many countries have two kinds of dialysis centres, public and private.  Some are completely separate (like Australian and the UK); others have private chairs in public units (like in China).  Public dialysis is usually free to the citizens of that country, while everyone must pay to use a private unit.  So visitors like me usually book into private units.

However, not always.  Some countries with public health services have signed reciprocal health care agreements, so that their public hospitals will cover any medically necessary treatment which may be required while in that country, including dialysis, at no charge.  Australia has reciprocal health care agreements with 11 countries: New Zealand, The United Kingdom, The Republic of Ireland, Sweden, Norway, Finland, The Netherlands, Italy, Belgium, Malta, and Slovenia.

In theory, this is great: cost-free dialysis while travelling the world (or a subset of it).  However, the reality is that in most of these countries, the public health system is super-busy all the time, and their dialysis units are usually operating at full capacity.  I have tried to book into public BigD units around the UK before with zero success, so in the past I have used a private unit (The London Clinic) and limited my travel to day trips close to London.

I have had success in other countries in the group: I have dialysed in public units in both Italy and in Ireland.  The dialysis was safe, expert, and free, and both had a delightful local flavour.

I have another option this time.  My local BigD clinic is a Diaverum clinic, a relatively new group, created 4 years ago by spinning off the Gambro Healthcare clinics in Europe.  I have asked my Unit Manager if it is possible to use the Diaverum clinics in Europe.  Hopefully, there could be some benefit in doing this.

Though I dialyse 5 days per week in Melbourne, it is quite difficult to do so when travelling, so I will drop back to four or even three days per week (with increased time at each session, as needed).  So, over the next few weeks we will:

1. Identify possible dialysis units in each country (public first, then if not available, private – Diaverum, then others), in particular, a contact name, phone number and email address (Global Dialysis is the best place to start, it is a wonderful resource for BigD travellers)
2. Choose suitable dates and if possible, approximate times, based on our flight plan
3. Prepare an email for each unit, listing our proposed dates and times
4. Send the emails to my Unit Manager
5. She will send them on under her name, talking the BigD talk with the contact people and eventually confirming the booking dates and times
6. Once we get tentative confirmation, we book the flights and accommodation
7. Ask my Unit Manager to make a last check of the itinerary, to make sure I am getting enough dialysis – it’s easy to miss a day when arrangements are constantly changing
8. Arrange some form of travel insurance (again, we will use the Global Dialysis recommended insurer, http://www.worldwideinsure.com to get a quote), though I have found useful cover difficult to get in the past.

Steps 5 and 6 tend to be iterative.  First choice days may not be available and they may suggest others.  This usually means we will have to rework our flight and accommodation bookings.  Eventually, they will all mesh and we will be ready to go.

Obviously, in addition to getting our China visas (no visas are required for the UK or Sweden) and ensuring our passports are valid, I usually get all my meds packaged in blister packs at the local pharmacy.  This is a great service.  It saves me worrying about all those different plastic pill bottles and packs, and helps minimise questions during drug searches (well I think it will, I have never actually been searched for drugs [though I have had a prostate check… at least that what the doc said it was]).  I usually take at least two extra week’s worth of blister packs, just in case I am delayed anywhere.

It is also useful to the take the contact details of other BigD units at each destination, just in case something falls through.

So, the preparation begins.  I’ll let you know how it progresses.