Navigating Chronic Illness While Traveling/Living Abroad

This is not easy. I know I have enormous privilege to be able to travel and live outside my home country. Nevertheless, accessing and navigating healthcare abroad is hard to begin with, let alone if you have a chronic condition.

I’m American, but I’ve spent most of my adult life living outside the US, mostly in Canada and one year in the UK. The general pros and cons of the American, Canadian and British healthcare systems will not be discussed at this time, but I will mention how I’ve dealt with my endo in each country.

I broke down some of my experiences with accessing endo care in the three countries I’ve lived in, as well as some general things I do while traveling with a chronic illness.

Comparing care in the USA, Canada, UK

United States

While still on my parents’ health insurance, I was lucky enough to have the laparoscopy, excision, appendectomy, cystoscopy, etc., that led to my various diagnoses. I also have had all the scans and lab work for my endometriosis diagnosis done in the US. Until recently, it was the only country I had a gynecologist in. Although it took me a few years to actually have the surgery, this was by far the fastest I received care for my condition, and it would have taken less time if I hadn’t been living abroad (to allow for consistent follow up appointments and surgery scheduling in the US). It was also incredibly expensive, and without insurance, this care would have costed WAY more than my net worth.

Canada

To get to a gynecologist through the public healthcare system in Canada, you first have to be referred to them by your family doctor. When I first approached my family doctor in 2020 about endometriosis, she told me “to invest in better painkillers,” and that she had to give me a pelvic exam before she ordered an ultrasound, even though I had recent images from the US. She was going to wait on those results before putting in my referral to a gynecologist. From those efforts, I don’t think I ever made it off the list of patients waiting for a place.

Once I returned to Canada after my surgery and official diagnosis in the US, I was immediately put on the referral list, and had an appointment at the gynecology practice six months later. The gynecologist I saw there was kind and validating, it’s just such a shame that it took so long to get to see her! I have not received much actual care at this practice so far, just check ins. But the appointments are free of charge, and the quality of care is really good. I do have a feeling if I were to wait for a laparoscopy or imaging order, it would take a really long time to get off the waiting list.

England

The moment I arrived in England, I got an appointment with a GP to remove some stitches. Their triage system is similar to Canada’s in that if you want to access care through the public healthcare system, you have to be referred to a specialist by your GP. When I described my symptoms and suspicion that I had endometriosis, my new GP put in a gynecological referral for my right away, and I waited and waited to hear about my appointment. Several months went by and I finally received a letter with my appointment date: two weeks after my lease ended and I was due to leave the country (following the end of my Master’s course). Then I received another notice, that appointment had been cancelled and pushed to the following year. This coincided with some of my worst endometriosis symptoms leading up to my surgery in the US, and felt incredibly defeating. I felt hopeless, since I was not sure I would be able to get surgery in the US and didn’t think I could take the pain much longer. The NHS was (and is) incredibly backed up after covid, with much more urgent matters like cancer treatments apparently in years long backlog. In this context and considering I was only in the country temporarily, I understand why it was difficult for me to get in to see a gynecologist, but nevertheless, it felt awful, especially being so far from home and isolated from my family.

Seeing a private clinic would have been expensive, but I would have been able to get an appointment sooner. While in England, I tried acupuncture, which was prohibitively expensive (at the frequency the clinic prescribed and in the city I lived in). I only did one session, so I can't judge if the treatment was right for me or not.

Traveling with Chronic Illness and Pain

More generally, traveling can feel more stressful and isolating when you have chronic pain. Am I going to have a major flare up? What can I do if I have one? How can I describe my symptoms in another language or access the healthcare system if needed? How can I manage my symptoms and still try to enjoy the trip? As my endometriosis symptoms got worse, I actually had more opportunities to travel, including road trips through Canada and the US and research trips to Italy. Although they're not the highlights of these trips, the endo flare ups I experienced definitely stick out as memories. Here's how I dealt with it:

I always get travel insurance, because if I’ve gone to the emergency room for a flare up once on vacation, it can happen again (luckily, this happened to me in the US, so at the time I was covered under my parents' insurance). I also make sure I have comfortable travel clothing (no tight waists and nothing constricting), bring plenty of ibuprofen (my pain reliever of choice since it targets inflammation), and pack MyOovi (get 10% off). MyOovi is a tiny TENs machine that really is a lifesaver when it comes to discreet pain management that doesn't involve painkillers. I also try to focus on eating anti inflammatory foods and drinking plenty of water and tea to make sure my digestion runs smoothly. If I’m traveling abroad, I look up general information about their healthcare system (ie what pharmacies can prescribe, how their triage system works etc), and keep a list of my medications, conditions and recent test results in case I need to present them to a doctor. It also doesn't harm to know how to say something about abdominal pain in another language. Above all, I try to make sure I’m getting enough sleep and avoiding stress to safeguard against an inflammatory reaction.

I hope you find this helpful! The purpose of sharing my experience in the different countries isn’t to say one is better than the other, it’s just to show that 1) moving around makes it way harder to address chronic illness, especially in countries where you have to wait long periods of time to access specialist care, 2) it’s possible to access chronic illness care if you move abroad–it’s not easy, but don’t let it discourage you too much from experiencing a new country and living your life! Did you have similar experiences in these countries? Let me know!