A couple of months ago, a popular travel blogger wrote about her experiences of travelling without health insurance and why she felt it wasn't necessary (i.e. nothing really bad had happened to her ergo insurance was a waste of time) before launching into an extremely ropey promotion of natural remedies and solutions to severe medical problems (based on her medical training of, as far as I'm aware, zero years). Vaccinations were also dismissed as unnecessary most of the time.
On previous articles on this site, we've advocated the stance that if you can't afford travel insurance, then you really can't afford to travel. The same goes for vaccinations and malaria tablets. However, despite the multitude of horror stories of things going wrong on the road and, y'know, empirical medical evidence rather than a yoga mantra, some people still don't purchase any of the above.
Our recent experience along the rail tracks in southern Peru will hopefully underline exactly why both pre-trip vaccinations and travel insurance are entirely necessary for every backpacker.
As stingy bastards, we look to save money at most opportunities when we're travelling.
Of course, if the experience is worth the cost, then we'll spend what's required but, as we're discovering more and more, certain countries take advantage of the gringo tourist buck and people's lack of desire to 'miss out' on the done thing. They therefore charge prices which do not reflect good value.
In the south of Peru, we found this practice to be rife.
In Cusco, for example, one is compelled to purchase a boleto turistico for 130 soles (£25/$40) in order to enter some of the sites in and outside of town. Not all the sites that you'd want to visit, no no, you still have to pay entry to some of those. And If you just want to visit a a couple of those ruins on the boleto? Bad luck, you can only enter with the boleto.
Most representative of how Peru is taking advantage of its position as a 'must see' on every traveller's list is the train journey to Aguas Calientes, the gateway town to Machu Picchu. For a round-trip of only 60 kilometres, booking one month in advance, the cheapest seat at a reasonable departure time from Ollantaytambo costs $121-126. If wishing to travel to/from Cusco, then this increases to around $160 per person.
None of these prices actually include your entry (an extra $40+) or transport to the site (a $24 return trip).
For a long time therefore, we knew that we were going to take the cheapest route to Aguas Calientes due to necessity, preference and stubbornness.
The necessity? We simply couldn't justify or afford such high costs for a two-hour train ride.
The preference? We had read and heard great things about the cheap walking route and it sounded like a memorable way to make it to Machu Picchu. In fact, it sounded like it would be the only time we would be able to escape the tourist hordes on our visit.
The stubbornness? We both hate the parts of the tourist trade which simply take the piss out of people and think they can charge whatever they like. From research on-line, it was also clear that the train company dollars were't exactly filtering down to the people who should be benefitting from it in Peru (aside from subsidising very cheap train travel for locals).
So, for us, the journey to one of the most visited tourist destinations in the world would begin at 6 a.m with a brief collectivo journey full of weather-beaten men chewing on coca leaves, sneaking past train guards and a 28 kilometre walk sandwiched between train tracks and a rushing river.
It would prove to be unforgettable.
We're both massive dog lovers and this usually means fawning over every pooch we see, giving them names, concocting funny outfits and situations for them and, in general, just being a bit mental.
Throughout Latin America, there are a huge number of dogs on the street. In cities and towns the majority of them pose no problems, given that they're often an unfortunate mix of starving, unwell, scared of humans or, so craving of affection and contact, that they're harmless and heartbreakingly submissive.
The dogs with whom we've suffered most problems have actually been those in the countryside. Probably because they have much less daily human contact and have some territory to defend, they're much more aggressive. Vicious barking, snarling and stalking us from a distance had been common place on hikes in Ecuador and Colombia but had, thus far, caused no problem apart from making us quicken our pace or divert our route slightly.
I had however taken to picking up a handful of stones or a stick, just in case.
The walk along the train tracks, from Ollantaytambo to Aguas Calientes, was going well. We had done our research in advance, discussed safety and feasibility concerns with locals and our focus the entire time was to do it safely, sensibly and at a pace which would allow us to reach our hostel before the sun went down.
We picnicked on our homemade tuna sandwiches and crisps beside the river, spoke to cows we met along the way and felt smug when people in passing tourist trains looked upon us with an expression of shock on their faces. We stopped at the only stand along the way to guzzle down a refreshing bottle of ice-cold coke. Blue skies were all around us, butterflies were in the air and everything was, well, pretty much perfect.
Until kilometre 22.
An abandoned warehouse was on the left-hand side of the track and, as was becoming pretty common on this walk, the two resident dogs started barking. I picked up my handful of stones and went ahead of Emily who tucked in behind as we both moved further to the opposite side.
One of the dogs edged out further. His bark was more ferocious than those we usually encountered but, at that stage, we didn't realise that his bite would actually be much much worse.
I continued moving ahead, quickening my pace a little whilst the dog continued to stalk. I got ahead of him and, assuming Emily was closer to me, thought we had narrowly avoided an incident.
And then he launched himself.
I was far too late in throwing the stones; his teeth had already sunk deep into Emily's leg.
There was blood. A lot of blood.
Thankfully, we always travel on hikes with our little first-aid kit (you'd be foolish not to). Under Emily's instruction, I clumsily sorted out the three puncture wounds on a grassy verge whilst both of us panicked and kept looking over our shoulder to make sure the dog had gone elsewhere and that a train wasn't around the corner.
We still had 6 kms to go. There was no alternative route, no way we could hitch a ride on the train or just walk up to a nearby road because, if you hadn't realised by now, one does not exist.
Walking 6 kms with a pretty bad dog bite, shaken and emotional with blisters on your feet, isn't exactly going to be easy. Emily though, channelling every ounce of her little donkey warrior spirit, made it.
Not being idiots, we had both taken the full course of rabies vaccinations prior to the trip. Three injections at £90 / $130 each, isn't cheap but we felt it was essential.
Without them, a bite from a potentially infected dog means you need to source a booster injection quick (at least within 24 hours); our pre-trip vaccinations gave us 72 hours. We both felt, given the type of places we would be travelling to on this two-year trip, those extra 48 hours might be critical.
And so it proved.
Aguas Calientes, despite seeming to have every tourist and tour guide in Peru, a few luxury hotels and mountains of tat, isn't exactly well equipped for medical issues.
We made our way to the small clinic in the dark after a couple of stiff Pisco sours. The young doctor cleaned and dressed the wound, some antibiotics were prescribed (they didn't have enough in stock so we had to go to a pharmacy down the road for more) and, when the issue of rabies was raised, they told us they didn't have any vaccines in the entire town.
We would have to go back to Cusco.
Cusco, an extortionate train-ride away or only reachable via a two-hour walk on the train tracks followed by four collectivos.
Our insurance policy is not the greatest travel insurance out there. Given my background working in the industry for four years, I spent a lot of time researching the options and we purchased one which I felt gave us the optimal balance between coverage and affordability. It wouldn't cover us for lots but, hopefully, it would be there for us when we really needed it
Our biggest concern were the transport costs. The medical expenses were unlikely to be much more than our £80 excess but the train and taxi to Cusco could cost four days of our joint budget.
We could afford it the hit but, given that the south of Peru and Machu Picchu was already proving to be some of the most expensive parts of our entire trip, it would be through gritted teeth and with the awareness that it would likely mean missing out on a couple of experiences elsewhere.
After much discussion with our insurance provider, we were eventually given the go-ahead to purchase the train tickets.
So, how did it all resolve itself?
Well, Emily thankfully hasn't turned into a rabies-infected zombie. We, with some difficulty, secured the two booster vaccinations within the required time period. Her bites have healed well and haven't scarred too badly. A hitherto non-existent fear of dogs has fortuitously abated and we recouped all the costs, medical and transport, related to the claim.
The total claim only amounted to £228 / $350 , which meant we recovered £148 / $220 following the deduction of our excess. If you're reading this from the comfort of your home and security of a monthly salary, that may not sound like a huge amount of money but, to us, that £148 equates to five to seven days of our lives on the road.
But, the specific monetary amounts under discussion here are less important. What's central is the lesson that we want to pass on to you, whether you're an experienced traveller or not.
We were in the most touristy part of Peru, if not South America. Emily suffered a relatively standard and very treatable medical issue. If the locus of the bite wasn't on train tracks during a 30km walk, then this would all have been very unremarkable.
However, despite that, a simple dog bite still resulted in a number of unforeseen issues:
- We speak Spanish, so could deal with doctors and clinics to secure the correct treatment and obtain advice. What if we didn't speak a word?
- Emily is a doctor, so was aware of the treatment required, time windows and medication, but what if neither of us were aware of what to do?
- What if Emily hadn't taken the recommended rabies vaccines before this trip? Her 72-hour window for treatment would have been reduced to 24 hours and the required treatment would have been much more extensive, expensive and difficult to source.
- In the city of Arequipa, where Emily had to have the second booster, it transpired that not one single clinic had a rabies vaccine; this is despite people dying in and around this city FROM RABIES in the last few years.
- Despite the extra costs, there was a relatively easy transport route for us to access the hospital. What if there wasn't?
- If we hadn't been able to persuade and cajole a pharmacy to courier a special delivery of the vaccine, what would we have done?
- Our costs were, ultimately, affordable for us. What if they weren't and we had no insurance cover?
- We had internet so could Skype and e-mail our insurance company. What if we were travelling without a computer or were in a remote location?
In short, we didn't purchase insurance because of the threat of dog bites but we needed it just the same.
Just imagine how awful it would be if you suffered a more serious medical emergency whilst in a more remote location or even less developed country and did not have the safety net of travel insurance and vaccinations?
Hot water, peppermint and essential oils won't be nearly as useful.