International travel is fabulous: new worlds, new food, new language, new experiences, adventures and delights.
Of course, international travel can also be a little daunting. Once you step outside your door, your supports: your language, your local knowledge, your contacts, your comfort zone, disappear. You are in the hands of others for the simplest of activities, from getting around, to eating, drinking, sleeping, going to the bathroom, and especially dialysis, because we all need our regular BigD fix, no matter what.
So preparation, planning and once you arrive, vigilance are the orders of the day(s).
Our last trip, as readers of this blog, will know was to Lisbon, Madrid and London for the 2016 Diaverum Global Dialysis Conference.
Apart from the great time we had, I learned a few (more) lessons about dialysing in foreign lands, and I’d like to share them with you.
As any BigD-er who travels knows, arranging dialysis is not a trivial exercise. Getting units who don’t know you from Adam (or Eve) to make room in their already busy unit needs a little dedication and some negotiating skills. Your Unit Manager is the ideal starting place (see eight steps to scheduling your dialysis for details).
If you are travelling to non-English-speaking countries (like Portugal and Spain), ask for an English-speaking contact in your first email. You will also need someone at your end who speaks the lingo, at the very least to check that the arrangements being made are the arrangements you want.
This was my second dialysis holiday to non-English-speaking countries – the first was China – and I thought I knew the ropes. But no.
China was a short stay (a week) and all dialysis was at the same unit. This time, I was away longer (15 days) and I dialysed nine times at four different units: two units in Lisbon, one in Madrid and one in London.
I had forgotten how stressed I can get when I don’t know the people or the unit I am visiting, whether it’s down the road or on the other side of the world. So I usually check everything with the nurse putting me on and confirm all the settings and pressures are as I like it.
But some units in Lisbon and Madrid, nurses only spoke their home tongue and I was stopped before I began. I found this very stressful.
- Minimise stress and worry by minimising the number of different units you visit. Getting to know the staff and the quirks of each new unit is highly stressful.
If possible, minimise the number of units you visit that don’t speak your language. While most have someone that can speak basic English, there is no guarantee that they will be available. Trying to ask simple questions, like “What is the wireless password?” or “May I have a glass of ice?” can be very difficult and frustrating.
Here the Google Translate App can be very useful, especially if you type out a few standard questions ahead of time. Just call up the translation and turn your phone into landscape mode: the message will appear in huge letters that can be read from across the room.
- Some units are less accommodating than others. Ask about any requirements you have (they may be standard in your unit, but against some policy in the one you are visiting). For example, in the Fresenius unit in Madrid, when dialysing at dinner time I was not allowed to eat anything (no matter that I have eaten dinner on dialysis for 20 years). To me, “It’s protocol” is another way of saying the unit is organised for the benefit of staff, not the patients – who are paying (€300 in cash – about US$343) for the privilege.
- Keep up your protein intake. Be prepared for different food and if you don’t like what’s on offer, make sure you eat something else that roughly equates with what you would normally eat. The alternative is skipping a meal or two, which combined with the additional exercise you get just by walking around will results in you losing weight without realising it.
All of a sudden your blood pressure rises, and doesn’t go down after dialysis, because your base weight has fallen. In my case, I lost 2 kilos during the first week and I couldn’t work out why my BP was so high. Once I realised, I reduced my dialysis base weight and my BP returned to normal.
- Go to units with good lighting that you can control; this makes sleeping and using a computer less of a struggle
- Find a way to keep your EPO/Aranesp refrigerated. Unrefrigerated, it will last only 7 days. If you run out or have to throw it away, you may find it very difficult to replace.
Lisbon and Madrid turned out to be just wonderful. I had very little prior knowledge of them, especially of Lisbon. I knew from Casablanca that it was neutral during WW2 (that’s where Ilsa and Victor Laszlo went to escape from the Nazis!), but not much more. So before leaving, I read a great history of Portugal, called “Conquerors: How Portugal Forged the First Global Empire” by Roger Crowley. It was quite an education, and I was keen to see all the historical places that spawned the age of Discovery.
But Lisbon is so much more than that. It is a mediaeval city surrounded by 18th to 21stcentury modernity. Tiny trams on cobbled streets wind around the seven hills that embrace that beautiful city. Early morning walks through deserted streets and stairways with brooding clouds over earthquake ravaged cathedrals; evening promenades through the bustling and musical Latin nightlife. The views over the city from the high points reminded me of Malta on the Med with the red- tiled roofs, pastel coloured walls and wrought iron balconies. And a surprise and adventure around every corner.
Though we were there only a couple of days, Madrid was as bewitching. Sipping red wine while watching passionate Flamenco dancers on a tiny stage in a tiny café. Night walks where everything was just starting, every tiny shop and café open, people walking in groups, singing, dancing and eating. Beautiful architecture and broad vistas never far from amazing plazas packed with life.
London was its usual dynamic, delightful, spectacular self.
What’s not to like about international holiday dialysis?