Surprise Healthcare Tourism: My Knee Injury in Latin America

A Fall That Changed Everything

Eight months into my fifteen-month trip, it was nighttime, and I was headed downhill on a borrowed bike on a dark two-lane highway on the outskirts of Manizales, Colombia, when I had a minor freak-out. As I rode into a stretch of road with no streetlights, I tried to increase the brightness of my bike light, and instead of glowing brighter, it started to strobe. Rolling quickly down into the flashing darkness, I tried to press the button again. I wobbled, then went down sideways. I was able to slow down before I fell, but but all my weight landed on my right knee on the asphalt.

I learned how to ride a bike around 1998, and though I’m comfortable getting around, I wouldn’t call myself an advanced rider. In eight years of living in Colorado, I never went mountain biking. A bike has never been my daily driver. So when something scares me or I run into a sticky situation, I tend to freeze up and lose control. It had happened a month earlier, when I slid out trying to avoid an oncoming chiva on a gravel road.

Toughing it Out

LuisMi (then not yet my boyfriend) stopped up ahead and hurried back to check on me. We got the bike out of the middle of the road, and I sat in the grass on the shoulder for a while, collecting myself. There was no blood, but it hurt a lot. Eventually, I stood and took a few steps. I was ok. I could move my knee. We were about 1/3 into our night ride, and we were already pretty far away from my AirBnb. It would’ve been difficult to find a taxi that could fit a bike or two in it. So, even though I would’ve been happy to be picked up and driven home right then, I decided I could keep going.

We pedaled hard over a rolling gravel road that ran alongside a stream. The water splashed and gurgled, foamy white in the moonlight. We eventually stopped, turned around, and took a break at an open-air roadside restaurant to heat our chilly hands around hot bowls of agua panela con queso (unrefined cane sugar melted in hot water, with a block of fresh cheese floating on top–very Colombian). By this time, I was having a hard time walking. My knee was painful as I extended my leg beneath the table. But Manizales is a city perched on a mountain, and we still had a ways to ride to get back. We powered our way up the steep, winding road back into the city, riding on the sidewalk to avoid the cars.

We eventually made it back to the guest house where I was staying. I slept with my knee elevated on pillows. The next morning, it was bruised and swollen. I couldn’t put weight on it. I spent most of the day in bed, and LuisMi brought me ibuprofen and an elastic wrap bandage. I only had a couple of days left in Manizales. Soon, I would catch an overnight bus to Bogotá and then a flight to Costa Rica. I’d been hoping to do some active outdoorsy things for my last few days in Colombia. Instead, I mostly stayed in my room, and took short taxi rides and shorter walks, leaning hard on LuisMi’s shoulder.

A Curmudgeon in Costa Rica

I’d had high hopes for Costa Rica. They’ve done such a good job promoting their country to the American market, so I’d heard a lot about the natural beauty there. I had been looking forward to big rainforest and volcano hikes. Instead, I was limping around with my backpack and front pack, and lying around in hostels hearing about everyone’s fun adventures. I probably pushed myself more than I should’ve, walking along the beach in Uvita a day or two after arriving. I hobbled along a riverside trail to a waterfall swimming hole, using my hands to brace myself on trees and boulders, jealous of everyone who hopped lightly from rock to rock like I normally would. I spent evenings icing my knee with whatever I could find at my accommodations.

I was irritable, feeling sorry for myself, and frustrated that my time in Costa Rica wasn’t turning out the way I’d hoped. So much for the best-laid schemes of mice and men, huh? But shortly afterward, I ran into someone from my high school on a public bus, and my Costa Rica experience went from very disappointing to incredibly special.

After a week and a half in Costa Rica, I was ready to head off to less expensive pastures, so I caught a bus up to Nicaragua. I was able to do some kayaking and canoeing there. I was grateful to be active outdoors without using my legs too much. But I still could feel that my mood was sour. I was bummed when everyone from my room at a hostel on Ometepe Island went hiking together and I couldn’t go. But later that week, my limited mobility led me to a pool within walking distance, where I met two new friends, Francesca and Laura. I ended up seeing them again in León, Nicaragua, and again when I visited each of them at their respective homes in England and Spain later in the year.

My First Appointment in El Salvador

I took a bus to El Salvador, chilling (or rather, roasting) in the beach town of El Tunco, where I stayed in a private room with a rotating fan, but no AC. I went to the beach and watched all the surfers from the rocky shore. I’m a far cry from calling myself a surfer, but the waves I saw in Central America looked inviting and approachable, and I couldn’t help but feed my little kernel of bitterness. It had been a month and a half since my fall. I’d been hoping that my knee was just sprained and would heal on its own, but it was becoming clear that something more serious was wrong. I couldn’t straighten it completely, it still hurt to walk, and I was worried.

So, I left my hostel and caught a bus to San Salvador to see a doctor. I stayed in a private room at a shared AirBnB, a luxury I didn’t usually allow myself during my long trip. I was more of a hostel dorm kind of traveler. I found an orthopedist with good Google reviews, and made an appointment. The doctor I saw spoke perfect English, and he sent me for an x-ray, or radiographía, at a radiology center down the street. When I came back forty minutes later, he confirmed that nothing was broken and I’d need an MRI to diagnose my injury. I’d already booked a flight to Mexico for a few days later, so I waited until I arrived in Mexico City to book my MRI appointment.

An MRI in Mexico City

I read a bunch of Google reviews, sent some WhatsApp messages for quotes, and found the cheapest MRI I could. In Mexico City there are several privately owned imaging centers, where it’s easy to book an MRI, or resonancia, and they give you the images to take to your doctor. According to my radiologist father, in the US, the injection of contrast solution alone costs more than MRI and contrast solution combined in Mexico. Food for thought.

When I arrived the morning of my appointment, there was nobody else in the office. I filled out paperwork and they took me to a small changing room with lockers, where I took off my jewelry and any other metal I was wearing. I spent about 20 minutes beneath the big magnet in the MRI room, earplugs in, listening to the intermittent banging noises. I remember it being painful to keep my knee extended for so long.

They gave me a CD with the image files as well as the printed images, which came as a bunch of small cross-sections of my knee on a few giant sheets of thin, semi-rigid plastic. The kind that makes a wokawokawok sound when you wobble it. They reminded me of my childhood, hanging around in the radiology department of the hospital after school while my dad read x-rays. These days, everything has gone digital, and it’s not as common to see printed scans glowing on backlit walls.

Dr. Alba, My Mexican Orthopedist

I was staying at a hostel in Condesa, a bougie, beautiful part of Mexico City. I used Google Maps to research orthopedists in the area. I made an appointment with a doctor who had great reviews, who was within walking distance of my accommodations. Despite my bum knee, I was still doing my best to be frugal. Mexico City has Uber and a similar app called DiDi, but I tried to only use them at night or for longer distances.

I met Dr. Alba in his brightly lit office on the third floor of the Hospital Angeles. He looked at my MRI images and did an examination of my knee. He showed me a model of a knee joint, and explained that he could see a minor tear of my MCL in the MRI, but that based on the exam, he suspected that I’d also torn my meniscus. The resolution of my cheap MRI didn’t allow him to see the severity of the meniscal tear, so he told me I’d need to get another MRI to determine whether I’d need surgery.

This conversation was completely in Spanish. Unlike the doctor in San Salvador, Dr. Alba doesn’t speak English. But he was exceedingly patient with my limited Spanish (at the time, probably about B1), and he repeated and clarified whenever I was confused.

A Foreign Healthcare Experience

He told me where I could make an appointment for my high resolution MRI, and prescribed an intramuscular steroid injection. I’ve never had one of these in the US, so I’m not sure how it normally works, but I was surprised that I could just pick it up at the pharmacy for about $20, syringe included. My friend Alyssa, an Australian nursing student, did the honors of injecting the steroid into my butt cheek in the parking lot of the ancient Teohuaticán pyramids outside of Mexico City.

I got my second MRI within a few days, and I had my follow-up appointment with Dr. Alba the next week. By this time, the steroid had done its miraculous work, and I was straightening my knee completely without pain. He examined the new MRI I’d brought on a thumb drive and told me that I wouldn’t need surgery. I’d just need to go to physical therapy to strengthen the knee, and I should make a full recovery.

I didn’t think about this at the time, but someone recently said to me that they wondered whether a doctor in the US would’ve given me the same assessment. Our healthcare system is a bit eager to put people under the knife. I guess I’ll never know, but I was so grateful to hear that I’d be ok with physical therapy alone. I was in Mexico in April and May of 2023, and my trip would continue into October, so a surgery would’ve severely altered the course of my year.

Physical Therapy Plop

I left Mexico City to spend some time in Oaxaca. I was tired after two months of fast travel with a bum knee, and I needed what I call a plop–an extended period of staying in one place. I treated myself to three weeks in a private room at an AirBnb guest house in a quiet neighborhood, a few blocks away from a physical therapy office with good Google reviews. I hardly explored the city, focusing on going to PT appointments in Spanish three times a week and spending a couple of hours a day doing strength and mobility exercises.

As my time in Mexico came to an end, I headed back to Mexico City. I had a follow-up appointment with Dr. Alba, and he recommended that I continue my PT during my upcoming month-long visit to the US. I told him that I’d been having some pain while walking again, and he prescribed another steroid injection, which Alyssa obligingly applied.

My Extended Recovery

I found a physical therapist in Lyons, Colorado, and had a few appointments there, continuing my at-home PT routine diligently for the next few months. By the time I got to Europe later that summer, I could go on long hikes again. It’s been nearly two years since that bike fall, and I’m as active as ever. I wear a knee brace when I train Muay Thai (because it involves a lot of impact on the knee) or go on a really big hike. My knee is never going to be quite the same, but that’s just life after 30.

Tearing my MCL and meniscus was absolutely not something I had planned to do halfway through my 15-month solo trip. In retrospect, if it had been a little worse, that injury would’ve ended my trip. As it was, it forced me to adjust my expectations and examine my attitude. I found bright spots in old and new friends even as I struggled with my frustrations about missing out on my favorite activities on a once-in-a-lifetime trip.

Healthcare in a Spanish-Speaking Country

It was also an opportunity for me to take note of my Spanish progress. My skills were good enough to navigate the healthcare system in Mexico! Besides my two MRIs and two physical therapy offices, I also went to a dermatologist to have a (benign) skin lesion on my face removed. And I went to a dentist to get my teeth cleaned.

It wasn’t always easy, but I figured it out. I was able to communicate my needs, and they were able to communicate the relevant information about my diagnoses and treatment. At the PT office in Oaxaca, I even chatted with the therapists, asking each other questions about our lives.

All of the healthcare professionals who helped me were patient, kind, and highly qualified, and the care I received was excellent. (With the exception of the dentist… that was not a thorough cleaning. But it did me no harm.) The offices were sparkling clean and well appointed; the physical therapy and dermatologist offices had a boutique feel. And even though it was 2023, Mexican healthcare settings were still very strict about COVID control procedures. I couldn’t enter any of these spaces without a mask.

The Moral? You Need Travel Insurance

My knee injury treatment was also pretty much free. Not just because high-quality healthcare is cheaper in Mexico than the US (which it is). But because before my trip, I had taken the advice of all the travel bloggers I’d read during my research phase and enrolled in SafetyWing Nomad Travel Medical Insurance. Throughout my 15-month trip, I was paying less than $50 USD per month for my insurance policy. (Actually, I’m still enrolled in the same plan, though the cost is more like $56 this year.)

When I got hurt, I waited a while to see if I’d get better on my own. But in retrospect, I should’ve just gone straight to a doctor. When I reviewed my policy to see what was covered, I was relieved (and a little surprised) to find that an injury like mine would probably be covered completely. There are some sports that aren’t covered, like skydiving and , but riding a bike is absolutely within their parameters.

I just had to be diligent about documentation. To file my claim, I needed to send in all the records from the healthcare providers I saw, including the initial exam in El Salvador, the doctor’s MRI order, the MRI results, the diagnosis, the order for PT, and all of my receipts. When I filed the claim, SafetyWing was easy to work with. I didn’t get any pushback. And they reimbursed everything. Completely. Even the extra MRI.

So, if you’re going to head out on an adventure, big or small, I highly recommend enrolling in a SafetyWing policy. I did my research ahead of time, and it was the most economical option for travel insurance for a person my age. That was mostly why I chose it. But after actually getting hurt and needing to use it, the straightforward claims experience really sealed the deal for me.

Full disclosure: if you sign up after using the link from my blog, SafetyWing will give me a referral bonus. Which I guess is why I saw them on so many other blogs. But I would absolutely not promote this plan if I didn’t think it was a great option.

The Other Moral: Go Be a Healthcare Tourist

I think in the US, we get a bit brainwashed into the mythology of American Exceptionalism. We are better at everything than everyone else, obviously. In spite of our healthcare system woes, I think the majority of people from the US would be highly skeptical of the idea of getting healthcare in Mexico. But it turns out that they have good medical schools and hospitals all over the world. Turns out that in the US, we’re getting screwed over by a system that values profits over patients.

After this experience, I’m an advocate for healthcare tourism. Yes, the US has great specialists and hospitals. But we’re also probably the only country that charges an arm and a leg for an ambulance and childbirth and cancer meds. If you are able travel to another country for elective or non-urgent procedures, I think it’s worth looking into. I’ve heard of people traveling to Korea for dermatological procedures, Turkey for hair transplants, and Thailand for dentistry. I’m not saying that all healthcare in every developing country is going to be as good as all healthcare in the US. But you can easily do the research to find a place with high standards.

An important note: SafetyWing insurance is not going to cover healthcare tourism. They don’t cover pre-existing conditions or elective procedures. For example, I couldn’t use that insurance for my dental cleaning. It’s more for urgent things that come up while you’re traveling.

My point is that this experience opened my eyes to the options. Before my big trip, I would never have opted to get healthcare outside of the United States. But after my months-long experience of unintentional healthcare tourism, I realized that it’s safe and cost effective. So, if the cost of a round-trip ticket to another country, accommodations, and paying out of pocket for a comparable level of care is still less than what you’d pay after insurance in the US, why not take a trip?

A Gallery of Creative Knee Icing during Long-Term Travel