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Broken Bone: Triple Country Care Plan

Updated: Jul 19, 2023

Here's how we navigated a bone broken in the UK, surgically set in Greece, and final pin removal in Turkey. It can be done!


We’re in our 5th year of worldschooling with no home base. And it happened. A broken wrist.


First, the good news: The bone is perfectly aligned, medical care is complete, and the injury is fully recovered.


The awkward part: The injury occurred during a time of faster travel for our family. We needed to coordinate care from England to Greece to Turkey, as well as follow airline safety rules regarding full casts on flights (more info below).


Many people reached out to ask how we navigated this because it is a common concern for traveling families. Accidents happen. Illnesses happen. These situations require time and effort to organize and resolve, but they are 100% surmountable!


The most important thing to remember is that no one wants to see a child in pain or with an untreated injury. People genuinely care and want to create the best possible resolution for your family. Though solutions may not present themselves in the manner you’re accustomed to ‘back home,’ these experiences are a vital reason of why our family worldschools—we want to experience what life is like around the globe.


All right, here’s the rundown of our experience and the explanation of times when we didn’t have complete information for our decision-making process. In hindsight, we may have made different choices (who wouldn’t?); but honestly, we’re happy with the results and know we made solid choices with the information and services available at the time.

 

Global Healthcare Policy

Our family carries a healthcare policy with Cigna Global. We’ve been customers since July 2019 and experienced a handful of minor urgent care issues (ruptured ear drum, potential broken wrist, potential stitches). We’ve been satisfied with their network of providers and assistance with claims, payments, and follow-up care.


The policy we carry has inpatient and outpatient coverage and we keep it as a catastrophic policy for incidents, such as this, which may incur major medical expenses. To keep our costs lower we have a high deductible for inpatient care. Charges for the broken bone treatment were 100% out of pocket because they were below our inpatient deductible of US$7500.


We continue to be happy with Cigna’s policies and customer service and have no plans to change healthcare providers.

 

The Incident

On Dec 3, 2022, we were in the Lakes District in England when our 13yo fell while skiing (yes, you can ski in England… it was a ‘dry ski slope’ made of plastic bristles and misted with water for lubrication). My child was diagnosed with a distal radius fracture, a common injury when someone catches a fall with their full weight on the arm.


Fortunately, we were with a slew of worldschool friends when it happened which makes me even more grateful that we’re able to surround ourselves with community as we travel. Everyone sprang into action to care for my child (and me). Honestly, it was beautiful to watch. No one was upset, everyone remained calm, and we just did what needed to get done.


Once the child was stabilized, one mom offered to drive us to the urgent care center while another walked the rest of the children back home. I was totally prepared to drive my child to the clinic, but it was so nice to let someone transport us. She knew the way and I didn’t have to navigate unknown roads or find parking.

 

NHS Care in England: Urgent Care

We went to the nearest NHS clinic, checked in, and settled in the waiting room.


Good to Know: I didn’t have any ID on me… my wallet had been stolen in London and I hadn’t yet received my replacement driver's license (that’s another story, a minor headache but everything sorted fine). Also, I typically do not carry our physical passports on my person, I have photos on my phone. Good news: ID was not necessary for urgent care at the NHS in England, eventually it was with our follow-up care.


Smart Move: Our friend knew we’d have a wait before being seen, x-rayed, and treated, so she left but came back to deliver a meal and hot tea to make our wait time more comfortable, so sweet!


Our appointment started with x-rays to confirm the bone was broken and I informed the staff of our travel plans, flight dates, and timeline for care. Because it was Sunday and there were no orthopedic doctors on duty, a follow-up virtual visit was arranged for the next day. The doctor on duty explained we’d need additional x-rays and potential resetting of the bone.


However, before we were sent home, the arm required proper stabilizing and was set in a plaster splint or half-cast. During the plaster application, the med tech told us it may not be possible to fly with a full cast due to the slim chance of swelling during a flight (which is a rare occurrence but must be considered). This meant that any treatment requiring a full cast may inhibit our plans to fly to Athens on Dec 16th.


The doctor, tech, and I chatted about our options, and I learned that once the full cast is applied, it can be split down both sides. This creates space to accommodate potential swelling and seemed like the perfect option if necessary. At this point our initial care was complete. We were satisfied with the care and information we received, and we were sent on our way.


Smart Move: I asked for copies of the x-rays for our records and received them on a CD.


Hindsight Revelation: I took the med tech’s knowledge about not being able to fly with a cast at face value. Later when I did some research, I found the plaster policies vary by airline. Had I investigated this sooner, we would have made different choices.

 

NHS Care in England: Follow-Up Care

The virtual visit was a very quick phone call which confirmed the bone was broken and we needed to be seen in person at the hospital’s orthopedic department. We were scheduled for following day.


On our Dec 6th appointment, we completed secondary x-rays and learned the bone was offset by 15 degrees. The doctor said that they could manipulate the bone back into position if we wanted it to be aligned and this could be performed immediately in the office. Initially we opted for this procedure, until we learned it would be kept in place with a full cast.


I asked the team about the possibility of splitting the cast open so we could fly in 10 days. The doctor said it wasn’t possible. The cast needed to be one week old before they could split it and the office wasn’t going to be open within our timeline. They only have orthopedic office hours 2-3 times per week at that location.


However, the doctor assured me that the 15° angulation was within the realm of normal healing and said he was happy leaving the injury to heal on its own. We were sent home in the same splint applied at the urgent care clinic with a follow-up plan to take x-rays in 2 weeks when we arrived in Greece. Once more we were satisfied with our care and felt we had a good grasp on how to handle the next steps.


Smart Move: I anticipated language barriers in Greece and Turkey, so I had questions written down before our visit. I took excellent notes on the long-term care plan including timeline for the splint and weight lifting restrictions (typically no physical therapy is needed for children with this injury, they regain their range of motion naturally through normal body movement).


Smart Move: I again asked for copies of the x-rays. This required a visit the medical records department which needed two forms of photo ID to release the x-rays. This time I had my physical passport on me and I explained my situation about my driver’s license. Luckily, a department manager was able to override the secondary ID requirement because I was a foreigner, and I received the x-rays on a CD.


Hindsight Revelation: We were not offered an ‘after visit summary’ at either NHS appointment. These typically include diagnosis, care completed, future care plan, and, in our case flight clearance (application a splint instead of a full cast). I thought about it at the hospital, but we were too worn down after waiting in medical records to go back and request one. This lack of paperwork didn’t affect adversely anything for us, but it was a poor choice.


Hindsight Revelation: We carry private health insurance. When the NHS doctor told me the clinic was unavailable within our timeline to split the cast, it didn’t dawn on me that private hospital care was an option. I wish we would have sought treatment outside of the NHS as soon as they said they could not provide care to match our timeline.


Though our initial costs at the urgent care clinic were complimentary, we eventually were charged for the virtual visit and in-person visit at the NHS hospital. Our total bill was £369 paid via bank transfer.


Hindsight Revelation: Shortly before our Dec 16th flight, I finally did some research about flying with casts. Turns out some airlines allow full casts, especially if they're not brand new. In fact, our flight was with EasyJet and their policy is that the cast needs to be 24 hours old in order to fly. There was no need to have it split. We could have had the alignment completed on Dec 5th in the UK and been fine to fly to Athens on the 16th in a full cast. Live and learn!

 

Healthcare in Athens: First Appointment

Initially I wanted to have our follow-up appointments scheduled prior to landing in Greece. I like being organized and thought we would feel more settled if our care plan was in place. As I reviewed Cigna’s Provider Network, it appeared we had lots of choices in Athens, but scheduling an appointment online was not straightforward, and I didn’t want to call due to a potential language barrier.


Smart Move: As I was venting about this frustration, my worldschool friend suggested we just show up at a Greek hospital and have them schedule an appointment in person. Oh man, what a great idea! Here I was putting effort into something that really didn’t need to be micromanaged to that degree. Of course they would get us an appointment.


Once in Athens I selected a hospital with an orthopedic department (and good reviews) and we set off with passports and insurance cards in hand. Upon arrival they asked the age of my child. When I replied 13, they informed me that they only treat patients 15+ years of age. Fortunately for us, there was a pediatric hospital just a few blocks away.


Amazingly, the pediatric orthopedist could see us that afternoon! This did require completing paperwork in Greek, but with the help of the staff, it was rather simple. We met with the doctor shortly after and found that he studied in the US and was fluent in English. We do not take this for granted in the least. Being able to converse in English simplified our decision-making process because we completely understood the current condition of the injury and the treatment options.


When the doctor reviewed the UK x-rays, his face fell. The 15° angulation I understood to be perfectly fine, was not acceptable in his opinion. He explained that a child 10 years of age or younger has years of bone growth in front of them, a 15° angle is no problem… but for a 6-ft-tall 13yo, we must anticipate most growth spurts are complete and 15° is difficult to mend via normal bone remodeling.


I felt terrible that we arrived unannounced with a difficult case, and the doctor is visibly upset by the current care plan. But, we haven’t completed the secondary x-rays, so we cross fingers and hope that the bone hasn’t shifted during the first 15 days of healing.


Unfortunately, our fingers weren’t crossed tightly enough… the new x-rays showed a 30° angle which is now impossible to heal without medical manipulation. It’s like trying to grow a bone around a corner; it may form a callus but would always be weak and prone to future breakage. “Ugh” doesn’t even describe how it felt to receive this news.


Hindsight Revelation: Actually, it was probably lucky that the bone shifted further out of alignment. Had it stayed at a 15° angle, we may have had tougher decisions to make.


Well, there was nothing to do but treat the present condition. A plan is made to rebreak and align the bone, set the injury with a pin, and stabilize the area with a splint to ensure that we are able to board our Jan 8th flight to Antalya, Turkey.


Smart Move: The doctor prepared documentation in English with the diagnosis, treatment plan, and flight clearance for us to use with our insurance company and ongoing travel and healthcare plans.


To our surprise, the doctor schedules an operation the next morning pending passing a PCR test for covid (fortunately no problem there, both my child and I tested negative at 50€ each). We would be back at the hospital bright and early.


Our initial visit was 80€ to cover the doctor’s appointment and x-rays. I paid by credit card. Though I asked about surgery costs, I was unable to even get a ballpark figure. The staff reported they cannot create a bill until the surgery and inpatient care was complete. There was nothing more I could do, but I was happy to note that the hospital accepted credit cards directly at the desk.

 

Healthcare in Athens: Surgery Prep

When we arrived back at our flat, I called the insurance company to get preapproval for surgery. No problem at all, they set up a case number for the injury so any care related to it could be filed properly. Within a few minutes I had an email with the pre-approval case number and guarantee of coverage to present to the hospital.


I also anticipated that I could pay for my portion of the surgery with our credit card. To fully open our credit line, I prepaid our current balance so I could cover surgery costs. Cigna would kick in any charges above our deductible… so without knowing the full surgery costs I knew I could cover 2-3 times my deductible between the two travel credit cards I carry.


Hindsight Revelation: I should have called both credit card companies and told them I was anticipating a large charge for a hospital bill… I was just a bit worn out with adulting by that time and didn’t feel like it. I figured that if I was declined on one card, the other card would pick it up. Additionally, I knew if I was declined on both cards, I had a toll-free number I could use to call the credit card agencies. However, good news, the first card approved the surgery charges without question.


Healthcare in Athens: Surgery Day

On the morning of surgery, I was bombarded with paperwork… all in Greek. Sometimes you just have to trust the process. The lovely intake staff did their best to summarize what the paperwork said, and I signed all of it without translating… Smart? Probably not, but my gut instinct wasn’t sensing anything alarming and everything went very smoothly (I don’t know about you, but the more we travel, the easier it is to tap into, and trust, my gut instinct). The paperwork was obviously the normal intake process, and I had all the insurance documentation we needed.


Surgery lasted from 8:00-9:00 and went very well. The doctor visited me twice in the waiting room (which had complimentary juice and pastries set out for me, nice touch!). The first visit was to show me the new x-ray with the pin and a perfectly aligned bone, no angulation! The doctor was beaming with pride. Though I was not uneasy about the procedure, it was very reassuring that he was so pleased with the result.


The second visit was to let me know that my child was in the post-op room waking up from the anesthesia. He also said that he’d see us later that afternoon to check in on both of us.


By 9:30 I was allowed in the recovery room and by 13:00 my child was able to have a plain cheese sandwich and get up to use the facilities. We were quite antsy to leave but needed to wait for the doctor’s return visit which didn’t happen until after 18:00, what a long day for him!


As they worked on our discharge paperwork, we were asked to pay the first 3000€ of the surgery. I made a quick visit to the pediatric clinic and paid the deposit with our credit card (earned points on that one).


Finally around 19:00, we were discharged with plans to return to the clinic for a check-up in one week. Before heading home, we had to stop at the pharmacy to pick up a round of preventative antibiotics. Though there were no incisions with surgery, a pin was inserted through the skin and placed into the bone, we needed to keep the body infection-free.


Smart Move: Before the doctor left, I asked him if there was a pharmacy on the property to fill that medication. The hospital did not have an in-house pharmacy, but he helped me locate one a few blocks away that was open until 21:00. My child would be able to walk the few blocks with me.


Hindsight Revelation: The doctor said we wouldn’t need a prescription for the over-the-counter antibiotic, however, the pharmacist did not agree. Had we been members of the Greek medical system, they would mark our account with the medication… but foreigners needed a prescription. The pharmacist kept the physical copy of our discharge papers as a record of why the antibiotic was dispensed. I didn’t resist because it was nearly 20:00 and we’d been up since 05:30… I did not have the energy to return to the hospital or contact the doctor at that point. I’m not sure I’d insist on a written prescription next time, but now I know the this could happen.


Smart Move: I took photos of the discharge papers before handing them over.

 

Healthcare in Athens: Post-Operation

The following day I receive the surgeon’s and anesthesiologist’s invoices via email, 1414€ and 424€ respectively. Those were both paid by bank transfer.


A week later we went for a quick checkup. The follow-up x-ray shows everything is going according to plan and we’re scheduled for a second follow-up the next week.


During the time between follow-up appointments, I receive the final bill for the hospital’s portion of the surgery, 3521€. Via email I was able to tell them I’d pay the remaining 521€ in person with my credit card at the second appointment. Easy!


Our second post-op appointment was more involved than the first. It was time to remove the splint, check for infection, and reapply a fresh dressing. Again, we had good news. All was going according to plan and a topical antibiotic was applied as a preventative.


The doctor and I talked about the future care needed for the injury. The pin needed to stay in place for 4-6 weeks, so that gave us a 2-week window in Turkey to have the pin withdrawn. Initially I thought that the pin was enclosed in the skin and required a second surgery, however, the end of the pin remains outside of the skin and is bent at an angle to ensure it can be easily gripped for removal. The doctor told us the pin withdrawal was a simple outpatient procedure and potentially we could remove it ourselves (though when I questioned him about this, he did say it was better to have it professionally removed).


Smart Move: The doctor had me take pictures of the exposed pin so we could show our future care team what to expect before they removed the splint.


We also talked about weight lifting restrictions, the unlikeliness that physical therapy was necessary, and timeline for returning to sporting activities. I had all documents in English and, again, took excellent notes. We were completely satisfied with our experience.


Smart Move: The doctor noticed the new dressing looked a bit snug before we left. He asked how it felt and my child replied it felt a little tight but would probably stretch out… however the surgeon decided that ‘a little tight’ was too tight and removed and reapplied the entire dressing.


Smart Move: I received physical and/or emailed copies of all the x-rays taken in Athens to bring with us for flight check-in, airline security clearance, and future care.


There was no charge for either of our follow-up appointments or x-rays, these were included in the surgeon’s payment. Additionally, I paid the 2nd installment of the hospital surgery charge at the end of this appointment. We were all set for the next stage.

 

Healthcare in Turkey: The Pre-Plan

Before traveling to Turkey, I contacted a worldschool acquaintance there and told her about our situation. She gave me the names of two different hospitals with orthopedic departments during our 2-week span to have the pin removed. This was reassuring to me, and again, we did not set up appointments ahead of time, we would do it in person.


On our earlier flight from London to Athens, there was no question at all about flying with a bandaged arm… not at the check-in desk, not at security, nor at the gate. We just walked straight onto our EasyJet flight. However, Turkish Airlines stopped us right away at the check-in desk. We were questioned about the injury, how old it was, how it was set, and if we had doctor’s clearance to travel. Fortunately, all the questions were in English and our verbal answers were sufficient. Regardless, I had the doctor’s paperwork and x-rays on my person.


Note: I browsed Turkish Airlines’ website for a cast policy but did not find one. Because we were in a splint, I decided it wasn’t worth calling. Had we been in a cast I would have made the appropriate phone calls to ensure we had proper clearance to fly.


When we arrived in Kaş, we were busy exploring the coast and did not go to the hospital on the first day of the possible pin removal. We decided it was better to let the pin remain in the bone a bit longer for proper healing. Our child was okay with this choice, but also was starting to become more and more uncomfortable with the idea of this pin implanted in the bone. We decided to wait for a total of 4 weeks and 3 days before seeking healthcare.


On the day we went to the hospital, the child is really done with this pin and wants it out. Unfortunately, the language barrier was more difficult to navigate than in Greece. The ladies at the “Advice” desk did not speak English and we used our phone translators to tell them we needed an orthopedic doctor to complete the care for this broken wrist.


It was a Friday and the doctor was at another site all day. I was given a phone number to schedule an appointment for the following week, but it ended up being a robo operator. I couldn’t figure out the numbers to press to speak to a human, so we went home to regroup.


The second hospital was nearly 2 hours away and we’d already waited in line at the local hospital for an hour to hit a dead end. We decided it wasn’t worth driving 4 hours round trip for an unknown result.


Hindsight Revelation: After we left the hospital, I researched pin removal and found that it doesn’t need to be completed by an orthopedist. A physician’s assistant or nurse practitioner (or similarly qualified individual) are also trained for this procedure. We could have just requested an office visit… however, the answer may have been the same, “call the number.”

 

Healthcare in Turkey: Do - It - Yourself?

Back at home, the child does not want to wait until the following week to try another office visit. This pin is mentally more difficult to accept each day past the 4-week minimum placement. To honor our child’s discomfort, we needed to create the best possible solution with the tools we had. If anyone has texture sensitivities, you can understand how this pin, or even just the idea of a pin being there, can be unnerving and stressful. Our child did a phenomenal job of accepting the 4-week period, but those extra days became very trying.


We began to talk about removing the pin ourselves. Believe me, this is not a small discussion. We first needed to know the risks, feel comfortable with our self-removal plan, and devise a valid back-up plan if we encountered a situation outside of what we were prepared to handle. Having access to a nearby Emergency Department was an instrumental piece of our decision-making process.


Disclaimer: I am in no way recommending DIY medical procedures. However, I believe our experience and thought processes are relevant to worldschoolers because there are situations where solutions may not simply appear within our timeline. We can trust our gut instincts… not blindly of course, but we can make intuitive and informed decisions with the information we have. In our case, my gut instinct was completely comfortable with the choices we made.


As a family, we researched pin removal procedures. After reviewing numerous articles and YouTube videos, formulating a care plan, gathering supplies, and reviewing notes taken with our Greek doctor, we elect to remove the pin ourselves. One of the deciding factors was access to an enormous first aid kit. I carry a well-stocked kit myself, but the secondary kit had gloves, iodine disinfectant wash, medical scissors, sterile gauze wraps of different sizes (way more than I carry), etc.


We knew the risks (mainly infection) and prepared our treatment area in a sanitized manner. I was not overly concerned about a perfectly sterile environment because during our surgery infection check in Greece, the doctor only wore gloves for part of the procedure (evidently, I also took mental notes).


Each of us played a different role to ensure a safe DIY pin removal. We laid out all the necessary supplies and prepped the area with the iodine disinfectant. The pin released after a little resistance (which can indicate that the bone is quite strong). Fortunately, we were prepared for that via the articles and YouTube videos.


Our child was a bit light-headed afterwards; however, that wasn’t a surprise as this particular human doesn’t do well with blood draws or getting IVs either, due to the sensitivity of foreign objects being in the body. We remedied this with rest, cool washcloth, and fresh air.


We treated the area as recommended by our online research: let it bleed if wants, clean and cover with sterile dressing, but do not apply topical antibiotic other than the pre-procedure washing. The initial dressing remained in place 24 hours and then we started applying topical antibiotic ointment with fresh dressings (we read 24 - 48 hours before any topical applications were recommended). We kept the area dry for 72 hours and then resumed normal bathing.


Because infection was the main risk, I diligently monitored the child for symptoms (fever, redness, swelling, puss, etc). There were zero symptoms, everything healed quickly and perfectly. Was there a risk? Yes. Did we do the right thing? We did the right thing for us.


Smart Move: We retained all the x-rays and medical paperwork as the scab was healing in case we needed to explain our circumstance for further treatment, such as an oral antibiotic.

 

DIY Healthcare in Turkey: Confidence in our Decisions

I assume a good portion of my audience will read this and be shocked by how reckless we were with our home-made healthcare choices… we could have waited, or tried the Turkish hospital on Thursday instead of Friday, or driven to the other hospital, or gone to the ER. We know. We considered all those options.


I also expect a handful of my readers will claim it’s brilliant that we manufactured a solution as the pin became increasingly unpleasant for our child.


Regardless, I didn’t spend 8 hours writing this article to be judged or to ask for approval.


I wrote this so each of you can contemplate what medical decisions look like abroad: sometimes there is a language barrier, sometimes we don’t get proper care at the proper time, sometimes we need to make choices without having perfect information, sometimes we need to switch care plans… but a lot of it comes down to trusting the process and knowing you’re on the right path for you.


Everyone’s path is going to look different depending on their comfort levels, language mastery, medical knowledge, child’s demeanor, etc, and we often don’t know what choices we’ll make until we need to make them.


My family made the right choices for us at each step of the way. Though my “hindsight revelations” give insight into what could be done differently, I’m a firm believer that our choices lead us on the perfect life path for our individual human experiences. This situation played out exactly the way it was supposed to.


Humans are incredible problem solvers, and frankly, this experience was a series of problems that needed solutions. We addressed each circumstance with the knowledge we had at the time and found our way to a perfectly aligned bone and happy, healthy kid.


While I cannot say our decision-making path is one others should follow, I do hope it gives reassurance that medical incidents abroad are manageable. Had we waited for the appointment in Turkey, I'm confident that we would have found competent and professional care, we just didn't anticipate our child's needs were going to change so quickly.


People often ask me what I appreciate about worldschooling and what this lifestyle fosters in my children. I always reply that worldschooling cultivates confidence, creativity, adaptability, and flexibility… and this experience provided all of us a hardcore lesson, adults included.


I’m wishing you all happy & healthy travels, but also the confidence to know you can find the right solutions, make tough choices, trust your decisions, and know you’re on the right path for you.


 

Want to know more about worldschooling with teens? Here are a few other articles I've written:

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