Foreign travel on dialysis is something you can do

By Bill Peckham

UPDATED BELOW
Here is a revised post to answer questions I'm often asked: How many countries have you been too? How many have you dialyzed in? The answer depends on what you count as a country. I primarily used Wikipedia as my reference source and after a full accounting (see footnotes for the complete list of countries visited under in each category) I can now say that in my life:

I have visited 34 countries with general international recognition including:

• 33 member countries of the United Nations⁽¹⁾
  I have dialyzed in 20 countries with general international recognition, on five continents
• 1 country with general international recognition but not UN membership⁽²⁾

In addition I have visited 7 nations that are not fully independent countries, dialyzing in 2:

• 1 oversea territory of France, governed as an overseas collective⁽³⁾
• 2 oversea countries in the Kingdom of the Netherlands⁽⁴⁾
  
• 3 British dependencies⁽⁵⁾
• 1 Chinese territory under (temporary) Portuguese administration⁽⁶⁾

⁽¹⁾ _* USA – Home base Seattle, Washington (Dialysis in over 20 States)
_* Canada - multiple; Dialysis Sydney (aboard Grand Waltz) '07
_* New Zealand - CKD '87; Dialysis Auckland '99
_* Australia - CKD '87; Dialysis Freemantle, Sydney, Noosa & Cairns '99
_* Nepal - CKD '87
_* Thailand - CKD '87
_* Mexico - weekend '94; Dialysis Cancun '05; NxStage Freedom Cruise, Cozumel '10
_* Costa Rica - Dialysis San Juan '95
_* Netherlands - Dialysis: Amsterdam '96, '98, '99; Dialysis: Hilversum '00; Dialysis: Utrecht '03,'04
_* Germany - Dialysis: Straubing '96; Dialysis at Sea, Wilhelmshaven '98; Dialysis: Trier '02
_* Czech Republic - weekend '96
_* Italy - weekend '96; Dialysis: Florence & Rome '97
_* Switzerland - Dialysis: Lugano & Interlaken '96; Dialysis: Interlaken '02
_* France - Dialysis: Dijon & Tassin '96; Dialysis: Marseilles '97; Dialysis: Paris '96, '98, '00, '02; Dialysis: Arles '01
_* Austria - weekend '96
_* United Kingdom - Dialysis: London '97, '98, '03; Dialysis: Edinburgh '03
_* Portugal - weekend '97
_* Spain - Dialysis: Seville, Madrid, Barcelona '97; Dialysis: Ibiza '03
_* Belgium - Dialysis: Brugge '98; Dialysis: Brussles '04
_* Sweden - Dialysis at Sea, Stockholm '98
_* Norway - Dialysis at Sea, Oslo '98
_* Finland - Dialysis at Sea, Helsinki '98
_* Russia - Dialysis at Sea, St. Petersburg '98
_* Estonia - Dialysis at Sea, Tallinn '98
_* Denmark - Dialysis at Sea, Copenhagen '98; Dialysis: Copenhagen '04
_* Monaco - weekend '97; Dialysis: Monaco '99
_* South Africa - Dialysis: Capetown, Port Elizabeth & Nelspruit '99
_* Turkey - Dialysis: Kusadasi & Istanbul '00
_* Luxembourg - weekend '02
_* Bahamas - Dialysis: Centerville '03
_* Singapore - Dialysis: Singapore '04
_* Honduras - NxStage Freedom Cruise, Isle Roatan '10
_* Belize - NxStage Freedom Cruise, Lamanai River '10
⁽²⁾ _* The Vatican - weekend '97
⁽³⁾ _* Saint Martin - weekend '02
⁽⁴⁾ _* Sint Maartin - Dialysis: Philipsburg '02
_* Aruba - Dialysis: Oranjestad '07
⁽⁵⁾ _* Hong Kong - CKD '87
_* Cayman Islands - 1989 Post Transplant; NxStage Freedom Cruise, '10
_* Anguilla - weekend '02
⁽⁶⁾ _* Macau - CKD '87

Whew, that's a lot of travel! I never expected to be able to travel at all once I transitioned into CKD5 and now here it's been over 20 years of CKD5 travel - the majority of the time visiting units and dialyzing incenter, however, recently I've been able to travel using the NxStage to meet my renal replacement needs.

I've met a number of people who say just knowing I've done all this gave them hope when they heard that they are facing dialysis and that makes me happy. I have a wanderlust comorbidity and the thought that I would never travel - let alone travel extensively abroad - was the most depressing thing about my kidney disease diagnosis. Now I think I will reach a personal goal of visiting 50 countries and six continents (not sure about Antarctica but with with future NxStage innovations maybe that too will be an option).

My choice would be to visit South American next. I'd like to see Machu Picchu and Iguazu Falls and the Amazon and Chile and ... well you get the idea. Having a wanderlust comorbidity means I want to see it all. And it can be done - even when you need renal replacement. Happy travels!

UPDATE 1/11/2010
While answering a comment to an old Dialysis in Fiji post I realized that I had made a grievous oversight when I posted this without crediting the Northwest Kidney Centers' highly skilled visitor dialysis services for their help in making it all happen. All those trips were facilitated by the most awesome dialysis transient coordinator in the business. Without Cheryl it would have been a lot less fun to organize the travel that has meant so much to me.

All that travel only happened after all the paperwork was faxed to a unit. I took my first trip within four months of starting dialysis; there was no internet back in 1990. Cheryl made it happen no matter the languages and besides all the languages involved, there is also the fact that each unit has their own particular way of setting up the visit. They all have their own quirky hoops.

I wish everyone dialyzed in partnership with the Northwest Kidney Centers (NKC) but I know that isn't possible. Instead, I'll wish all dialysis providers followed the Northwest Kidney Centers model of  promoting the optimal health, quality of life and independence of people with kidney disease. NKC does this through patient care, education, research ... and Cheryl.

Comments

[Kamal Shah]

Amazing Bill! You truly are an inspiration! Now, can you do something to get NxStage to get the System One to India?!

[Peter Laird, MD]

Bill, what an amazing testimony of what a person can experience and accomplish even on dialysis. Go Bill, Go!!!

[Gus]

Thats quite a marathon, I bet Nano dialysis would even make life much much easier, no need to haul 50 pound machine nor supplies..

[Rich Berkowitz]

Hmm, not sure what countries I dialyzed in, but now can say I've visited four while on dialysis. My list now has Grand Cayman, Honduras, Belize and Mexico. The 2010 Freedom Cruise started my personal log of countries visited. I hope to travel with Bill to more.

[Erich Ditschman]

Now that you have been on NxStage for some time, how do you feel when you travel abroad and have to revert back to traditional three times a week dialysis? Is it frustrating not to feel as well as you are use to on daily nocturnal?

Erich

[Bill Peckham]

I haven't traveled incenter since starting nocturnal Erich but I've had the same basic issue since I was went to the B Braun in '01. And even before that switching from incenter at the Northwest Kidney Centers often meant getting less good dialysis.

But I do acknowledge the situation ... for one I switch back to a strict incenter diet which has always been too bad since eating experimentally is a lot of fun when you're abroad. When I had insurance through the union they had no problem paying for every other day treatments or back to back treatments (4/week) and that helps quite a bit. As does, most of the time, using a large incenter artificial kidney and a high incenter dialysate flow.

But the number one thing is that travel, to me, is a drug and when I am traveling for fun somewhere new, taking in a kaleidoscope of new experiences ... it really doesn't matter how I feel - well that whole Nepal thing - in my experience, most times, enthusiasm trumps uremia.

[MIchelle]

How did you orgainse you dialysis in kusadasi my partner has been to marmaris before but finding it hard to get a hold of kusadasi hospital. can you help. my email address is shelleysymon@yahoo.co.uk if you can.

[Sancar Eke]

Michelle, I am Bills's friend who used to work in Kusadasi Hospital many many years ago, I shall be happy to contact them for you, if you want to reach them yourself their phone # 90-256-6131313. Please email me at ekesancar@gmail.com.

[Bill Peckham]

Thank you for your help Sancar. Michelle here is an article I wrote after my 2000 trip to Turkey
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/02/dialysis-travel.html

[Des Bezuidenhout]

Bill,

You need to visit South Africa again. Then we can meet and have a "braai"(BBQ). Let me know when you come this way again then we can have dialysis together.I have a very complete list of ALL the dialysis centres here in SA. if you need it for someone else.

Thanks for being an inspiration to us all.

Lovies
Des

[Glyn Winn]

Hi Bill,
In Canada we don't have the NXStage and my husband does nocturnal home hemo, usually six nights a week. The last time he switched to in-centre when we were on holidays, all of those old constraints can rushing back; watching his fluid intake and restricting his diet, the low period after the run -- really a full day lost. Have you found centres willing to do four sessions of four hour runs per week when you were traveling prior to the NXStage? We're heading for a family reunion in Mexico next Xmas and the location will be determined by quality of dialysis.
Last autumn we were able to travel within our province with the dialysis machine in our RV. We camped on the sandy beach in the city of Penticton, the centre of wine country in British Columbia. Waking to the waves lapping a few feet away was incredible. The water system was excellent. We've now booked a trip to Los Angeles in April where my husband will do nocturnal in-centre dialysis. That will be a first for us but we're hoping to find more units outside of North America that can supply that kind of extensive treatment

[K. William]

Hello Bill -

We are planning on a trip to Spain in the fall, and wondered if any health insurance / Medicare might help pay for dialysis? Any suggestions?

Thanks very much.

[Orlando Perez]

I have the same questions as Bill, since we love traveling through Spain. I looked at all the centers there, but can't find information on costs for people who are paying cash.

[Bill Peckham]

Medicare will not pay anything towards dialysis outside of the US. Medicare only reimburses for dialysis provided at units it can have inspected - which is why reimbursement is not available abroad or even on dialysis cruises that occur entirely in US waters or leave/return from/to a US port.

As far as the cost, Orlando, it has been nearly 15 years since I traveled in Spain but as far as I remember the cost per treatment was in the neighborhood of 300 Euros. I think it is possible that if you identify yourself as being an unreimbursed self pay dialyzor they may give you a better deal.