If you value your son’s life, you’ll come with me right now. Your wife can find you later.

I still remember this expat’s story distinctly, told by a friend-of-a-friend we’ll call Frank.¹ His son was gravely ill, so Frank and his wife went to a nearby hospital to see a good doctor. But when the doctor gave his diagnosis, Frank was waiting for his wife to come back from an errand when the doctor’s words made him realize this was a life-or-death situation.

The doctor dropped Frank and his boy off in a different room and Frank assumed someone would stop by to help, but no one did. After an eternity of waiting, he realized that he needed to get help, not wait for it to come to him. But when he called the staff over, despite it being a life-threatening situation, they were unwilling to help until he got a hospital account card. Then, he found out the card wasn’t enough, he had to preload it with money for the medicine his son needed. All the while Frank’s son lay septic and untreated in another room.

Thankfully, his son survived, but the experience left Frank shaken, and it taught me something vital: when it comes to medical emergencies abroad, assuming that you know how a hospital works can cost lives.

In this article, I’ll help you identify what you need to know about your local hospital system before you need to use it. Because, as Frank’s story shows, assumptions can kill—but preparation can save.

Articles on The Prepared Expat may contain affiliate links that help support this site at no cost to you. The Prepared Expat articles do not constitute legal, medical, or financial advice and should not replace consultation with a qualified professional. See full disclosures & disclaimers.

Assumptions about hospitals can kill

If you’re a long-term expat, you can skip this paragraph. But if you haven’t left your passport country yet or are new to your host country, let me first note why I’m even writing about this topic.

Too often new expats have an unchallenged assumption that hospitals are the same the world over. That preconception can make sense if you’ve not gone to a hospital in another country, but nothing could be further from the truth. There are massive differences in hospitals, and I don’t just mean differences in quality, which even new expats might expect. I mean differences in a hospital system: getting an appointment, responsibilities of the hospital v. patient, philosophies of medicine, procurement of supplies, truthfulness of diagnoses, and more.

In every area of life, you have assumptions about how “things are done,” and those assumptions are often laced with values, leading you to believe there are ways “things should be done.”

In most areas of life, though, your assumptions won’t kill you. Assumptions about hospitals, though, very well could. Yet, too often, expats don’t realize that hospitals function differently from what they’re used to until there’s a medical problem. In an emergency, when minutes can’t be spared, expats waste valuable time figuring out how the hospital works instead of getting medical help.

After all, who goes to the hospital when they’re not sick to check if their assumptions are correct?

Who goes to the hospital when they’re not sick? You will after you read this article.

Hopefully you will, after reading this article.

What you need to know

Since hospitals are different and since the time to discover those differences is not when you have a medical emergency, here are things that you need to learn before you have a medical event. I’ve divided them into categories to help you learn the answers you need.

Note: I’m assuming that you live in a place with medical professionals. If you live in a community where medical care is provided by someone other than a doctor (e.g. shaman, healer, etc.), then much of the below will not apply to you. It’s probably still helpful to read what follows because it will help you think through the assumptions you have and what you need to know about how healing works in your community.

Being allowed to see medical professionals

You need to know how to get professional medical help, but this process isn’t always as straightforward as you might think.

• Do you go to a medical professional, do they come to you, or does it depend? If it depends, how do you know if it’s a situation where they would come to you v. you need to go to them?
• What medical options exist for getting care? Are there hospitals? Doctor’s offices? Urgent Care? Emergency rooms? Clinics? When do you go to one option v. another? I.e. in the US, pharmacies often have tiny clinics for minor issues, a doctor’s office is for scheduled or “routine” matters, urgent care is for urgent-but-not-life-threatening issues, an emergency room is for true emergencies, and a hospital visit is usually for quite serious issues. What options exist in your host country? When do you go to one and not another?
• Are all medical options equipped the same? Are all hospitals basically the same, or do some have specialized equipment that others don’t have? Are some hospitals better at some things than others? Should you avoid any particular medical options in your city?
• How do you make an appointment? Do you need to call in advance? Use an app? Login to a website? Show up and get a number? Have a relationship with medical staff who can get an appointment for you?
• When do you need to schedule an appointment? Do you need to show up at the hospital in the morning to get an appointment in the afternoon, do you need to call a week in advance to schedule something, or can you just show up and immediately be seen? If the answer “depends,” what does it depend upon? How do you know when to schedule something?
• Are there times you don’t need an appointment? In what situations do you not need an advance appointment? For which medical providers?
• What documents are needed? To get an appointment, what document(s) do you need? Can you just show up or do you need your passport? Local registration? Citizenship, permanent residence, or social services card? Insurance cards? Do you need to bring these documents every visit or just for the first one, where you register, after which you don’t need to show up?

The process of making an appointment isn’t always as simple as you’d think.

Getting medical care

Once you have an appointment (or not!), what does it look like to actually see a medical professional? What should you expect? Here are some questions to help you discern what that looks like:

• What’s the general process? At a high level, what happens when you visit a doctor? Do you have to move around to the doctor and test stations, or do they come to you? Will you be shown to an individual patient room or will you wait in a general waiting area? How long will you generally wait before being seen? Etc.
• How proactive must you be to get care? In some hospitals, the staff proactively checks on you to ensure everything is fine and have alarms that will alert them if there’s a problem. In other places, as in Frank’s example, it’s the patient’s responsibility to go to medical staff or ask staff to come to the patient’s room. Even in an emergency, like someone going into cardiac arrest, the staff may not come unless you inform them of the need and hurry them to your room.
• What does the hospital provide v. what do you bring? In some countries, it is the patient’s job to buy and bring all medical supplies and medicines: disinfectant, IV bags, tubes, syringes, bandages, bedsheets, toilet paper, gloves for the staff, etc. Even medicines for injections or IVs may be something you need to buy at the pharmacy and bring to the hospital for them to use, rather than something they provide.
• How do you get food or drink? Some hospitals will bring food to your room while others require that you bring into the hospital the food or even water that the patient will need. How does that work?
• Are interpreters available or do you need to bring your own? Some hospitals have multilingual staff and/or staff interpreters who are able to help you while others expect you to understand the local language and/or provide your own interpreter if needed.

Don’t assume the hospital will provide what you expect or serve you the same way that you’re used to.

• What does the hospital do v. the patient or family? In the West, staff do all they can to provide for all the care a patient needs: assisting with food, cleaning bedpans, changing sheets, etc. In other countries, patients and/or their families are expected to fulfill many of these roles, including more medical roles like changing IV bags or administering medicines at specific times. In contrast, in other countries, family members may not be allowed to perform some of these roles.
• Do you need a helper or can you go alone? In places where patients/family are expected to have a large amount of involvement in medical care, you may be required to have someone who stays with the patient 24/7 in order to buy supplies, fill prescriptions, and pay for procedures/tests as they occur. Particularly for overnight stays, you may be required (or simply prefer) to ensure there is always someone other than the patient present. Sometimes hospitals have an approved list of people you can hire, recommendations, and sometimes it’s 100% your responsibility to provide a helper to the patient.
• What privacy can you expect? This one will differ radically from country to country. The US has strict privacy-protection laws and doctors face severe punishment for disclosing medical information without permission, even if it’s to a patient’s family. On the other hand, I’ve been in hospitals where people regularly walk in and out of the room, as the doctor examines me, because it was proactive medical care and they needed to inform the doctor that they were present and waiting for him. Awkward, but apparently only for me—everyone else took it in stride.

Diagnoses and treatment

You’ve made your appointment and you’ve seen the medical professional. Here’s some things to be aware of as the doctor diagnoses you and gives you a treatment.

• Will the doctor tell you the truth? This may be shocking to many from Western countries, but in many countries in the world a doctor will not tell you the full truth of your diagnoses, even or especially with serious diseases. Perhaps the local culture has a superstition that speaking of a bad disease will make it worse, but sometimes it’s because the medical professional doesn’t believe it’s helpful for you to know the full information about a disease. Sometimes doctors keep the true diagnoses to themselves, sometimes they tell only the family, and sometimes they’ll tell the patient (but not the family). It’s good to know what to expect and to know you can get full accurate information if you do desire it.²

You can’t even assume the doctor will tell you the truth about your illness.

• What consent is required for a procedure? Can a family member sign a consent form for you? At what age do children have to provide consent v. their parents? At what age can a child get medical care without their parent’s consent or against that consent? How are disputes within the family about medical care or end-of-life decisions handled?
• Are second opinions possible? If you disagree with a diagnosis, what’s the procedure for gaining a second opinion? Do you, as a patient or family member, have authority to reject treatment or is the doctor able to unilaterally treat someone against their/family’s wishes in order to keep someone alive?
• Can you adjust treatment? Doctors worldwide tend to be cautious as well as to suggest the most expensive treatment option. I’ve been in a situation where general anesthesia was recommend by the doctor but, when I asked if I could do local anesthesia only, the doctor said it was fine. That choice alone saved me thousands of dollars. If the doctor wants you to stay overnight, ask why and see if you can just come in for a check-up the next day. There’s a lot more flexibility with doctor prescriptions than most people think; if you can understand why something is being suggested, you often can find a cheaper or less inconvenient alternative.
• What will be prescribed? A doctor may prescribe exercise, herbs, antibiotics, IVs, or other local remedies. Don’t be surprised if the prescription differs dramatically from what you think a doctor “should” prescribe. This often relates to different cultural philosophies of what makes for good health and what causes disease.
• How will a prescription be delivered? The expectation in the West is often that a doctor will tell you what to do and then you’ll do it. In other countries, a doctor may try to “guide you” to the right answer through leading questions. In other systems, a doctor may simply ask you to continue coming back, and the medical staff will administer medications rather than you.³
• Who keeps medical records? Now that you’ve had medical work done, does the hospital keep records and provide them to you in the future, or do you need to keep records yourself?

Paying for medical work

• Do you need insurance? You may be required to provide proof of insurance to visit some hospitals or to schedule some procedures. What information do you need to provide to demonstrate that you qualify for public or private insurance? Learn more about how different countries treat insurance in Expat Health Insurance Demystified: Your Essential Guide.
• Do you prepay? In some systems, you preload a card/account with a certain amount of funds, money is deducted as you spend it, and you can withdraw the balance after your procedure is over. How much money do you need to load onto the card/account? Where do you load the card? What payments do they accept (cash, credit, debit, etc.)?
• Do you pay as you go? Do you have to pay for each test or procedure as it is ordered? If so, where do you pay? What payments do they accept?
• Do you pay afterward? If so, how are expenses tracked? Should you be asking for receipts along the way to check the hospital’s records or can you trust they’ll be accurate? When do you pay or how do they bill you (e.g. at the hospital before you leave, after they mail you a bill, etc.?) Where do you pay and what payments do they accept?
• What is negotiable? In some situations, you can negotiate your total fee, apply for hardship grants/discounts, or get a discount just for paying cash. Don’t assume that just because you got a bill for a certain amount that you need to pay that amount. In many situations, parts of it may be negotiable.

Being able to prepay, pay as you go, or even pay afterwards can put a major stress on your finances. Learn how to set up your finances to cover emergency medical bills in Cash in a Flash: Fluid Finances for Expat Emergencies.

Emergencies

The above questions walk you through differences in “normal” hospital visits. If you have an emergency medical event, though, here are things you’ll want to know in advance:

• How do you call emergency services? Is there an integrated emergency hotline (like the US’ 911) or do you have to contact a specific hospital for an ambulance? Make sure that your kids know this emergency number too.
• How do emergency services find you? Do they gain access to your location when you call an emergency line, or do you have to provide that for them?
• How do ambulances work? Do you have to pay before they’ll take you in the ambulance? Do you have to subscribe to an ambulance service for them to come? Is there an app where you pre-register your information before a medical event happens?
• What about ambulance response times? How long will it take an ambulance to arrive? Do they get right of way in traffic (and is that right of way respected)? Are you better off having someone drive you to the hospital?
• Which hospitals are open 24/7 for emergencies? Some hospitals close and some stay open—and they may even rotate which is which throughout the week. Some hospitals have emergency rooms just for adults and some are just for children. Learn what is available for you.
• How does payment work in an emergency? Will hospitals administer life-saving care before payment is made, or do they require payment before they’ll administer care? The West generally requires hospitals to save lives before payment and has systems to compensate hospitals if patients are unable to pay, but this is far from universal. In some countries, failure to pay is such a gross problem that some hospitals will refuse to administer even life-saving care without payment. You need to know how the system works to make sure your family is safe.

Pregnancy

Pregnancy is a distinct category of medical with lots of questions you should ask. Rather than address it in this article, I’ll point you to Dispelling Birth Assumptions written by an international doula who has experienced how pregnancy is handled differently around the world.

How to learn these things

The above list of questions may feel overwhelming. I can definitely see that and my goal isn’t to overwhelm—but imagine how much more overwhelming it would be to face a medical emergency without knowing the answers to these kinds of questions. An ounce of prevention truly is worth a pound of cure. This is another example of the Paradox of Safety: once you urgently need this information, it’s too late to be prepared with it.

The good news is that many of these questions become relatively easy to answer and, as you begin to understand how the medical system works, you’ll find that you become able to predict answers to many of the other questions.

What I’d suggest is this: as soon as you can, go to a hospital with a local friend and ask them to show you generally how it works. Once you’ve done a “dry run,” you’ll be far more ready for a real medical situation—and ask a local to go with you in that situation too so that they can help you. Or, if your local friend needs to visit the hospital before you do, see if you can accompany that friend (if it’s culturally appropriate to do so) so that you can learn. Once you have a couple visits down, you’ll generally be able to predict the answer to many of the questions above.

If you’re using GPA to learn, then these make for great Phase 3 or Phase 4 topics. Make one of your shared activities (Phase 3) a visit to a hospital or have your nurturer tell you a story about a hospital visit (Phase 4).

This assumes, of course, that you have a local friend who can be your guide. That’s another topic for another day, but yet another reason why you need local friends and not just to live inside an expat bubble.

One other note

This is as good a time as any to remind you that, if you don’t know CPR or First Aid, it’s a really wise thing for you to learn. It’s so important, in fact, that I wrote an entire article about it: Stayin’ Alive Abroad: The Life-Saving Skills Every Expat Needs.

Conclusion

When minutes matter in a medical emergency, assumptions can be deadly. Frank’s story illustrates how not knowing the local hospital system can turn a crisis into chaos. In those critical moments, understanding how to navigate foreign medical care can mean the difference between life and death.

The questions outlined in this article are designed to help you avoid the pitfalls of assumption and equip you with the knowledge you need to survive and thrive. By taking the time now to prepare, practice, and learn, you can protect yourself and your family from unnecessary risks. Don’t let assumptions become your downfall—start preparing today to write your own survival story instead of becoming a cautionary tale.

Thrive and survive with free resources!

Appreciate this article? Subscribe to my newsletter to never miss another post. When you do, I’ll pass along a free chapter of my book and other resources I’ve developed for expats like you.

• Email
• Threads
• Bluesky
• X
• Facebook
• Instagram
• Pinterest
• LinkedIn
• Telegram
• Tumblr
• WordPress
• RSS Feed

Footnotes

1. It’s a true story, but names changed. ↩︎
2. This is quite common where I live. A friend’s grandfather was diagnosed with a fatal disease, but the doctor only told the family, not the patient. Then the doctor, staff, and family then all participated in an immense coverup of the true diagnosis, including producing fictional medical documents so that the grandfather wouldn’t know. Since his heart was bad, they feared the shock of a “fatal” diagnosis would instantly kill him and everyone thought it better that he live his last days without knowing they were his last. That’s truly shocking to Westerners, I know, who feel they have a “right” to this information, but it’s a radically different culture and set of values. ↩︎
3. Where I am, it’s quite common to return to the hospital or a local clinic daily to receive medications via IV. Annoyingly, IV drops are quite slow, which sometimes means you have to spend 2-3 hours in a hospital every day for a week just to get the medicine that otherwise would be in a pill in the US. This reflects differing philosophies of health between the US and my host culture. In the US, we view sickness as external to the body, invading it (germs, virus, pathogens, etc.) and so the goal is to eliminate/kill these external causes of diseases and so we use pills, even though they may have side effects. In my host culture, the idea of health is that the body is “balanced” amongst its different “elements” and so a pill that causes side effects is just exchanging one form of ill health (a disease) for another form of ill health (side effect). Thus, they opt for more targeted and personal health interventions which are more “natural” (like an IV rather than a pill). It’s fascinating, really, and these differing philosophies of health sometimes show up on cultural taxonomies. ↩︎