Martin de Alteriis, The Traveling Cartoonist:
"Segovian Medicine"

At a certain point, you have to admit defeat, and prepare for the worst.

I reached just such a point one January, in Segovia, Spain, when it became clear that my stomach ailments required medical attention, and I would have to find a Spanish doctor.

Segovia, it must be said, is a divine city --even when one is reeling from one public toilet to another. It’s a medieval hill town that doesn’t appear much changed since the days when Isabel la Cattolica was crowned Queen of Castile in front of its fine Cathedral. Isabel, as some Americans know, sponsored Columbus’ voyages of discovery.

But instead of marveling over the gothic towers and baroque facades, I spent my time calculating the shortest distances to the nearest public toilets. In the great hall of the Alcazar, the wondrous Royal castle, I gazed at the throne and hoped that the “servicios” (rest rooms) were open. At the top of the castle’s windswept tower, with half the province under my purview, I wondered if I could make it down 140 steep steps, and into the servicios before my stomach exploded.

By that point, I had long since stopped worrying about the quality of Spanish toilets. In Toledo, the day before, I made use of a restaurant servicio from which my predecessor, a rugged Italian, had fled in horror.

“Why won’t you see a doctor?” my girlfriend Kimberly pleaded. “I saw one in France last year and he was great.” “Think of the difficulties,” I wailed: “The wait, the language barrier, the cost….. “

So while Kimberly devoured plates of fried shrimp, calamari, local paella, seafood salads and the like, I starved myself, sitting gloomily in restaurants and tapas bars, sipping mineral water and chomping plain bread. For two days. To no avail. My stomach might have been empty, but it was still erupting at irregular intervals.

I went to a pharmacy, summoned the pharmacist, and held up my capsules of Immodium AD. Did she have anything “mas fuerte” (stronger)? For “La diarrea”? “Yes,” I grimaced. No, she replied, what I had was as “mas fuerte” as it got. “Non funciona,” I bleated, believing I’d said that the Immodium AD wasn’t working. The pharmacist looked horrified and recommended I see a “Medico” (doctor).

The concierge at our hotel told me to go a nearby public health clinic. There were no other doctors to be found. There was a shortage in at that time, he said with a shrug.

With great trepidation, through the pelting rain, we followed his directions to the clinic. I wanted to turn back but Kimberly wouldn’t let me. “This is ruining our holiday,” she cried.

The clinic was in a large, early twentieth century building. There was a life-sized creche in the entrance hall that contained about a dozen large statues. By a podium, we saw two people, both wearing white coats, and neither seeming terribly busy.

In halting Spanish I tried to explain my condition. “Room number three,” the guy behind the podium instructed. The other fellow, a man of about 50 with a slightly grizzled look and alcohol on his breath, ushered me towards room number three, where he sat me down, and began to take down my particulars. He got my name and age before problems arose.

“You’re not a citizen of the EU,” he declared. “No.” I affirmed. This appeared to be a problem because the clinic’s services were free – and it was impossible to pay, the grizzled fellow seemed to say. Citizens of other EU nations were covered by reciprocal agreements, he added. “I am disposed to pay,” I babbled in my absurd Spanish, wondering if I should offer him a bribe. “No problem,” he leered.

The usher lectured me on the beauty of Segovia, and how it was much more lovely than Madrid, Toledo, or anyplace else in the world. It seemed advisable to agree. He gave me his opinion on President Clinton, laughing and gesticulating crudely. I nodded. Finally, he told me we were waiting for the doctors, who were busy with a patient. “It’s funny,” the guy said. “You’re only the second patient to show up today but you arrived just after the first and he’s probably going to need a lot of time.”

At that point, a third patient appeared, a Spaniard, who needed to get a prescription filled. The usher was forced to attend to him. At that moment, fortunately enough, the doctors appeared and beckoned me in.

They were young, amiable, and delighted by the opportunity to practice their English, which was rather rudimentary, but certainly better than my Spanish. Very quickly, they examined me and reached a diagnosis. “Gastroenterititis,” they decided. Did I know what that was?

‘Si,” I groaned. “You must not eat anything for 24 hours.” they instructed me. “But you can drink as much of the solution we prescribe as you want. And we’ll give you something for the pain. After 24 hours, you can eat the following foods: plain boiled rice, boiled fish, tortilla espanol (a potato omelet) and lean, boiled ham. No milk or cheese, they instructed. “And whatever you do, don’t drink the local water.”

Ah ha.

Then they gave me the medicines they had prescribed. No need to go to the pharmacist. No need to pay. And they wished me well for the remainder of my vacation.

I left the hospital reflecting how I’d had a much better experience than any poor sick Spaniard would have here in the United States…..

And in two days, I was better.

Sidebar: Public health care for travelers in Europe: While public health clinics attached to public hospitals are standard in Spain, and common in many other western European nations, these clinics are not obliged to treat American tourists without charge. I was lucky. Most will not turn sick travelers away, but all can charge for the treatment they provide. Therefore, travel insurance is always recommended, even though you might still have to pay for the treatment when you receive it and claim reimbursement after you return to the United States. (Consequently, always ask for a receipt if you are charged by a foreign health care provided.)

If you don’t have insurance – or even if you do, public health clinics are a reasonable alternative to requesting that your hotel send a doctor to your room. Standards of treatment are usually high – and it is always possible that you will not be charged simply because the clinics are not used to charging patients, and may well want to avoid the hassle and paperwork involved.

Oh yes, avoid rare steaks, seafood tapas that have been sitting in stands for interminable periods of time, and be wary, very wary, of tap water.

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