FAQ - Medical Care

David's been feeling under the weather the last couple of days. A touch of the flu, perhaps? Nothing serious, he's just not feeling 100%. This brings up a very frequently asked question – what do you do about medical care while you're sailing around the world? First, we do not have medical insurance and haven't had since we moved aboard. There are three primary reasons for this, just in case you're interested. First, of course, the cost of monthly insurance premiums even for catastrophic coverage is beyond what we can reasonably afford. Quite honestly, the cost of any medical care we've needed thus far has been significantly less than any insurance policy we could get. Second, Marcie was not insurable until recently (breast cancer in 1997). And third, US health insurance policies do not usually cover health care issues out of country. That said, how do we handle routine healthcare and emergencies?

Routine healthcare is easy. We have routine physicals every few years. We maintain all of our own health records, lab reports and physician reports. Marcie has had mammograms in several different countries and we have all the x-rays (now digital) aboard to prove it. Dental appointments (every six months) are part of our routine and our budget. Eye exams happen every two years or whenever we feel the need for new glasses (or lose a pair overboard!). We've had colonoscopies in Cape Town, mammos in Chile and skin checks in Venezuela. Prevention and early detection are part of our insurance program.

We do belong to DAN (Divers Alert Network) which provides for emergency transport to the nearest medical facility as needed including air ambulance as long as you're more than 50 miles (80km) away from home. Accidents or illness do not need to be diving related. The membership is minimal and friends who have had medical emergencies found DAN's assistance and benefits to be excellent.

Health care is a comparative bargain in many places. Most countries we visited in South America, for instance, offered excellent private healthcare if you ferreted out the right facility and the right physician. David had major surgery and hospitalization in Chile. Marcie had an MRI, cortisone shots and PT in Ecuador for a back problem. All costs were a small fraction of what the same care would have cost in the USA...or Australia for that matter.

So what do we do aboard? We carry a good medical kit which we try to update regularly. Most local physicians will write us prescriptions for what we need once they know our situation and, in fact, will make suggestions of new products available or drugs that make sense to add because of the area in which we're traveling. In Colombia, for instance, the local physician suggested yellow fever shots. In Vanuatu, we were both given malaria kits for testing and treatment in case we needed them. We've both taken CPR classes that admittedly could be refreshed. Seven Seas Cruising Association (SSCA) to which we belong offered several “medicine at sea” classes which we took during one of their gams. They probably offer them as part of their virtual Seven Seas University, now, which would allow you to take them from anywhere in the world.

We carry two books aboard that we use as references: Merck's Manual of Medical Information. Merck's is a good overall guide to symptoms and potential diseases/medical issues although after looking up “rash”, we usually come away thinking we have an obscure, incurable disease. The Onboard Medical Handbook is a practical approach to common and some uncommon problems and how to handle them. Everything from emergency dentistry to dermatology to jellyfish stings to yeast infections is covered and it also provides a good list of what to include in an on-board medical kit.

Staying healthy is a good part of medical care. Trying to eat properly, exercise and stay fit is key in maintaining our health. Sometimes easier said than done, but being aware is the first step. Being prudent is another key element to staying healthy. Regular check-ups and reasonable follow-up when something doesn't seem right make sense when medical care is more than just a phone call away.

In our nearly 13 years aboard, we have not had any major emergencies to handle other than David's surgery and Marcie's back problem. We were close enough to shore for both of these to get medical help in a reasonable period of time. Other bruises, cuts and infections have been handled aboard with advice from fellow cruising physicians when necessary and the contents of our on-board medical kit.

If you have questions that you'd like to have answered about living on a sailboat or traveling from place to place, leave a comment or send an email? Thanks to David V. for suggesting this post topic.

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FAQ: what does it cost to live aboard Nine of Cups?

 

So, what does it cost us to live aboard Nine of Cups? This is a very frequently asked question. Some people assume that living aboard a “yacht” automatically assumes a high cost of living. Others have no idea and are just curious. Some are interested because they're dreaming of sailing off into the sunset one day. In actuality, once you own the boat, you can live aboard quite inexpensively or it can cost a mint. If you're in charge, you get to make the decisions.

Before we answer the question, some discussion is necessary. We keep track of every penny we spend. While I (David) am admittedly a bit sloppy when it comes to leaving papers, parts and clothes lying around, I am quite compulsive about other things like boat maintenance, repairs and tracking our expenses. Marcie is quite compulsive about keeping things neat and tidy below. So while Marcie tactfully and patiently stacks all my daily debris on the Nav station or in the laundry each evening, I am busy entering each day's expenses. Thus it fell to me to write today's blog. The budget we use is an average over the last few years, and I am quite confident it is reasonably accurate.

I have broken the budget into four basic categories. The first is basic expenses. This covers all the usual day to day expenses like food, clothing, liquor and laundry costs. This varies a bit depending on what part of the world we are in, but is a pretty accurate average of our basic expenses. One of the line items in the basic expenses category is the cost of health care, and we will probably do a blog soon that is devoted to this subject. We do not have health insurance. The amount we budget is the approximate average amount we have spent over the past several years. We've found that health care in many areas of the world is quite good and costs far less than in the U.S. Stay tuned for this blog in the next few weeks.

The second category is for the expenses related to operating, maintaining and repairing the boat, such as fuel and marina costs as well as routine maintenance and repairs. The operating expenses are almost all directly related to boat size. For example, Cups is 45 feet long and she takes twice as much bottom paint at $200/gallon for us to do our annual antifouling as it would for a 35 foot boat. Likewise, repair and replacement parts cost more for bigger boats. Bigger boats also have more stuff aboard, and therefore, more stuff to break. So if you are contemplating a smaller or a larger boat, your operating expenses will likely be considerably different depending upon your decision. There are a lot of other variables in this category as well. How much time you spend in marinas, how much motoring you do, how many of the repairs you do yourself versus having someone do them, etc. all have a big effect on how much you spend.

The next category of the budget is local expenses – the money we spend when we are in port and seeing the local sights or traveling inland. A good portion of yesterday's blog was devoted to this topic. One further observation, however, is that we tend to spend far less than the usual tourist. If you have flown to some exotic place for a ten day vacation or have stopped in a port for the day as part of a cruise ship itinerary, you are apt to spend a lot of money seeing everything there is to see in the short time you are there. You may have saved all year for the trip (or will spend the next year paying it off), and are probably not as cost conscious as you would be if it were your lifestyle and have days or weeks to explore a place.

The final budget category is called accruals. This category allows us to budget for major expenses that occur every once in a while, like replacing an engine or the sails, or flying home every 18 to 24 months. I think this is an area that is overlooked or glossed over in many cruising budgets. If your plan is to outfit your boat and head out for a two or three year Pacific cruise, then it is probably justified to omit this section. All the big repairs can probably be put off until you return and won't actually be an expense while you are cruising. If you are planning to go cruising indefinitely, then you really should expect to have some major repairs and refits. Likewise, if you plan to fly home to visit family, it ought to be part of your budget.

So to get back to the original question, what does it cost us to live aboard Nine of Cups and maintain our lifestyle? We will happily provide you with a copy of our monthly and annual budget on request, but the answer to the question is just over $34,000 per year.

We've read many articles written by cruising folks and talked to lots of other cruisers, and I'm not always convinced that everyone really accounts for everything they spend. That opinion aside, I think our budget is probably pretty close to the mean. We know several cruisers who do just fine on a much smaller budget, and just as many that spend a great deal more.

While we try to be frugal, we also feel we can carry the frugality too far sometimes. Though we work hard not to waste anything, by the same token, we want to enjoy our life aboard. Our reason for sailing around the world is to experience new cultures and new places. It's definitely cheaper to stay aboard and not spend any money ashore, but it kind of defeats our purpose of sailing around the world if we never get ashore to experience anything. It all comes down to evaluating what's important to us … and to you if you're considering this type of life … as to what will be spent where and how much.

If you like the opera or dancing or scuba diving, that's where your entertainment budget will lie. If you prefer living in a marina all the time or enjoy gourmet food and eating out, you'll spend your money there. It's all about choices...little ones and big ones. “Shall we eat out tonight?” is a small choice. If eating out every night, however, means you have to get a job or stop cruising, is eating out regularly worth it? There are no right or wrong answers. It comes down to individual preferences and those preferences will determine your cost of living aboard. We hate when people lecture at us or tell us there's only one way to do things. Having lived aboard for the past 13 years, we're sharing what's important to us.

If you are interested in getting a copy of our annual budget, send an email and we will happily send it along.

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