Being an international GoGirl is pretty spectacular. Unfortunately, one of its major downsides is the question of what to do when you’re injured or sick while on the run. Equally unfortunately, the answer depends on your location, citizenship, immigration status, and financial power. Let me give you a very recent example of what I mean by this.

Today, I woke up with a strange rash on the back of my knee. At first, I thought I’d slept on it funny- you know, it had that pink tone to it that Caucasian skin gets when you’ve been putting pressure on it for a while. But the more I looked at it, the more it occurred to me that it was shaped like an elliptical bull’s eye. And being from New England, my first reaction to that realization was “ZOMG! LYME DISEASE!” While I didn’t seem to have many of the other symptoms of Lyme Disease, or at least any that couldn’t also be explained by my recent transition to full-time employment, I headed off to work with the understanding that I might end up needing medical attention by the end of the day.

Part of the problem, for me, is that I fall into a sort of in-between category for medical care in Germany. As a contractor for the U.S. military, I’m eligible for most of the on-base benefits that soldiers and their families receive…with medical care being the notable exception. My contract does provide me with insurance, which is accepted at many hospitals and clinics off-base, but it doesn’t “kick in” for another month and, well, I still don’t speak German well enough to explain my intricate disease theories to someone who doesn’t speak English well.

Thus began a day of quandry-exploring. My coworkers gave me phone numbers of doctors who, they assured me, could communicate in English without problems and would be more than happy to see me about this rash (which was getting progressively bigger, redder, and more painful). My concerns about health insurance were met with some hesitation- part of the reason the doctors they were referring me to would be excited to have me is that my insurance would be a payment into the German medical system, from which I would take nothing, and thus not having insurance made me less likely to be seen. However, the alternative was an emergency room- ANY emergency room, including the military one- and that seemed time-consuming, expensive, and rather unnecessary. I thanked my co-workers and tried to pretend that the rash was just from the unusually hot weather the Rhineland is getting this week.

By the end of the day, however, it was obvious that the rash wasn’t going away and was in fact worthy of a doctor’s visit. My partner and I decided we would budget for the cost of an emergency room visit and that we’d go to the military hospital, where we’d be guaranteed the ability to communicate with the medical staff. Four hours later, hobbling back home after having been poked and prodded by some unbelievably eccentric military doctors, the diagnosis (acute dermatitis, or in other words, “you have a rash”) called for three medications and an appointment with a military dermatologist tomorrow. My partner had been repeatedly referred to as my husband, even though we’re not married, and the worry had been planted in my mind that tomorrow the dermatologist would take one look at my ID card and turn me away for being outside of military medical coverage. But at least I’d managed to assuage my growing anxiety that this was Lyme Disease or- worse to my arachnophobic self- a spider bite.

Culturally, medical care abroad is always going to be a challenge. But here in Germany, with two potential medical systems at my disposal, it’s doubly so. Military-associated life, I’m rapidly discovering, is as radically different from mainstream cultures in the US as Japanese cultures are. The language, expectations, and systems are completely different. So what appears to be an easy out for an American abroad who can’t navigate German culture is, in fact, a beast unto itself. While other global hospitals might accept a patient into the ER without too much ado, a military hospital requires an ID and registration in their system before you can be seen. Being seen on day one doesn’t guarantee that you’ll be seen on day two, either. And, of course, this all depends on what you’re presenting when you first walk in. If my skin hadn’t grown exponentially worse over the course of the day, I might have been rejected out of hand. This is still a possibility tomorrow.

So if you require medical attention while on the go, bear a few things in mind. Having a passport, insurance card (if you’re covered), and your immigration paperwork (if applicable) can make your life a lot easier. But also remember that many places won’t see you until the situation is life-threatening or equally dire- and if they do, they might not offer you continuing care. Try to have a translation dictionary with you when you go in case the receptionist, nurse, or doctor doesn’t speak the same language(s) you do. And, as I discovered today, having a game in your pocket- Sudoku, a cell phone game, or just a pen and paper- will save you from the most common ER diagnosis of all: boredom.