Chris Bowers found himself in a dirty ward in Paris, suffering from diarrhoea. He explains how others can avoid a similar experience
It was the hospital from hell, and I was in it with serious diarrhoea. There was no loo paper in the casualty department ("use paper towels," the staff told me), the bins looked as if they should have been emptied days ago, and there was brown dirt all over the walls, floors and ledges.

The doctor came to see me. He told me I had an intestinal infection, which I could probably have worked out for myself. I asked him what I could eat. He said I should avoid vegetables, eggs and anything too acidic. Ninety minutes later, lunch arrived - omelette with vegetables, accompanied by a tomato and vinaigrette salad. "Oh, it's a standard meal," the member of staff explained, as if this made it all right.

I received a visit from an octogenarian who seemed to think I was her son. I pressed my call button, expecting to be rescued. Nothing happened. Fortunately, the wind changed and she wandered out. She came back later. This time, the call button did elicit a response: a white-coated man arriving just in time to stop her accosting me.

I wanted a shower and asked for a towel. "We don't have towels here, this is a hospital," I was told. I asked how I should dry myself after a shower. The nurse offered me three paper towels. When I suggested this was insufficient, she offered me a sheet from the bed linen supply. At least she was trying.

I could go on, but no doubt the general drift is clear. And where is this hospital of horrors? Some seedy Third World country? An unfashionable corner of the eastern Mediterranean? No, this was a state hospitalon the western outskirts of Paris. It was a rude way to be disabused of my sub-conscious assumption that standards of medical care are all much of a muchness within the member states of the European Union.

Maybe I was just unlucky; maybe this is how the NHS appears to foreigners needing treatment in this country. But is there any way travellers can avoid such an unpleasant, not to say frightening experience?

All travel insurance policies have a 24-hour helpline (which take reverse- charge calls), and it really is important to phone at the first opportunity. Obviously, if you are scraped off the tarmac and wake up in a ward, you have no chance to contact the helpline before going into hospital, but if you are ill, notify the helpline staff before you do much more than see a doctor as they will probably have local agents who can advise about the best hospitals. In my case, I was on medication for a day and a half before a concerned friend said: "I'm worried about you; I'm taking you to the nearest hospital now." A quick phone call to my helpline might have landed me in a better hospital - no guarantee, of course, but the chances of avoiding the hospital from hell would have been greater.

Helpline services are supposed to have enough bi-ligual and tri-lingual staff to cover the languages spoken in the most popular destinations. This means they can chat to the doctor treating you to discuss when you are fit enough to travel home, and they can if necessary get you to a different hospital (assuming the hospital you are already in considers you fit enough to travel, which it might not if it thinks you want to go to a "rival" hospital). My helpline, once I did make contact, felt like a friend fighting my cause, and it probably got me out of Paris a couple of days more quickly than the hospital intended.

Would a standard travel insurance, such as I had, cover care in a private hospital if of better quality?Most insurers are, understandably, vague about this. "We cover what's necessary," said a spokesperson for Bishopsgate, the Southampton-based underwriters of Lunn Poly's travel insurance, "and if a private hospital is the only place someone can get treatment, we will pay for it, though we won't pay extras like single-room supplements." Chase Parkinson of Weybridge, who administer Austravel's policy, say much the same: "As there is a state medical care system in Australia equivalent to the British NHS and as UK residents are entitled to Australian Medicare treatment, we would expect them to avail themselves of the state service."

But what happens if your partner or a friend takes you to hospital out of concern, and that happens to be a private hospital in a city where state hospitals are available? The insurers I spoke to said they would pay the costs of private treatment, assuming that the decision to go to a private hospital was made in good faith.

The only way to guarantee private health care would appear to be to take out travel insurance through a private health insurer in this country. Bupa's basic British policies will allow you private care in foreign hospitals in the case of "sudden illness or injury", but Bupa also urge clients to take out their own travel insurance. A spokeswoman said: "Our travel policy allows you the 'best treatment available', which can be private, but it might not be appropriate to be in a private hospital if the necessary facilities for your treatment are better in a state hospital." Bupa tend to be around 20-25 per cent more expensive than standard travel policies - the annual premium for a single person covered world-wide is pounds 99.

Finally, if you have standard travel insurance, make sure you still have an E111, the form which allows you certain parts of your treatment free "on the NHS" in EU member states. Many travel policies will cover you for pounds 1m or more of medical expenses, but excluding anything you can get free with your E111, so keep your E111 with your insurance papers.Like all insurance, travel insurance covers you for some things and not others. The problem is that most people buy their insurance and then forget about it, assuming everything is taken care of. Indeed, everything is taken care of - except, of course, the things that are excluded, so it is worth reading the small print from time to time.

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