When I travel overseas doing stuff like kitesurfing & paragliding I carry trip-specific medical evacuation and repatriation insurance. It’s trip-specific and usually costs me $100-$200 per trip, which for me is certainly worth the expense. My experience visiting local clinics in Brazil for minor injuries has been that they were clean and very professional. The insurance comes into play for anything life-threatening. I usually get my travel insurance from Seven Corners.