Posted October 14, 2006

First a brief personal note. In 1996, I contracted "Ciguatera" (which I had never heard of) in the tropics. I won't tell you all the symptoms (you may be having your morning coffee and a bagel), but I lost about 40 lbs in a month. Andy at Baywatch on Orient Beach later told me he saw a guy fall off a stool at a restaurant, overcome by Ciguatera. (Google it). Bottom line, I got better and am fine, but it could have been much worse....

You never know. Should you need to get an air ambulance to be flown to a hospital near home, the cost can easily exceed $30,000. Here is a chronicle of one such nightmare from JMB Website Supporters members Barry and Marcia.

Nightmare Trip: Barry & Marcia

We’ve long strongly recommended that anyone traveling more than about 100 miles from home carry emergency medical evacuation insurance. Texas residents Barry and Marcia visited SXM in July, 2004, and will never forget that trip…. Here is their story, edited slightly for space. We urge you to read it fully and pass it on to friends . . . it could just save a life.

June 28th, Flew in from DFW for 21 days. Marcia and I were staying at a hotel on the beach in SXM.

July 4th, went to party at Baywatch but it rained.

July 5th, Day 7 out of 21, I [Barry] started feeling under the weather.

July 6th, Went to Doctor. X-rays showed extreme case of pneumonia.

July 7th, Was worse and Marcia called the doctor and he came to our room and told us to go to the emergency room. I was put in ICU.

July 8th, Condition worsened.

July 9th, 1:00am I was put on the ventilator and kidneys and liver started shutting down. Marcia started looking for a way to get me home, but getting it approved through our insurance was out of the question on a Friday. I don’t know how she managed it, but $21,000 later an air ambulance out of North Carolina headed to SXM and arrived at 11:00pm. The airfield closes at midnight, so after a wild ambulance ride to the airport, pulled up to plane at 11:35, loaded, and took off. Since I was in a sedated induced coma I knew nothing about it. Marcia had to hold my head to keep it from banging against the side of the ambulance on the ride to the airport.

Early July 10th, Landed at Miami, pilot runs in and checks us all through customs and we proceed to their hanger to refuel.

5:30am arrive at DFW and get in ambulance to hospital. An hour later, doctor tells Marcia I have a 30 to 50% change of living over the next 24 hours but I start improving.

Tuesday July 13th, They do an open lung biopsy to try and determine the diagnosis. I did test positive for Legionnaires Disease. I was possibly infected in the hotel room, either thru AC ventilation or water in hot tub, [or by drinking contaminated water elsewhere –Ed.] ... but I most likely caught it due to my resistance being low from the problems I’d been having since February. The in house lab couldn’t determine what else so they sent the biopsy to the Mayo Clinic and it came back some Interstitial Lung Disease (just a general term that could mean a number of diseases.)

I was in a sedated coma until Saturday July 17th. I woke up in restraints with tubes coming out of my mouth. I was in ICU and it was between visiting hours so I was alone in the room so not knowing what had gone on over the last 10 days I thought I was in some kind of jail. That afternoon they took the tubes out of my side and mouth and moved me to a regular room.

Monday they had me walking around with the help of a walker and dragging an oxygen bottle. They released me Thursday the 22nd with 24 hour oxygen, a strong antibiotic, and a 28 day heavy steroid program. The steroids has induced diabetes (temporally most likely), so now I have to check my blood sugar three times a day and have had to take insulin shots after each test.

I have been doing all my exercises and riding my exercise bike like I’m supposed to so I’m getting stronger every day. I go back to the lung doctor the 31st, and should be able to get off the oxygen at least during the day.

The air ambulance company we used was MedCenter Air. [End of Barry & Marcia story. See next story for much more on this subject.]

Medical Care Away from Home

Tim, whose qualifications you’ll read about in a moment, read of Barry’s experience (see previous story) and has these comments. He says, “Bear in mind that my perspective is that of a traveler (business and pleasure); as an ICU director; and as a trauma surgeon.”

Here is Tim’s advice. We strongly suggest you forward this story to anyone you know who ever ventures more than 100 miles from home:

1. First and foremost, best wishes to Barry and congratulations to Marcia. She did everything exactly right and, from their reports, may well have saved his life.

2. Travel has gotten less expensive and easier in recent years. Travelers have become older and somewhat more adventuresome. The combination is important, because it predicts that a health/illness related event is more probable today than it was in the past. I am overseas four or five times a year on lecture tour or on (SXM!) holiday. I ALWAYS have a travel-related health policy that provides for repatriation (transport back to the USA). For frequent travelers like myself, the best way to do this is with an annual policy that costs a few hundred dollars a year. For the occasional traveler, this can be done as trip-specific insurance. Others have pointed to websites that offer comparisons. For what it's worth, I have used the Travelex policy for years. Parenthetically, they offer delayed luggage insurance and they actually do pay the claims. (This might not be credible for a trip to Club O [the naturist resort –Ed.], but it was when I had to lecture in Philly and my bags ended up in Phoenix...) [Editor's note: our recommendations for Emergency Medical Evacuation protection are at the end of this email.]

3. Travelers owe it to themselves to be familiar with health problems that are endemic at their destinations. This shouldn't put a damper on their holiday, but it can be life-saving. For example, if you travel to SXM [or anywhere in the Caribbean – Ed.] and have never heard the term "ciguatera toxin", take a moment to Google it and read one of the summaries, perhaps on eMedicine. [From Jeff: I was stricken with Ciguatera toxin in SXM after having an absolutely delicious Red Snapper at Seafood Galley restaurant in Philipsburg in 1996. Good info on Ciguatera is at http://vm.cfsan.fda.gov/~mow/chap36.html .]

4. If you have a medical condition and are traveling transoceanic, remember to take a list of your medications and keep it on your person, and take some of your essential medications with you. About every third or fourth transoceanic flight, there is an overhead page "If there is a doctor on board this flight, please ring your call button...". The crew is quick to tell me that they can be in "radio contact with Mayo (or Hopkins, or...)" which is just fine but pretty useless when the aircraft is 3000 km from anything resembling real medical care. The on board supplies that are carried on transoceanic flights are pretty thin.

5. If you do happen to get sick, really sick, while traveling, hope that you have a "Marcia" with you who can act as your advocate. The U. S. embassy, consulate or even military base can help. Here is a perfect reason to get a passport and not horse around with a birth certificate. Those of you who have a US passport, open to the first page and follow along: "The Secretary of State of the United States of America hereby requests all whom it may concern to permit the citizen/national of the United States of America named herein to pass without delay or hindrance AND IN CASE OF NEED TO GIVE ALL LAWFUL AID and protection" (emphasis added). Medical aid is certainly lawful, and citizens have been known to turn up at military bases requesting same. I am not suggesting that as a first choice, but as a last-ditch approach. There is nothing on the birth certificate about all lawful aid, etc. Anyone out there still trying to travel on just a birth certificate? [From Jeff: We have always strongly recommended overseas travel with a passport. Here’s yet another reason to do it.]

6. Some parts of the world have terrific medical care. Others are a lot weaker. If you're traveling and aren't sure, surf. If the medical care is plus/minus and the patient is sick and getting sicker, medical evacuation is key. We use it all the time in the USA to get patients from smaller, less well equipped hospitals to major trauma centers and teaching hospitals. It DOES make a difference as Barry and Marcia found out.

7. Aircraft are packed with people from all four corners of the globe. It doesn't take long to transmit infectious agents worldwide. That shouldn't prevent people from flying. However, if you do get a serious illness, let the airlines that you have been flying on know what has happened. The recent history of the SARS epidemic (Far East to Toronto) is a fitting reminder of how fast contagious illness can move by air.

8. Legionnaire's Disease was unrecognized until 1976 and acquired its name from an outbreak in Philadelphia at a convention of the American Legion. The convention was held in a venerable hotel (I had stayed there as a child) and was seemingly spread as an aerosol through the ventilation system. It continues to crop up periodically in hotels and hospitals especially. Fortunately, it is sensitive to two commonly available classes of drugs: the quinolones (like Ciprofloxicin) and macrolides (like Azithromycin). The latter is available in a blister pack called a Z-Pac. If you're traveling outside routinely available medical care, having a Z-Pac in your travel kit (along with the ibuprofen, the Imodium, the diphenhydramine [Benedryl]) can be reassuring and maybe even lifesaving.

9. If you are going to some really exotic place, make sure you tell your physician well in advance AND check the web for recommended immunizations well in advance. Travel medicine is a lot more specialized than it was even a couple of decades ago, and the best way to get out of trouble is to stay out of trouble.

10. Maybe most importantly, travel with confidence but make a plan ahead of time for what you’re going to do if someone's health unravels. As Barry and Marcia's story illustrates, it can happen in a hurry.

An Immediate Choice for Medical Evacuation

It’s important to be sure that the medical evacuation coverage you obtain takes you home, not simply to the nearest qualified medical center. SkyMed, which we recommend, “takes you home”.

For more information, visit www.skymed.com/jmbsxm . If you are a member of JMB Website Supporters, visit www.jmbcommunications.com/secret , the secret site for members, and use the members’ link to SkyMed for reduced annual rates for members.

Most of you are planning trips over the next few months . . . we recommend you do this now, before the holidays, so it doesn't get lost amid holiday festivities. Again, the links are in the prior paragraph.

--The Everything St. Maarten / St. Martin Team