Right now travel health care providers need to be reassessing how they will operate should they be faced with similar situations in the future.
Barbara Johnston was a victim of a flawed system. And those of us who believed that Cuba had a progressive health care system have become very disillusioned.
For those not aware of the story, here it is as taken and edited from the Winnipeg Free Press, and as they responded to the story in the Brandon Sun as reported by Colin Corneau.
“In one month, the Johnstons endured enough heartbreak to last a family a lifetime.
In the early hours of Dec. 29, Oak Lake’s Barbara Johnston, 54, died at the Brandon Regional Health Centre. While the exact cause of the fiercely proud mother’s death isn’t known, her last month was one fraught with frustration, anguish and stress.
On Nov. 20, Barbara and her husband John, like they had done so many times before, packed up their bags and flew to Cuba for a weeklong vacation.
Then Barbara got sick.
“It was a 36-day nightmare after that,” John recounted while sitting at the kitchen table with his sons Derek, 28, and Ryan, 25.
What started as vomiting soon turned dire at a resort. Then, in the middle of the night, John went to the front desk to request an ambulance or doctor be sent to the resort.
That night, Barbara was transferred to a small clinic on the Cayo Santa Maria island, where she was treated for septic shock. In the morning, when the clinic’s day staff arrived, John said the doctor made the decision she needed to be transferred to a mainland hospital in Santa Clara.
Hospital’s ER ‘scary as hell’
“It was shock when I got there with what the hospital was like,” John said. “The ER is scary as hell. When you’re on the island and the resorts are beautiful and what you see is all really nice, but you get into Santa Clara and it was a real shock.”
There was no running water, no antiseptic and no blankets, according to John. The hospital was open to the environment, the beds were stained and staff wore their street clothes in the intensive care unit.
The following day, Derek and his younger brother Riley, 22, flew to Cuba to be by their mother’s side.
Riley, a paramedic in Manitoba, took over from his father at the hospital.
“It’s hard enough to have a sick loved one and then to know they aren’t being treated properly. And knowing if you got her out of Cuba she would have gotten better care.”
The doctors relied on antiquated practices, according to Riley.
“The hospital doesn’t supply food,” he said. “When she was doing better they wanted to feed her, but they didn’t have feeding agent, so they wanted us to bring orange juice to pour down her feeding tube.”
Airline, consulate little help
Getting just hours of sleep a day, the family took turns being at Barbara’s side. However, a quirky rule at the hospital meant they could only change out during a 30-minute window at 7 a.m. or 7 p.m.
If they left the room for any reason, staff wouldn’t allow them back in. The rule meant they had about a 10-minute window to see each other each day and catch up on what was happening.
On Nov. 29, four days after the initial signs of illness, John and Derek decided to make a run back to the resort to pack up their things. They also needed to get John’s insulin after he packed just the bare necessities during the initial transfer.
It’s around this time the family really started to feel like they were on an island, literally and figuratively.
Air Canada representatives were ill-prepared to deal with them when they arrived back at the resort.
A call to the Canadian consulate fell on deaf ears. “(The consulate said) they don’t have time to run around and help every sick person in Cuba,” Derek said. “Meanwhile, she’s in the ICU on the edge of death.”
Difficulty leaving Cuba
The consulate seemed more concerned about ensuring the family’s insurance money was going to come through, he added.
Because Barbara was initially transferred to the mainland on a Friday, there was a delay from the insurance company until after the weekend, according to John.
On Tuesday, Dec. 1, Barbara was moved out of the three-bed ICU and into a private room. John suspects that’s when the insurance company finally green-lighted funds to the hospital.
At the same time, Barbara had stabilized. And through a series of phone calls, family and friends had found a company that would life-flight her out of Cuba.
The plan was to fly out that morning. But Cuban doctors spiked that plan, suggesting she wasn’t stable enough to fly. While the family contemplated flying her out of Cuba regardless, John was informed that their insurance wouldn’t be valid if he went against doctors’ orders.
That meant if Barbara was airlifted and had to be grounded anywhere due to complications that any bills would be paid out of pocket. That could amount to hundreds of thousands of dollars, depending on where they landed.
It was at that point that Riley, who had been communicating with doctors and nurses back in Brandon, called the insurance company and sternly explained that the Cuban doctors were never going to make the decision to let her leave.
“I don’t think the doctors there realized that the life flight crew had better equipment than they had in the hospital,” Derek said.
Finally on Thursday, after arguing with doctors and insurance agents, the decision was made to transport Barbara.
But not before more complications and stress.
“They got her to the door and then they stick this piece of paper in my face and it says we’re moving her against their will,” John said.
Again, concerned the family’s insurance will be void, John called Riley and Derek, who left for the airport to fly home just hours before.
After being reassured, John relented and signed the forms. Finally, Barbara was transferred to the airport, where John was forced to go through customs, which took another 25 minutes.
Cause of illness unknown
Derek and Riley were finally put at ease when they heard the life flight plane roar off the tarmac.
Over the next three weeks, doctors ran tests, but never found out what initially made Barbara sick.
With the family by her side on Christmas morning, her doctor delivered more bad news. Barbara wasn’t expected to live more than 48 hours.
The news kicked off another chain of events as the family had read about how difficult the process of repatriation could be.
They also wanted her home.
“We wanted her to die around her family,” Derek said. “So family would have a chance to say goodbye.”
‘She hung on to wait for him’
On Dec. 28, three days after being told she only had 48 hours to live, Barbara and John touched down safely at the Brandon airport at 9:30 a.m. Once again, it was the family who organized the flight while the insurance company fumbled around, according to John.
Waiting at the Brandon airport was Judy Podobni, an ambulance attendant from Oak Lake who knew Barbara and worked tirelessly to get her home.
The entire family was in Brandon awaiting Barb’s arrival, except Riley, who stayed behind with his father, who travelled back on the life flight.
Riley flew home that same day, travelling by air from Florida to Winnipeg via Toronto, then by vehicle from Winnipeg to Brandon.
Arriving in Winnipeg at 10 p.m., Riley rushed out of the city getting to the Brandon hospital shortly before midnight.
An hour later, Barbara died.
“She hung on to wait for him to get back,” Derek said.
While the family may never know what killed Barbara, they hope by sharing their story it might help another family avoid a similar fate.
“There’s a million Canadians down there that have no idea what’s going to happen to them if they get sick,” John said. “Be prepared when you go down there. Have an emergency plan and make sure you’re aware of the dangers.”
This Story Raises Loads of Questions with Few good answers at this stage.
Is the Cuban health care system that bad throughout the island?
Should the insurance company have listened to the doctors or the family?
Should the pressure of being on your own financially be the way insurance companies hold back good decisions?
Do we have to worry about what happens when we get sick in other countries?
There are no easy answers.
Firstly I think it is important to have insurance from a company who specialize in travel policies as a significant portion of their business. The big players have contacts and experience with hospitals and doctors around the world.
It is important that the insurance company be called even before a person is taken to the hospital, unless of course it is an accident that requires urgent attention.
We may need to do more homework on the places we will visit, especially to those 3rd world countries where health care may not compare to our standards.
While it does not appear to be a case in this circumstance, pre-existing conditions have put people into poverty because they did not answer the questions completely. Example…a change in medicine is a change even if it is a positive one.
Know that the insurance company can get information from your doctor, getting even the notes of a conversation that may express concerns
Prepare and action plan for sickness just in case.
Bother your insurance company by calling them directly to ask questions, even though you may have purchased the insurance through a secondary source.
If you are concerned begin a publicity campaign earlier rather than later.
But even at that we are sometimes the victim of a series of terrible circumstances, people, and service. We just hope we have done enough pre-planning to prevent this kind of event from occurring ever again.