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Emergency in the Solomons

Oct 1, 2014

Voyager’s medical crisis demonstrates need for international health assistance

Carina on a mooring at Roderick Bay, Nggela Sule Island in the Solomon Islands.

Carina on a mooring at Roderick Bay, Nggela Sule Island in the Solomon Islands.

Carina swung on a mooring in Roderick Bay off Nggela Sule Island in the Florida Group of the Solomon Islands. This bay, in the shadow of Susupu Hill on Sandfly Passage, is isolated; no ferries, roads or even cell phone signals reach it. We had come for a clan cultural festival and lingered, enjoying its ambience after all other yachts had departed. We were alone and content amongst the resident Ruka clan.

John Ruka, along with his nephew Willy, was busy underwater scrubbing marine growth off Carina’s hull. They had insisted on helping me because they wanted to sail with us to Honiara to sell their produce and they knew also that I had experienced chest pain while snorkeling only a week earlier. I watched and fidgeted for a while but decided I could not stay idle as they worked; I would be damned if I was going to let someone else do this difficult task for me while I sat on my butt in the cockpit.

I considered the chest pain symptoms I had experienced to be serious enough that I planned to return to the U.S. “soon” to have a complete cardiovascular checkup. In the meantime, I decided to carry on as usual since I felt sure my symptoms were mild and my heart strong; serious attacks happen to other people and I was fit.

I pushed off the ladder backwards and fell away from Carina and was enveloped by the warm turquoise sea. When I turned forward to clear my mask and snorkel, I saw a school of small, neon-blue angelfish scatter away from my noisy entrance. The coral reef 20 feet below Carina’s keel was shot through with myriad colors: red, blue, green and yellow — though I paid little attention to its beauty.

Voyagers Leslie and Philip pose for a picture with their friends the Ruka Clan of Roderick Bay.

I began by testing myself, free diving on the hull and soon determined that my ability to stay submerged for long periods seemed as before. I was encouraged and took up my scraper and began to work. After only about five minutes, I suddenly began to lose energy, started to get dizzy and a seeping discomfort spread across my chest, shoulders and left arm. I decided to let go of my macho pride and get out of the water as quickly as possible. Even with my wife Leslie’s help, negotiating the boarding ladder and getting over the lifelines was a battle I was not sure I would win. I made my way to the cockpit and sat down waiting for the pain to subside.

But the pain didn’t subside; it actually got much more intense.

Leslie insisted I take aspirin immediately since this would help to alleviate the pain and the effects of a potential cardiovascular blockage. She also demanded I lay down on the settee where she could monitor me as she dealt with the worried Solomon Islanders. John and Willy had also gotten out of the water by this time and they expressed concern for my health. Seeing that we were solely preoccupied, they offered any assistance they might be able to give and climbed into their dugout canoe and paddled off to their village.

I tried to find a position that would mitigate the discomfort but no matter which way I sat up or laid down, nothing seemed to help. Leslie pulled out one of our medical texts, and we read the classic symptoms of a heart attack: a crushing chest pain along with pain in the left arm and shoulders, sweating, dizziness, lethargy and a “sense of impending doom.” I seemed to be a textbook example of the symptoms.

As the evening progressed, the pain stabilized a bit and I was able to finally fall asleep, though my rest was disturbed with strange and vivid dreams where scenes and the sense of time were out of sync and disjointed. In the morning, the pain had almost completely subsided but I still felt weak and dizzy.

Steps toward care
We began to assess our situation and what steps we needed to take to get medical care. I had picked a particularly poor place to have a heart attack, if it was indeed a heart attack. We were moored 29 nautical miles across windswept Iron Bottom Bay from the capital Honiara on Guadalcanal Island. We doubted, however, that Honiara, even though it is the capital of the Solomons, would have appropriate care and suspected its quality would be sub-par. Still, it was our only option and we felt that if I could see a doctor, get some medication and stabilize my condition, I could then make plans for a trip to my home in the U.S. for first world medical care.

Chief John Ruka still planned to accompany us to Honiara, but he also offered to watch over Leslie and Carina after I left for the US. Leslie would stay with Carina and if I were delayed, she and John would take Carina back to Roderick Bay where the family would watch her. Honiara is a dirty and dangerous town and I needed to make sure Leslie would be safe while I was away since I had no idea how long I would be gone. John matter-of-factly assured me not to worry; he would kill anyone who tried to harm her. This was not an idle boast; police protection is notably poor in the Solomons and the islanders assume responsibility for the protection of their clan. Their perspective on living (and dying) is vastly different than those of us who live in the developed world.

Philip and Leslie were  anchored at Nggela Sule Island where no medical help was available. Philip had to get to the Solomon Island capital of Honiara.

A few days after my attack, Leslie, John, John’s nephew George and I made our way across Iron Bottom Sound, dropped our anchor in Honiara’s tiny bay and then turned Carina around and med-moored stern-to against Honiara’s rip rap. I was not much help during the crossing as I still had little expendable energy.

Seeking a clinic
The next day, Leslie and I pulled our dinghy ashore on the beach behind the Point Cruz Yacht Club and, on the advice of the yacht club vice commodore, sought an appointment at a private clinic out of town. Getting off the bus onto the dusty roadside, we walked back and forth looking for a building that looked like a clinic. Finally directed to a shabby looking house down a muddy driveway, we entered a small dark office. The doctor examined me and suggested I get an electrocardiogram (ECG) at the public hospital and then to return it to him so he could see the results. He seemed competent enough but was certainly no cardiologist.

We rode to the hospital in one of the dirty, dented and high-mileage taxi vans that swarm across Honiara, Arriving at the hospital, we strode though the emergency room doors into bedlam. Moaning patients and screaming children were lying on gurneys, shelves and even the floor. There was no receiving station as we expected; just harried nurses and the occasional doctor going about the very slow business of treating patients. The floors, walls and windows inside the hospital were streaked with ageless grime.

We finally got the attention of a nurse who asked us some questions and told us to wait in an examining room. After an hour, we were surprised to be visited by two young medical students from the U.K. This was their second day on the job as temporary help and they looked a little bewildered and shell-shocked. But we were buoyed by their chin-up attitude, confidence and their unflagging good humor even though they looked like they just graduated from secondary school.

They explained they would perform an ECG just as soon as the one-and-only ECG in the Solomon Islands was located in the hospital. After another long wait, a nurse finally wheeled a rusty three-tiered tray into the room. On the top tier sat the ancient ECG; the bottom tier held empty plastic electrode gel bottles rolling on their sides and the second shelf had a used hypodermic needle with its business end pointed outward. Not an impressive sight.

A Solomon Islands house and dock on Nggela Sule Island.

The two med students finally returned. One of them said, “Right-oh; we’ll just get rid of that,” when he saw the used syringe. They quickly set up the ECG, swabbed my chest with electrode gel and attached the machine’s suction cups to my chest. I was frankly surprised when the machine spit out a paper report, as I was not expecting it to work. The young doctors-to-be stood shoulder-to-shoulder while they looked at the report and concluded the results showed there may be a “bit of an anomaly.” By this time it was late in the day and we decided to return to the clinic first thing in the morning and show the doctor there the ECG.

In short, the ECG proved ambiguous; there appeared to be an anomaly in the graph, but at the same time, results were determined to be inconclusive. “Could I safely travel back to the U.S. for treatment?” I asked the doctor. “Yes, I don’t see a problem with that,” was his reply.

Fate takes a hand
Here fate stepped in. A good friend, Ed, a cruiser temporarily living back in Seattle, began scouting around for cardiologists and generously offered to pick me up and run me around town. That piece in place, Leslie began trying to make airline reservations but met with limited success. The few flights leaving each week for Nadi, Fiji were booked far in advance, making a connection we had booked to the U.S. impossible.

At this juncture we decided to call Divers Alert Network (DAN) and ask their TravelAssist department for help. We had been members for nine years. TravelAssist is a member benefit that applies to medical emergencies while traveling away from home. TravelAssist will help to evacuate DAN members to appropriate care.

We explained to DAN what had happened and asked the TravelAssist desk to help us book a flight from Honiara to Nadi to meet my reservation from Nadi to Los Angeles with a connection to Seattle. The next day, the TravelAssist desk called back with the flight arrangements. A few hours later I received a call on our local cell phone from a medical advisor for DAN. The woman asked some questions about the episode and then strongly suggested I allow DAN to make arrangements to evacuate me for medical treatment in Australia, the closest cardiac care center.

She explained that the first 14 days after a heart attack – and she was pretty convinced that was what I experienced – were critical and I would be prone to another, possibly fatal, attack during that time. Furthermore, flying at 35,000 feet in an environment of reduced oxygen, could prompt such an attack and on a commercial aircraft there would be no medical care.

Philip on a stretcher aboard the air ambulance jet. 

I was taken aback by her call and told her I needed to contemplate what she was saying and then make a decision. After I broke the connection and explained the situation to Leslie, she insisted I should not take a chance but should agree to the evacuation. I knew she was right and agreed but felt a little uneasy about all the fuss. I called the medical advisor back and asked DAN to make the arrangements. It was now 1400 on a Saturday and she asked me if I wanted the evacuation to occur that afternoon! I assured her I would be okay for one more day and asked her to schedule the evacuation for the next day.

My head was swimming. There seemed so much to do to get ready. In actuality, all I needed was to pack a small bag and get myself to the airport the next afternoon. Leslie went online and arranged for an Electronic Travel Authority (ETA) visa into Australia for me — a simple and instantaneous process.

The next day was a Sunday and it was hot and steamy. Buses are rare on Sunday and taxis almost non-existent, so we planned on a long wait in front of the Point Cruz Yacht Club before getting transit to the international airport east of the city. While waiting, we were surprised when Maurice Tinoni, John Ruka’s nephew living in Guadalcanal, ambled up next to us. It seems Maurice had been sent to ensure our expeditious passage to the airport. Our adopted Solomon Island clan continued to watch out for our well-being!

Everything seemed wilted and droopy when we arrived at the airport filled with outbound passengers. Soon we were alone in the cavernous building. Airport personnel were monitoring the arrival of the air ambulance. Eventually, a small Lear jet swooped down from the sky, landed and taxied to the terminal. Four people in flight suits with sewn-on patches saying CareFlight — two men and two women — jumped out and strode into the terminal building. The two women, Sue and Lane, doctor and nurse respectively, immediately began examining me in the terminal lobby to determine my condition and what preparations they needed to take for my embarkation. The two men, pilot and co-pilot, both named Arthur, left us to make arrangements for an imminent departure. I was overwhelmed by all the fuss and the fact that DAN had booked a private jet ambulance to fly all the way from Australia to the Solomons and back, just for me.

Specially-equipped jet
The doctor explained that the Lear jet was specially equipped to monitor and treat my condition and could fly swiftly at low altitude to avert a crisis in the event my blood oxygen levels became low. After I was settled into my seat with monitors producing data on my condition, Leslie was allowed aboard for a hasty goodbye. She stood on the tarmac as the small jet taxied away and watched as we rocketed skyward for the approximate three hour flight to Australia and the Cairns Base Hospital. As soon as we landed, a representative of Immigration stamped me into the country and I was transferred to a waiting ambulance. All this attention seemed extraordinarily cautious to me. Aside from a little dizziness and lack of energy, I felt pretty normal at this point.

The hospital’s emergency staff was efficient and thorough but, before doing much in the way of examination, advised me I would be responsible for the cost of medical care in Australia as I had no medical insurance there. I was asked to sign a form acknowledging that fact.

At some point in the evening, I mentioned to a nurse that I would like to stabilize my condition so I could travel back home to the U.S. to get medical care there. She looked at me, grabbed my ankles and exclaimed, “You look so fit! But we have done tests; you have had a heart attack and you are NOT going anywhere!”

The CareFlight jet at Honiara airport. The jet flew Philip to Cairns base hospital in Australia.

I spent a week at the Cairns Base hospital where I received exceptional medical care. During that time, I was subjected to a treadmill stress test (which I failed miserably) as well as an angiogram, which showed I had plaque blocking one of the arteries feeding my heart. The doctors suggested an angioplasty with an insertion of a stent in the offending artery. After a few days of waiting, I had the surgery and I immediately felt much healthier.

A day later, the cardiologist who visited told me I would be soon discharged. He started to explain what I would need to tell my “primary medical provider” as soon as I got back home. I interrupted him gently and explained that I had no such provider where I was going; I would return to my wife and our sailboat and continue our sailing trip as if this whole event had never happened. The doctor was a bit taken aback but then laughed and wished me well.

After an Immigration snafu, I was back aboard Carina 11 days from my departure from the Solomons, feeling quite healthy and very fortunate. Without the good advice of the professionals at Divers Alert Network, their evacuation assistance and the superb care received at Cairns Base Hospital, I would have likely gotten on a commercial flight to the U.S. and I might not be here now to write this. A recent medical crisis experienced by a yacht crew, also in the Solomon Islands, resulted in an estimated cost for a similar evacuation by air ambulance, of $40,000 USD.

Much of the allure of navigating across oceans in a private yacht is the opportunity to visit places few others have seen. The more remote locations are, in fact, the most intriguing. Based upon my experience, I encourage everyone who takes to blue water to ensure they have evacuation benefits should the unexpected happen when you and your yacht are far, far removed from modern medical care. Your life may depend on it.

Philip DiNuovo and Leslie Linkkila live and voyage aboard their Mason 33 Carina. You can follow their adventures at www.sv-carina.org.

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