Ransom notes and sponge baths – tales from a South American hospital
Until last month, I had not spent a night in hospital (other than when I was born!) for my entire 39 and three-quarter years. I have regularly travelled overseas since I was 21 and have always had travel insurance, but I’ve never used it for more than a lost bag or damaged piece of equipment – even then, I think I’ve maybe submitted two claims in all those years. It feels like tempting fate to type this, but I’m not really someone who has been plagued with bad luck. I generally land on my feet (terrible pun) and life has been kind to me. But here’s the thing, sometimes, life throws you a curve ball with no warning whatsoever! And so, I ended up in hospital in South America for two weeks after breaking my ankle hiking in Patagonia (you can read about what happened here).
My first hospital was in Puerto Natales, a town of 20,000 people and the gateway to the Torres Del Paine National Park in Patagonia where my accident happened. It is 3,100 kilometres from Chile’s capital, Santiago. It’s remote, very remote. I arrived at the Puerto Natales hospital around midnight after eight hours of being carried down the mountain and a two hour ambulance journey from the Park on largely unsealed roads. I was exhausted, in pain and pretty scared, but very relieved to have arrived. They took my blood pressure, pulse and put a port in my arm to hook me up to an IV for pain relief. This is when I first learned the word “dolore” which is Spanish for pain. After some preliminary care from the nurses and an x-ray, the doctor on duty arrived. He spoke a little English and informed me I had fractured my ankle, it was definitely going to require surgery and I would need to go to the hospital in Punta Arenas to see the traumatologist. He couldn’t do anything for me as he was not a bone doctor. The second thing he asked about was insurance. He tried to be gentle, but it was very clear I needed to sort that out and quickly. And so at 2am I was lying on a table getting more x-rays and lodging my claim with QBE’s emergency line, with the reception nearly cutting out every time they shut the door for another x-ray.
Because my insurance was via my NAB credit card, I needed to supply QBE (the underwriter) with various documents to prove my eligibility and allow them to determine if they would accept liability. There was no wi-fi in the hospital. Cate and I did our best to gather some information on a computer in the emergency room and then on her phone once we were moved to a room before it became clear that wasn’t going to work. I needed access to bank statements to show proof of transport related travel costs prior to departure to trigger eligibility for the policy that weren’t available via the phone app – I needed a desktop computer. As much as I didn’t want to panic anyone, I needed help, so I bit the bullet and called my sister and a close girlfriend. I sent them the email from QBE and a list of my banking and email passwords and asked them to pull the required info together. It was about 3.30am Chile time and early evening in Australia. I needed sleep if I was going to function the following day so, I left them to it and got a couple of hours sleep, waking at 6am to find they had been busy talking to QBE and getting things together – they were both so wonderful. Another couple of hours of work on my side of the world and theirs and we had enough for me to be comfortable that I would be covered. Of course, you can never be certain of these things until liability is officially accepted which took about 24 hours, but I was confident I had met all the requirements which reduced the feeling of dread to a dull ache!
My logical, organised, ex-lawyer brain knew I had double checked the insurance requirements for my credit card before I left the country. But my sleep deprived, traumatised, seriously medicated brain was not quite convinced until I could see it all in black and white. My learning from all of that?
Find out what your insurance company will need in the event of an emergency and keep a separate file in your email with all of those documents so you don’t need to be scrambling for them if you are stuck in a hospital on the other side of the world with no internet! Send that file to a trusted person at home also, just in case. It will save a lot of angst.
Anyone who has spent time in the health system will know that things are very uncertain. Even in Australia where we have some of the best care in the world, you are never sure when you are going to see a doctor or how long you might have to wait for something. I was initially told I would be having surgery in Punta Arenas the following day. Punta Arenas is a city of about 125,000 people, 3 hours south from Puerto Natales. It is on the edge of the world, next stop Antarctica. Cate caught the bus there around midday as she wouldn’t be able to come in the ambulance. I was supposed to be transferred at around 11am…then 2pm…then 3pm. At 4pm, two patient transfer people came into the room, had a conversation with the nurses I couldn’t understand and then at 5pm a nurse came back in to tell me (via a Google Translate screen on her phone) that the ambulance had to leave because there was someone more urgent than me. By that stage, it was about 28 hours since I had broken my ankle and nobody had looked at it beyond taking x-rays. It still had the splint on it that a guide on the mountain has provided and had just been loosely re-bandaged by the x-ray techs. I knew now it would be at least another 24 hours until I saw the traumatologist. After an initial overwhelmed breakdown, I eventually got Google Translate out and told a nurse I needed to see a doctor. The doctor on duty came in soon after and he spoke English well. He apologised about the transfer and explained of the 6 ambulances they had, only 3 were working – money is a problem. I explained my concerns about timeframes and he made the decision to put an open cast on to stabilise the bones until I could get to the traumatologist. I still have no idea if the cast was really required or if the doctor was just trying to make me feel better about the situation. It’s pretty hard to have a nuanced conversation about your concerns and options with someone who speaks basic English or via a translation app. Those first few days were laced with fear because of that uncertainty and lack of a plan. I had no idea how bad things were or what was going to happen for about 2 and a half days after the accident…that is a long time to sit with uncertainty in any circumstance, but the language barrier made it especially challenging.
The next day was long. Cate was in Punta Arenas and I was just in limbo, waiting for a transfer. It was still early days for the insurance side of things and QBE had not sent through the paperwork the hospital needed for payment. After several discussions with the finance team in the hospital in halting English, I eventually had to hand over my credit card. They only charged me for one night as I was supposed to have been transferred the previous day. I handed over $1400 after QBE reassured me they would reimburse the expense as part of my claim.
I was transferred to Punta Arenas around 4pm the following day, arriving at 7pm. Cate arrived not long after and it was fantastic to see her face after a difficult 24 hours. And then my surgeon, Stefan arrived. He had this wonderful manner that immediately made me feel safe and like I was in the right place. He was competence and kindness and certainty in human form (and just a tiny bit dreamy!). This is the first time I found out what had actually happened to my ankle. I had fractured both my tibia and fibia and dislocated the ankle joint. There was also a wound where the bone had pressed from the inside to try and get out – I was very lucky it wasn’t a compound fracture as that would have changed everything on the mountain. He showed me x-rays and explained where the breaks were and that I would need two surgeries. One to put an external fixation on to allow the swelling to reduce, before he would be able to operate to then repair the broken bones and put everything back where it should be. He hoped to operate the next day to place the fixation.
It’s difficult to underestimate the relief I felt after seeing Stefan. Yes, it was pretty bad, but it had been 2 and a half days since the break and we finally had a plan and a doctor that we felt comfortable and confident with. The relief was brutally short-lived. About five minutes after Stefan left, a woman from the finance department came into the room with an EFTPOS machine in her hand. She spoke no English at all, but Cate explained in basic Spanish that I was covered by insurance and she left. Shortly afterwards, someone brought a phone into me and a man on the other end who spoke great English explained there were issues with my insurance and I had two options. I could either guarantee payment with my own credit card or they would need to transfer me to the public hospital. They had not received a letter of guarantee from QBE and they had some bills outstanding from another patient covered by QBE. A combination of panic and lawyer Kim kicked in and poor Richard (who I met many times over the subsequent two weeks and was lovely and just doing his job) copped a pretty unhappy patient. As did the QBE person unlucky enough to answer the phone when I called and said I was about to be kicked out on the street because they hadn’t sent the guarantee through or paid their previous bills and their whole job was to look after me at this point of the game. Whilst I was on this call, the finance lady returned with her EFTPOS machine and a note that she had written in green pen saying “You must pay 2,500,000 or we cannot hopsitalise you”.
There was no way I was leaving that hospital. We finally had some comfort and certainty in Stefan and there was no way in hell I was leaving. So, after QBE assured me they would get in touch with Richard and sort it out, I ran the worst case scenario of extending my mortgage through my head, decided it was worth it, handed over my credit card to the ransom note lady and crossed my fingers it would all work out. Richard refunded the money 24 hours later once he had sorted out things with QBE. Talk about a rollercoaster of emotions.
I was in Clinica Magallenas for just under two weeks. The clinic is a private one and is the main hospital used by the various bases in Antarctica which means it is quite well funded. Over the course of the time I was there, there were three evacuations of people with various broken bones after falls on ships crossing the Drake passage. It was like there was a little international community in the hospital and we all knew about each other. No serious patient confidentiality was breached, but we knew when Jenny the Australian was going in for surgery with her multiple fractures and how she went, when the Brazillian guy flew home for his final surgery on his ankle and when the poor young man from the Falklands arrived having broken two arms in a fall. There was something quite comforting about being part of this little group of people who had badly injured themselves on big adventures. And of course, there is always someone worse off than you and that perspective is important.
The hospital employed a wonderful man named John who is English but has lived in Chile for a very long time indeed. His job is basically to help out the international patients with translations and arrangements for families and whatever else you might need. John came to see me twice a day. He would pop in, have a chat, check how I was doing and what I might need. He is an honorary British consul and received an OBE from Prince Charles in Santiago for his works. Between Stefan coming in to see me every day and John twice a day, even with the language challenges, we never felt completely out of the loop. John had us moved to a bigger room after a night in a smaller room which made things much more comfortable for Cate. He helped on the finance side of things and made sure Cate was ok for accommodation. He helped explain my drug regime when I was discharged for the flight home. He was the person I talked to when QBE was keen to bring me home in between surgeries and I was worried about it and needed to talk it through with someone who had seen many people in this position. It was so great for Cate and I to be able to speak to someone other than each other in fluent English. John provided enormous comfort through his presence and normality. He was our angel.
Most of the nurses did not speak any English and my Spanish is pretty much non-existent beyond ordering a beer which I didn’t utilise much in the two weeks I was in hospital! This was challenging in a lot of ways, especially for someone who likes to be in control, but it was also probably quite helpful in terms of putting yourself in a headspace of just taking it one day, one step at a time. Most of the time I had no idea what was happening around me, what drugs I was on, what was ok for me to do or not do. Google Translate was very useful at times, but it could only take you so far. There were times when I thought I was capable of doing something (usually related to me going to the toilet on my own!) and I would ask a nurse and they would say no. You can’t then have a reasoned discussion about it or try and explain why you think you’ll be ok. The language barrier stops you there, at the first question and answer. I had to pick my battles and when we really wanted to push a point we would speak to John! I’m sure our first, very exciting outing to the café with Cate pushing me in a wheelchair wouldn’t have happened without his help to convince the nurses!
When your world consists of four walls and a big adventure is getting a coffee at the café or sitting in the arm chair instead of the bed, you really cling onto what you can understand. I thought I had the routine of the observations down. The nurses would come in, take my blood pressure and pulse and ask me how the pain was. “Dolore?” and I would respond with a number rating, “Dos or Cuatro or Seis”. In the mornings, they would say “Poo poo? Wee wee?” For the first week I thought they were asking if I needed to go to the toilet right then, but were actually asking if I had been to the toilet over the previous 24 hours. I said no every time. I have no idea how I managed to avoid a catheter! It’s amazing how your world shrinks to life’s most basic functions and needs in a hospital. If you’ve ever had to experience the humiliation of a bed pan or sponge bath, I can only empathise. I don’t know if it’s better or worse when you have absolutely no clue of what’s about to happen. And just when you think you understand the routine, it changes. I was very pleased when I was able to eventually take care of those basic needs on my own!
Eventually, three days after my second surgery, Stefan cleared me to fly home. I think those next 24 hours were the slowest of the whole time. We were so ready to get out of there and get home. A 33 hour journey was ahead for me, with three flights and a four hour car ride at the end of it to be admitted to Warrnambool hospital. We escaped the hospital in the dead of night, a car collecting us at 3.30am for a 6am flight to Santiago. It was a strange, almost anti-climactic moment, to leave that place with almost nobody around in the quiet of the night. I was really anxious about the journey ahead, I had existed in the security of that small hospital for nearly two weeks and I was leaving it to fly to the other side of the world. Cate stayed in the hospital room with me, but neither of us slept much that night. The trip home was long. Stage by stage, we made our way home. Cate and I said a very quick, perfunctory goodbye at Melbourne airport. We were both focused on getting to our final destinations, her to her brother in Melbourne and me to the hospital in Warrnambool. It was not the time for long thank yous and tearful farewells. Arriving in emergency at South West Health Care was surreal. The QBE driver dropped me at the door at 2.30am and I was home, well nearly. I spent three nights in Warrnambool to keep an eye on some pretty angry post-surgery wounds. The first morning was a busy one for the nurses there. The very kind woman looking after me kept apologising that she was doing other things. Although I told her, I’m not sure she really understood how relieved I was to be able to have a full conversation about what was happening and what the plan was for the day. People kept coming into my room to explain things to me, the food routine, the isolation procedures because I had come from a foreign hospital, the drug regime. I had my first shower in two weeks, I washed my hair and I did most of that on my own because I could explain that I was ok in a way that allowed the nurse to believe me. Funnily enough, it was the ease of those three days in hospital in Warrnambool that really brought home how hard it is to be in hospital overseas where you don’t speak the language. And in many ways, I was very lucky because I had John and Stefan spoke some English and I had Cate by my side. This experience won’t stop me travelling and it also won’t stop me solo travelling, but it certainly would have been a lot tougher without Cate there.
I’ve just been cleared to start to put some weight on my ankle and start physio. There’s still some way to go until I hit the hiking trail again, but I am determined to do so. And will make sure I have comprehensive travel insurance when I do!
