A medical evacuation story – and why you should never travel without medical evacuation insurance

“I’m so alone,” I sobbed into the phone. “I’m so totally alone. I’ve never been this alone before.” Tears streamed down my cheeks and my shoulders heaved as I tried telling my mother, thousands of miles away, what was going on. I was alone. More alone than I ever thought possible.

I tried telling myself I wasn’t alone in Tel Aviv, Israel. My husband, after all, was a mere three blocks away in the hospital. But really, that didn’t help at all. In fact, that was the problem. My husband was in the hospital and was in serious danger of dying and I was terrified. The good news was that we WERE in Tel Aviv.

ethiopian tukulIt had all started on a beautiful Sunday afternoon in Addis Ababa, Ethiopia where we had lived for the previous nine months while teaching at the international school there. For our summer vacation, we had planned a grand bike tour through Kenya and Tanzania and would be leaving in three weeks. That morning John and I set out for a good training ride.

It was a perfect day with bright blue skies and perfect cycling temperatures. Our bikes were stored at a friend’s house sixty miles away so we took a bus out there and started cycling back. The only problem was that we forgot our water bottles at home – that becomes important in a bit.

Ethiopian countrysideWe pedaled a few miles before I was thirsty. I stopped at the next village to get a bottle of water and sat outside the store to drink it. John sat next to me, twiddling his thumbs in impatience.

A few miles later, I stopped again. The high mountain air surrounding Addis was dry and I always drank a lot. “This is crazy,” John said. “We’re leaving for a tour in a couple weeks and I want to get in a good training ride. Would you mind if I just took off and you can take as long as you want? I want to ride hard today.”

I had no problem making my way back home alone, so I kissed him goodbye and he took off. Hours later I straggled into our house to find John collapsed onto the couch.

“Come feel my pulse, Nancy,” he mumbled as soon as I walked in. “It’s going crazy and I’m terribly winded. I can’t hardly even walk over to the bathroom with gasping for air.”

I felt his pulse expecting the typical bah-DUM bah-DUM bah-DUM of the heartbeat. But this time, rather than that expected beat, it was more like bah bah DUM bah DUM DUM bah. I couldn’t detect any pattern at all. It was beating, but not like one would expect.

In retrospect, we realize we should have raced him off to the hospital immediately, but we had no idea what was happening. We had never heard of an irregular heartbeat and figured we just didn’t know anything. He was obviously still breathing and living so all would be well. Or so we thought.

Ethiopian girl with babyThe next day John went to work. As the computer teacher at our school, he frequently had to haul computers around to various places. Normally, that wasn’t a problem, but this time he could barely do it. He had to set the computers down every few feet in order to rest and catch his breath.

On Wednesday he went to see a doctor. “Your heart is in arrhythmia,” the doctor said. “That means it’s not beating regularly. It probably happened as a result of dehydration on your bike ride which led to an electrolyte imbalance, but we’ll never know for sure. Take these potassium pills, eat plenty of bananas, and go get an EKG.”

John took the potassium pills and ate bananas, but he didn’t go get the EKG.

Until the following Monday. His heart had now been beating irregularly for nine days.

As he stood in line at the clinic waiting for his turn, he collapsed. The friend he was with rushed him to the clinic in a taxi and called me at school. I left my classroom and raced to the clinic.

I’ll never forget Nurse Sarah’s face. She calmly reached out to take John’s pulse, then calmly excused herself. A few moments later she returned and said, “The doctor will be here shortly.” Sarah told me later she had never felt a pulse that erratic in her many years of nursing and it took every ounce of professionalism she had to maintain a calm exterior.

The doctor arrived, felt John’s pulse, then turned to me and said, “You need to get him to the hospital now. I’ll call ahead and they’ll be ready to admit him into the ICU.”

I was starting to get a tiny inkling of just how serious this was.

John remained in ICU in Ethiopia while the doctors gave him a few medicines to convert his heart. By Wednesday, Day 11, they started talking about needing a medical evacuation to get him out of the country. The Ethiopian doctors knew precisely what needed to be done – they needed to shock him to convert his heartbeat – but they weren’t prepared to put in a pacemaker in case the shock stopped his heart rather than converting it. “If he was Ethiopian with no chance of leaving the country, we would take the risk. But since he has evacuation insurance and can leave, it’s better that he go elsewhere.”

Wednesday night I called our medical evacuation insurance company and told them we may need to arrange an evacuation. There was a Lufthansa flight to Germany Thursday evening, so we made plans to fly out then. I went to bed that night totally expecting to fly to Europe the next day.

A few hours before the flight, however, the Lufthansa doctor came to the hospital. He took one glance at John’s chart and said, “There is no way he can fly Lufthansa; he’s got a heart condition.”

Our hopes came crashing down around our feet in that split second.

I picked up the phone in the hospital room and called our insurance company. Tears streamed down my face as I sobbed hysterically into the phone. “They won’t let him fly out,” I hiccupped. “There’s no way to get out of Ethiopia.”

I have tremendous respect for people who can work in such a situation and I will always be grateful for the woman on the other end of the phone that day. I was wallowing in my own self-pity, terrified beyond imagination, and crying uncontrollably.

“We suspected he would be turned down for commercial flights as they don’t typically like heart patients on their planes. The trouble is that if he’s been turned down by one airline, he’ll most likely be turned down by them all. We’ve been working on getting an air ambulance in case this happened.”

Saturday morning – Day 14 – the insurance company called to tell me we would be flying to Tel Aviv that afternoon. “The plane will be there around noon,” they told me. “We’ll keep you updated.”

I packed a bag with a few items for me and John and headed off to the hospital to wait for our flight.

Around noon I got a call. “I just want to let you know we’re doing everything we can to get your husband out,” the Israeli ambassador said. “We’ll let you know when it’s time.”

That’s nice, I thought. I guess that’s standard procedure when someone is being evacuated out.

Fifteen minutes later I got a call from the American ambassador. “I just want to let you know we’re doing everything we can to process this evacuation. We’ll let you know what happens.”

I was a bit puzzled, but figured this was all standard. We had never been evacuated out before and had no basis for comparison.

One hour passed and we heard nothing. Two hours; still nothing. Three hours. Four. We didn’t worry. It was, as far as we were concerned, just a typical medical evacuation.

Five hours after first hearing from the American ambassador, he called again. “I think we’ve got it straightened out. I’ll come personally to escort you to the hospital.”

Another two hours passed before the ambassador walked into our hospital room. We got John into a wheelchair and took him out to the waiting car. At the airport the ambassador instructed us to wait in the car while he dealt with things.

John was, by this time, very weak. He couldn’t sit up for long; walking even a few feet was very difficult. He laid down in the back seat of the car and rested his head on my lap. We waited.

And waited.

air ambulance

An air ambulance is specially equipped to deal with many medical situations on board

More than an hour later, the ambassador returned to the car and told us everything was set. We got John into the wheelchair and headed into the airport. The departures area in the Addis airport is upstairs. The ambassador had arranged for us to pass through the arrivals area downstairs.

As we waited for the plane on the tarmac, the ambassador turned to us and said, “You never would have gotten out of this country if the embassy hadn’t gotten involved.”

We had no clue what he meant. I’m glad I was still ignorant.

The plane arrived, they got John on board, the doctor hooked him up to an IV, and we took off for Tel Aviv where, after a grand total of 22 days in arrhythmia, doctors were able to convert his heart.

The Behind-the-Scenes Story of John’s Evacuation

The behind the scenes story of what happened came out once we arrived safely in Tel Aviv – and I was ever so grateful we had a professional team behind us who knew what they were doing. I’m also grateful that they never, ever, let on just how difficult his evacuation was.

So what was that behind the scenes story? Get ready – it’s crazy.

I spent hours talking with Karen, the woman at the hospital who arranged the evacuation. She had been doing this job for many years and had never, ever, run into a situation like ours. She sat on the edge of her chair for hours, hoping and praying she could pull it off. I can’t thank her enough for her tenacity. Any lesser of a person would have given up.

She first got the call from our insurance company in the wee hours of the morning Saturday morning. She assembled the team – a doctor, nurse, pilot, co-pilot, and navigator and got them ready on the plane. By six in the morning, the plane was ready for takeoff for the 7.5-hour flight to Addis.

But then came the call from Egypt. “You can’t fly over the Sinai peninsula. It’s Egyptian airspace and you can’t fly over it.”

Karen launched into problem-solving mode, called the Egyptian prime minister to plead our case. “There’s a very ill man in Ethiopia and we need to get a plane down there.”

It took three hours to secure the permission, but the plane finally took off at nine in the morning.

Three hours later, Karen got a call from Ethiopia. “Don’t send the plane,” they said. “It can’t land here in Addis.”

Apparently the issue was fear – fear of who this American man was that Israel wanted so badly that they were willing to send a plane all the way down for him. Was he a spy? What was he doing in Ethiopia? Why did Israel want him?

“At that point I had to make a decision,” Karen told me. “I could call the plane back right then or let it go knowing I had three hours to work this out. I decided to let it go.”

Karen immediately called the Israeli embassy in Addis Ababa to get them involved, then moved on to the American embassy. At one point they had a conference call going with the Israeli ambassador, the American ambassador, the president of Ethiopia, the prime minister of Israel, and the hospital. All just to get my husband out of Ethiopia for medical care.

It was only through high-level diplomatic negotiations that the plane was able to land. It was held up for five hours on the tarmac before being allowed to leave. But in the end, it did leave and John got the medical care he needed.

I write all this for two reasons: to get it down (finally) for my own memories and to encourage you to always have evacuation insurance when you travel.

We like to think nothing will happen to us, but if my husband – a fit, strong, healthy person – can have this fluke of a situation, then you can too.

The air ambulance alone came at a cost of $90,000. That’s not including the cost of his treatment. Do you really want to have to pay that?

But I think the strongest reason for having medical evacuation insurance is simply to have the team behind you. I was thankful I had people trained in medical emergencies working on making arrangements. They had the contacts and know-how to pull this off whereas I would have been clueless. They were professional, they did their job, and they did it well.

According to all accounts, John’s evacuation was one of the most difficult ever, yet they did it. All I had to do was sit back and trust them.

Don’t you want that team working for you if you need it?

books by Nancy Sathre-Vogel

About Nancy Sathre-Vogel

After 21 years as a classroom teacher, Nancy Sathre-Vogel finally woke up and realized that life was too short to spend it all with other people's kids. She and her husband quit their jobs and, together with their twin sons, climbed aboard bicycles to see the world. They enjoyed four years cycling as a family - three of them riding from Alaska to Argentina and one exploring the USA and Mexico. Now they are back in Idaho, putting down roots, enjoying life at home, and living a different type of adventure. It's a fairly sure bet that you'll find her either writing on her computer or creating fantastical pieces with the beads she's collected all over the world.

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20 Responses to A medical evacuation story – and why you should never travel without medical evacuation insurance

  1. Wilma Hatcher March 22, 2012 at 7:33 pm #

    Nancy,

    My heart started racing as I read this and what a case for evacuation insurance. The story “behind the scenes” is one for the books. I empathize with you because my son was experiencing arrhythmias about three years ago. He had a cauterization which showed his vessels were fine, no blockage. He was between the cauterization and further testing when he experienced an arrhythmia so severe that we could see his heart beating through his tee shirt. Thankfully, his wife was able to rush him to the ER in their city while I stayed with their six children. After receiving a defibrillator and a final diagnosis a year and three months later, he is now free of the arrhythmias.

    I know how frightened we were that night and I can’t imagine your fear and apprehension. We had none of the problems in getting him to treatment. We are both very fortunate that we have both John and my son here with us today. Still love to read your blog!

    [Reply]

    Nancy Reply:

    @Wilma Hatcher, Thanks Wilma! It is quite the story, eh? I am so very glad I didn’t realize how serious it all was until after the fact – I think that would have pushed me over the edge. As it turned out, John was able to get to israel and get the care he needed. Whew!

    So glad it all worked out well for your son!

    [Reply]

  2. anand teke March 23, 2012 at 9:51 pm #

    The story seriously is something for a book. Hats off to the professionalism of all the people involved. thanks a lot for sharing.

    [Reply]

    Nancy Reply:

    @anand teke, This story definitely could be a book in and of itself. It’s a pretty amazing story.

    [Reply]

  3. Heidi March 24, 2012 at 3:47 am #

    It’s so great to hear how well the international insurance worked. That’s much more than just paying the bills…

    [Reply]

    Nancy Reply:

    @Heidi, For sure! They were amazing.

    [Reply]

  4. Jillian April 3, 2012 at 2:53 pm #

    My heard was racing reading your story. My husband too became sick in Ethiopia, but nothing like your story. Fortunately he recovered enough by the time we were back in Addis Abba (we were in Harar when he fell ill) that we did not have to seek local hospital care or be evacuated. It was scary enough though that I thought we would have to use it- and I was ever so grateful to have evacuation insurance at that moment.

    Thanks for sharing your story!

    [Reply]

    Nancy Reply:

    @Jillian, It’s scary for sure! If you need medical help, you want to get it. I’m so glad we had that insurance.

    [Reply]

  5. Francisco Carmona April 12, 2012 at 5:32 pm #

    Great article and truly a warning to any international traveler. I would like to point out that although many health insurance companies will pay “customary and reasonable” hospital costs abroad, very few will pay for your medical evacuation back to the home country. U.S. citizen can find more information about this issue in http://travel.state.gov/travel/tips/brochures/brochures_1215.html

    [Reply]

    Nancy Reply:

    @Francisco Carmona, After our insurance company paid nearly $100K to get John to Israel, they refused to fly him back to Ethiopia after he was “fixed”. At that point, it was no longer a “life or death situation” so they wouldn’t pay. We fought with them for 1.5 years and they finally paid after we wrote a letter to the president of the company.

    [Reply]

  6. Wftristan April 13, 2012 at 4:55 am #

    Hi – Amazing story – very moving indeed.

    Tristan

    [Reply]

  7. Tom @ Waegook Tom August 26, 2012 at 6:46 am #

    This story is INSANE! I had no idea of all the things involved in pulling off a medical evacuation – the conference call…I mean oh my god…that’s crazy. Of course I’m glad it all got sorted out in the end and that everything worked out OK.

    [Reply]

  8. Debra Speakes August 26, 2012 at 9:30 am #

    WOW! I guess I’ll read the fine print in my medical travel policy the next time I go to Europe.

    [Reply]

  9. Kelly Dunning August 26, 2012 at 10:18 am #

    Wow, what an intense and terrifying story. I am so glad that John is OK!

    [Reply]

  10. Laurel- Capturing la Vita April 1, 2013 at 11:16 pm #

    What an incredible story, Nancy. Thank you so much for sharing it with us. An ounce of prevention…

    You are a true inspiration.

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Laurel- Capturing la Vita, It is an incredible story! I am so glad I knew nothing while it was happening.

    [Reply]

  11. Bethaney - Flashpacker Family June 27, 2013 at 5:04 pm #

    Whoah Nancy! That is one crazy story!!!!!!!

    “Att one point they had a conference call going with the Israeli ambassador, the American ambassador, the president of Ethiopia, the prime minister of Israel, and the hospital. All just to get my husband out of Ethiopia for medical care.”

    That must have been SOME phone call!!!!!!!!!!!!!

    [Reply]

    Nancy Sathre-Vogel Reply:

    @Bethaney – Flashpacker Family, Can you imagine? I never, ever, would have been able to pull that off. They have connections. I do not.

    [Reply]

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