Crossing borders

Who could have imagined that a trip to the Salar de Uyuni, one of Bolivia’s most breathtaking destinations, would culminate in a successful international medical logistics operation? According to Dr Andrea Rodríguez, Case Management Supervisor at Logimedex, managing medical logistics and clinical care in international emergencies involves navigating a complex network of stakeholders and resources.

This case study illustrates the journey of a middle-aged male patient who sustained a traumatic injury while visiting the stunning Salar de Uyuni. After a series of unfortunate events, he was eventually transferred to Mexico for definitive surgical treatment, with support from two separate insurers and assistance companies.

Case description

In mid-August, we were tasked with coordinating the repatriation of a middle-aged male patient to Mexico. During an excursion at the Salar de Uyuni, he suffered a fall that led to severe pain in his right pelvic area. Although he received local medical care and was transferred to a medical facility, the ambulance transporting him was involved in a vehicular accident, resulting in additional injuries.

Upon arrival at the medical center in Oruro, the patient was assessed by internal medicine and orthopaedic specialists, who confirmed diagnoses of right lower extremity trauma, ankle fracture, and tibial plateau fracture. Despite the initial assessment, the patient decided to be transferred to Mexico for comprehensive treatment.

Medical transport planning

Planning the transfer involved identifying commercial flights that could meet the patient’s needs. At the client’s request, we arranged for a medical escort from our team to accompany the patient from La Paz, Bolivia, to Querétaro, Mexico, where he would be treated at a high-specialty hospital.

Logistical coordination required constant communication with local medical and ambulance providers in Bolivia, as well as with the medical team in Mexico. Securing a reliable ambulance provider for the journey from Oruro to La Paz was a primary challenge. Additionally, we encountered connectivity issues between Bolivia and Mexico and experienced delays in confirming travel dates due to local coordination problems. Despite these obstacles, we successfully transported the patient by ground ambulance from Oruro to La Paz, where he was admitted to a secondary medical facility and met our medical escort.

International transfer

The medical escort evaluated the patient in La Paz and, based on instructions from treating physicians, confirmed that the patient was fit to fly commercially with the necessary accommodations (WCHC, leg extension, three additional seats in Class T, and medical escort support). During the flight, the patient was continuously monitored. Just before landing in Mexico City, he experienced a pain episode, which was managed efficiently.

Upon landing, an ambulance was already awaiting to transport the patient to a high-specialty hospital in Querétaro. There, a multidisciplinary team was prepared to receive him and initiate treatment.

Surgical intervention

and outcomes During the transfer, we were approached by another of our clients to organise the admission and treatment upon the patient’s arrival in Queretaro’s hospital. Coordination with an orthopedic specialist was established, who reviewed the medical notes and was ready for the required procedures. The patient underwent an open reduction and internal fixation of the tibial plateau, an open reduction and internal fixation of the right ankle, and a knee arthroscopy. The surgeries proceeded without complications, and the patient was discharged two days post-surgery to continue his recovery at home. Conclusion This case highlights the importance of being prepared for unexpected events and the necessity of impeccable logistical coordination through detailed planning and effective communication between all the involved parties. It underscores the need to exceed standard coordination efforts to ensure patient safety and wellbeing during each phase of an international transfer. The collaboration between healthcare units in Bolivia and Mexico, coupled with the timely intervention of the medical escort, facilitated the patient’s successful recovery.

The next time we find ourselves in a remote location, let’s remember the value of having a team of experts by our side.