The hunt for ventilators in West Africa

In February, AIMS received an email request from the insurer regarding a patient in West Africa who was experiencing severe vomiting. The hospital that was mentioned was not part of our network and a different one from within our network was recommended. AIMS requested full case details and an initial Guarantee of Payment (GOP), but there was a lack of response from the insurer.

The incident highlights the necessity for insurers to act promptly on the recommendations provided by medical assistance services like AIMS.

Escalation of the situation

When the insurer finally got back to AIMS, they apologised for the delay and informed us that the patient had been admitted to the hospital, with surgery planned if her condition did not improve. AIMS reiterated that they had no knowledge of the hospital’s suitability and recommended evacuation to Johannesburg, South Africa, or alternatively the UK, emphasising the necessity for urgent stabilisation at a hospital known to us.

Urgent need for evacuation

Communication issues arose as neither the patient nor her companions could be reached. AIMS stressed the need to evacuate the patient; the insurer proposed evacuation to the Canary Islands, but we advised against this due to limited facilities there. An evacuation back to the UK was suggested.

Medical report and further complications

The hospital provided a medical report, as a laparotomy had been done; however, it lacked details on surgical findings and post-operative treatment. Within the first 24 hours post-operatively, the patient complicated with a cardio-respiratory arrest requiring intubation, which is when matters became troubling.

Coordination and intervention

A conference call was arranged between AIMS’ CEO, Bernadette Breton, and the treating doctor. The surgeon was very reassuring – until she made it known that while the patient was indeed intubated, there wasn’t a ventilator! When asked how exactly the patient was being maintained in the absence of a ventilator, the surgeon very confidently told Bernadette not to worry, as she had a row of ventilators: “They are called nurses.” This undoubtedly confirmed the patient’s need for transfer to where a mechanical ventilator was available.

The transfer was complicated as the available ventilators – of which there were two – belonged to a local government hospital four-bed intensive care unit (ICU), with all beds presently occupied by nationals of the West African country concerned. Stress levels were high, with suggestions coming from the insurer’s side of the possibility to involve both the patient’s embassy and the police, and to send an ambulance with a ventilator.

Fortunately, local knowledge of the area was called upon – AIMS got in touch with a local doctor they have known for many years, who then contacted the government hospital to explain the situation. They asked if assistance might be rendered to this elderly patient, and in this instance luck prevailed and space was made available in the ICU, with a ventilator set up for the patient.

Additional extenuating circumstances included opportunistic locals, from staff in the hotel to the first hospital telling family members that blood for the patient’s transfusion was being looked for in the streets of the town – transfer monies and the required antibiotics could be purchased!

In conclusion

This case underscores the critical importance of timely action and adherence to expert local knowledge and medical input. Any delays in response and action by the parties involved can exacerbate the patient’s condition, which should highlight the necessity for overseas insurers to listen closely to the recommendations of medical assistance services like AIMS. Prompt communication and swift action are crucial in ensuring the best possible outcomes for patients in precarious conditions.