A psycho-geriatric repatriation from Canada to Ghana

Our nurse case manager received a call from a worried lady in a small town in Alberta, Canada: “My sister from Ghana has been visiting for the last six months. She is increasingly confused and delusional. A doctor at the local walk-in clinic suspects dementia. She can definitely not travel back home alone.”

We learned that the traveller had no history of recent disruptive behaviour, was usually friendly and correctable, but was highly anxious if triggered. The family highlighted the importance of not making the patient feel that she was being involuntarily repatriated to Ghana, and not to “medicalise” the transfer.

Our medical director reviewed the limited medical documents we had, complemented by the family’s report.

A cognitive impairment was identified, as well as multiple incidents of misunderstood behaviour. Oral anxiolytics were ordered, alongside a light sedative in case of challenging behaviour.

Arranging the repatriation

Accra, with one stop in Europe. The first flight was eastbound and overnight. Anticipated problems were sundowning and delirious behaviour due to sleep disruption, stressors of flight and the change of time zones.

Business class seating was considered for the transfer, as it offered increased privacy and comfort, and fewer triggers from a crowded and busy cabin. However, the downside was expected to be the quick access to the aisle and the flight nurse being outside of direct view in a separate pod – both of which would make it easier for the patient to wander off.

The choice was ultimately made to fly in premium economy class, with the patient in the window seat and the flight nurse at the aisle.

Selecting a flight nurse

Next, a flight nurse was selected for the mission, taking into account factors such as gender, race, age, language and personality, all of which can unintentionally influence the mission in either a positive or a negative way. We found a flight nurse who was experienced with dementia travel. She was soft spoken, patient, nonconfrontational, and respectful and had the ability to cue and redirect without patronising or downplaying the perspective of the patient.

The nurse was instructed to travel in her personal clothes, in soft colours, rather than her medical escort uniform, and she was equipped with an unbranded carry-on instead of our standard medical backpack. She was deployed 48 hours ahead of the departure from Calgary, to ensure that there was plenty of extra time to build rapport as a family friend/travel companion rather then a professional nurse.

The nurse was instructed
to travel in her personal
clothes, in soft colours

The flight nurse’s strategy was to create an enjoyable and personalised travel experience. The family was asked to pack the patient’s favourite snacks, comfort items and a picture book. The patient was encouraged to wear comfortable clothes, and easy-fitting shoes. The family’s vehicle was used for the drive to the airport.

The flight

At the airport, the flight nurse was mindful of avoiding loud noises, crowded spaces, and any discomfort.

Regular washroom breaks were included in the schedule, and a sunflower lanyard was used to discretely alert airport and airline staff of a hidden disability, especially at the high-paced airport security checkpoint. The patient was provided with wheelchair assistance up to the door of the aircraft.

The flight nurse’s strategy
was to create an enjoyable
and personalised travel
experience

Once onboard, the flight nurse was prepared to follow the needs of the patient. A good balance was found between staying restful and keeping busy, with plenty of distraction offered. The flight time was filled with plenty of calm and pleasant interaction. There was some moderate turbulence above the Atlantic Ocean, but the flight nurse learns that the patient travelled a lot in her younger years, and did not appear to be even remotely anxious due to the flight conditions.

After the dinner service the cabin lights were dimmed, and it was only then that the patient’s anxiety kicked in. She was adamant that there was a power outage, and she must alert other passengers and help them evacuate. The flight nurse quickly intervened and was able to tactically avert a panic attack by engaging a flight attendant and reassuring the patient.

The next day the patient arrives safely in Accra, Ghana, as expected.