“He shouldn’t be alive…” 
A complex medical case in Arequipa, Peru

By Lisa Fryar

Every day is different in emergency assistance; each case brings with it a new problem to solve. This was exactly the case when we received a call from an emotional wife who was travelling with her husband who had been hospitalised with an unknown, yet critical diagnosis. This case would turn into our longest and most-expensive case to date.

WE Assist are the in-house emergency assistance team at World Nomads Group. We receive over 56,000 calls per year from travellers who need our help. This is made possible by our global network of local partners who are our eyes and ears on the ground. Traveller Assist is our cost-containment and assistance provider for complex medical cases in Latin America.

On the 29th January, we opened a case for a young male who had been assessed in a hospital in Arequipa, Peru. His condition was critical, and he was not expected to live. Within 3-hours of opening the case, we activated Traveller Assist to obtain a medical report and the medical expenses to date, and to ask if the hospital our traveller was in was the best option.

As with most travel insurance policies there are general exclusions including pre-existing conditions as well as drug and alcohol related illnesses, so in order for our team to confirm financial cover for any expenses, we required a medical report with a working diagnosis. 

Traveller Assist was activated at 7:51am (Sydney time) and they were able to obtain the medical report for us within two-hours. In addition, the Head of Assistance and Medical Director at Traveller Assist was able to confirm that the hospital where the patient had been transferred to was the best possible option.

The initial medical report confirmed the patient had an acute pancreatitis and whilst the cause was unknown, we needed to confirm this was not linked to any pre-existing condition.  

We were contacted by the Medical Director at Traveller Assist to inform us that the patient had been rushed in for life-saving surgery. This would be the first of 26-surgeries over 14-weeks, including one that was so serious, the patient received 17-units of blood which activated an emergency blood drive in Peru.

To say this case was complex does not even begin to explain it. Traveller Assist was in constant contact with the medical team at the hospital who in addition to providing daily written medical reports, would also provide verbal updates due to the hour-by-hour fluctuation of the patients condition. Traveller Assist then translated all written documents, transcribed all phone calls and submitted them to WE Assist, along with all updated weekly medical bills.

At the beginning of March, five-weeks into the case, the Underwriters requested a review of all expenses to date on this case, including substantial medical bills. I called the Traveller Assist, Head of Assistance (Danny) to discuss cost-containment strategies. He reiterated that this case would likely be ongoing for a substantial time longer, and that he thought the best strategy was for him to deploy to Peru, visit the hospital and speak to the business leaders directly.

Cost Containment

On March 8th, Danny arrived in Arequipa, Peru. Within 24-hours of his arrival, he informed us that he had negotiated the current medical bills down by 38%, and had agreed upon a discounted daily bed rate moving forward. In addition, he had set a strict weekly billing schedule, that also included the requirement for the hospital to contact Traveller Assist immediately after a surgery to provide a separate medical bill. The underwriters approved the medical expenses, and Traveller Assist provided a Guarantee of Payment to the hospital.

Danny also explained that he had met the wife and sister of the patient, who were both understandably emotional, stressed and sleep deprived. Caring for their welfare, and also understanding that they were also World Nomads Group travellers, he didn’t want them to become ill so he arranged for them to spend some down-time away from the hospital.

Repatriation of Mortal Remains

In the third week of April, the Treating Medical Officer at the hospital contacted the Traveller Assist Medical Director and explained that he did not believe the patient would survive past midnight. He further explained that the hospital would only then keep the body for 24-hours before being sent to the morgue. This was important information because a repatriation of mortal remains in Peru is not simple, and time is of the essence.

While the patient was being rushed in for emergency surgery for septic shock, Traveller Assist was planning the repatriation of mortal remains from Peru to Australia, all the while, hoping for the best and preparing for the worst. The Medical Director was on a moments notice to fly into Peru to complete all associated paperwork. From past experience, a Doctors signature when dealing with an RMR expedites the process, and reduces corruption risks, not only in Peru, but throughout Latin America.

Happy Ending

To everyones amazement, within 72-hours of the patient coming out of surgery, he was awake and attempting to speak. It took the Doctors until May 1st to use the word ‘Stable’ on his Medical Report and specialists from around the world were contacting the hospital to discuss the treatment he had been given. The doctors and nurses at the hospital worked diligently and against all odds, saved our travellers life.

Working together, WE Assist and Traveller Assist returned him home to Australia via a wing-to-wing air ambulance and commercial medical repatriation. He was hospitalised in Australia for a further 3-weeks and then discharged with a view to living a long and healthy life! When speaking to the Treating Medical Officer before the repatriation, he said, “he shouldn't be alive, but he is, and I hope he lives every day to the fullest.”

WE Assist maintains a monthly “Average Days Open” on cases at 1.5-days. This case was 118-days. We also average 7-calls per case. This case totalled 840-calls. This case was certainly outside our norm, in more ways than one. We managed the case for 118-days, spoke to a distraught wife daily and relied heavily on our partner, Traveller Assist. The case opened on January 29th and was closed on May 26th, 2017. It was the longest and most expensive case that we have managed to date.

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Lisa Fryar is the Head of Assistance for WE Assist, the in-house assistance company for World Nomads Group Australia and New Zealand.

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