International Maritime assistance, Ambulance,  Event Medical Cover, Drug and Alcohol Testing, International Medical Assistance, Emergency Evacuation, Pre Employment Medical Testing.

Psychiatric Patient in Brazil.

 

This story is inserted to illustrate how difficult it can be to decide on a diagnosis, and then rescue a patient who has been taken ill or is injured in a remote location.

 

This was a young cadet from Eastern Europe who presented with a serious psychiatric disorder. This is difficult at the best of times but his ship was in a remote area of South America. There is adequate medical care there but no sophisticated psychiatric assistance and local facilities were very hard pressed to cope. Mixed reports were received, and parents were understandably very worried. The father was flown to assist. Instead of this helping, it made the situation worse as the patient reacted badly to the father’s presence. Our doctors took psychiatric advice and talked almost daily to those in charge of the case. Finally it was decided that the patient may have been well enough to be repatriated and we sent a doctor and psychiatric nurse to escort the patient home. The patient was discovered in a poor physical and mental condition, quite unstable and clearly having received little effective treatment. The doctor, psychiatric nurse and patient’s father managed with great difficulty to escort the patient on the first leg of the long journey home but by the time they reached the first  transit stop  the patient – in spite of the maximum permitted sedative treatment – became completely uncontrollable and in no way fit to be presented to a scheduled aircraft flight. He was again hospitalised but this time in a dedicated psychiatric institution. The father was sent home and the escorts also.

 

Some three weeks later, after effective drug treatment and counselling the patient was again considered fit to be repatriated and the same doctor and nurse team achieved it, not without some difficulty as the journey was again not straightforward.

 

Lessons Learned:

 

1. Until we see the patient, assessment of condition and fitness for repatriation is uncertain. Local doctors may have little understanding of the rigours of the journey.

2. It may be necessary to move a patient to better local facilities before final repatriation.

Never underestimate the severity of psychiatric conditions, particularly in the young seafarer, nor the embarrassment they will feel when facing their family.

 

Other Psychiatric Stories.

 

We arrived at a non psychiatric hospital in the USA to escort home a seafarer who had attempted suicide by jumping from his ship. He was under armed guard………..

 

On another occasion, again in the USA, a local doctor had declared in writing that a psychiatric patient was fully fit to be escorted home and our team found him chained to a table in the Seaman’s Hostel. The doctor had never seen him; the condition was undiagnosed and untreated. The escort team had to go home and the patient hospitalised.

Remote facilities may not have access to advanced diagnostic tools and resources.

After more than 17 years engaged in this business, there are always still new lessons to be learned—Particularly when the patient is in a remote facility!

Date: November 2008