A Medical Emergency in Uzbekistan
Once again we are jumping forwards of where we should be on our blog.
The Russian Altai and Pamir Highway blog will follow but in the last week circumstances have changed affecting the rest of our trip.
Leaving Dushanbe in Tajikistan last Sunday (2nd September) morning we had no idea of the turmoil that was about to hit us.
By lunchtime Sunday completely out of the blue with no prior warning Angela started experiencing painful stomach spasms as we drove to Tashkent in Uzbekistan. By evening the spasms had turned to constant pain. We both assumed some sort of food poisoning but by Monday morning it was clear Angela needed to visit a doctor. Dave contacted World Nomads our medical insurance and asked for a clinic we could attend. Although they had no specific clinics they gave us the details of two that previous customers had used.
We chose the Tashkent International Clinic, as we believed they would have English speaking staff and we hoped western standard facilities. Angela was seen promptly and taken into an examination room where the excellent Dr Inom Tashmatov and his nurses carried out an examination followed by x-rays and ultra sound examinations.
From these it appeared Angela had a blockage in the bowel causing it to bulge. Throughout the day Angela was put on a drip and medication given to try and reduce the bulging and some of the pain. A surgeon was brought in for a second opinion and the consensus was Angela might need emergency surgery and definitely needed monitoring over night something the clinic does not normally do. To the doctors it made sense that Angela be transferred to the State Hospital where surgery if needed could be carried out. Angela was transferred by ambulance and Dave followed in the Land Rover.
On arrival, the State Hospital seemed like chaos, and the facilities were like something out of 1950’s hospital. Almost no one spoke English and it seemed Angela was dragged from pillar to post to repeat all the tests from earlier then put in a room for the night. Dr Inom had already spoken with the State Hospital Deputy Director to arrange things before Angela arrived but it seems the messages were not passed down to the doctors on the wards.
Angela spent a rather uncomfortable night at the State Hospital. In the morning Dave arrived back and both Dave and Angela saw the doctors together. There were 4 doctors but only one who spoke English.
The conversation was about whether Angela would remain in the State Hospital or we would leave. More than once we asked if Angela was well enough to fly to which in every case we were told yes she could fly. Dave contacted the medical insurance to get a second opinion but due to the time difference no doctor was available. Whilst waiting for a second opinion we were harassed to the point it felt like Angela was a complication they did not want to have to deal with. Later we heard they don't like treating foreigners as usually the embassies get involved giving them additional pressure.
So Angela was discharged, we went back to the hotel and Dave booked a flight and arranged with the children for Angela to be met in London and then in Aberdeen.
With a few hours to go before the flight Dave finally spoke with the UK doctor who was not comfortable with Angela flying preferring that she have more tests before she would certify her fit to fly. This left us in a position where one set of doctors said she was well enough to fly and another believing she wasn’t.
We discussed with the insurance and were advised that if we went ahead and flew Angela and there was a medical emergency then the insurance would not cover it. So although we would lose the money paid for the flight we accepted the UK doctor’s assessment and Angela returned to Dr Inom at the Tashkent International Clinic for further ultrasounds and a CT Scan.
When Dr Inom heard what had happened at the State Hospital he was very apologetic. Further tests were completed which showed Angela’s condition was far from improving but actually getting worse.
Dr Inom discussed with the insurance who were by now having heard and been involved with our State Hospital experience looking to fly Angela out by Air Ambulance. However Dr Inom felt here was no time to wait and surgery was required urgently within the next 6 to 12 hours maximum.
Although we didn’t like it, it looked like Angela would have to go back to the State Hospital for surgery. Angela had concerns after her previous visit including risk of infection etc. Dave tried to show he was not concerned to try and put Angela at ease but he had the same thoughts and when speaking to the insurance asked if an alternative hospital was available.
It appears Dr Inom was also having the same concerns about the State Hospital phoning around private hospitals to try and get one to accept Angela. At 9pm Dr Inom told us we were going to Akfa Medline a new private hospital. Dave phoned the insurance to advise them and they were happy and started making arrangements through the Moscow agent to get Angela admitted.
Dr Inom drove round with Angela in his own car and all her test results so he could speak directly with the surgeon Dr. Bekmuradov Amirkul.
After an examination with both doctors and the surgical team present it was agreed surgery could not wait.
Angela was admitted and preps for surgery started. At this time the administration arrived concerned about payment. Whilst we understand they need to be paid Dave was not happy about arguing about payment in front of Angela who was in considerable pain.
There are complications for private hospitals in Uzbekistan around who and how payment can be made. The insurance had sent a letter to the hospital guaranteeing payment and Dave stated repeatedly if the insurance did not pay he would pay personally however they could not or would not accept credit card or debit card. They wanted cash even suggesting he go to an ATM to get out a pre payment of $4000. This was midnight now and Dave was trying to explain UK banks limit the amount you can withdraw daily through an ATM.
By now Dave was stressed and frustrated. They wanted payment, which was absolutely fine, but they had no means of accepting payment except cash and it was after midnight. Finally they agreed to let Dave go to a bank the next day and withdraw cash but he would have to sign a guarantee stating he would pay the costs in full. As it happened the insurance managed to sort arrangements to make the payment direct and Dave was not asked to go and withdraw the required cash.
Finally Angela was ready to go into surgery and at 1am Angela entered the operating theatre and Dave returned to her room.
At 4.30am the surgeon returned to explain the surgery had been completed and that they had to remove 70cm of Angela’s bowel. The surgery had gone well and Angela was in ICU on a ventilator.
At this point Dave could not see Angela so he headed back to the hotel for a shower and to check out as the hotel was going to be full with earlier bookings and they had no room available.
By 5.30 Dave was back at the hospital but was not able to see Angela until late morning. The ventilator was removed but the tubes etc. were still in place. Angela was awake but could not speak so Dave really only had the opportunity to explain how things went, confirm she was not in pain and reassure her he was at the hospital and everything was under control. Later that day the tubes were removed and Dave was allowed back into ICU to spend 30 minutes with Angela.
Also at 8.30am the hospital administration returned but to Dave’s surprise there was no mention of payment only apologies for what had occurred the evening before. It now seems the insurance payment has been resolved. The administration throughout assisted by liaising directly with the insurances Russian Agent. Sadly the Russian Agent did seem to make everything more difficult for the hospital and for Dave but finally everything was resolved.
Next day Angela looked and seemed much happier in herself although bored from staring at the ceiling it seemed her recovery was going well. She spent another 2 days in ICU before she was transferred to the ward.
Over the next week of recovery Dave did not spend 2 nights in the same bed having to book hotels on a night by night basis whilst waiting to see how Angela's recovery and repatriation would be resolved.
With Angela's discharge imminent a hotel was booked for Dave where Angela would join him once she was discharged. At 9pm he arrived at the hotel to find no booking and after 3 hours of calls he paid for his own room for the night getting to bed around 1am!
Next day having been assured the hotel situation had been sorted out he again attended at a different hotel with a "confirmed" reservation. Upon arrival at 8pm there was no reservation. 2 hours later with nothing resolved a very angry and stressed Dave booked into another hotel and paid himself. This was the final straw and all faith was now lost with the Russian Agent who seemed to cause more complications throughout the whole saga than resolve them. 5 minutes on booking.com and Dave could book a hotel but the Russian Agent could not achieve this in a full day and after the first nights fiasco you would think they would have taken extra care to ensure everything was in place.. The UK contacts agreed and the next nights hotel was arranged by another agent. Angela was discharged and check in at the hotel went without a hitch.
The facilities at the Akfa Medline Hospital are first class modern, clean and the staff are exceptional. They are attentive, helpful and nothing seems too much trouble. The doctors and nurses in ICU were excellent taking care of Angela and allowing Dave to visit for as long as needed. And whilst Angela was in ICU Dave was using Angela’s room on the ward. The nurses there would check in on him to make sure he was ok, bringing tea and coffee.
Angela has now been discharged from hospital and we are currently in a hotel waiting for Angela to get approval to fly and have her repatriated to the UK and home. Recovery for Angela is going to be about 6 months so for her the trip is most definitely over and once well enough she will fly home to UK for after care etc.
Dave has the issue of the Land Rover and cannot leave Uzbekistan without it. We have asked the UK Embassy in Tashkent for assistance to try arrange a dispensation to allow Dave to fly back with Angela to get her settled then return to Uzbekistan to collect the Land Rover and drive it home alone. We await to see what they can arrange.
If nothing can be done either Angela will fly home with a medical escort or perhaps her son Ryan will fly out to collect her and fly back with her. Dave will then drive to Almaty and leave Wilson there at ARB where Anna has been great once again and set everything up for us. Dave will then fly back to the UK for a few weeks and return to Almaty to drive Wilson home alone.
This is the kind of nightmare scenario we all worry about when travelling and thankfully for most of us is a very rare ocurrance. But as we have proved it can happen so please make sure your medical insurance is adequate.
Secondly some, even ourselves at one point looked to save on medical insurance thinking if anything happened we could just fly home to get it sorted. This does not always work and in our case Angela went from no symptoms at all to not being fit to fly was less than 24 hours and to emergency surgery was less than 72 hours.
Thirdly get a second opinion. If we had not discussed with the UK doctor regarding Angela being fit to fly and just taken the word of the doctors at the State Hospital Angela’s condition could have been fatal.
And finally although it may not seem it we have been lucky. The previous week we had been driving the Pamir Highway, less than a month earlier we were in the remote Gobi Desert.
If this had occurred in either of those places or any remote location we have been to during this trip the outcome could have been much worse or even fatal.
So we thank our blessings, and thank in particular Dr Inom and his staff of Tashkent International Clinic who went above and beyond with professional treatment and personal care for Angela.
We thank the Surgical Team and the staff and Nurses at Akfa Medline Hospital who have taken such good care of us both.
left to right: 1). Nazarov Ismoil; 2). Karimov Zarshed; 3). Dave Spinks; 4). Bekmuradov Amirkul; 5). Brown Angela; 6). Yuldashev Alimardon; 7). Khalikulov Hasan.
And thanks to World Nomads Insurance, particularly Gary West, who have chased, assisted and taken much of the stress of the situation for us.
Angela will hopefully continue to recover. Dave will continue to document and photograph his drive home alone.
In the UK we will do small trips when Angela is well enough, attend the overland shows and start prepping for another longer trip possible Africa or possibly Americas.