After a recent accident whist away on vacation in an exotic location I came away thankful to be alive, still hungry to travel but reflective on the experience. It will change the way I plan and prepare for future journeys.
Now for the serious stuff …
- Accidents happen – being away from home makes these more problematic
- Being prepared is wise. Take as much of a medical kit as you can manage. Include basics such as band-aids, bandages, rubber gloves and antiseptic cream
- Have a plan in case of emergencies. Have all your emergency contacts for your trip easily at hand so they can be found by you or someone else under your guidance
- Leave a detailed itinerary of your travels with someone responsible back home who will be useful in a crisis. This might sound morbid but they should know your wishes about treatment, who to contact in case of serious injury or death, where your will is and such things about repatriating your remains or not etc. This person / person(s) should be made known to any tour operator and on any emergency contact documents you carry with you. Putting their name in your passport is a good idea if they are your regular emergency contact
- Don’t expect the same standard of medical care you get at home as you will be disappointed
- Travel insurance is good but can be limited
- Try to be positive during and after any catastrophe. Don’t let it limit or define your future!
The Story in full
I was never a boy scout so I guess “be prepared” does not pass as a natural phrase between my lips. Sadly, on my last trip – which was one of my bucket list places – in Borneo I came a cropper. I did have holiday insurance but unfortunately that didn’t prove much help on this occasion.
Anyway, the accident occurred when we were staying at the Kinabatangan Wetlands Resort. Getting about this area is somewhat a boggy affair (the clue is in the name “wetlands”) so you get everywhere on raised boardwalks (see the picture above). There are 10 private guest rooms which are spread over a wide area. Our room was number 10 and was right at the end of the walkway, about two hundred yards or so from the main longhouse lodge. We had been out on a late afternoon boat ride to look at monkeys roosting by the river and had returned later than expected; so it was very dark. We were returning to our room to get ready for dinner and made our way along the boardwalk.
The walkways were very dimly lit and we hadn’t been expecting to be back so late so had not bought our flashlight (torch for my fellow Brits) and they didn’t supply us with one. The long and the short of this sorry tale is that I was literally one step from reaching the chalet and I fell at the point where the walkway turned a sharp 90 degrees. On the way down I hit my side on the steps and fell to the ground, which was about 6 foot down (see the picture two below). Unfortunately, this was about the highest point on the boardwalk in the whole resort.
Somehow I managed to scramble up … at this stage I was running on adrenaline. By this time Karen was shouting for help and luckily a young Norwegian girl heard her calls and fetched help. When I got back to our room I was in the most pain I can ever remember. The guides from the resort turned up with the smallest first aid kit we had ever seen. Karen said she carried bigger kits backpacking with Boy Scouts! I was not filled with a lot of confidence. They did manage to clean up some of the cuts I had but that was the extent of the first aid. By now it was pitch black and a storm had rolled in so there was no getting in or out until the morning.
Needless to say it was not the most comfortable nights sleep I had ever had. I don’t think Karen has heard me used the F word so much … in fact every time I got up or moved I let out a string of expletives. By the time morning came I was in a real mess and although I had hoped to shrug this off as a little knock it was obviously a bit more serious. Anyway, I persuaded Karen to go off on the morning boat tour on which she got to see a small herd of pygmy elephants (I am so jealous).
By the time she got back the decision was made to take me, by boat, back to Sandakan where there was a hospital. So, they packed me up on a wheelchair and rumbled me down the boardwalk. I felt every rut, on every board (there were hundreds) as the rickety old wheelchair rattled its way to the waiting boat. I did manage to stop en route and ate some breakfast. If I could eat I decided my wounds were not fatal, at least not for now.
Soon we were on the boat for our 90 minute trip back to town. The first 45 minutes were okay as we skimmed down the tranquil waters of the the Kinabatangan River. Then we hit the open sea and the choppy waves. I had obviously been unkind to the driver in a previous life because he suddenly opened the throttle and we were suddenly bouncing off the tops of the waves. The pain was indescribable but the macho man in me was too proud to ask him to slow down – I just thought what would Bear Grylls do?
Eventually we arrived at the dock in Sandakan and I was taken by minivan to the local government hospital, the Hospital Duchess of Kent. The entrance to the emergency room was like a bag drop at the airport, with two waiting areas that you get directed to depending on how serious your ailment is.
Obviously by the pained expression on my face I earned my place in the more serious injury waiting room and was seen fairly quickly by a doctor. In fact the place was crawling with doctors and nurses, to the point they were almost tripping over each other. I was popped onto a gurney and sent from one room to another, eventually ending up in an urgent care room with some pretty unwell looking people. I thought I would lie on my back and think of England. The mold that was growing on the ceiling tiles did little to ease my woes. I seemed to hang there for ages, with only the melee of urgent care to entertain me. Karen was allowed in briefly, but was told to wear a mask as the patient in the bed next to me was a suspected case of active tuberculosis. Ugh!
They took my blood for analysis (they did this a few times whilst I was there) and the nurse did not wear gloves whilst doing this! They got blood on them and then went off to the next patient. Karen saw this and was horrified!
After a while I remember being wheeled to one side of the room and curtain pulled across. This is where they did the ultrasounds. I was joined in this space by a couple of doctors and what seemed like 10 student doctors. Lab rat! I think this space doubled up as the janitors closet as there were buckets, mops and large plastic containers of bleach.
The ultrasound was inconclusive so next up was an x-ray. So, I was wheeled away to an x-ray room where the technicians greeted me dressed in soccer (aka “football” for the Brits) shirts as scrubs. They manhandled the x-rays plates underneath me on the gurney, which was really, really painful.
When my x-rays were read the bad news was I had 5 broken ribs, a couple in two places. The good news was I did not have a pneumothorax ( a punctured or collapsed lung ) so I could fly. If my lung had be been compromised I would have been stuck in Sandakan for several weeks.
After spending quite sometime in a “holding” area I was finally wheeled to the ward, where I was to spend the next 2 or 3 days under observation (being poked by several doctors under the observation of armies of student doctors).
I don’t want the following to come across as a bashing of the public healthcare systems of developing countries. These are just observations. The staff at the hospital were friendly and competent within the limited resources available to them. That said I think basic sanitation is within reach of these institutions; a lot of it comes down to education.
In some ways I was lucky to be in the ward I was, which was half empty. Apparently the main surgical ward was full, noisy and very hot. There was of course no air conditioning, which in a tropical country was interesting, apart from the opened windows (letting the hot air in) and some ceiling fans, one of which squealed like a stuck pig (apologies to my fellow vegans for that metaphor). The open windows did let in the lizards, who did a super job keeping down the insects and were to be my only source of entertainment outside of visiting hours.
I was next to the bathroom. Which was good in the sense of not having far to stagger but bad in that there was a constant stream of folks coming past. The bathroom had a single toilet stall, whose wooden stanchions were rotting from the base up, due to the humidity and the sluicing of water when they are being cleaned. The door frame to the toilet stall was about 5 foot 10 inches high, and I am 6 foot 5 inches, so I had to keep ducking which was not easy with broken ribs. The shower was basic with no grab rails or disabled seat. And yes there was not toilet paper or soap in the bathroom!
The ward itself was open plan, which I didn’t have a big issue with. My biggest initial concern was with the bed, which was about 5 foot long, so even sitting up my feet were wedged against the end. Malaysians are generally short so I guess they make the beds to fit. Much to my relief, on my 2nd day at the Duchess of Kent, one of the nurses saw my plight and removed the end to the bed. Oh my goodness the wonder of being able to stretch out. As well as getting no toilets roll, they did not provide food or water. Luckily I had Karen and Sheng, from Kinabatangan Wetlands Resort (she did an amazing job looking after us – including washing my clothes), to feed and water me. If I had been traveling alone goodness knows what would have happened.
Everyday I was asked to get up by the nurses so they could make my bed. They also gave me some clean scrubs to wear. The blankets on my bed had large brown stains on them. I thought this might be coffee. But when they took the pillowcases off and there were two hand sized blood stains on the pillow I realized that this was probably not “coffee”.
The ward furniture was also a little worst for wear. The beds and side cabinets were made of metal and had started to show the effects of years of exposure to the humid atmosphere of Borneo.
One of the nice things that happened whilst I was in the hospital was I got plenty of visitors. This included Sheng from KWR, the reps from Exo Travel, the local tour company and my fellow gooner Kenneth. Everyone was so kind.
Finally I was discharged with a big bag of medications. Sadly, for broken ribs there is no real treatment apart from time and pain management. We decided to cancel the next parts of our trip in Borneo as this involved 4 wheel drive journeys through jungles – which would not have been much fun with broken ribs. Instead we decided to fly to the regional capital of Kota Kinabalu and rest up for a few days and plan our next steps.
Before leaving the hospital we had to pay my bill. For my emergency room visit, three nights in the hospital and loads of drugs the total charge was $168. That is about half the cost of a visit to see my doctor at their office back in the US!
With broken ribs I couldn’t carry my backpack or pull my suitcase. Somehow Karen managed to carry both backpacks and handle two suitcases – but we did get some funny looks as we traveled through airports. My chivalrous persona was badly dented!
We had a couple of days of rest in the Marriott in Kota Kinabalu, our peace was only disturbed by the hoards of drunken US marines on shore leave. Our first thought was to get early flights back to the US, but I needed extra legroom, and the best offer we got from Singapore Airlines was for two business class tickets $15,000. So, we decided to stay and travel to Singapore and spend a few days there.
My injuries were quite bad. The first day or two it was just swelling, but then the bruising came out and blood started leeching around my body!
The end of this story is that we returned the US where I immediately went to urgent care and got another x-ray which showed I had a hemothorax. This is where blood fills the chest cavity preventing the lung from fully inflating. I was admitted to hospital where I had a chest drain inserted and had 2.5 liters (Karen likes to say this is equivalent to 3 wine bottles) of blood sucked from my chest. The chest drain was probably the worst part of the whole experience! After a couple of days I was released. Two days later I had severe pain on my left side (the opposite one to my broken ribs) so I went back the emergency room. After a CT scan I was diagnosed with a Pulmonary Embolism (blot clot) on my left lung, so I was readmitted. I had another chest drain put in on my right side, and another 800ml (another wine bottle) of fluid was removed from my chest (not so much blood in this) and I was put on an intravenous heparin (blood thinner) drip. Eventually, after much poking and prodding I was left to go home.
Now, whilst we had travel insurance we did not really get to use it. The cost of the treatment in Borneo was negligible and the medical costs in the US was not covered as I had returned from my “travel”. I could have got an emergency evacuation to the US but that wasn’t necessary. In hindsight I should have reported to a hospital in Singapore, which has an excellent healthcare system, and got treated there.
This is partly a cautionary tale. We learnt a lot and will make changes to how we travel, including carrying even more first aid items with us, such as rubber gloves. I would also say that despite this being a really horrible experience that interrupted our much anticipated Borneo adventure, it was an adventure of sorts and I am trying to think of it as just one part of our life’s rich journey. It has not put me off traveling one bit!
Retrospectively, Karen compiled a report of suggested safety improvements for the Kinabatangan Wetlands Resort, and I am pleased to say that they have started to make changes.