Medical care in South Pacific

[57redbird]

Hi all -- we're booked on a 35 day HAL cruise to Hawaii, Tahiti & Marquesas --- hubby has a history of atrial fib/flutter.  His cardiologist has said he should be good to go but I'm a little nervous about it.  Has anybody needed medical care both on the ship or in any facility (other than in Hawaii) & how has it been?   TIA.

[Flatbush Flyer]

1 hour ago, 57redbird said:

Hi all -- we're booked on a 35 day HAL cruise to Hawaii, Tahiti & Marquesas --- hubby has a history of atrial fib/flutter.  His cardiologist has said he should be good to go but I'm a little nervous about it.  Has anybody needed medical care both on the ship or in any facility (other than in Hawaii) & how has it been?   TIA.

Excellent question. 
One would think that, as is the case with so many other areas, the French government takes good care of public health and welfare in Polynesia. But, even then, only so much can be accomplished in such a remote area (so far from cosmopolitan cities).

FWIW, while you can rely on many remote Pacific ports for emergency response, you should be considering both MedEvac (AND the time it takes to get from first land ER to appropriate treatment location) in your cruise itinerary decisions.

[mom says]

3 hours ago, 57redbird said:

Hi all -- we're booked on a 35 day HAL cruise to Hawaii, Tahiti & Marquesas --- hubby has a history of atrial fib/flutter.  His cardiologist has said he should be good to go but I'm a little nervous about it.  Has anybody needed medical care both on the ship or in any facility (other than in Hawaii) & how has it been?   TIA.

Unless there is someone here with the same cardiac condition and needed intervention for that problem, (OR is a physician who has practiced on one of the Pacific Islands you will visit) then no one can adequately answer your question. Medical care for a broken leg or a kidney stone is completely different from someone in active A fib who throws a clot. Only his cardiologist can adequately evaluate both your husband and the medical care possible on your cruise. 

[57redbird]

1 minute ago, mom says said:

Unless there is someone here with the same cardiac condition and needed intervention for that problem, (OR is a physician who has practiced on one of the Pacific Islands you will visit) then no one can adequately answer your question. Medical care for a broken leg or a kidney stone is completely different from someone in active A fib who throws a clot. Only his cardiologist can adequately evaluate both your husband and the medical care possible on your cruise. 

Thanks - that's what I'm looking for is someone with experience with this....I'm a retired RN so I'm not exactly clueless.

[lissie]

25 minutes ago, 57redbird said:

Thanks - that's what I'm looking for is someone with experience with this....I'm a retired RN so I'm not exactly clueless.

You need to have a serious discussion with the cardiologist. My partner has heart  failure/ afib and I'm not a nurse. I know a stupid amount about his specific condition now though.  What's the main issue?  Clots? That used to be my partner's main risk - but post heart valve replacement he's on permanent blood thinners so  its no longer a worry. 

 

Both Hawaii (USA) and Marquesas/ FP (France) have 1st world health care. But they are scattered islands with small populations and most of the time you are out of medivac range.   Small towns can't support specialist cardiologist services anywhere in the world. 

 

We experienced the on-board hospital experience on Cunard (turned out to be cellulitis) - it was impressive. Not just  dr - but they have access to consultants off ship. 

 

My partner and I have had lots of discussions about this - he'd rather carry on living and travelling than worrying about the "what ifs" .  

 

One thing I do insist now - is that he give me a current list of meds/dosages/purpose - so I can hand it over if I get asked because its too bloody hard trying to remember what is what in the moment 

[Hlitner]

I think the OP has opened up a seldom discussed topic which is about onboard medical care.  When we take longer or more exotic cruises we often find ourselves in relatively remote parts of the world where the ship can be days away from shore care and even further from really decent shore care.  At that point it falls on the ship's own medical personnel to handle situations and that is a tough topic.  All cruise ships have at least one physician (many ships have two) but their skill/ability really does vary.  At best you will have a decent emergency medicine physician on a ship and at worst....we do not even want to go there!  The OP is talking about a pretty sophisticated cardiac problem that ideally would be treated by a trained cardiologist who has access to the best testing equipment and labs.  You are not going to generally get either on a ship.  And if you need skilled specialist care in the middle of the South Pacific you may find that you are several days from that type of help.  There is obviously good healthcare in Hawaii and also in Tahiti but there is a lot of distance between (about 2700 miles).  

 

A few years ago we were on a South Pacific cruise when one of our fellow passengers had an acute Kidney Stone attack.   He was medically evacuated off at the next port (I do not recall the particular island but it did not have sophisticated medical care) and later airlifted to the island of Tahiti where apparently the French government supports some decent healthcare facilities.  He was treated (for several) days on Tahiti and then he was able to rejoin our cruise when we stopped at another island (it was a transpacific cruise from Seattle to Sydney)  

 

We have also been in a bad medical situation when DW badly injured her leg in Vietnam, was treated on the Golden Princess, and ultimately taken to a teaching hospital in Osaka, Japan where she received outpatient surgery before being evacuated back to the USA (at the suggestion of both the Japanese surgeon and our ship's South African physician.   Although we wanted to continue on that cruise (which has several weeks of cruising before finally arriving in Alaska) the ship's physician made it clear he did not have the necessary skill in the event DWs situation deteriorated.  His fear (and mine) was that we had a few days between Northern Japan and a major Alaskan city where there were few medical options.  In retrospect (and even at the time) we think that the ship's physician made a smart recommendation (i.e. get her home NOW).  Weeks later her skilled physician here in the States gave lots of credit to both the Japanese hospital staff and the Golden Princess's physician.  His felling was that DW would have lost her leg (or worse) without the care received in Japan (ordered by the onboard physician) and the decision to evacuate her back to the USA.  She could have received comparable care if we had stayed in Osaka, but we would have been there for many weeks...if not months.

 

I think the post is more about the issue of needing sophisticated medical care on a remote cruise...rather than a specific cardiac condition.  When anyone takes a cruise to a relatively remote area (or an area that lacks quality healthcare) they are rolling the dice.  It is the chance we all take with exotic travel and we must accept that there are times when we will be days away from high quality medical care.  I do think (many may disagree) that if folks are not comfortable taking that risk they should make different travel decisions.

 

Having the cardiologist say its OK to take the trip is certainly a major hurdle.  But only the OP and his DW can make the decision if they can handle any anxiety involved in knowing they are going to be a few days from the type of medical care they can get near home.   Just knowing that there are over 12 million Americans with A-Fib is not helpful when you are talking about a loved one.

 

Hank

[Flatbush Flyer]

58 minutes ago, lissie said:

....One thing I do insist now - is that he give me a current list of meds/dosages/purpose - so I can hand it over if I get asked because its too bloody hard trying to remember what is what in the moment.

You may also want to determine which medical records system is used by his cardiologist and by other docs and hospitals where he gets care. If you’re fortunate, it will be MyChart (or a related Epic product), which is the most widely used system (at least in the US). With a few clicks on your laptop or smart phone, you can grant permissions necessary to immediately send his records to other providers worldwide.

[lissie]

6 hours ago, Flatbush Flyer said:

You may also want to determine which medical records system is used by his cardiologist and by other docs and hospitals where he gets care. If you’re fortunate, it will be MyChart (or a related Epic product), which is the most widely used system (at least in the US). With a few clicks on your laptop or smart phone, you can grant permissions necessary to immediately send his records to other providers worldwide.

I've never heard of that - I'll get him to ask his cardiologist at his next appointment. I usually just get a letter with a summary of latest tests, current prescriptions and any concerns  

[Flatbush Flyer]

2 hours ago, lissie said:

I've never heard of that - I'll get him to ask his cardiologist at his next appointment. I usually just get a letter with a summary of latest tests, current prescriptions and any concerns  

https://www.mychart.com 
you may find out a bit more about MyChart here.

many county health departments as well as most major hospitals use MyChart as their electronic records system. You can even have your main hospital provider (where the cardiologist is affiliated) scan/upload all sorts of older docs, images, and other medical history plus records of vaccination, etc.

 

FWIW: Whenever I see a new doctor (perhaps not affiliated with my main provider (University of California San Francisco - Medical Center), one of the first questions I ask is if they use MyChart and/or another records system that can communicate with MyChart. It really is as close to a national medical records system as exists in the US. Maybe someone in Canada or elsewhere can comment about its use there.

[lissie]

6 hours ago, Flatbush Flyer said:

 

FWIW: Whenever I see a new doctor (perhaps not affiliated with my main provider (University of California San Francisco - Medical Center), one of the first questions I ask is if they use MyChart and/or another records system that can communicate with MyChart. It really is as close to a national medical records system as exists in the US. Maybe someone in Canada or elsewhere can comment about its use there.

I had a look - its entirely American centric and wouldn't meet New Zealand's privacy rules.   All NZ health providers use a common "manage my health" platform - so the actual lab results are available anywhere if you login - but the interpretative stuff from the specialist we generally get via an (email) letter.  

[SantaCruzer]

Having AFib is very scary.  I would not want to be so far away from quality medical care.  I would strongly recommend having the Ablation Procedure, if he hasn't already.  They say I am AFIb free, for now, but I did experience a flutter about a year ago.  They could not get me out of it and I wound up doing the "shock me" treatment.  I am on blood thinners- Pradaxa and Heart Meds - Cardizem Cd 180 mg.  They had me on 120 mg, but did up me to 180mg after that episode.

I too am on the fence about our Panama Cruise in November, 15 days, but I have until August to decide!

[57redbird]

15 hours ago, SantaCruzer said:

Having AFib is very scary.  I would not want to be so far away from quality medical care.  I would strongly recommend having the Ablation Procedure, if he hasn't already.  They say I am AFIb free, for now, but I did experience a flutter about a year ago.  They could not get me out of it and I wound up doing the "shock me" treatment.  I am on blood thinners- Pradaxa and Heart Meds - Cardizem Cd 180 mg.  They had me on 120 mg, but did up me to 180mg after that episode.

I too am on the fence about our Panama Cruise in November, 15 days, but I have until August to decide!

He's had 2 ablations - 1 for fib & 1 for flutter + at least 4 cardioversions.  Had been doing fine for 2-3 years until last month--- tried medical methods but ended up having 2 'shocks' in 2 days for atypical left a-flutter + medication changes.  Fingers crossed.....