[120825, 0424 UTC, Roderick Bay, Nggela Sule Island, Solomon Islands
09º01' S / 160º 07' E]
Most of you already know that Philip suffered a minor heart attack while we were at a remote anchorage in the Solomon Islands. Some people asked for more info and so we thought it worthwhile to explain what happened, what we did and to reflect on what we could have done differently.
Our first inkling that something was wrong was during a short hike across the island of Santa Ana. Two miles each way, the wide trail climbed somewhat steeply to the height of land and then down to sea level on the other side. We walked and chatted at a casual pace with crews from three yachts. Later, back on Carina, Philip confessed he had a feeling of tightening in his chest which persisted even then, a few hours later.
The following day, he felt fine and we made no changes to our plan to stay a few more days, waiting for a carving to be completed, before heading to our next stop at Tavanipupu Island in Marau Sound and then onto Honiara on the island of Guadalcanal. A week later, while at Tavanipupu, we hiked and Philip also free dove and cleaned Carina's hull. He felt fine so we continued onto Honiara for the Festival of Pacific Arts. Honiara is a hot, dirty, ugly town and we spent much time walking around and taking rattletrap "collectivo" buses in search of the stuff cruisers always need. We'd been six weeks traveling since our last grocery store - or any store - so we needed quite a bit of "stuff". Philip reported occasional feelings of tightness in his chest during some of the more rigorous outings but he always quickly recovered. He finally agreed to begin taking low dosage aspirin each day - something he'd resisted. We also began to discuss what to do about finding a competent cardiologist for a more extensive checkup. This would mean leaving the Solomons where such doctors do not exist; probably for a trip to the US. To get care immediately, going by Carina wasn't a good choice, as Australia was the only place within reasonable distance that was both sailable and offered first world care, and Oz's quarantine folks wouldn't take kindly to Jake's presence aboard. So, as we contemplated our options and explored care in the USA, Philippines, Guam and even Fiji, life went on almost as normal.
After Honiara, we'd committed to go to a small yacht festival in Roderick Bay in the Florida Group of islands, 29 miles north. On day one of the festival, given a break in the events to use for snorkeling or relaxing, we swam off our mooring to a reef nearby. The swim induced significant chest pain in Philip though the pain only lasted for about 15 minutes. Philip finally became convinced he needed care immediately and confided in John Ruka, the chief, so that he could ascertain whether Carina and Leslie and Jake would be safe in his bay and under his protection while he traveled. Chief John, when queried, assured Philip no one would bother them and went on to casually and earnestly assure Philip that, if anyone bothered Leslie or Carina, he would kill them, weigh down the bodies, and dump them in the sea! (The police here aren't effective and clans take responsibility for security on their lands and in their bays.)
We considered Roderick Bay safe and the Ruka clan trustworthy but the bay's lack of communications resources and with Leslie alone aboard, it would present a few problems. Emails could be done by radio modem but that would be the extent of it. However, while Honiara's horrible harbor has good wifi internet (enabling Skype calls) and telephone coverage, plus a USA consulate, it presented a greater security concern. We continued to ponder our options.
After the festival at Roderick Bay, we remained aboard to rest and plan. Knowing that Philip wasn't feeling well, two days before we intended to head for Honiara to make plane reservations for Philip, chief John and Willy showed up to scrub Carina's hull. When Philip joined chief John and Willy in free diving, and after only 5 minutes of work, he experienced a lot of discomfort that continued to build even after exiting the water. Leslie administered four aspirin immediately for the pain (and to facilitate blood flow should it have been a heart attack) and then Philip rested as well as the pain would allow. The chest and arm pain, he said similar in discomfort level to a severe kidney stone attack, lasted for about 12 hours before gradually lessening over the next two and a half days. Philip was finally convinced that immediate medical attention was necessary. In fact, when we pulled out a thick medical manual written for merchant vessels, the symptoms described for a heart attack matched with what we were seeing, right down to the patient expressing a sense of doom. Uninterested in eating and finding it difficult to find a comfortable position to rest, Philip helped only as absolutely required as Leslie prepared for the trip to Honiara.
Two days after the heart attack, John Ruka and his nephew George, came aboard Carina and we were underway by 8 am, riding a strong current out of Sandfly Pass. Not a whisper of wind blew that day and we chugged under power across Iron Bottom Sound, while Philip rested below. Friends helped with our lines as Philip and John dropped Carina's anchor and we spun her around to med moor once again in close proximity of the police dock. With a line tied to the rip rap to windward during tradewinds and a stern anchor to windward when the wind shifted to overnight offshore breezes, Carina was a secure as she could be in Honiara's sorry little port.
In Honiara we visited a Dr. Nathan Kere, a GP who was recommended to us by the Point Cruz Yacht Club. He suggested Philip get an EKG at the public hospital in Honiara. We arrived at the emergency room at the hospital and were a bit shocked at a scene of bedlam after we walked through the dirt-smeared swinging doors. Infants and children were screaming, patients resided on tables, benches and gurneys waiting for treatment. Eventually, we were shown into an examining room, where we battled mosquitoes that seemed to be residing in the air conditioner. After an hour or so, two young medical students from the UK - their second day in the Solomon Islands - popped their head in and said they'd do what they could to help us, soon. First they needed to find out about the EKG. Eventually it showed up on a rusted metal cart. The first shelf held the ancient machine (adorned with a bright red bumper sticker for the local telekom company) nestled in a shallow cardboard box. The second shelf had a used syringe with its business end pointed outbound and on the third shelf, empty electro-gel containers rolled around.
The med students, Teo and Johnny, got rid of the used syringe, did a thorough interview and then turned their attention to making the EKG work. They tried to decipher the graph but weren't sure what they were seeing. They thought, maybe, the test showed some abnormality but suggested we seek expert cardiac care. First we had to return to Dr. Kere, 6 km up the road by public bus. He agreed that though the EKG didn't show anything significant, abnormalities in Philip's heartbeat were sufficient cause for referral to a cardiologist. Dr. Kere however, told Philip he was fit to fly by commercial carrier, a judgment that would be questioned later.
Where to go for care was another concern; Medicare would not cover Philip outside of the USA, and would also limit the choices he'd have for physicians in the USA as we understood that some doctors wouldn't even take Medicare patients without supplemental insurance. All that being said, and with good friend Ed Hoeschen ready to help him in Seattle, Philip finally decided that he would travel to the US for care. At that point Leslie, using frequent flier miles, tried to make flight arrangements. Everything was great except for the fact that there were no seats on any planes leaving Honiara (for any price) that would get Philip to Fiji to connect with the itinerary...for at least two weeks. At this point we called on Diver's Alert Network (DAN) for assistance in booking the Honiara to Nadi Fiji flight.
A word about DAN at this point. Before we left the states to go cruising, a county health worker suggested that we should join DAN even though we are not SCUBA divers. For a $55 annual family membership, DAN members traveling more than 50 miles from home share the benefit of TravelAssist which will arrange medical evacuation to appropriate care for any medical emergency. We joined in 2003 and have been members ever since.
We called DAN's TravelAssist and explained our need for help in booking the necessary leg of Philip's journey. Miriam, one of DAN's medical staff, called us back on our cell phone while we were off the boat in downtown Honiara. After a brief interview, she strongly suggested we allow DAN to arrange for an air ambulance to take Philip to Cairns Australia, the closest place with first class cardiac care. Mariam explained that the first 14 days after a heart attack - which she was convinced Philip had had at Roderick Bay - was a critical time period and another attack was likely and could be fatal, especially if it occurred at 35,000 feet in a commercial airplane. At Leslie's urging, Philip reluctantly agreed and we canceled the flights to Seattle and called DAN back to make the arrangements for evacuation. DAN wanted to make immediate arrangements but Philip, wanting to get his head around the new developments, asked they book the travel for the next day (a Sunday). Within a few hours DAN emailed us with an itinerary that called for a Sunday afternoon flight from Honiara to Cairn's Base Hospital in Cairns Australia.
Just after noon on Sunday, Philip in company of Leslie and friend Larry (sv Tribute), waited at the bus stop near Pt. Cruz Yacht Club for one of Honiara's small public minivan buses. Soon, John Ruka's nephew, Maurice, joined us. Seems our friends at Roderick Bay sent Maurice to make sure we made it to the airport okay. Climbing aboard a "KG6" bus, we were jostled down the main road on Guadalcanal until we reached the end of the line at the Lunga river, 2 km from the airport. Maurice, thinking quickly, offered the bus driver and conductor $20 Solomon dollars to continue onto the airport, the price we'd pay for a taxi, though it was unlikely an empty taxi would drive by on a Sunday afternoon. Ensconced at the airport and sipping on pop, we learned that the air ambulance had just left Oz; seems the someone had confused cities and times of departure. We settled in for a long hot wait.
Hours later, at the corrected arrival time, a Lear 35 jet - looking very much like a rocket with stubby wings - swooped down over historic Henderson Field (the site of fierce fighting during WWII) and taxied to the airport building. The crew consisted of two pilots, Susan, a doctor; and Layne, a nurse. While the jet took on fuel, Susan and Layne prepared by interviewing Philip and reviewing the medical records we had (such as they were). The whole entourage: Dr., nurse, Philip, Leslie and Larry walked out onto the tarmac to the waiting jet. Philip was soon on the gurney and hooked to machines to monitor his oxygen and EKG, heartbeat, etc.. Once the Dr. gave the go ahead, Leslie was able to climb aboard to say goodbye and then the jet was sealed, the pilots ran through their safety checks, they taxied and lifted off for Cairns as Leslie and Larry watched the plane disappear into the ink-black stormy sky.
Philip arrived in Cairns at about 1800 local time, was greeted by Australian officials who came to the plane and was transferred to an ambulance for transport to the critical care unit of Cairns Base Hospital, a modern, immaculate public facility which faces the Pacific and the Great Barrier Reef. Philip had hoped that once he was in Australia, doctors would tell him he was indeed quite fine, and thus able to travel to the US for medical care. The doctors quickly disabused him of that idea; blood tests showed that he had suffered a heart attack and further tests would be necessary. Not the most patient patient on the earth, Philip grumbled a bit but finally decided to reconcile himself to a "vacation" at the hospital.
That same night, a cardiologist performed an ultra-sound test and recommended an angiogram in order to determine the extent of damage. After a few day's delay (apparently there was a queue of cardio patients in Queensland, Australia), the angiogram - performed at Cairns Private Hospital - indicated minor damage which would be repairable by an angioplasty and the insertion of a stent in an artery. There was also a queue waiting for angioplasty procedures and the wait could have been up to four days. At this point, Leslie was still in Honiara, unwilling to give up good telephone contact with Philip, so she paid the fare for John Ruka to return to Roderick Bay by local transport. John had been eating aboard Carina but staying aboard sv Tribute and watching Carina at night to assure Leslie's safety.
Somehow, someway, the angioplasty was scheduled and executed the following day before Leslie even knew it was scheduled. A groggy, slightly tipsy but elated Philip greeted her when she called for the first time that day. Two days later, Philip was a free man and staying in a backpacker hotel waiting clearance to travel and negotiating to pay the Queensland government for care. Before release from the hospital, Philip's cardiologist, Steve Sutcliffe, started to give him instructions as to future medical visits. Philip just smiled and said that what he planned to do was to fly back to the Solomons as soon as possible to join back up with Leslie and continue on cruising. The doctor just laughed and said that that was probably as good a plan as any.
We want to thank all of you who expressed your concern and well wishes; the response was heartwarming (pun intended) and much appreciated. We've tried to send a personal email to all who wrote and hope we haven't missed anyone in our thanks. A special thanks also to Michelle (sv Warrior, Brisbane Australia) who offered hospitality, a warm bunk, good cheer and a ride to the airport to Philip when he was marooned in Brisbane due to the Solomon Islands temporarily refusing Philip entry back into the country on a one way ticket. While Philip was enjoying a second vacation in Brisbane, Leslie was on the ground in Honiara dealing with recalcitrant officials. Without Leslie in Honiara (and the help of the US Consulate there) Philip might still be in Brisbane trying to get home to Carina.
Your friends of SV Carina,
Philip, Leslie and fat cat, Jake