So What Exactly Happened?

As many of you may or may not know, Kendall was recently run over by a car in Victoria Falls, Zimbabwe. It’s been a long time posting on the blog, but I know a lot of you have many questions regarding some recent events and how it all transpired.

The following post is written in a narrative style as there is no other way for me to appropriately convey the complexity of what happened, what people were feeling, the pain of dealing with a cash based 3rd world medical system in an emergency, and all the efforts everyone went through to get Kendall transported to a Level I trauma center. It is a long read, and meant more of as a “beach” read, but if you read it all I promise by the end you will be in disbelief of everything that had transpired. I will also say that if you do read the whole story, that despite all it’s flaws you will gain a new appreciation for the US healthcare system.

The following is a true story.

“28 Hours”

10:30AM – 12:00PM

Contact solution. Of all the things to forget, I had forgotten contact solution back in our preflight hotel in Columbus, Ohio. It had been 96 hours since I removed my contacts, and at this point my eyes were burning with the passion of a thousand suns so we were walking to buy some after Sunday morning mass. Little did I know how one small insignificant mistake would snowball into a life changing event.

On June 19th, 2022, at approximately 10:30AM me, my mom, Zack and Lucy were walking on the opposite side of the road of Kendall in Victoria Falls, Zimbabwe. Out of nowhere, I suddenly hear tires screeching and the rumbling of a car going off road. I then hear my mom scream “Kendall!”

I turn my head and see a cloud of dust. As it clears I see a white Toyota Landcruiser on the side of the road where Kendall was but I do not see Kendall. My heart immediately sank as I assumed she was dead. I start dashing across the road frantically screaming for her without any response.

At this point, it felt like an out of body experience where everything was moving in slow motion. No matter how fast I ran everything was slowing down. I felt like I was living out one of those tragic romantic movie scenes where the protagonist runs over to his lover only to find her barely alive. She briefly utters some final words, and then he watches as she dies in his arms. While this may sound overly dramatic and cliché, I saw our life together flash before my eyes as I dashed across the road. I could not believe this was actually happening.

I arrived at the SUV, and peered under the rear bumper and saw her laying motionless. I immediately pulled her out, expecting to find her either dead or dying. I fully expected to have to hold her dead in my arms. Shockingly, after I pulled her out, I saw her breathing and then heard some moaning. A huge weight was partially lifted, but I was still panicking as I assumed she had to have sustained massive injuries given she literally was just run over by a vehicle. I very quickly looked over at Zack and Lucy to make sure they were ok. I saw them crying and screaming “Mommy!” as my mom held them tightly to keep them from running over to me.

I return my attention to Kendall to start scanning her body looking for any major bleeding or compound fractures which to my absolute shock there were no visible deformities of her upper body or limbs. I do notice some very severe abrasions all over her body and blood all over her arms and legs but nothing too serious EXCEPT that the heel of her left foot was now dangling from her foot. Now rather than living out a romantic tragedy, I felt like I was in the movie Saving Private Ryan.

At this point the driver hops out of the vehicle, and tells me the hospital is just 3 minutes from here and we need to get her into the car and move her. He starts to pick her up to which I respond “Don’t touch her! Just don’t touch her! Just leave her there. We need her on a board in case she has a spinal injury.”

We proceeded to argue about this for about a minute at which time a safari guide who was walking by ran over and pulled a med kit from his bag. We proceeded to start to wrap Kendall’s heel with gauze. In my medical career I have seen some gruesome injuries and haven’t blinked twice, but seeing my wife in this state was too much for me too handle and I just couldn’t finish wrapping it, so I let the guide finish up. By now a crowd was starting to gather and due to the nature of the injury a lady offered her scarf to keep the foot covered from public view.

Kendall was now starting to become more lucid and was asking about what had happened. She was obviously in massive amounts of pain at the time and asked if she was ever going to walk again. Given she was just run over and could possibly have spinal cord injuries, multiple fractures, nerve damage, etc. AND her heel was detached from her foot it was not promising. Definitely not one to lie and accurate to a fault, I stammered “I don’t know. I honestly don’t know.” That was obviously not the answer Kendall was hoping to hear in that moment.

The “ambulance” (if you really want to call it that) arrived about 5 min later. The “ambulance” was equipped with a stretcher…. And that was about it. There was no oxygen, no iv fluids, no defibrillator, no drugs, no c-collar. It had a stretcher and a board. That’s it.

The police arrived at that time as well. They attempted to get my statement of what happened, but Kendall was being strapped onto a board and moved to the “hospital” so I left before the officer could take my statement. For my fellow UofL Medical graduates this would have been an automatic Room 9 all hands on deck trauma. For the non UofL medical crowd that means a serious trauma, and a vehicle runover with a heel detachment and other unknown potential sustained injuries would definitely qualify.

In the realm of Zimbabwe, this was treated with about the same urgency of the common cold. Kendall was wheeled into a standard ward room in this 4 bed hospital. From the time we arrived to the “hospital” it took about 5 minutes before we saw a physician, meanwhile, Kendall is writhing in pain from the trauma.

The moment we finally saw the physician I told him we needed to call for a stat medevac NOW. He stated “Well, before we call for transport, we need to get some X-rays. We need to know whats broken.” I vehemently argue that we need to call NOW, and we cannot treat this here as it will require extensive repair. What bones are broken makes no difference. His response was “First, we get X-rays.” in his heavy African accent. I cannot describe my frustration at this point.

My frustration only grew when I found out there is no X-ray machine in this “hospital.” So we have to reload Kendall into the “ambulance” and take her across town to the clinic with an X-ray machine further delaying evacuation.

Also, of note, for the medical professionals out there, upon admission to the hospital they never took her vitals. They never listened to her with a stethoscope. There was no IV placed. There were no labs of any kind including a CBC despite her blood loss. They did not check her glucose. They also never asked about her past medical history or what other meds she was on at this time. They did ask about allergies though. So I give them credit for that. The only treatment they did at this time was give her shot of Demerol, which is an very mild opiate for pain, and replace the bandage that was placed in the field, as it was starting to get soaked in blood.

Impressively, there was no active bleeding despite the injury, so I knew we missed injuring any major blood vessels, but there was some very significant oozing from all over her body. Kendall also began to have some nausea from her pain meds, causing her to vomit. There were no emesis basins at this “hospital” but we manage to scrounge up a trash can. Other things missing from this hospital was any kind of bedside monitor, towels, vending machine for food or drinks, and an ice machine. To get ice, they poured water into a plastic bag (not even an ice tray), froze it, dumped it out and crushed it manually. This does not effect patient care but just something I found interesting.

After about an hour at this “hospital” we finally reload Kendall into the “ambulance” and start to pull out. As we are leaving, my parents, Zack and Lucy pull up in a car. Keep in mind, I have no cell service in Zimbabwe so I have been unable to communicate with anyone since this began. As far as they know she could have been dead at this point. I told the “ambulance” to stop, and opened a window and told my family she was alive and she was going to live, but severely injured and we were going to get X-rays. I very quickly gave them Kendall’s parents numbers so they could attempt to contact them.

12:00PM – 2:00PM

Once we start driving the requests for payment started. Having traveled extensively, I am more than well aware of the cash based nature of third world healthcare systems, but this was the first time I have ever encountered this in a true emergency. The EMT in the ambulance then told me it is $20 USD per transport, and that I owed $40 USD in cash at this point (Zimbabwe uses both US Dollars and South African Rands). I said that was fine. He repeatedly emphasized I owed $40 dollars. I told him no worries I’d pay but just not right now as I am trying to attend to Kendall as she is about to vomit again.

After about a 5 minute drive where every bump was causing Kendall excruciating pain we arrive at the clinic with an X-ray machine. We unloaded her and brought her to the X-ray room. Upon arrival, I am immediately escorted to the reception desk so I can fill out some forms and we can process my payment. They were shocked when they found that the other doctor ordered 8 X-rays. The reception person asked “Are you aware they ordered 8 X-rays? That is a lot? That will be $50 dollars an X-ray or $400 total.”

To this I responded, “That is fine. To be honest. I can’t believe it’s not more.”

“Ok, I need you to pay now.”

I responded, “Sure, here’s my card.”

“I’m sorry sir. We don’t take swipe.”

“Well. I don’t have $400 on me. There’s no way I can pay you. I can either pay you with a credit card, or you can send me a bill and I’ll pay you later.”

This argument over payment continued for about 15 minutes with me repeatedly stating I would be more than happy to pay with a card or they can send me a bill, but he insisted on cash payment stating his card machine was down.

At this point the police officer caught up to me and interrupted our conversation. I proceeded to give my statement, and she gave me a paper that she expressly wanted a GOVERNMENT PHYSICIAN to fill out and sign and not a private physician about the nature of Kendall’s injuries. Not sure why, but I suspect something fishy was going on.

I then went back to attend to Kendall and see how the X-rays were going, or should I say NOT GOING. Twenty minutes after arrival she was still in the stretcher as we were waiting for an X-ray tech to arrive from home to do the X-rays. In the meantime, Kendall was still continuing to vomit the entire time and again there are no emesis basins available and we had to just find a nearby trash can.

Ten minutes later the tech sauntered in and looked at the order sheet and again couldn’t believe Kendall had 8 X-rays ordered. I again emphasized that I was aware of the number and cost and we needed ALL of them done. So they proceeded to move Kendall to the X-ray table and begin the process.

Well, again there is a complete lack of expediency in Zimbabwe. It took about an hour and 15 minutes for them do 8 X-rays. This was even with me donning some lead, which are the gowns techs wear to protect themselves from radiation, and assisting them so we could speed this up. Kendall could have had an MRI done in that amount of time.

During the X-rays, blood on Kendall’s bandage on her foot began soaking through, and began to drip onto the table. We also now noticed a laceration on her left elbow that was missed at the “hospital” which was also dripping blood. This clinic, however, did not have any bandages. To get around this problem they unwrapped the blood soaked bandage on her foot, took the same bandage, and then rewrapped her foot with the less blood soaked side. They also then proceeded to cut off a piece of the less blood soaked part and wrap her left elbow with it. There are no words. That’s recycling for you.

After each film was developed, they threw the film on the lightboard so I could see it. I was astonished that film after film that I read, I did not see any fractures. I almost couldn’t believe my eyes. How could Kendall have been run over and have no fractures, yet have her heel ripped off her foot? Is that even possible?!! It’s a miracle as at this point I was assuming she was going to have more hardware than Home Depot installed into her lower torso.

Finally, after about 2 hours we were done with the X-rays, and we loaded up into the “ambulance” to get back to the “hospital.” As we are about to leave, there is a knock on the “ambulance” door. It’s the reception guy again demanding payment. My patience is wearing thin as it’s been about 3 hours since Kendall was runover and all we’ve accomplished is her getting one shot of demerol, some blood soaked bandages and 8 X-rays. She is still on a board as the physician has not seen the xrays to clear her spine. In the US there’s a good chance she could have been in an OR already. At the bare minimum she would be at a Level 1 trauma center by now.

So we stop, as he demands payment before we leave and won’t let us leave until I pay. I again explain I don’t walk around with $400 USD in cash in my pocket. I tell him I only have a card. No cash. Suddenly his credit card machine is working. How convenient! So we stop the ambulance and delay care again, just so I can pay $400 dollars. For reasons unbeknownst to me this takes 15 minutes for him to run my card. I finally pay, and get in the “ambulance.”

As we are driving back the EMT again requests $40 dollars. Unlike $400 dollars I do have $40 so I hand him the cash in the back of the ambulance. We arrive back at the “hospital” at about 2:00 PM, which is now about 3 and a half hours since Kendall was run over. So now this is where things start to get real fun.

2:00PM – 4:15 PM

When we get back the doctor confirms what I already know in that through some miracle Kendall has no fractures. This does not change the fact that she has massive damage to her left foot. So he finally calls a medevac team, and the medevac representative comes to the hospital. This is not like in the US where a doctor calls for a transport and someone sends some insurance info and it just magically happens. This is more of a dance where there are two parties involved and they see if this is the right fit for you based on price, aircraft, timing, etc. He sees Kendall, I talk to him, and he talks to the doctor and we are all in agreement that Kendall needs be evacuated out as they clearly do not have the capabilities to fix this problem here. I know, shocking. We only knew this 3 and a half hours ago. So he says he needs to work on quotes for the evacuation cost to either Harare or Johannesburg and he’ll be back.

In the mean time, they finally obtain a set of vitals on Kendall for the first time since she had her accident, and through no surprise, her blood pressure is low likely due to blood loss, her temp is also 35.5 C and she is in shock. They finally start an IV and some fluids and give her another shot of demerol for pain and give her a blanket.

While we await a quote from the medevac company, the physician wants to irrigate and disinfect the wounds with saline and beta-dine and sew up Kendall’s laceration on her elbow. However, they have no drugs for concious sedation. I do not have to describe to you the sheer amount of pain that Kendall was going through during this, but I will anyway. This definitely felt like wartime field medic stuff at this point as we were holding her down while he irrigated the wound as best he could (which was awful as the surgeons at the accepting hospital were appalled at the dirtiness of the wound) and applied beta-dine to it. The only difference is at least a field medic would have some morphine on hand, whereas Kendall has one shot of Demerol in her system which might as well have been nothing.

At this point, Kendall, was basically tucked in as there is really nothing more they can do for her here, other than pain control. So the first medevac guy comes back at about 2:30pm and tells us the prices for the evacuation which must all be paid up front before they can schedule the medevac. It will be $5500 USD to Harare and $11000 USD to Johannesburg. I ask the attending physician where the best doctors are at and he states “Joburg, definitely.” I figured as much as South Africa has always been on the cutting edge of medicine with many medical advances, including the first heart transplant, and more recently the uncovering of the infamous Omicron. Cost is not an issue as we always travel with travel insurance so this is will all be paid in full when we file a claim at the end so cost thankfully does not play a part in the decision making process.

So I tell the guy, “We’ll go to Joburg. Let’s pay and go.” He then tells me they only take wire transfer. Keep in mind today is Sunday. All the banks are closed in the US. To make matters worse, Monday is the Juneteenth observed holiday. The banks won’t open until Tuesday at 3:00PM Victoria Falls time. That is 48 hours from now. We tell him, this is just not possible. We cannot move that amount of money on a Sunday. I can pay with my credit card, but I can’t wire transfer money on a Sunday. He then refuses the transport. The physician then tells us he will call the other company in town. Meanwhile, I start wondering if all these delays in care will cost Kendall some of her some function of her left foot or lead to amputation.

I find a quick moment now to ask the nurse about wifi in the hospital. Unfortunately, the wifi at the hospital is only good at the other end of the building and I can’t get wifi at Kendall’s bedside, so if I want to be able to communicate with people I can’t do it while attending to Kendall. I get the wifi code and now for the first time since this happened and I am now able to contact my parents to give them updates at the expense of leaving Kendall’s side. I am also finally able to make some very brief FaceTime audio calls to Kendall’s family but unfortunately due to the lack of wifi at her bedside she can’t talk to anyone.

Immediately after I get done talking to Kendall’s mom, I now have the receptionist at the current “hospital” hawking me for $760 dollars for the care they have given Kendall so far. I really question if the “care” was worth that much given the poor care she was receiving, but I say, “Ok. Here’s my credit card.”

Not shockingly at this point, they also do not accept credit card here. Their card readers are broken. I tell him, “I’m sorry, I simply do not carry $760 dollars cash on hand everday. I don’t think anyone typically carries $760 in cash every day.”

He then proceeds to ask me why I can’t just pull it out of the ATM. I tell him US banks typically have a $400 limit per day maximum that you can pull out of the ATM machines. He does not believe me, and then tells me he will drive me to the ATM machine to pull out the money. I tell him that I can only get up to $400.

So now I have a guy demanding I to go to an ATM machine while Kendall continues to be left alone in a foreign “hospital” in massive pain. The last thing I want to think about right now is pulling money out of an ATM. The frustration just continues to mount.

While I was arguing with this guy about payment the new medevac team shows up. They tell me they do take credit card and as a bonus I am also allowed to fly with Kendall. I say, “Great! Get me a quote. I want to get her moved as fast as possible.” At this point it’s about 3:00PM and about 4.5 hours since the accident. They leave to go back to their office to assemble a quote and get the paperwork started, as this medevac crosses country borders and requires more paperwork than a domestic medevac.

The moment I get done talking with the new medevac team the receptionist guy immediately approaches me again asking to pay my current hospital bill and he will drive me to an ATM machine. So he drives me to the ATM machine and I show him that I can only get a maximum of $400 as the machine rejects any amount over that. At this point he continues to harass me for the rest of payment. My only option for getting more cash is my family who is traveling with some cash as well and I also have a little bit more cash at the lodge. He then proceeds to drive me to our lodge so that I can get more money from my parents and from the cash in the in-room safe. Between me and my parents we are able to scrounge up $760 and pay off the current bill so we can continue to receive “care” at the “hospital”. As I am leaving the lodge the medevac team shows up as they were told I was there so they can my obtain our passport and vaccine card information to get the international medevac approved.

I then get back to the “hospital” and have the first bit of downtime all day as I await the medevac quote. As I sat next to Kendall, I tried to remain optimistic and calm while talking to Kendall, and at the same time continue wondering if all this delay in care will result in permanent loss of function in her foot given the extensive damage. In the mean time, I desperately try to keep the flies off her as they kept trying to feast on her wounds as she’s in too much pain to really care.

After 5 min of peace and quiet in which someone was not asking for money, at about 3:30pm the medevac team comes back with a quote of about 273,000 Rand which is about $17,200 for the transport to Joburg. This is $6,000 more than the the other company but they take credit card so I really don’t care. This company is based out of Harare, so everything they do has to be approved through their home base including payment. I say “Great. Let me pay and let’s go.”

They now have to get final approval and a link for payment sent from their home office. About 15 minutes later they get the link. I am elated. FINALLY we will get Kendall moved. I leave Kendall’s bedside so I can get wifi so they can forward me the link for payment. I get the link, and I try to pay with my credit card only to be blocked due a requirement for a 6 digit number sent to my cell number for authorization.

My heart sinks again. I have no cell reception here in Zimbabwe for my phone and have no way to get that number. I try my backup credit card and it’s the same thing as they are both Capital One cards. I tell them the issue, and they state they HAVE to have payment before they can schedule the transport. I told him I have to make an international phone call then to try and get the purchase approved by Capital One. I go to the reception desk at the “hospital“ and ask if I can use their phone to make an international call and they say “no.”

4:15PM – 6:00PM

At this point they offered to take me to their office and allow me to make an international phone call from there to my bank. So we then go to their office and I call Capital One. At this point it is 4:15PM and they informed me that the airport in Victoria Falls closes at 6:00PM and if payment is not made by then the earliest we can get Kendall out will be on a flight at 6:00AM tomorrow. This is not acceptable to me. So now I have an hour and 45 minutes to try and make a payment so we can potentially get out today.

I spend the next 45 minutes on the phone with Capital One. There are multiple ways to approve payment but none will work as I do not have a cell connection and because today of all days the Capital One app server is down so they cannot verify my identity through the app. I eventually get to upper management on the phone and they finally approve the purchase by using other means to verify my identity. They stated that they have approved the payment and there are no blockages on their end to this payment but for reasons unknown to anyone I cannot get a payment through despite ample credit. It is now 5:00 PM and the clock is ticking to get Kendall out today. The payment just won’t go through.

I then decide to go to the lodge where my parents and kids are at and start trying their credit cards. My mother has cell reception here with her carrier and can receieve verification txts and can make international phone calls so she should be able to verify a purchase. So she tries her card and she gets the 6 digit verification code. THANK GOD I think. We are FINALLY gonna make a payment. Sadly, when she types in the code the payment is still for some reason denied. My heart dies again. She proceeds to spend 45 minutes on the phone with Capital One in an attempt to get her card to go through. They state there is nothing blocking the transaction on their end and they don’t know why it won’t go through.

At this point, we are down to the last 15 minutes before we lose our chance to evacuate Kendall today, and realize we aren’t going to be able to make a payment at this time. We begin to just flat out beg them like a 5 year old wanting a new toy to take her as we are just out of options.

“Please, please, please take her,” we pleaded. We were practically on our knees at this point. We again show them we have travel insurance (they were shown the policy and coverages long ago) as proof they would for sure get paid. I offered my camera equipment, which is very expensive, as collateral, if we didn’t pay. We also begged them out of the goodness of their heart to take her, but they refused to budge.

The clock struck midnight and Kendall was screwed for today and I just wanted to cry. Yet another delay. I had no way to contact Kendall throughout all of this as she has no wifi at that end of the hospital so she was laying there having no clue as to what was going on. The lodge was very nice and was able to place a phone call to hospital, but since there are no phones in the rooms in the hospital I was unable to call Kendall but could at least give a message to the reception to relay to Kendall that we were not leaving today. I felt like a complete and utter failure at this point.

6:00PM – 9:30PM

However, we still had a chance to get her out by 6:00AM tomorrow. So we now made that our new goal. With a renewed sense of purpose we got our second wind and pulled ourselves off the mat. For the next hour my mom and I sat in the lobby of the hotel with the medevac team and continued to work on figuring out why their end would not accept our payments. We wondered if it was because there was a limit on how much their system would take so we had them brake down the payments into smaller amounts. That failed. They stated each link only works for one specific person and card so we had new links sent. That failed. We tried running them in USD as the currency. That failed. We also suggest manually running it via swipe or chip, but strangely enough the home office refused to take the swipe or chip form of payment. They only wanted us to pay with links. The medevac team eventually had to leave for another job at 7:30pm, but stated they’d continue to be in touch as we continued to attempt payment.

At this point I gathered some clothes and belongings so I could spend the night at the hospital with Kendall. I hitched a ride from the medevac team back to the “hospital” to spend the night with Kendall. For all the “hospitals” faults, since there was no one in the other bed in her room they allowed me to sleep in it. In the meantime, we had now recruited Kendall’s mother as well to try and make a payment. Unfortunately, all of her cards were blocked as well.

I am then again approached by the receptionist demanding payment for the $260 dollars of further bills we have incurred tonight and possibly more based on the meds she receives overnight. I tell her I have maxed out my ATM withdrawals for the day, and that I will be unable to pay anymore today and I will need to find a way to scrounge up another $260 dollars. I then call my mom asking if they have any cash left as I am down to my last $156 dollars. Thankfully, she has $200 still and will drop it off in the AM before they leave for that morning’s safari with the kids.

It was quickly sinking in that credit card payment might not be an option and we would need to make a wire transfer somehow. How can we possibly make a wire transfer if the US banks are closed till Tuesday, and it’s still 2pm on a Sunday at home? If only we could travel forward in time. Then it hit me. The Philippines is ahead on time. They are ahead of Victoria Falls by six hours so if it is 9AM in the Philippines, it is 3AM in Victoria Falls. So we started calling my family in the Philippines so they could make a wire transfer first thing in the morning when the banks open Kendall could get moved ASAP. We woke up one of my aunts at 2AM Philippine time so they could be ready to transmit the money as soon as humanly possible.

Given things have slowed down for a second while our other relatives tried to make payment, Zack and Lucy, my brother and dad had time for a quick visit to the “hospital.” I felt it was really important for them to see that Mom was ok before she left as the last time they saw her she was being loaded into an “ambulance.” Lucy was of course upset about leaving Momma and Papa behind, and we were very sad to say goodbye as well, but it helped to know they would be well taken care of by my parents and brother and would be having fun continuing on the safari in Botswana.

In the meantime, Kendall‘s aunts and uncles who were vacationing with her mom were frantically calling their banks and trying their credit cards to try and get the payment through. Thankfully, at around 9:30 PM another miracle occurred, and it was not the first of the day.

I get a text that Uncle Johnny, one of Kendall’s uncles, had his card go through and payment was made. They send the receipt to my email and I cry tears of joy when I see it. I immediately forward the receipt to the med evac company. So now we FINALLY had everything in place to get Kendall the care she needs so desperately.

9:30PM – 1:00AM

I then call for a taxi to get some final items from the lodge including some Zofran (a very strong antiemetic) for Kendall that I have in my bag as the “hospital” here does not have any and the phenergan they have been giving her for nausea has been doing nothing to help. I tell my parents to pack the Zofran and also a towel, as the hospital has no towels if you want to take a shower, and a charging cable. I get to the lodge and as I walk to our room, God continues to taunt me about our now ruined vacation, as I see an elephant outside of our room. I then pick up my stuff and get back to the taxi and go back to the “hospital.”

For the first time today I actually have a small feeling of optimism. We were gonna get out at 6:00AM and FINALLY get Kendall the care and surgery she needed so badly. However, in the famous words of Lee Corso, “NOT SO FAST MY FRIEND!”

9:30PM – 5:00AM

So after I send the medevac team the receipt that the payment is through and to schedule the flight, everything in theory was good. However, about 30 minutes later they tell me that there is actually ONE MORE thing they need to have to get the flight approved. The receiving physician at the accepting hospital needs to write a letter of acceptance on a hospital letterhead and earlier today he only sent it as an email. Without this letterhead letter we cannot be approved for medevac transport to South Africa.

I then hound the physician in our “hospital” to call the other hospital to make sure they send that letter ASAP so we can fly out at 6AM. After harassing the physician at our hospital, repeatedly he eventually states that everything has been done and we should be good to go and that the physician on the other end has completed the letter.

However, when speaking with the medevac team they state that the letter still has not been sent. Apparently, the physician here likely just lied to me to get me to shut up. They tell me to contact their boss, and give me their bosses number. I attempt to contact the boss that night so she will schedule the flight but I get no responses.

At this point I am beyond frustrated as we moved mountains to get the payment, but now we have one more obstacle and I really start to question if Kendall will get out at 6 AM. It is 1AM and there is absolutely nothing more I can do to try and expedite this process. I attempt to sleep, but that fails as all I can think about is whether these delays will potentially cost Kendall function in her foot, or in the worst case amputation. If she loses her foot because we couldn’t get a credit card payment through fast enough I will never forgive myself.

Kendall has continued to be nauseous vomiting every 1-2 hours from her pain meds as unfortunately the Zofran was not in the bag I picked up from the lodge. To further complicate matters the mosquitoes were absolutely insufferable and were eating both of us alive through the night. At around 5 AM I finally get a text from the medevac boss, stating that the physician who needs to write the letter will not be in until 8 AM to write it. At this point I just want to die. NOTHING, ABSOLUTELY NOTHING will go our way.

At about 6AM my family comes by one last time before they are off on a safari for the day and drop off some money and finally get me the Zofran. I get Kendall some Zofran which finally helps her vomitting. And she is able to fall asleep for a little bit.

However, As if on cue, the receptionist comes around again asking for $330 now, up from $260, due to the extra meds Kendall received overnight. Kendall has continued to be in 8-9/10 pain despite our best effort to control the pain with them giving her Demerol shots every 4 hours. So these payments do not exactly make me feel great. I honestly don’t know what I’m paying for.

6:00AM – 2:00PM

FINALLY at 8:32AM I finally get the text message I had been waiting 22 hours to see.

“Team now proceeding to the airport”

Then followed by:

“The Harare one”

My heart sunk one more time. They never mentioned the team had to take off from Harare and then fly to Victoria Falls. All along they made it sound like the team was waiting at the Victoria Falls airport. The team from Harare has a current ETA of 11:05AM.

Kendall continues to be in massive pain, but is trying to time her last dose of pain meds right before she has to begin the evac. However, she holds off as long as she can and at 9:50AM finally asks for meds as the team will arrive at 10:30AM to pick us up. The nurse goes to ask the doctor, and eventually he comes back at 10:10AM stating she got her last dose at 6:20AM and the doctor doesn’t want her to get her next dose till 10:20AM as it is supposed to be every 4 hours for the opiate so she can’t get it for another 10 minutes. He then suggests Tylenol.

At this point I had just had it. I very sternly but politely said, “Her left heel is currently dangling off her foot. Tylenol just isn’t gonna cut it. I am a neonatologist. I give babies Q2H morphine for pain and they do just fine. 10 minutes is not gonna make or break us here.”

He gave the med.

Shortly there after the medevac team arrived and we loaded Kendall into the ambulance. Given this was the medevac team ambulance, it actually looked and felt like a real ambulance. They had things like IV fluids, code drugs, a defibrillator and oxygen. I immediately felt better.

We arrived at the airport and I have to split off from Kendall as security escorted me through immigration and security but Kendall just rode the ambulance straight to the tarmac. I rejoined Kendall on the tarmac. We beat the plane there and waited about five minutes for it to land. As the plane pulled up to us on the tarmac I started having flashbacks to my air transport days as a neonatal fellow as they were flying a Beechcraft aircraft as well.

They loaded Kendall onto the aircraft, and the captain gave me a quick safety briefing and off we went into the wild blue yonder. The Beechcraft was actually pretty nice. Definitely nicer than the transport planes I used to ride in.

I looked out the window and saw Victoria Falls and I bid thee farewell. A feeling of relief began to wash over me as we started our ascent. However, there was still some lingering angst as our journey was not yet quite complete. There was one last hurdle and that was for payment of Kendall’s admission at the Johannesburg hospital, Netcare Milpark.

2:00PM – 6:00PM.

We landed at the smaller Lanseria Johannesburg airport, and not O.R. Tambo where the commercial airlines land. I go through immigration for the both of us and meet back up with the ambulance. We then took a 40 minute drive to Netcare Milpark, a level 1 trauma center. We arrived at about 3:00PM and I had never felt more relief in my life. The hospital looked and felt like a normal western hospital. It was actually nicer than the hospital I work at to be honest. I immediately looked at Kendall and said, “Kendall, it’s a real hospital. You’re gonna be ok.” 28 hours later we were at the promised land.

They whisked her to the ED where no visitors are allowed and they took me to registration. While waiting for a registrar to free up I try to log onto wifi as I haven’t had wifi since we left at 10:30AM and needed to send people updates. Well, yet another snag. To get wifi, I have to have a working cellphone to accept a confirmation text. So basically I need internet to get internet. That was useless.

So a registrar opens up, and I was bracing for the fun of making one more payment. They asked if I received an estimate for treatment costs already as I should have, which I had not. So the physician now would have to come up with an estimate quickly so I could make payment and get Kendall a room. While they awaited the estimate, I did talk to a plastic surgeon who saw Kendall. He immediately wanted to take Kendall to “theater”, which is what they call the OR in South Africa. He was unsurprisingly thoroughly appalled at the treatment Kendall received at the previous “hospital.” While they awaited a surgery slot in “theater” they did irrigate Kendall’s wound UNDER SEDATION this time in the emergency department. They could not believe the condition it was in and how dirty it was and were very concerned about infection. Also to add insult to injury, Kendall is covid positive on admission. She is completely asymptomatic.

While I was in the waiting room, I was approached by registration stating my estimate was ready. I see the amount of 600,000 rands, which translates to about $38,000 dollars. I tell them once again, sounds good and ask if they take credit card. And thankfully, without a second thought, they say, “Absolutely.”

I’ve been down this path before, but I hope to God this goes better as they won’t book Kendall a bed or OR time without payment. My heart is racing as I can’t imagine being this close to care and being denied. I can’t bear telling Kendall we were delayed one more time despite the fact Kendall has through all of this maintained complete calm and composure. I honestly don’t know how she has been able to be so composed despite all the pain. She’s a stronger person than I.

I insert my main credit card and it gets denied. My heart sinks. I say a quick prayer before I try my backup card which I can tap. They try it on the machine and it says “error” which is different from a denial. I about die. They tell me that sometimes happens and that they’ll try a different machine and maybe it’ll go through. At this point I am completely out of backup plans. I currently have no wifi to confirm any transactions and no way to call anyone to try anyone else’s cards. This is it. If it doesn’t go through we are hosed. They tap it on the second machine. We wait for what feels like an eternity and then I suddenly hear the sound of a receipt printing. I immediately drop my head to the desk and and I cry tears of joy. I felt the weight of the world taken off my shoulder. Kendall is FINALLY going to get the care she needs. I can finally breath.

While I know it’s still a very long road ahead, every journey begins with a single step and this was that step. A journey that was caused by one small mistake made a world away. Contact solution. Of all the things. Contact solution.