Compass Point - Healthcare: Emotional cost of overseas health care
Caymanian Compass, November 10, 2011
Travelling off island for medical attention can be costly, stressful and time-consuming. But every year, hundreds of people in the Cayman Islands find themselves with no choice but to do so.
Between July 2010 and June 2011, the Overseas Referral Office at the Health Services Authority, which handles most of the cases referred off island for medical care, processed more than 1,500 cases.
While insurance companies pick up the bill for much of the medical costs involved, patients and their families usually pay for their own travel, transportation and hotel costs and also pay the emotional cost of being away from home during one of the most stressful and vulnerable times of their lives.
Ina Bogdan is one such case.
The 27-year-old was diagnosed in July 2010 with a cancerous tumour on her right ovary. A few months later, another cancerous growth was found on her left ovary. In February, doctors told her she also had lung cancer and gave her nine months to live.
Now, flying to Miami repeatedly for six surgeries, 15 chemotherapy sessions and countless tests and check-ups, she has been given the all-clear and nine months after that terrifying prognosis, she will be walking down a wedding aisle this month as a bride.
For the foreseeable future, she will also be returning to Miami every three months for further checks.
“I’ve been going through this for the past 15 months,” Ms Bogdan said. “Every week or every other week, I was flying to Miami.”
Her ovarian cancer was discovered during a laparoscopy in Cayman to remove what doctors thought was an ovarian cyst. Once the cancer was discovered, her doctor said she needed to be treated immediately, within the next day, if possible. Ms Bogdan, from Romania, did not have a US visa, so instead flew to Jamaica for medical help.
“I had to do everything according to the insurance company’s rules. They said I had to go see a particular doctor. I went to that doctor, but he wouldn’t do anything. So they sent me to see another one. The same thing. Every doctor I saw passed me from one to the other, saying they wouldn’t do it or they’d never seen anything like it.
“Can you imagine? You just find out one day before that you have cancer and now you see all these doctors and they won’t do anything,” she said.
She stayed in Jamaica for three days, still trying to find a doctor who would treat her, but when her US visa came through, she and her fiancé Avi Avraham boarded a flight straight to Miami.
Things did not go smoothly there either for the newly diagnosed and scared cancer patient.
“Because of the insurance, I couldn’t do everything in one place. For example, I was supposed to get a scan. They accepted to do the surgery at Baptist Hospital, but they were not allowed to do the scans in that facility. I was supposed to go two hours away for a scan, then another two hours in the other side of the place for the lab test. For every single small thing, I was supposed to go in a different direction and wait if the insurance approved it or not,” she said.
While getting chemotherapy, she would fly to Miami around noon, get to the hospital within half an hour, undergo chemo for five hours and then return to the airport to fly home that evening.
“After the chemo, you start to feel very bad in the next 24 hours. You just want to be home in your own place, in your own bed,” Ms Bogdan said.
During her surgeries, she stayed in Miami. She said she’s one of the lucky ones, as a contact through her company let her and her fiancé or her sister stay in a home in Miami so she did not have to stay in a hotel.
Her insurance covered $500 for air travel expenses. “That paid for one flight,” Ms Bogdan said.
This September, she underwent her fifth and sixth surgery within one week. Doctors thought she already had Stage 4 lung cancer and operated on her lungs first. However, when she woke up from surgery, she got her first good news – she did not have lung cancer. A week later, she had surgery to remove a 5 centimetre (2 inches) and growing mass on her left ovary.
“I woke up to see my sister Ramona crying all over me. I was still under anaesthesia. I asked what happened and she said ‘you’re cancer free and you still have your ovary!’. She knew this was very important to me,” Ms Bogdan said.
The surgeon had removed the growth and half her ovary. She said with half an ovary, she can still have children, something she has dreamed about since she was a little girl.
In another case, the mother of a 22-year-old college student who goes to school in Miami, has found herself flying to the US from Cayman every month so she can be there while her daughter undergoes therapies to combat her cancer.
The mother, who asked not to be named, said her daughter first discovered a lump in her breast more than a year before she was diagnosed with cancer. Then, last year, pains in her back for which she was getting treatment from a chiropractor, eventually led to her seeking medical attention. After an ultrasound, MRI and blood tests, biopsy showed she had stage 4 cancer. It was breast cancer than had spread to her bones, in her spine and hip, but not to any organs.
“They said it was controllable,” the mother said.
Her daughter underwent radiation treatment and needed to be driven the hour’s drive from her apartment to the hospital for the treatments, so her mother flew to Miami each time. The patient has completed the radiation treatments, but is still undergoing an intravenous treatment to build up calcium in her bones. She is taking Tamoxifen, a drug which has reduced the breast tumour size from more than 5 centimetres to just more than 1 centimetre, her mother said.
Her mother flies to Miami for each of the treatments, usually on a medical ticket on Cayman Airways. She said the fare is not much cheaper than a regular ticket, but people on those flights are usually guaranteed a seat.
She said the regular travelling and dealing with her child’s cancer has been stressful, but her workplace has been supportive about giving her the time off she needs to be with her daughter.
Like Ms Bogdan, the mother has been in touch with the Cancer Society, which has helped fund some of the flights to Miami.
The Cancer Society offers financial assistance to people who need help with their medical expenses.
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