Volume 2, Number 1, Winter 2000 - Summer 2001

A Student's Response to Injury and Medical Evacuation from Abroad to the US

by Rebecca Orozco

I am a recent graduate with a Bachelor's Degree in Psychology and Spanish from the University of Southern California. As a sophomore, I was a Residential Advisor for forty students, and I was also very involved with several campus organizations. The summer following my sophomore year, I took part in a study abroad program in Madrid, Spain.

Traveling and studying abroad was truly one of the best experiences of my life. Being immersed in Madrid's Spanish culture was fulfilling, both socially and academically. Each day I found myself taken with the arts and historic heritage that surrounded me. Whether gazing at the city from the balcony of Amelia and Enrique'spiso, or flat, where I resided, or perusing the incredible paintings at the famous Prado Museum, my days were filled with excitement and wonder. The richness of the Spanish culture truly contrasted with the newness of the United States.

The professors of the program served as dynamic catalysts in making it all come alive, from the textbooks to the streets and countryside. This was facilitated through their extensive knowledge of the culture and years of experience as citizens in Spain. The curriculum was challenging but was continually reinforced through the surroundings. I especially appreciated the depth of literature selected for my class. It was very meaningful and helped me to relate more to the people of Spain as I learned of their past and present hardships.

In addition to this tremendous learning, it was a pleasure to interact with the Spanish people on a daily basis and to use the language out of necessity. Exploring the city, via metro, bus or on foot, always required interaction with the natives. Even getting a scoop of ice cream was a learning experience. I did not know, for example, that a scoop was called abolaand, when attempting to order, received a full explanation from the cashier behind the counter. One sweet memory I treasure is of the woman with whom I lived. She only knew one English word, "lamb," which she pronounced "lam-bee." When she attempted to ask me if I would like to eat that for dinner, I did not have a clue as to what she was referring. When we finally understood our error, we just laughed and laughed. Speaking only Spanish in the home, especially around the dinner table, was very helpful in expanding my vocabulary and also taught me more colloquial terms.

Unfortunately, my pleasure turned to pain quite unexpectedly on June 28th, 1997. It was Saturday afternoon, the last weekend before my class finals, and I was on my way to El Prado Museum. My classmate Jessica and I had just headed off in different directions as we neared the corner of el Paseo de la Castellana and Calle Pedro Texeira. I was crossing the two-lane frontage road when an automobile struck me.

I remember what happened very clearly. I heard the car and was filled with panic just before it hit. I felt an enormous blow to my left side. I saw the glass as my body broke the windshield and then my view alternated between ground and sky as I flew through the air. It was the day of the Seville versus Barcelona soccer championship game, and the streets were filled. Immediately after I landed, people wearing soccer jerseys and scarves surrounded me. Two women, who identified themselves as doctors, approached me and started to ask questions. Luckily, my memory of Spanish anatomy vocabulary did not fail me, and I was able to tell them exactly where it hurt: my left elbow, back, left knee, and hips.

My friend Jessica phoned the police and ambulance in a nearby restaurant, and the paramedics arrived within minutes. I was taken to La Paz Hospital, where a doctor examined me. I also had various x-rays taken of my abdomen and extremities. After giving an account of my accident to a policewoman, I was given medication and informed of my injuries. I had fractured my twelfth thoracic vertebra and my pelvis in two places and shattered and dislocated my left elbow. Also, because of language difficulties, there was a traumatic misunderstanding, when my doctor tried to explain my injuries to me in English. He said that I would be paralyzed when he actually meant to say that I could have been paralyzed if the crack in my vertebra had been more severe.

I spent the next nine days in the traumatology unit of La Paz. There, I learned some more necessary vocabulary.Cuñameans bedpan andcalmanteis a painkiller. Being flat on my back, I was pretty helpless and very dependent on my friends and the nurses to do everything for me, including use of the bedpan and feeding me. Personal grooming and modesty were out of the question. My doctor said that my elbow needed surgery as soon as possible and that I should be transported very quickly back to the United States. While I was in bed, there was a great deal of nightmarish activity going on back home in Fresno, California, of which I was virtually unaware.

Basically, my parents were in a major dispute with our insurance company. Before leaving the United States, the Health Management Organization (HMO) assured us that their policy met all of the requirements needed for me to be involved in the University Summer Program in Madrid, including medical transport if it were deemed necessary. However, when called upon, the HMO dropped the ball. They were definitely out of their league when handling a situation of this nature.

The business personnel in charge of my case only looked at the money involved and did not want to bring me home for that reason alone. Finances were their top priority and my well-being was second. Of course, this attitude was unacceptable to my family, since I would be totally alone in a foreign country where the medical standards were not comparable to those of the United States. For example, during my time in La Paz, I was never monitored or connected to an IV and was forced to use a bedpan in place of a catheter, which is standard procedure in the U.S. Additionally, I had to have a blood transfusion in preparation for my return flight, because the insurance company had allowed so much time to pass before making a decision and then continued bungling attempts for arranging my transport.

The decision to transport me back to the United States only came after my parents had made every connection they could (friends, lawyers, state senators, and finally the Secretary of State of California). My mother later told me that my parents did not sleep for the entire time that I was in the hospital in Madrid. Most of their time was spent arguing and pleading in the personnel office of the HMO and, the rest of the time, they were either talking on the phone or waiting for a call. Because of the time difference, they were forced to make and receive calls in the middle of the night.

After hours of listening to my parents and others plead on my behalf, the people dealing with my case at the HMO realized that they had made a monumental error. They had even canceled a scheduled surgery for me in Spain, because they did not want to guarantee payment to the hospital there. As a result of this, a portion of my shattered elbow bone was dead by the time I finally got back to Fresno for the surgery. It is currently held in place now by a metal rod that will remain for the rest of my life unless the dead bone piece deteriorates... This was definitely a parent's worst nightmare.

Studying abroad can, however, be an incredible experience, which is both fun and educational. Through my experience, I learned that several precautions must be taken. As a word of advice, parents and students alike, should be sure to do the following things, just in case the unexpected should happen.

When traveling abroad:

• Know the emergency numbers in the city where you're staying: Police, Ambulance, Embassy, Residence, Program Director.
• Carry proper identification with you at all times.
• Carry proof of insurance with you at all times.
• Buy full insurance coverage that includes medical transport from a foreign country.
• Know exactly what your insurance covers.
• Buy an International Student Identification Card and carry it with you at all times.
• Parents should have current passports in case they must come quickly due to an emergency.
• Have a full understanding of where to solicit help, financially and legally.

The aforementioned items are all practical precautions that I now know are necessary ingredients of safe traveling. However, my experience also gave me other insights as well. I realize that bad things can happen to good people. It does not mean that anyone or anything is necessarily to blame. My accident helped me to understand that I am human and fragile. I realize that it could have happened to anyone. Because this is true, I believe any student who makes the decision to travel abroad should have a clear understanding that, in the event of an accident, the student, along with his or her family, must be prepared and know their resources. I discovered that it was impossible to rely fully on my university to take care of me. The summer program director, along with my university, could only assist to a certain extent and the majority of the responsibility fell on the shoulders of my parents and myself.

All in all, the learning that takes place during a study abroad program is incomparable. If I were to be given the opportunity to participate further, I am sure that I would do so. I thoroughly enjoyed my stay in Spain before the accident occurred and was amazed at the amount of information I could learn so quickly through total immersion in the culture. In retrospect, I see that is very easy to make the decision to study abroad, but it takes time to familiarize yourself with the resources available to you, along with the laws and emergency systems of the country to which you are traveling. Using extreme caution and thorough preparation is essential to having a great experience overseas.

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Rebecca A. Orozco is a recent graduate of the University of Southern California in Los Angeles. She earned a Bachelor's degree, majoring in Psychology and Spanish and hopes to attain her Master's Degree in Physical Therapy after graduation. She enjoys reading, dancing, exercising, and spending quality time with good friends.