Anatomy of a Maritime Medical Emergency
There seems to be an increasing amount shipping crossing the South Atlantic between the south eastern ports of South America, the Cape of Good Hope, and thence round to Indian Ocean ports and the far east.
Tristan has the only hospital in the long stretch between Uruguay and South Africa, and so it occasionally provides help with maritime medical emergencies, as far as its limited resources allow. We have reported briefly on these in the past, but a case that transpired during the Christmas 2024 period gives us an opportunity to go into more details about how Tristan handles such emergencies.
Accident on the high seas
On the 18th December 2024, the bulk carrier MV Yasa Dream was well into the South Atlantic leg of her voyage from Jingtang, China to Itaguai, Brazil when a crewman suffered a serious head injury due to an accident involving a heavy manhole cover. It was quickly apparent that the casualty would require hospital treatment.
The ship’s captain immediately contacted the management company, and they in turn contacted Tristan da Cunha for urgent medical assistance, sending a photograph of the injury. The ship’s position at that time was about 600nm north east of the island, making Tristan the closest land.
Dr Jorge Cury at Camogli Hospital promptly contacted the captain to acknowledge the call for assistance. His initial assessment from the picture was that the hospital should be able to treat such injuries, but warned that they could not provide neurosurgery care, CT or MRI scans (only X-rays). Also there was no Intensive Care Unit or ventilation treatment available for cases of severe brain injury or deep coma.
Dr Jorge asked for medical observations on the state of the patient, his medical history and details of first aid treatment received. The captain quickly provided this information, and Dr Jorge sent advice on further treatment while in transit to Tristan, which again, was promptly acted upon.
The next day, the captain reported on the patient’s condition and sent further photographs of the injury. These were enough for Dr Jorge to outline his proposed course of treatment in the hospital, which would require thorough cleaning and closure of the wound under anaesthetic.
In parallel with the exchange of medical information, the captain was in communication with the Administrator and the Immigration team to arrange disembarkation of the patient and his transfer to the hospital. The estimated time of arrival was mid-afternoon on the 20th December. The captain proposed to drop off the patient and continue on his voyage, but he was persuaded to wait for a few hours to hear the outcome of the full assessment and if necessary re-embark the patient for additional urgent treatment at their destination.
Arrival and Treatment in Tristan’s Camogli Hospital
It was fortunate that when the Yasa Dream arrived as expected off the harbour on the 20th December, the harbour was relatively calm. Otherwise, disembarkation may not have been possible. However, it was raining heavily, making visibility difficult and there was a heavy swell alongside the vessel. The Search and Rescue Team did a great job in difficult circumstances in bringing the injured crewman ashore in the RIB Atlantic Dawn to the waiting ambulance, which then took him to the hospital.
As it happened, the 20th December was also Break Up Day, when the whole island closes down for the three week Christmas and New Year break. However, the Search and Rescue crew of the Atlantic Dawn and the hospital staff willingly deferred their partying to deal with this emergency.
The patient had been advised to fast for eight hours prior to arrival, which meant that he could enter theatre in the shortest possible time. The procedure was completed successfully in one stage, and tests, including X-rays were all unremarkable. However, Dr Jorge strongly recommended further brain scans that could not be done on the island.
The patient recovered well, with an uneventful post-operative period and satisfactory reviews. He remained in the hospital for a couple of days and was then discharged to the care of one of the island’s guest houses.
Repatriation
Unfortunately, the Yasa Dream was not able to wait long enough to re-embark the patient. The captain and the management company had been informed of the difficulties of repatriation from Tristan. In this case it would have been a month before the next scheduled ship departed for Cape Town, and this was already fully booked with the Medevac island passengers. The ship’s management company was therefore asked to make alternative arrangements for the patient’s repatriation. Fortunately, a sister ship – the bulk carrier MV Yasa Unity – was en route between Bahia Blanca, Argentina and Jebel Ali, Dubai, and it was possible to divert her to Tristan to pick up the patient.
The Yasa Unity arrived off Tristan after dark on the 30th December. Harbour operations cannot be done safely at night, so the ship stood off until daylight. At 6:30 on the morning of the 31st December, the Atlantic Dawn was again launched, sea conditions being acceptable, and the patient was successfully transferred to the ship. We can be certain that the islanders ensured he had as good a Christmas as possible in the circumstances, and he departed with a wave and a smile.
It is important to point out that the 31st December 2024 turned out to be a day of mixed feelings for Tristan. Old Year’s Night is traditionally a day of festivity on Tristan, but apart from the early morning activity in the harbour, there was also the funeral later of a beloved elder islander, who had passed away the day before. The family had, however, graciously expressed the wish that the rest of the day should continue as usual.
Postscript
We are pleased that this maritime emergency seems to have ended well. The patient was picked up by a launch as the Yasa Unity passed Port Elizabeth/Gqeberha, South Africa on the 7th January 2025. After further medical checks, he was deemed fit to fly onwards to his home.
The Administrator and authorities on Tristan were grateful for the excellent communication between the ships, the company and our hospital, which made the rescue operation and recovery run smoothly.
© 2025, Tristan da Cunha Government & Tristan da Cunha Association (webmaster@tristandc.com). Reviewed: 2025-01-14
