It took 40 hours before Virginia Webb, bleeding, burned and suffering from 14 broken bones, including a fractured left elbow with the bone sticking through the skin, got any medical care.
Dangling by her seat belt in a van at the bottom of a ravine in Pakistan, she was too far away from any medical facility that could deal with the extent of her injuries.
The memories still bring her to tears 26 years later.
"The radiator was between the two front seats. The water boiled out and burned my right side and flank. My neck was broken in three places," she recalls. "I had a scalp laceration that nearly cut off the top of my head. My nose was broken. I had a compound fracture on my left elbow, seven broken ribs, five pelvic fractures and lots of cuts and contusions."
A photographer, Webb was living in a small town in Pakistan with her husband, a foreign service officer in the U.S. Embassy. She was returning from a photo shoot near the Pakistan/Afghanistan border when the driver of the van she was riding in fell asleep and drove off the side of a steep hill. The van flipped multiple times before coming to rest on its roof, Webb says.
"It was a tremendous day because I had taken a lot of wonderful pictures. We were on our way home," she says. "We stopped for lunch and then stopped in a tunnel to eat an apple. The next thing I remembered was waking up in Geneva, Switzerland, two weeks later."
By that time, she was in a coma and barely had a pulse. For the next two weeks, even in a well-equipped hospital, she was not treated for her injuries because the doctors thought she was going to die.
While Webb's experience is on the high side of horror, many Americans who travel overseas find themselves either injured or ill while in a foreign country. In some places, it's similar to being in the U.S.: hospitals are good and doctors are well-trained. But in Third-World nations -- and even some that aren't -- medical care is worse than sub-par. It can be deadly.
Injuries cause 23 percent of deaths of United States citizens while abroad, according to the U.S. Centers for Disease Control and Prevention. Contributing to the toll is travelers' exposure to unfamiliar and perhaps risky environments, differences in language and communications, less stringent product safety and vehicle standards, unfamiliar rules and regulations, a carefree holiday or vacation spirit that leads to more risk-taking behavior, and over-reliance on travel and tour operators to protect one's safety and security, the CDC notes.
From 2009 through 2011, an estimated 2,773 American citizens died from non-natural causes such as injuries and violence while in foreign countries (excluding deaths occurring in the wars in Iraq and Afghanistan), according to the CDC.
"Motor vehicle crashes - not crime or terrorism - are the No. 1 killer of healthy U.S. citizens living, working or traveling in foreign countries," the CDC website notes. "If a traveler is seriously injured, emergency care may not be available or acceptable by U.S. standards. Trauma centers capable of providing optimal care for serious injuries are uncommon outside urban areas in many foreign destinations."
If you're heading out of the country, whether it's to a luxurious international destination or a Third-World backwater, you might want to check out the "Pre-Travel Consultation Counseling & Advice for Travels" page on the CDC website (cdc.gov), which points out the hazards of traveling overseas and points out what - and where - they are.
When in Rome
Though medical treatment was available to Hildred Thompson when she fell and broke her femur at the Sistine Chapel in Italy in April 2012, she was not pleased with the overall care - or lack of it - she received at the hospital.
"The Sistine Chapel was packed," she says. "There was a large group of students behind me and somebody pushed me and I lost my balance."
She was taken by ambulance to the hospital where, she says, her 16-day nightmare began.
"I was taken to the hospital and had surgery one week later," the 88-year-old says. "I was told they only do surgery two days a week unless it's an emergency. Evidently, a seriously broken bone is not an emergency under socialized medicine guidelines."
She was given a pillow, two sheets and a blanket. Nothing else.
"Patients have to provide their own towels, soap, toiletry items, including toilet paper, and even a cup to drink out of," she says. "Typically, it's provided by a family or friend. The experience was very impersonal without room for compassion."
A pastor's wife from North Carolina, who lived in Rome, supplied her with the items she needed, including water, which Thompson says the hospital does not provide. She says she was never bathed, her hair was never washed and she received only three 10-minute therapy sessions after surgery.
"In the States, a doctor would have me start physical therapy the day after surgery and have me doing it every day," she says. "In Rome, they didn't even attempt to get me out of the bed."
Nine days after the surgery, she was released. She immediately flew home; ironically, she lives in Rome, Ga.
"The experience was horrible," she says. "I was numb and probably in shock much of the time I was in the hospital. But I survived. I had good medical procedures in Italy, but I did not have good care."
Because she didn't have adequate therapy in Italy, Thompson says she had to stay in the hospital in Rome, Ga., for two weeks for extensive physical therapy. "They wouldn't let me go home until I could walk out the door."
Getting covered
Chattanooga travel consultant West Oehmig says Americans traveling internationally should always purchase travel insurance, which covers far more than the costs of your trip if it gets canceled or if your bags get lost.
"That's certainly a facet, but I consider the most important part of it is the health and the repatriation (returning a person to their place of origin of citizenship) in case of sudden illness, injury or death," he says.
Travel insurance premiums typically run about 3 to 5 percent of the total trip cost, he says.
"That's a small premium to pay for peace of mind," he says. "It is absolutely as important as the trip itself, particularly when you go out of the country. Most people's health insurance stops at our borders. Be sure, though, to check with your insurance agent about your particular health policy."
About 98 percent of his clients now purchase travel insurance, Oehmig says.
"It's just so prudent. We recommend that clients take a copy of the policy when traveling so they've got immediate proof of coverage. It's an essential element of travel these days," he says.
Thompson says she had travel insurance when went to Rome, but it didn't cover medevac expenses and didn't provide any coverage since Italy offers socialized medicine that's free to anyone in the country, even foreigners.
"If I had medevac coverage, I would have been airlifted back to the States immediately," she says.
The insurance did, however, cover the cost of her son's airfare from Georgia to Italy so he could be with her, she says, and it also covered the cost of a physician's assistant in America to accompany her on the flight from Rome, Italy, to Atlanta. The physician's assistant also accompanied her to the hospital in Rome, Ga., before heading back to his home base in Colorado.
Caroline Rice of Soddy-Daisy had a similar experience to Thompson's seven years ago while also in Italy. On her first day there, she stepped off a curb and broke her leg.
"I tried to get up and passed out," the 57-year-old says. "We called a cab but the driver spoke no English. We asked someone walking by to interpret for us. The driver had been asking us if we wanted to go to an American hospital or an Italian hospital. I stupidly asked which one was closer and he took me to the Italian hospital."
Bad choice, she now says.
"Even the wheelchairs looked ancient. Hardly anyone spoke English. My left ankle was swollen over my sneaker and I couldn't even get any ice to put on it. They only had two stretchers - I wanted to elevate my feet - but both were being used."
A doctor said her right foot needed immediate surgery - it was her left foot that was broken.
She settled on plaster casts because it turned out one ankle was broken and the other sprained. She was given medication to prevent blood clots, but no pain pills.
She did not have travel insurance but, because of Italy's socialized medicine, there was no charge for her medical care. She did, however, have to fork out $4,000 for the first-class airline ticket that took her back to America two days later.
Never again will she travel without insurance, she says.
"It's worth the money," she says. "And, if you're in a country and you require medical attention, always choose an American hospital over a foreign one if you have the choice."
From China to Chattanooga
Joanie Sompayrac, 50, a professor of accounting at the University of Tennessee at Chattanooga, had travel insurance when she broke her leg in 2012 while traveling in China with her husband and a group of UTC students. She slipped on someone else's mess on a bathroom floor.
"I broke my leg so badly that my foot flopped on the end of my leg," she says. "They took me to a hospital straight out of the 1960s, and I was told that, because my leg was broken so badly, I needed immediate surgery."
But Sompayrac was adamant that she'd only have surgery in Chattanooga. All she would allow in China was for doctors to put what she called a "primitive cast" on her leg.
"The hospital looked dirty to me. There were mosquitoes everywhere, and the place was crowded," she says. "There were six patients to a room. I told my husband that, if I passed out, not to let anyone cut me. I'm going home.
"Travel insurance refused to pay for my flight home because I was traveling against medical advice," she says. "So I flew coach, which was very crowded, and my leg was purple by the time we got to Atlanta."
Fragmented fear
Webb, too, is an advocate of travel insurance even though, because her former husband was a diplomat, all medical expenses from her terrifying ordeal in Pakistan were paid by the U.S. Department of State. She also suggests that international travelers visit the U.S. Department of State website (state.gov) and the World Health Organization site (who.int) to learn about medical care in other countries as well as safety issues.
Although her memories of what exactly happened after the accident are sporadic and hazy, Webb, 68, remembers bits and pieces, and others have helped fill in the gaps.
Moments after the wreck, which took place on April 29, 1989, a group of Pakistani men who saw it happen climbed down the steep hill and got Webb, the driver and four other people out of the van.
"They laid me on the ground and one of the men took off his turban, shook it out and covered me because he thought I was dead," Webb says.
One of the passengers, a nurse who had sustained a broken back, crawled over to Webb.
"She felt a pulse and then cleared my nose and mouth so I could breath," Webb says. "She saved my life right there in the dirt."
After loading her and the other injured passengers into the bed of a truck, the local men drove around for about 30 minutes, looking for a health clinic. When they finally found one, it was locked, so they drove around more, searching for someone who had the keys. After getting in, there was no medical equipment, no electricity and no water.
"They put me on a stainless-steel table covered by an oilcloth," Webb says.
Locals notified the U.S. Embassy in Islamabad that an American van had wrecked in a ravine, but embassy staff couldn't locate the site. They eventually had to call in a United Nations team that was disarming munitions just over the border in Afghanistan - a team with a medical bus on hand - to try to find the clinic. An American doctor and nurse also were sent from Islamabad in an attempt to find it.
"They crisscrossed until they found us," Webb says. The search took seven hours.
She was taken to a Red Cross Hospital in Peshawar - "It was where they treated a lot of Afghanistan war wounded," says Webb - but it couldn't treat her type of injuries, except for giving her a blood transfusion. She received five units.
The American doctor arranged for her to be flown to Geneva on an Learjet air ambulance but, because they were in a no-fly zone, they had get permission from the president of Pakistan to fly her out. Still, no one thought she would survive even after she arrived in Switzerland.
"Because I was in Europe, where they have socialized medicine, they didn't treat me at first because they thought I was going to die. They don't have an aggressive form of treatment like we do in this country. A Swiss nurse told me that, in Europe, patients are treated on a best-case scenario and, in America, they are treated on a worst-case scenario."
After Webb came out of her coma two weeks after arriving and began slowly showing signs of improvement, the medical staff got her well enough to be transported to America. After about six weeks in Geneva, she was flown to Atlanta, where she was immediately taken to Emory Hospital, where she stayed for 3 1/2 months.
After numerous surgeries and extensive therapy, Webb recovered. Though today she has limited mobility in her neck, she lives a full and active life. And, yes, she still travels overseas - she went to China in 2009 - and wants to travel more.
"I take a lot of risks," she says. "All the travel I did in Pakistan involved risks. I do not live in fear. I will not live in fear."
Contact Karen Nazor Hill at khill@timesfree press.com or 423-757-6396.