DAN was there for me

DAN was my lifeline!

Julika is a documentary filmmaker who travelled to Indonesia and then on to her dream destination Kri in West Papua. Although Julika is an experienced diver, having undertaken several hundred dives, her dream adventure did not go as planned.

In the lead up to her trip Julika took out insurance with a well-known travel insurance company that covered diving. She checked and double-checked this with her travel agent who assured her that she was definitely covered. Based on this Julika didn’t think it was necessary to ‘double insure’ herself with DAN protection. In hindsight Julika says, “How wrong I was!”.

Following Julika’s story: upon arrival at the Lembeh Straits in East Sulawesi I rested and undertook my first dive at 3.30pm the day after my arrival. During the following five days I completed eight dives in total. The deepest dive over the five days was 26 metres. The dives were completely devoid of physical exertion, as we were utterly spoilt and didn’t need to carry or lift our tanks around. The dive sites were all within an easy ten minutes boat ride and there was virtually no current on any of the dives. The sea surface was extremely calm as the Straits are sheltered from the open sea. The weather was warm with a slight pleasant breeze.

Our ascents were slow. However, despite all the favourable conditions, I still felt the cold. Wearing a 7mm long-john sleeveless wetsuit worn with a lycra top, I was soon shivering and feeling extremely cold during the dives and literally had the shakes. I rented a regulator and had issues with it leaking. The dive manager thought there was nothing wrong with it but after further use and further complaint it was found that the membrane was split. I was given another one and no further problems were experienced. After the first or second dive on day two, approximately half an hour after the dive, I was sitting with my friend and I felt mild tingling in my left foot. I decided to report it to the diving manager straightaway. He asked me whether I had pain in the joints or a rash, neither of which I did, so the matter was dropped.

After subsequent dives the ‘needles’ sensation seemed to disappear. But then following another later dive I again reported that I had ‘pins and needles’ in my left foot. The dive manager didn’t consider this very serious and the symptoms didn’t persist enough to alarm me. Meanwhile I began to feel unwell with cold-like symptoms and assumed I’d caught a chill.

My last dive was on Friday 13th June at 8.30am. On Sunday 15th, two days later, I flew to my ultimate dream destination in West Papua. This entailed a 1.5 hour flight at 17,000 feet. This is where I suddenly noticed the tingling in my left foot considerably exacerbated plus the tingling started in my left hand. Fellow adventure divers and myself then took the three-hour boat ride from the mainland to arrive at the little dream island of Kri covered in tropical rain forest and surrounded by coral reef. The diving ahead was likely to be the most beautiful and diverse I’d experienced in my life. But it wasn’t to be. Fate snatched that dream right out of my hands. The tingling in both my left hand and foot persisted. Over the next days the symptoms didn’t worsen, but they also didn’t subside. In addition I still felt the slight lung compression sensation. With a heavy heart I decided I could not undertake any diving on Kri.

The tingling was now becoming a concern so I decided to contact DAN Southern Africa to get some professional advice. But in our world of modern communication where cell phones are as important as our shoes, I was on an island of rare bliss, where there was no phone reception and no internet, except if I waded through the sea for half an hour to another end of the island. I had to climb a three-storey bamboo tower to get reception. But I could then only SMS because when I left Cape Town I’d innocently activated ‘ROAMON’ which means you cannot receive or make calls, only SMS’s. The island manager kindly offered me her personal phone as there was no other mainline phone on the island. Dr Jack Meintjes, Medical Director of DAN SA, assessed the case and concluded with colleagues that the symptoms pointed towards decompression illness (DCI), especially since the symptoms became markedly worse at altitude. They advocated immediate evacuation to a recompression chamber. With DAN I was speaking to experienced diving doctors, who were making fast assessments and fast decisions.

When I called my insurance company in Johannesburg they were wondering if it was contagious, asked how I could climb a tower with ‘this sickness’ and were planning to get a doctor to come over and visit me. They did not realize that with DCS time is a vital factor. Plus Kri is an island where there’s only one boat a week. Although I was not a Member, DAN stepped in to help me in every way they could and remained in constant touch. From this very remote part of the world DAN was actually my lifeline. It was the only entity that took me seriously and gave me informed professional advice. When I phoned DAN they immediately put me on the line to a doctor, logged all correspondence and calls, mapped out on GPS my island’s exact position and activated an emergency evacuation plan – despite me not being a member!

DAN Medical Director Dr Meintjes also wrote a letter to the airlines explaining that I had DCS and suggested oxygen be administered should symptoms become acute.

So upon advice from DAN I commenced my journey to obtain treatment. On the flight from West Papua to Manado at 17,000 feet my tingling sensations worsened as expected. My advice via SMS from DAN was that if there’s no diving doctor at Manado to get to Singapore. Upon arrival there was no-one waiting to meet me, no chamber arrangements made by the Travel Insurer and no doctor trained in diving and hyperbaric medicine available, so I made the decision to get to Singapore as it was days until the next flight. (Note: I was criticised by a reader of a South African newspaper as to why an experienced diver would have got on that plane knowing symptoms would probably worsen. This was an informed decision I made WITH DAN because there was no diving doctor available at the chamber in Manado).

I was quickly assessed by an airport doctor, who passed me to fly, especially in view of Dr Meintjes’ letter to administer oxygen if necessary, which the flight crew were satisfied with. (Note: I was a conscious diver and was not experiencing acute symptoms such as paralysis or blindness. Had this been the case we would probably have made a different plan.) At 38,000 feet my left fingers went numb, my left wrist and arm began to ache and the tingling in my left foot, toes and left hand now extended to my right side as well. It was clear the situation was deteriorating. After landing there was still no assistance organised by my Travel Insurer, so I made my own way to the recompression chamber with directions via SMS from my friend in Cape Town, who co-ordinated the entire evacuation with DAN. I arrived at the superb Tan Tock Seng hospital, where I now came under the auspices of Dr Michael Ong. The whole team was on standby waiting for me, despite it being night-time when I arrived. After assessment I was glided into the transparent acrylic hull chamber and there given HBOT (Hyperbaric Oxygen Therapy) on US navy table six for five hours. The following day the same treatment was repeated. Both treatments went smoothly, and the tingling lessened. After an interval of one full rest day I had a third chamber session of US navy table five for three hours (13 hours in total). I’m now back in Cape Town, with my dream dive trip shattered, but at least I got back safely! This was thanks to DAN’s firm insistence that I get myself to a qualified diving doctor and a chamber, which they had checked and verified via the DAN Asia-Pacific office.

I would not do another diving trip without DAN.

What Can be Learnt from my Experience?

1. DCI doesn’t always present as a ‘typical’ profile. You don’t always have joint pain or rashes! Take even ‘minor’ symptoms seriously.
2. DCI is NOT exclusively caused by ‘going too deep’ or ‘coming up too fast’.
3. Check your mobile phone settings before departing on a trip to ensure you can make and receive call for emergencies situations such as mine.
4. Don’t risk going on a dive trip without DAN! With DAN from the moment you make that emergency or advice call, you’re instantly connected to a highly trained person, who assesses your call and transfers you to a doctor specialized in diving medicine. Within seconds you’re talking to a diving medical professional. If they’re not certain, they activate an immediate internal colleague-to-colleague collaboration.
5. Don’t rely exclusively on a conventional travel insurance company. You’re dealing with a call centre. In my case the well-known insurance company:

•  Insisted I wasn’t covered for diving when the call came in, but I was.
• Wondered how I could climb a tower to get phone reception if I had ‘such a sickness’.
• Wondered how I could fly as surely ‘the sickness’ was contagious.
• Instructed the Singapore doctor and chamber the wrong times for my arrival, despite having all my flight times in writing.
• Took several days to obtain authorisation for a special unchartered boat to get back to the mainland; by which time I’d already left Indonesia.
• Had too many intermediaries, which meant I never had one contact person and at no time did I ever speak to anyone who knew about diving or hyperbaric medicine.
• Ignored DAN’s written offer to assist.

Julika’s Conclusion

In a life/death scenario you don’t have time to play with. What I experienced with DAN was that there were no delays. Activation of a plan and decisions were immediate. I’ve rarely encountered this kind of efficiency and professionalism.

So how is Julika now?

Fortunately Julika is on her way to a full recovery. “Dr Meintjes (DAN SA) estimates that I might have lost 15% lung capacity, which I will re-gain over time, but there might be some residual loss. I have not resumed diving as I live in Cape Town and to be honest the waters there are too cold for me! Also, DAN advised that once I would like to dive again, I’d need a full diving medical to assess whether I’m okay to dive, and if I am then they would also assess whether in fact I might need my own diving table, which they would calculate for me”. Julika has been quoted as saying that the underwater is “an environment I am passionate about. I find peace and oneness in the water and it’s a time when I am right in the moment”.  With such a passion for diving and the underwater world we hope Julika will return to the underwater world in the near future. A further harsh reality of Julika’s experience with DCI is that she is out of pocket several thousand dollars. It must be reinforced that whilst all divers will receive medical advice from DAN, only DAN Members are covered for subsequent costs according to their Membership and Dive Injury (Treatment) Insurance option and conditions. It is important to note that DAN can only arrange emergency evacuation assistance for current DAN Members, so be sure to keep your membership up-to-date. Accidents can and do happen. It is essential that you have the right protection. Be sure to pass Julika’s story on to your dive buddies.

Final World from DAN AP Executive Director, John Lippmann

From simply viewing the depth and time profiles provided by Julika it is difficult to see where the problem arose, as they appear to be conservative. However, with minute by minute profile graphs one could see if there were areas of fast ascents, the depths at which the dive time was spent, and certain other factors that may have been contributory to the DCI. Factors, such as dehydration, exertion, current health and fitness level could have also played a part.

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Flying times:
Arrived Sunday 8th June in the morning. (Singapore-Manado)
1st dive the following day, 9th June at 3.30 pm
Last dive Friday 13th June.
Flew on Sunday 15th June at around lunchtime.

Other notes:
Always had a buddy and always dived with a dive master.

JULIKA’S DIVE PROFILE SUMMARY
Date	Maximum Depth	Total Diving Duration	Time Down
9 June 2008	18m	58 min	3.30pm
10 June 2008	22m	60 min	9am
10 June 2008	16m	64 min	4pm
11 June 2008	22.7m	69 min	11.30am
11 June 2008	19.2m	71 min	3pm
12 June 2008	26.7m	63 min	8.30am
12 June 2008	23.9m	68 min	11.30am
13 June 2008	10m	65 min	8.30 am