SeaDrill’s Medical Director on ensuring accurate diagnosis from a distance

Dr Jonathan O’Keeffe, Corporate Medical Director, SeaDrill   •   Aug 2018

Travelers who get sick abroad are exposed to a unique kind of double jeopardy. Symptoms that may seem (and may originally be) quite minor can be seriously compounded by inadequate medical care. I have seen cases of diarrhoeal illness turned into septicaemia through poor medical advice and cases of mosquito borne dengue fever misdiagnosed as leukaemia. The initial illness is unpleasant however the poor diagnostic capability in some countries may lead to serious complications. One recent case highlights this hazard to people travelling abroad who seek help at the wrong venue.

A worker of ours (let’s call him Jack), sought help for moderate to severe recurrent abdominal pain he had been experiencing for the previous 4 months. He was stationed in a south American country. At the advice of a local colleague he attended a doctor the company had used for several years, mostly in a fitness for duty screening capacity. The doctor was qualified in occupational health but not in primary care or surgery. Jack was told, after a thorough examination and ultrasound, he had bilateral inguinal hernias (lumps in the groin), requiring urgent abdominal surgery and was promptly shipped up the road to a surgical facility. I spoke with Jack as he had a few questions about the open abdominal surgical procedure he was about to endure – his first language is not Spanish and he did not quite understand the urgency as his symptoms had been months in the making. When we spoke, the picture he was describing did not make sense to me. If indeed he had an obstructed hernia, he would need urgent surgery, however he did not have any of the typical findings and I was perplexed. I arranged for him to be sent from the local hospital to a better equipped facility in the capital city to seek a second opinion. He was seen. No hernia was demonstrated and surgery was avoided, however the doctor there felt perhaps he had an intestinal inflammation called diverticulitis. They did not offer him a confirmatory camera test but instead gave him a course of antibiotics hoping things would settle. Jack’s symptoms persisted. In the end, we flew Jack home where we started from scratch. He had another abdominal exam and a camera test looking at his upper gastrointestinal tract (food pipe and stomach). They found gastritis and a sample of tissue taken showed the presence of H-Pylori, a common infection leading to chronic abdominal pain, gastritis and occasional ulceration. Treatment consisted of a course of the right antibiotics and Jack has been pain free, back at work in South America for six months now.

Medical misadventure is an oft-ignored hazard for people working or travelling abroad. It is sometimes a life-threatening condition that we may unwittingly walk towards. People naturally seek a word of mouth referral and may be directed into the hands of clinicians who are at best ill equipped to meet their needs. The cure for misadventure is to allow qualified people to ‘qualify’ the health care for you before you seek medical help. In some emergencies such as road traffic accidents resulting in severe trauma, the luxury of time may not exist however most symptoms allow some time to select the best available option. The first port of call when your workers develop symptoms should not be to a friend or colleague but to the company’s assistance provider to refer them into the hands of a suitable clinician.

The first rule of medicine is ‘First Do No Harm’, however this is all too often the real but avoidable risk to our people when working or travelling abroad.