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GLOBALHUB V O L U M E 1 , I S S U E 1 : N O V E M B E R , 2 0 1 3

I N S I D E:

06 | Evacuations from Egypt

08 | Extreme Challenges in Sudan

12 | Treatment in Southeast Asia

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On behalf of UnitedHealthcare International’s worldwide employees, I would like to welcome you to this inaugural issue of Global Hub. Over the past several years, my colleagues and I have had the privilege of travelling the world and meeting with companies like yours. What we have learned is that there is a rapidly increasing need for global companies to assess and mitigate global human capital risk. This risk typically includes safety and security, health care and wellness and the frequent need for assistance on any number of dimensions.

Most importantly, what we’ve learned is that companies often find themselves sourcing solutions to these needs from a myriad of providers. The result is a complex web of disintegrated service providers, with different business models, ways of communicating and pricing. The administrative burden on a company like yours can be daunting.

So what does that have to do with this magazine?

With Global Hub, we hope to demonstrate to you, through real life scenarios to which you can relate, that there is a better approach. Single sourced, streamlined administration, cost effectiveness, and – most importantly – the confidence that your global employees are having their health, safety and assistance needs met by a company that is itself a world-class global company. End-to-end, highly integrated service that meets their needs anywhere, anytime. That’s what we do at UnitedHealthcare International, and we think it’s a pretty unique approach.

As you read through these stories, you may see some of your own situations in them. I hope they will inspire you to think about how an integrated strategy for health, safety and security solutions could provide more alignment and value for your organization.

We welcome you feedback on Global Hub, and please share with us any ideas you have for future stories.

Warm regards, Kristin Herrera

Vice President UnitedHealthcare International +1.917.974.9599 [email protected]

To Our Readers


Sisters Overcome Jungle Accident and Get Home SafelyAmanda Schmid and her sister, Jenna, were traveling together in a group tour that would allow them to travel through Thailand, Laos and Cambodia for 25 days. While hiking on a jungle trek outside of Chiang Mai, Thailand, 18-year-old Amanda fell, breaking her right fibula, fracturing her ankle and tearing her deltoid ligament.

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“A traumatic situation of having a child undergo surgery in a foreign country on the other side of the world was eased by the amazing service that we received from FrontierMEDEX!!” – Roger & Lorraine Schmid

She was taken to Lanna Hospital, where her sister and the group tour leader called FrontierMEDEX, a UnitedHealthcare International company, to assist with Amanda’s medical care. Through a local doctor in our network of FrontierMEDEX Physician Advisors, we knew that this facility could provide Amanda with the appropriate care for her injuries.

FrontierMEDEX worked with the treating physicians at the hospital to assess her condition and determine the best course of action. Amanda would require surgery to set her broken bone, but was too swollen when she was first admitted. Five days after her injury, the swelling had gone down enough and she underwent the surgical procedure. Afterwards, Amanda required a week of recuperation time before being able to fly home.

While recuperating, FrontierMEDEX coordinated the return flights for Amanda and her other sister, Nicole, to Saskatoon, Saskatchewan in Canada. Nicole traveled to Thailand to accompany Amanda as a non-medical escort for the return trip, allowing Jenna to continue with the group tour in Thailand. We handled her and her sister’s sedan transportation to the airport, arranged for wheelchair assistance once at the airport and obtained the medical clearance required by the airline itself. They both arrived safely home on August 5 and Amanda continued on the road of healing from her injuries.

Amanda’s parents, Roger and Lorraine, were extremely grateful for our assistance to their daughters, saying, “FrontierMEDEX was absolutely incredible to communicate with throughout

the entire process. Every phone call to their toll free number was handled with compassionate professionalism by whoever answered the call, simply by providing them with Amanda’s claim number. They also were in constant correspondence with Amanda, Nicole and Jenna at the Lanna Hospital. A traumatic situation of having a child undergo surgery in a foreign country on the other side of the world was eased by the amazing service that we received from FrontierMEDEX! A huge Thank-You to them!”

Knowing FrontierMEDEX has her covered, Amanda is looking forward to many more trips in the future!


UnitedHealthcare International has elevated the standards and continues to change the landscape of expatriate benefits. No other global benefits carrier can match the range of advantages including exceptional member care, groundbreaking technologies, and innovation through integration.

One of the more vivid and inspiring demonstrations of UnitedHealthcare International’s unsurpassed capabilities is the integrated emergency response, medical case management, international network reach, and family support UnitedHealthcare International recently provided in a crisis.

Imagine, for a few moments, what you would do and how you would react if you or a loved one or a colleague fell seriously ill or injured while in a remote location, far from any hospital or clinic. This is the true story of a ship’s crew member who suffered a serious injury while on board, far from a hospital in rough waters off the coast of Tanzania.

The day began like most others at sea until a hatch opened unexpectedly, crushing the head of a male, mid-thirties crew member. The accident created an immediate medical emergency with potentially tragic consequences. With prudent foresight, the ship’s operator and UnitedHealthcare International’s client previously arranged for UnitedHealthcare International to staff the ship with remote medical personnel trained in emergency life rescue. This on-board medic immediately took the on-site lead to stabilize and assess the patient and initiate emergency protocols.

As part of an intricate implementation process, UnitedHealthcare International worked with the client to develop a Medical Emergency Response Plan, a MERP, that details the responsibilities of

The Life-Saving Power of Innovation Through Integration

team members during an emergency. Following the MERP guidelines, the captain immediately called the UnitedHealthcare International Emergency Response Center to request assistance and connected the medic on board with a medical director from UnitedHealthcare International. The medic conveyed patient information including detailed descriptions and assessment of the serious head injury. Taking into account factors such as eye response, verbal response, and motor response to assess level of consciousness, the medic reported the patient’s Glasgow index at six, which indicates a critical injury. A normal Glasgow index is 15. As part of the assessment, the medic noted the patient was suffering from trauma-related cortical blindness, an effect of severe head swelling that interferes with normal operation of the part of the brain that processes images. This information gave the UnitedHealthcare International medical director and the medical team very clear indicators that this was a life or death situation.

With guidance from the MERP protocols, the ship’s officers and crew carried out their emergency roles and responsibilities, including the captain, who ordered helicopter readiness to transport the patient to the closest land, which in this case was the Seychelles Islands. The UnitedHealthcare International assistance team, meanwhile, arranged for a ground ambulance to meet the patient as soon as the helicopter arrived and also worked to arrange admission into the Seychelles Victoria Hospital.

The normal assistance standard operating procedure would be to evaluate the patient at a local hospital and then determine whether an evacuation to a higher level of care is necessary and if the patient is stable enough for that transport. In this particular situation, UnitedHealthcare International was able to safely deviate from that normal protocol because the remote medic on board provided the medical director and assistance team such clarity of the medical information. Waiting for this patient to arrive at Seychelles Victoria Hospital for reassessment and subsequent evacuation would have seriously compromised the possibility of saving the man’s life.

While the patient was in transit to the Seychelles Islands, UnitedHealthcare International evaluated evacuation options, specifically Nairobi and South Africa. Decision factors included facilities best equipped to handle this type of injury as well as transportation times. UnitedHealthcare International also operates its own security team, enabling an overlay of security intelligence into the decision process. For example, Nairobi has

historically experienced civil unrest during political elections; the security team determined Nairobi was a safe destination at the time, even in the wake of recent elections. Although the security team was able to determine both locations were safe, South Africa emerged as the better option from a medical perspective because of the excellent facilities and capabilities for treating such a critical trauma patient.

UnitedHealthcare International also evaluated which air ambulances were available to reach the patient in the fastest time. Some of the air ambulances, because of their size, have longer flight durations. Regulations require pilot rest time as part of longer flight plans; some smaller air ambulance options would have required pilots to rest overnight and complete the transport of the patient the next day. In this situation, an overnight delay was not acceptable and not considered as an option; UnitedHealthcare International engaged an air ambulance provider with an aircraft large enough to be able to arrive in the Seychelles to pick up the patient and then continue to South Africa without delays that mandatory rest time would have caused. As a time-saving measure, UnitedHealthcare International dispatched the air ambulance before the patient arrived at the Victoria Hospital in the Seychelles. The patient was immediately evacuated upon arrival and the air ambulance was on its way to Milpark Hospital in South Africa, where UnitedHealthcare International had arranged for readmission. Milpark Hospital is a prescreened UnitedHealthcare International network facility and is renowned for capabilities in trauma treatment. The patient underwent successful surgery on his brain at Milpark Hospital. UnitedHealthcare International, recognizing the value of family support during recovery and extending its commitment to international employee assistance, brought his wife to his side from their home country.

This is a case in which all contributors, including the

on-board remote medic, ship’s officers and crew,

the assistance and security teams, the air ambulance,

network facility, and the employee assistance program

worked in tandem to flawlessly execute the medical

emergency response plan to turn a life-threatening brain

injury situation into a very positive medical outcome.

The events and descriptions of this case study are true; details that could reveal the patient’s identity have been altered to preserve his privacy.

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Evacuations from EgyptJanuary/February 2011

• Asthefifthdayofmajorprotestingstarted, FrontierMEDEX assisted numerous clients by providing security intelligence, advice, etc.

• Additionalcallsfromclientsand non-clients came into the Emergency Response Center (ERC).

• FrontierMEDEXarrangedforthefirst two charter aircrafts to leave on January 31 – a Hawker aircraft for nine passengers and a large body aircraft.

• CloselymonitoringthesituationinEgypt, FrontierMEDEX’s Security Services Division issued their first Evacuation Notification at the phase status of Alert.

• Mubarakdismissedthe Egyptian government.

• Acurfewwassetandthearmy was deployed in an attempt to keep the peace.

• Thefirstmajorproteststookplace in Cairo. Anti-government protesters and police clashed as demonstrators demanded that President Mubarak step down after being in power for almost 30 years.

J A N U A R Y 2 5 J A N U A R Y 2 8 J A N U A R Y 2 9

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• Transportedsmallgroupto Fixed-Base Operator (FBO) and airport for departure.

• Moveddifferentgrouptoanairporthotel for Tuesday departure.

• Severalclientswhosecommercialplanes were canceled were met at the airport, facilitated through immigration and transported to an airport hotel.

• SmallaircraftdepartedforSpain.

• Atatimewhenmostwere attempting to leave Egypt, FrontierMEDEX brought a client’s additional support personnel teams into Cairo via a small charter.

• Manyindividualswereconsulted with and moved to the airport for commercial departure.

• Asecondlargebodycharteraircraft was arranged for multiple clients to leave on February 1.

• InadditiontoflightsoutofEgypt,FrontierMEDEX planned ground movements, including secure transportation, to safely transport people to airports for departure.

• Insteadofresigning,Mubarakclaimed he would not run for re-election later in the year.

• EvacuationNotificationissued at the phase status Evacuate, as the situation intensified as a result of Mubarak’s remarks.

• Bothlargegroupswereprocessedthrough an airport hotel and moved to their respective aircraft.

• BothlargecharteraircraftleftCairo.

J A N U A R Y 3 1 F E B R U A R Y 2

J A N U A R Y 3 0 F E B R U A R Y 1


Extreme Challenges, Multiple Sites

The provision of health care to support 900 personnel across 32 different sites in post-conflict Sudan required the medical teams involved to overcome extreme challenges. Successful delivery required fresh thinking on how to deliver best-practice support. Medical Director EMEA at FrontierMEDEX, Dr. Phil Sharples reports.

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Sudan is an inhospitable place. For the most part it’s a desert, plagued by sandstorms. Bitterly cold winters follow scorching summers. There is little more than 12,000 km of highway, less than half of which is paved, no small problem for any organization attempting to establish itself here.

In 2006, while the country was still troubled by political unrest and violence, FrontierMEDEX (then operating as Frontier Medical) was appointed to provide medical support for 900 personnel. Its medics would be staying in camps which were the regional bases of the peace-keeping force provided by the African Union, in a project that was to last three years. Thirty-eight medics were employed to deliver both emergency and primary medical care. Most worked alone across individual locations. There was an additional medic in the support clinic in Nyala, the capital of South Darfur and a doctor manager in Al Fashir, the capital of North Darfur.

Poor Communication

Medics worked on three-month rotations, not particularly long stints in the world of remote medicine, but long enough given the difficulties and particularly the isolation they faced. Many camps had no internet connection. Communication by satellite phone was sporadic and the mobile phone service largely inaccessible. This lack of a reliable link to the outside world created additional pressure for professionals working alone in the field. It meant uncertainty in being able to access a Topside team if necessary and an additional factor to consider in mobilizing a medevac. As a result medics needed to work in an anticipatory mode, thinking sometimes as much as 12 hours ahead, acting on worst case scenarios long before they happened, to ensure they would be fully prepared and their patient communities 100% safe.

Poor communication also exacerbated the task of maintaining a regular supply of quality medicines, first into the country and then on and out by helicopter to the individual camps. In the end, these were sourced from Dubai under a UN contract.

Medical Challenges

The project came with its own particular medical challenges. On a day-to-day basis, most health issues revolved around managing the diseases of aging. The medics were tasked to support a largely unscreened population and needed to provide chronic medical disease management, dealing with acute medial mishaps such as heart attacks. However, there were other equally pressing and some unexpected challenges to break up their day.

For the teams working in the Darfur region, the impact of poor sanitation and overcrowding on the spread of disease were key concerns. The first medics were threatened by a serious cholera outbreak within just a few months of arrival. This presented a significant health risk because many of the local population were entering and leaving the compound daily. With the help of Topside Support, the team was able to implement very quickly the systems and protocols to prevent the possible spread of the disease. As a result of good management, contingency planning and team work, there was not one case of cholera.

The risk from most indigenous animals such as snakes, scorpions and mosquitoes across Africa is well-documented, but the medical teams on the Sudan project were to discover a less well-known culprit.

They were alerted by the number of patients presenting with what appeared to be symptoms of severe sunburn. Their symptoms were redness, peeling skin, blisters and other lesions – frequently leaving pigmented scars that lasted for some months. Consultation with the Topside team revealed that, although the lesions were a type of burn, the source was more earthly than solar. It was caused by Pederin, a toxic amide, an acid-like substance, particular to a species of the Paederus or ‘Rove’ beetle. Found in Africa, Asia and South America and more colloquially known as the ‘Acid Ant’ or ‘Champion Beetle’, it’s the female of the species that manufactures Pederin. Although otherwise harmless, she will leave her mark and something to remember her by if unnecessarily crushed. The medics were able to alert and educate their patient community, introducing measures to minimize incidents.


Political Unrest

Another challenge both in terms of the medical response as well as individual stress was the ongoing fighting between rebel factions. Sometimes this involved the African Union forces within the camps and inevitably crossed into the medics’ day-to-day working lives. In Darfur, fighting between factions was an everyday occurrence, putting a particular kind of pressure on the team working here. After their arrival, the stability of the region regressed to a point where shootings in the marketplace become common practice. Medics working near to the Chadian border lived with a background of heavy gunfire from nearby villages and faced attacks on their camps, one eventually overrun by militia.

Despite being briefed not to get involved and to maintain as much independence as possible, it is probably too much to expect that a medical professional working in an area of conflict will draw a clean line between the job they are doing and the problems around them. It’s important to understand that your

medics will always step in to help in an emergency and you need to prepare for it and manage it. As a result, the medics provided pro-active and preventative support to the African Union medical teams co-located in their camps. They worked together to create joint plans for mass casualties and catastrophes, responding jointly when things went wrong and providing support in case management.

Working in Isolation

Among all the very significant medical challenges, by far the biggest issue to overcome in terms of successful delivery of the project was the isolation, both in terms of its effect on morale and the possible impact on quality management.

Up front was the need to recruit a team who would be best-suited to working independently with this level of isolation, with the aptitude and skills needed for this type of medical provision. The recruitment processes a defined core set of skills that applicants needed to satisfy, both the

required medical skills as well as the ability to deliver the necessary standard of care without the usual support structures and away from the context of their normal environment.

For this project, where medics were required to work without even the normal contact provided by regular phone and email, the operational teams decided on an African solution. They recruited from among candidates who, because of the very nature of their African health service, were most used to remoteness and isolation in their work. It proved very effective. Having identified the candidates, the medical teams then set up a training centre in Harare, working with local providers of emergency medical services to deliver pre-deployment training. Every medic recruited was brought fully up-to-date in the latest approaches to pre-hospital care, in particular cardiac and trauma management. Each was taught the procedures and protocols to coordinate an effective medevac.

Quality in Adversity

Another issue was to build team spirit, which was initially achieved by providing group training sessions for all medics at the beginning of each rotation. The arrival of ten medics every month created an opportunity to bring them together and deliver refresher training, where protocols were reviewed, concerns tackled and skills updated.

Equally important were the systems devised by the in-country doctor which served both to keep the teams connected, but also and perhaps even more importantly, provided a vehicle for maintaining and enhancing their skills.

A Continuing Medical Education Program was developed, based on stringent remote medical guidelines. Papers were distributed regularly to the team in the field. They were encouraged to read around the proposed subject before completing their responses. Every medic then received personal support and feedback. Medics also kept clinical records and as part of an appraisal process, received a regular audit of their documentation and notes, again ensuring best practice and helping the teams remain clinically engaged.

Driver for Change

Both the scale and the complexity of the Sudan project made it quite exceptional in the field of remote medicine. It gave both the operational teams and the medics an appreciation for working in an extremely hostile and difficult environment. Not surprisingly, the experience was a driver for positive change, with some of the techniques implemented to maintain quality in an isolated work force now part of everyday practice for FrontierMEDEX health professionals, wherever they are based in the field. Isolation and political unrest are a combination that will always throw up the unexpected, but today they are challenges that the teams are better equipped to take in their stride.

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Isolation and political unrest are a combination that will always throw up the unexpected, but today they are challenges that the teams are better equipped to take in their stride.


UnitedHealthcare Global Solutions Member Evacuated and Treated in Southeast AsiaEmergency Response Team Guides Appropriate Care Delivery

Jim, an expatriate on assignment, lives in Australia with his wife, Sally. As UnitedHealthcare Global Solutions members, they have access to network providers, cashless transactions and world-class service. In Australia, laws and regulations require use of local, licensed insurers. Jim’s and Sally’s coverage provides simplified access to care in Australia thanks to a partnership with a leading local insurer, nib Health Funds. Jim’s and Sally’s in-country health care experience has been stress free. Jim and Sally also have access to care and service when traveling outside of Australia, which they had the opportunity to use on their five-day vacation to Hoi An, in central Vietnam. During the first night at the hotel, Sally awoke with severe abdominal pain. Jim’s concerns for his wife’s sudden symptoms were compounded by the realization that

they were in a small town in Vietnam, likely with inferior medical care, with a language barrier, and with little cash on hand.

Jim’s first thought is to seek assistance from the hotel front desk clerk. While Jim waited, the clerk made several phone calls, speaking in Vietnamese. The clerk then told Jim that a car and driver would come and take him and his wife to a nearby hospital.

Jim and Sally were shocked by the unsanitary hospital conditions and antiquated emergency room equipment. With severely limited English vocabulary and language skills, the very young doctor managed to communicate his opinion that Sally had appendicitis and required immediate surgery.

Jim did not have confidence in the doctor’s assessment, surgical capabilities or the hospital’s infection prevention practices, so he contacted UnitedHealthcare International. The customer service professional immediately reassured Jim, advising him that his UnitedHealthcare Global Solutions policy offered exactly the support services he needed. The customer service professional immediately conferenced Jim in with the UnitedHealthcare International emergency response team.

The emergency response team concurred with Jim’s assessment of the hospital conditions and determined that Sally’s current facility could not provide adequate treatment. They identified that the nearest appropriate facility was in Bangkok, Thailand.

UnitedHealthcare International arranged for Sally’s medical evacuation to Thailand and for Jim to accompany her in the air ambulance UnitedHealthcare also arranged for a ground ambulance to transfer Sally and Jim from the airport to the hospital, where the clinical team had already been alerted and briefed on Sally’s diagnosis. During the assistance support process, the emergency response team served as the communication hub for all stakeholders and constituents in the case. Jim and Sally were continually updated on progress.

The Bangkok hospital clinical staff immediately prepared Sally for surgery and successfully performed an emergency appendectomy. The UnitedHealthcare International medical team remained on the case until discharge to ensure continued medically safe and appropriate care, they monitored Sally’s recovery and addressed questions and assisted with overcoming language barriers. When Sally was ready for discharge the team coordinated return flights to Australia as well as post-discharge medical needs. Jim and Sally were able to quickly return to their regular lifestyle in Australia and Jim was able to return to his expatriate assignment.

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Unsanitary hospital conditions and antiquated emergency room equipment prompted Jim to seek assistance from UnitedHealthcare International.

©2013 UnitedHealth Group Incorporated. The service marks contained in this literature are owned by UnitedHealth Group Incorporated and its affiliated companies, many of which are registered and pending service marks in the United States and in various countries worldwide. Confidential property of UnitedHealth Group Incorporated. Do not reproduce or redistribute without the expressed written consent of UnitedHealth Group Incorporated. UnitedHealth Group does not provide medical care and cannot guarantee clinical outcomes. Products and services may be limited or excluded by applicable law.

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