Friday, July 25, 2008

Part 1: Quarantine at sea - the medical record vs. reality

Oh it's just a little too much sun/that new sunscreen/some plant in their backyard we don't have/European laundry detergent combined with fifth disease...

It's amazing what a range of excuses we'll come up with for health issues with an unknown cause while on vacation, in our case a European cruise.

We had spent several days in Oxfordshire beforehand adjusting to jetlag and visiting close friends of ours. Our son looked slightly pink when we left and had a night sweat, but the kids had also spent several warm days in the English sun and my well-traveled friend said that kids react to jetlag in all sorts of bizarre ways .

Unfortunately, the first morning we awoke on the cruise ship in the Channel Islands we couldn't ignore the fact that something was very wrong. You can click to enlarge the picture and see that 'slightly pink' had turned into a bright red rash on his face, and if you look closely at his chest you can see some of the thousands of bumps that covered his torso and arms but didn't go below his waist. It was a very bizarre combination and while I knew the 'slapped cheeks' red face was typical of fifth disease (which he hadn't had before) the bumps weren't.

The italics were what came to my mind, but there was a slight hitch: I couldn't research PubMed, MedlinePlus or any other online medical resource for myself due to the infuriatingly slow latency problem with the satellite internet connection we had on board. Even checking email was such an enormous hassle that I rarely did so, and most things that took a minute to do on our broadband connection at home translated to at least 10 minutes ($5.00) at sea.

Of course we tried to call the ship's medical center first thing but they were not open til 10 am and this clearly wasn't a medical emergency. He was perfectly fine other than looking awful, maybe a slight fever but not itchy or in pain. We had a morning tour that I tried to reschedule for the afternoon but that wasn't an option because all changes/cancellations had to be done by the night before.

I do not recommend being near a medical librarian on vacation whose young child is clearly having a medical problem without reliable access to her trusted sources of health information.

This left us with a tough decision: to forfeit our first shore excursion and see the doctor that morning, or go out then see the doctor in the afternoon?

Knowing that fifth disease is most contagious before the rash appears, not so much afterwards, and that he was current on all immunizations (including varicella), we decided to hope for the best and went on tour while having him keep his hands to himself as much as possible.

The ship's doctor examined him that afternoon, called in the other ship's doctor, and while they were able to rule out the scary stuff I wasn't allowing myself to consider (like meningitis) his symptoms weren't lining up with anything they knew. They decided the best course of action was quarantine with twice-daily checks until the rash began improving to be on the safe side, with more options to be discussed the next morning.

However, while the medical record says our son was in our room the entire time for the quarantine, the first doctor gave us permission to take him out on the promenade deck for a walk and fresh air every few hours as long as we didn't go into the dining rooms and other public areas of the ship.

I believe that if the doctor was 100% convinced we had a highly contagious situation he wouldn't have allowed this, yet it made me wonder how many other medical issues on cruise ships that could affect public health may not actually be managed the way the records say they are. (see the Cruise Ships section in the Port of ToxTown for more information)

What happened next that introduced us to a world of difference between public and private health care systems and how the ship's medical team searches for health information on the same pokey satellite internet connect? Stay tuned for Part 2 next week!