Airport Clinics: On the Front Lines

By Terri Morrison and Wayne A. Conaway
© Copyright 2004, All Rights Reserved

These facilities must be prepared to treat passengers with exotic conditions. Dr. Steven C. Garner of the Kennedy Medical Center at JFK Airport notes that his patients include "people who can’t speak English and have very weird diseases." Proper diagnosis requires knowing where these passengers have been. "If someone from Florida comes in with gastrointestinal problems, you might think E. coli. But if he just came in from Nigeria, you need to think about what is endemic there."

In truth, even at the busiest airport clinics, passengers make up a small percentage of the patients. The majority of patients are airport employees. Baggage handlers strain their backs; mechanics suffer scrapes and burns; pilots and flight attendants pick up minor illnesses overseas and wait until they return for treatment. And, in every airport under repair or undergoing new construction, construction workers get cuts, bruises and broken bones. Every time a new terminal is built, the local clinic stocks extra laceration kits.

Not All Airports Have Clinics
Airports without them refer medical needs to local hospitals. Even those airports with large, well-equipped clinics do not take the place of hospitals. The most recent health scare, Severe Acute Respiratory Syndrome (SARS), is not treated at clinics…suspected SARS sufferers are sent directly to hospitals, which have the space to isolate them.

Some airport clinics do not even treat the general public. For example, the clinic in Dallas-Fort Worth International Airport is owned by American Airlines, which has its hub at DFW Airport. Dr. Lily Ramphal is the sole physician at this clinic, and she ordinarily treats only American Airlines employees. Generally, if passengers become ill at DFW Airport, they are sent to one of several nearby hospitals.

However, there are exceptions. When an American Airlines passenger becomes ill in flight, Dr. Ramphal may be on the phone to the plane, giving advice. And, when American Airlines Flight 587 crashed in November of 2001, Dr. Ramphal was summoned to the crash site in Queens, New York. She wasn’t called to treat injured passengers—there weren’t any. All 260 people on board were killed. Dr. Ramphal was called because she speaks Spanish, and the doomed flight was bound for the Dominican Republic. She helped treat and counsel the hundreds of grieving relatives, many of whom only spoke Spanish. "I don’t mind telling you," Dr. Ramphal remembers, "you cry right along with them."

At San Francisco International Airport (SFO), the clinic is owned by the airport itself, although it is managed by St. Mary’s Medical Center. This clinic sees some 12,000 patients a year, about 15 percent of them for urgent care. The majority of sick passengers need treatment for fever or gastroenteritis. And since many passengers substitute alcohol for the water they need, dehydration is also a problem in the dry, low-pressure air on long, transpacific flights.

For those patients who are admitted with chest pains, the clinic has its own EKG station. Those who prove to have heart problems are transferred to the Cardiology department at a local hospital.

The clinic has a single physician available at all hours. That physician is usually Dr. Arnold Traynis, a native of Lithuania who came to the United States in 1989. Although trained as a physician in his homeland, he needed certification at the University of California in order to practice medicine here. In addition to English, Dr. Traynis speaks Lithuanian and Russian. Interpreters are usually available at the airport for him to communicate with the many Asian and Hispanic patients he sees.

An immigrant himself, Dr. Traynis has great empathy for the foreign patients he sees. "Travelers from poor countries in Asia and Africa," he notes, "have unrealistic expectations of what Western medicine can do for them. But they are very grateful to be treated by us." As a refugee from the former Soviet Union, Dr. Traynis has a particular affinity for patients from Eastern Europe. "I have treated many patients from totalitarian countries, like the former USSR and Yugoslavia. I know they often have distrust for the medical and psychiatric establishment." Such countries have a history of consigning dissidents to asylums and forcing unnecessary drugs upon them.

Dr. Traynis enjoys the variety of patients he sees at the clinic. "We get a little bit of everything here. All the time, (we see) interesting cases."

Another type of practice is the freestanding clinic that happens to be located on airport property, but is not owned by the airport or an airline. The Honolulu Airport Medical Corner is a freestanding clinic that just happens to be on the airport grounds. If someone—passenger, airport employee, construction worker or local resident needs to see a physician, the Airport Medical Corner is the closest place.

Dr. Darwin Chan is one of several physicians who work there. He and his colleagues see between 10 and 15 urgent-care cases from the airport a week. Most are lacerations or other injuries from airport personnel, especially mechanics, baggage handlers and the airplane cleaning staff, although they have also treated pilots and flight attendants. They rarely see passengers; when they do, it’s usually someone who became sick on the flight. "Usually it’s just gastroenteritis," notes Dr. Chan. "And we’ve yet to see a passenger with Deep Vein Thrombosis or SARS, thank God."

The Envy of Other Clinics
Finally, there is the airport clinic owned by a hospital, such as the nation’s busiest clinic: the Kennedy Medical Center at JFK Airport in New York City. This facility is owned by St. Vincent’s Catholic Medical Centers, which includes eight hospitals and 60 ambulatory sites.

The Kennedy Medical Center sees 40,000 patients a year, more than any other airport clinic in the United States. It maintains a 24-hour schedule 365 days per year and boasts a staff of 60 people. Six of the staffers are physicians; four of them work here full-time.

The equipment available to the Kennedy Medical Center staff is the envy of other clinics. They have portable vascular equipment to detect Deep Vein Thrombosis. They have top-flight cardiac care equipment. (Interestingly, at JFK they treat more heart attacks on Mondays than any other day of the week. This pattern doesn’t seem to repeat itself at other airports.) They also have the staff to handle most emergencies. The Kennedy Medical Center has primary-care physicians, an ophthalmologist, a podiatrist, a physical therapist and a chiropractor.

Naturally, the patients of the Kennedy Medical Center include many different types: passengers, airline employees, construction workers and residents from surrounding communities. The U.S. Customs Agency brings in suspected drug smugglers to be X-rayed. Surprisingly, the person reading the X-rays is often the Chief Medical Officer of the entire St. Vincent’s Network, Dr. Steven C. Garner. Trained in radiology and emergency medicine, Dr. Garner’s schedule is so busy that he sometimes doesn’t get to X-rays until the middle of the night. "We cannot only tell if someone’s swallowed drugs, but we can usually tell if it’s heroin or cocaine," Dr. Garner avers. "We even see people smuggling money by swallowing it. We had one woman who swallowed about $150,000."

U.S. Immigration brings business to Dr. Garner as well. Since minors are treated differently under U.S. law, so it is important to tell if someone is truly underage. "We X-ray their wrists," he explains. "The wrist bones are the last to fuse, between ages 16 to 18."

The staff of the Kennedy Medical Center treats patients from all walks of life. "When the president comes to New York," says Dr. Garner, "we provide doctors for him and his entourage. When Air Force One lands, we have a team of doctors standing there."

The Medical Center’s staff has to be prepared for all kinds of situations, including in-flight emergencies. Pregnant women often arrive in the United States near term, knowing that if their babies are born in the United States, their children automatically gain U.S. citizenship. But sometimes the mothers cut it too close. One gave birth on the plane en route to JFK not long ago. Others go into labor in the airport, while trying to get through U.S. Customs.

Despite space limitations and the organized chaos of airport life, Dr. Garner is adamant that patients should get high-quality medical care. As far as he’s concerned, patients at Kennedy Medical Center "should get the same standard of care that they get at St. Vincent’s or anywhere else."

Excerpted from OAG Frequent Flyer, February 11, 2004