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An expert opinion on what caused Tilahun’s death

Posted on by Elias Kifle

Dear Editor,

I read your piece entitled “Could Tilahun’s death have been prevented.” Thank you very much for your inquisitive mind and thought provocative curiosity!

I would like to pass my deepest condolences to Tilahun’s family and to Ethiopia at large. Indeed, Ethiopia has lost a true son! A legend has passed away! We should celebrate the life of this legend in unison.

Tilahun is blessed in a way that he died in his Ethiopia, the country he loved and adored all his life. May the Lord bless his soul.

Having said that, I would like to put forward a professional opinion regarding your question.

Based on what I learned from the media, my impression of Tilahun’s medical case is the following.

A 68 year old legendary artist patient with past medical history of Diabetes Mellitus (most likely type 2), heart disease, status post right leg amputation likely due to complication of his diabetes or peripheral vascular disease, and history of slitting trauma to his neck. His chronic heart disease appears to have been most likely coronary artery disease as diabetic patients tend to suffer complications affecting blood vessels. Coronary arteries (arteries supplying the heart muscle) are some of the blood vessels which get affected by complication of diabetes. Coronary artery disease can lead to heart attack, heart failure, and arrhythmia (abnormal hear rhythm including ventricular tachycardia, atrial fibrillation).

The acute medical condition that claimed the life of our icon could be heart attack, arrhythmia and or acute heart failure with pulmonary edema (filling of the lung with fluid because if his heart was not able to pump blood properly). The symptoms that I heard he told his wife include “yelibe ametat tikikil ayidelem, liben yazign”. He likely had fast or abnormal heart rhythm. I also heard that he was short of breath. Indeed, Tilahun was acutely and seriously sick and he needed urgent medical help for him to have any chance of surviving the episode.

Certainly, there was a missed window of opportunity to potentially save the life of the legend. He survived long enough to make it to Betezata clinic. Per his wife’s report, he did not seem to have received any medical help other than advice to take him to another hospital. I would not comment on the level of care provided at Betezata clinic other than saying a Basic Life Support care should be available. The physician may have thought the patient would get a better care if he was transferred quicker. The level of care provided at the clinic may be limited. The physician could have limitation in his training. Tilahun’s case would ideally require a care by a heart specialist (cardiologist). But, what could a non-cardiologist physician have done to help him?

Given the limitations of the health care in Ethiopia, I would use the example of what a non cardiologist physician in the US could have done to help Tilahun. At least the following could have been done.

1) Check his vital signs (heart rate, blood pressure, breathing rate, and his oxygen)
2) Perform a quick and focused history and physical exam.
3) Give him oxygen supplement
4) Give him aspirin, nitroglycerin
5) Check EKG
6) Secure iv access
7) Draw blood samples for laboratory tests.
8) If Tilahun was noted to have no pulse or recordable blood pressure, he could have been given IV fluid. If he had abnormal heart rhythm he would have been given medications to slow the heart rate or electric shock could be given as necessary.

These measures could have stabilized the patient until he gets specialized care. Also, Tilahun would have been transported by an ambulance which would be faster and would be able to provide Basic Life Support (BLS) or possibly Advanced Cardiac Life Support (ACLS).

I will leave the judgment to the reader if the above could have been done at Betezata clinic given the rudimentary nature of the health system in Ethiopia.

I think it is wise and appropriate for Elias Kifle and all concerned Ethiopians to ask if Tilahun’s death could have been prevented. I do not think the government is directly involved in Tilahun’s death. That being said, who is responsible for the precarious health care system in Ethiopia? Who is responsible for the quality of physician training? Who is responsible for the absence of such a basic life support care in clinics in the nation’s capital? Who is responsible for the inaccessibility of health care to the people? Definitely, the government is responsible for the poor health system and its untoward effect. In fact, we may be suffering from the effect of an ill conceived health policy. Prime Minister Meles once said Ethiopia does not need doctors, remember? If he has this feeling towards doctors, do you think he would care for the quality of their training?

The big question is, if Tilahun, as legendary as he is, dies wandering to get to a hospital in Addis Ababa, can you imagine what is happening to the poor millions like Aba Biya in the village of Serbo in Oromia?

May God Bless Tilahun’s soul!

– Wase

40 thoughts on “An expert opinion on what caused Tilahun’s death”

  1. Mind you; all the above stabilizing measures don’t need necessarily MD or Hospital. They can be done by paramedics in the car (ambulance). What lacking was either taking responsiblity or no resource whatsoever in the clinc.

    The question Elias raised sheds light to the so-called clinic /hospitals mushrooming in Ethiopia. They can be worse than none.

  2. Selam Wase,

    Thank you for your enlightening analysis about the likely casuse of death of our Artist Hero Tilahun. There is a recently inaugurated Children’s Heart Hospital. If he were Aba Biya, and his family are aware that there exists this hospital, they will definately rush him to this hospital. Because, Artist Tilahun’s family had a choise and money, they wanted to take him to a so called private hospital? or clinic? We really do not know how these private clinics operate and the degree of tested ability to save lives. Because it is private, does not really mean that it is better (in Ethiopia)! As a believer, I would say, it was his destined day. The good thing is, it happened on his own beloved soil. We all die. Ethiopia lost a great hero!! May God bless his soul.

    Melkam ken

  4. so you think the government is responsible for everything and not you?? the people make a government and the doctors come from the people. our selfish ethiopian doctors and other people are leaving ethiopia and going to america/ europe.

    but we always want to point fingers at others

  5. Are you guys out of your mind? Once a flamboyant NBA basketball player continuously said, “We are talking about practice….” and I wanted to echo similar noise…. “We are talking about Ethiopia…” The expert analysis makes sense if we were talking about some other developing country but not Ethiopia. At least not at the level she is in. People are having hard time getting basic care for gun wounds or car accidents. Forget heart attack and diabetes. It is even called “ye habtam beshita…” (disease of the rich). Accadamic knowledge without understanding the current reality is useless. Let’s come down and think based on the current facts in the country that we call home.

  6. Thanks Wase for your detailed explanation as to the possible cause of death to the late Tilahun. I totally agree with your comment. Well articulated and organized. Wase, let me ask you questions: Have you been in Ethiopia? How many hospitals in Ethiopia have intensive care unit? How many cardiologists are there? Are Gps trained how to treat a patient with MI and its complications? We also don’t know the real diagnosis. For an amputee who was not moving, massive pulmonary embolism could be a possibility. Autopsy should be done to come in to the actual cause of death. Let us say the diagnosis is coronary artery disease leading to MI and arrhythmia. Wase, do you think a completely blocked coronary artery can be managed there in Ethiopia? Even drugs are not available for simple rythm disturbance. How many hospitals have service for cardioversion/defbrillation? Absent pulse and unrecordable blood pressure is not always treated with intravenous fluids that might aggravate the situation in case of cardiogenic shock. Dear Wase, your comment is absolutely right, we don’t have to blame the Gp at Bete Zata Hospital and the government is not also responsible for every emergency death.

    Ato Elias, what is the cause of poor heath care system in Ethiopia? In order to answer this question one should have a concrete and positive reply to the following question too: Who/what is the cause poverty in Ethiopia?

  9. I am very saddened by Tilahun’s sudden death and the above I am very saddened by the sudden passing away of Tilahun Gessese. The lack of appropriate medical care at the verge of his death brought back my own painful memory and disappointment with the so-called private clinics/hospitals in Addis. Unlike the old days, medical services are today available at every corner of the city. The hotels and villas that once stood at crossroads or focal points have been converted to health care centers; new hospitals are mushrooming in the same speed as one builds bars and groceries. In other words, most of these places do not even meet the minimum standard. Moreover, the number of physicians and specialists is so limited that they have to revolve around the city, sometimes treating critical patients at the same time. That is not only due to the continuously increasing number of desperate patients, but also because of the lucrative pays in medical practice. The result is that medical and surgical specialists are thinly spread, making critical patient follow-up very difficult. That is why hear that many men and women die increasingly right after surgery. As you may know, there is no medical malpractice law in Ethiopia and victims tend to blame their own fate. I, therefore, have the gut feeling that Betezata would have admitted Tilahun, if he were an ordinary patient whose survival or death does not affect their reputation.

  10. I think Tilahun traveled around 18hrs above 30 thousand feet and he had many complicated chronic problems I don’t think even cardiologist would help him. so please we should never forget the decisions of God. he already assigned for this day. vital sign doesn’t help Tilahun because his date was that. God bless his soul.

  11. Appreciate the expert opinion! Just like any Ethiopian on this planet, I also share my empathy with all of you as well as Tilahun’s close relatives/friends.

    Having said that I do not, again, I do not want to join the bla bla talk on how Tilhauns Death could have been prevented (despite the grief I also share with many)if this and that procedures had been done. Why…..?

    Because, Tilhaun was blessed to have had a great life despite many up and downs as compared to many millions of Ethiopians. Of course, it should be very clear that I am not attempting to say or censor who should live or die. It would have been even greater if he had a chance to stay with us for many many years …..

    What should we do:

    Ethiopians across the globe, including myself, should be celebrating his life time journey and remember the great assets he left for us (love, joy, unity and Ethiopianess). As the late African Laureate Tsegaye G/Medhin once said, we should kill death itself by celebrating Tilahuns life.

    The Medical Bla Bla….AHEYAWEN FERTEW DAWLAWN (Dawlaw is Bet Zata…..AHEYAW is …..Melse Zenawi)

    When I come to medical issues raised earlier, as ER as well as the expert stated, “thousands and thousands” of Ethiopians die daily because of lack of very simple resources such as clean water/food and simple medical care let alone a specialized care that require thousands of dollars for treatment to treat conditions such as those Tilhaun may have had.

    Aadvanced life support, intensive and adequate care of patients with serious and acute illness that require respiratory support, cardiac bypass surgery and continuous monitoring and various medications are non existent in Ethiopia, where the Tigrai rulers sometimes appoint a TPLF field surgeons to take care of serious illness and allow idiots to run hopitals and the health care system itself. The reason why that is happening is very simple, because we allowed them to do that…. The Tigrai thugs ruling the nation and there pigs like Endreas Eshete/ Girma woldegiorgis often travel on charter flights to Saudi Arabia, Israel or to DC to have the specialized medical treatment on the Ethiopian tax payers money and some times on Americans tax payer money. As you may know Endrias Eshete recently received free treatment for stroke and funga infection (pneumonia) here in Maryland at Shady grove Hospital .

    Who Cause Tilhauns Death:

    The answer is simple……the CAUSE that is responsible for loss of Tilhaun and many millions Ethiopians ….is directly related to the system (regime)you and I let to destroy Ethiopia and Ethiopians.

    Melese Zenawi’s regime is responsible for the killings of millions of Ethiopians including GASH Tilhaun as result of its idiotic health care policy, financial abuses and in general bad governance.

    Tessema

    Let us Kill Death Itself by Celebrating Tilhauns life…..

  12. The Woyanes want every one to leave the country: doctor, teacher, etc. They also wish death for the people. They have shown their level of cruelity by shooting teenagers; by holding food and water in Ogaden and much more. Where were you Ato Birhanu? You better seek the truth. You too will be a victim one day.

  13. Did any one notice that this legend never had a rest for more than 12 hours? Although he is vulnerable to in terms of health, he never had enough rest. This may have been one of the reasons why he get heart problems.

    The death of this legend wakes up the problems that every Ethiopian could face and is facing when looking for medical treatments which most of the time need only a good will.

    This is only one legend but how may Ethiopians die of a very simple medical problem?

    May this legend rest in peace!

  15. its so sad he is gone the bottom line is those greedy the so colled doctors especially who got free education in ethiopia need to go back from abroad and serve their own folks who educated them.

  16. While very saddened by this tragic loss of our beloved singer, I just hope that it can be also used as a lesson to improve the quality of health services specially the really very very poor so called “medical schools” in the country. The education policy of the country is so focused on getting higher number of graduates that quality is so poor.

  17. I agree with one comment that said may be Bete Zata did not want Tilahun to die in their hands, after having a look at his condition and concluding he would not make it. But speculating what would have happened if they have admitted him is I think, impossible. We can not be sure that would hae saved his life, may be it would have sustained him for few more hours, may be not even that much. So let us put this to rest.
    It is so sad he had to die so suddenly. but I do not really believe he would have passed this day no matter what. His condition has been deteriorating for long, and Diabetis is a chronic desiese as we all know.

  18. May God comfort his soul.
    THE ONLY PLACE THIS COULD HAVE BEEN PREVENTED WAS THE USA.
    IT IS HIGHLY LIKELY THAT HE DIED OF ONE OR ANOTHER COMPLICATIN OF CORONARY ARTERY DISEASE WHICH WAS DIAGNOSED IN THE USA.BUT UNFORTUNATELY IT LOOKS CLEAR THAT THE DOCTORS IN THE US DID NOT DO CORONARY ANGIOGRAPHY TO DETERMINE HOW MANY OF TILAHU’S CORONARY ARTERIES WERE BLOCKED.
    IT WAS NOT DONE MOST LIKEY BECOUSE OF MONEY AS THESE PROCEDURE ARE EXPENSIE IN THE US.IF HE DIED OF COMPLICATED
    CORONARY HEART DISEASE, MOST LIKELY HE HAD NARROWING OF THREE CORONARY VESSELES AND HE COULD HAVE BEEN CURED BY CORONARY ARTERY BYPASS GRAFTING PROCEDURE.
    IT IS A SHAME HE WAS NOT PROPERLY MANAGED IN THE US BUT NO ONE WHO KNOWS THE US HEALTH SYSTEM WILL BE SURPRISED.
    yOU WON’T GET HIGH QUALITY CARE IF YOU ARE NOT SUPER RICH.

    THE OTHER POSSIBILITY IS PULMONARY EMBOLISM THAT IS BLOCKING OF THE MAJOR BLOOD VESSELES OF THE LUNG BY A BLOOD CLOT WHICH ORIGINATED IN THE LEG VESSELES.THIS IS A GOOD POSSIBILITY BECAUSE TILAHUN SICKNESS HAPPENED IMMEDIATELY AFTER A LONG DISTANCE FLIGHT.
    THIS TOO COULD HAVE BEEN PREVENTED IF DOCTORS IN THE US HAD GIVEN HIM BLOOD THINNING MEDICATION OR ANTICOAGULANT SINCE TILAHUN HAD A MAJOT RISK FACTOR FOR THIS COMPLICTION :THAT IS PERIPHERAL ARTERIAL DISEASE AND HE WAS PLANNING TO HAVE LONG DISTANCE FLIGHT.

    I AM SORRY TO SAY IT BUT HE DIED AS CONSEQUENCE OF POOR STATE OF HEALTH CARE DELIVERY FOR THE ORDINARY MAN IN THE US.

  19. I really appreciate the professional comment given by Wase about the help that could have been offered at Betezata. But I couldn’t figure out why the doctor in the clinic was so very reluctant, even not to help him by offering the ambulance. And I still feel a lot of pain when I visualize this reluctance. The government is responsible for the poor health care service as a whole, but still there are some responsibilities that we can do as a citizen.

  20. Now a days we have got the worst private and government hospitals in Addis. About government hospitals it has been said a lot. We are living in a time doctors give medical treatment after chewing khat. Most of the doctors are addicted to Khat, alchol and cigarette. Imagine, this is on top of poor medical training and lack of adequate medical equipment.

    Those mushrooming private medical colleges produce incompetent professionals. The government universities quality is declining from time to time. I belive some professions need regorous sreening and training. Unfortunately our country is not lucky enough for that because of the triabal thugs regime.
    It is common phenomena to die after getting hospital due to lack of proper medical support.

  21. Dear Mr/Dr Wase,
    I believe the most likely cause of death is PE (pulmonary embolism), which can be a problem following a long trip, particularly for patients like Dr Tilhun.
    Mez

  22. artist Dr. tilahun is the son of all ethiopians, not only the son of his mother or father. we are in a modern time and age. how tilahun couldn’t get life support treatment or even oxygen at Betezata clinic. why did they refuse to give any treatment? who will be responsible? who were in charge of night duty? they must be questioned? why not they send him by ambulance? May Allah bless you

    Mohammed Nasser
    Saudi arabia
    Al ruwais Jeddah

  23. Wase,

    You pointed an index finger at what ailing the health system in Ethiopia… good! But as Tilahun himself once crooned, sostu gin erask’n yimeleketuhal (the other three point your way). Pray, what are you doing about it now that you seem to know a lot about the need?

  24. lets pray for better Ethiopia. Let’s stop for a minute and ask your self. “What am I doing for my people / Ethiopia?” no matter where you are, instead of judging others.

  25. I agree pulmonary embolism should also be high in the differential diagnosis. I am in no way passing any blame to the GP at Betezata or the clinic itself given the poor health care system in the country. Nor do I believe with certainty that Tilahun could have been saved even with specialist care. No guarantee to that. The case in point is why is the health care system is in such precarious state? And who is responsible for this? Fellow Ethiopians, unless we ask critical questions at least on such momentous occasions as Tilahun’s death is, we may not see any improvement in our health care.
    May God rest Tilahun’s soul in peace.

  26. Tilahun has sang his heart out for Ethiopia and Ethiopians. His legend will live for ever. We will forever be grateful for his contribution. Ethiopia has no shortage of experts generous with their free advice solving all its ills over the net. What is lacking is positive material visible contribution on the ground. We have real heros in Dr Belay Abegaze who gave Ethiopia its only Cardiac Center and even a none medical diaspora who built a hospital in his hometown. The contribution of the majority of Ethiopian doctors living overseas to Ethiopia is not visible. Shouldn’t they at least pay back the tuition fees they owe Ethiopia let alone teach or build Cardiac Centers in Ethiopia?

    Qooyu Iyemetahunew

  27. I beleive that Betezata could send him away to another hospital. All clinics in Addis don’t want to be blamed for death of one and that is why they send them somewhere else. This has happened to my late father. Gabriel, Hyat and Betezata wouldn’t do anything but to say ‘take him somewhere else’ and Betezata was one who said to take him to Tikur Anbessa. My father later passed away. So I totally believe that Tilahun was sent away to another clinic instead of doing the basic thing as mentioned in the article.

  28. All the expert have said is true. However, considering his extensive medical history, the symptoms he showed before his death and after flying a grueling 17hrs flight, I suspect that the main cause of his death is Pulmonary embolism (PE). The MD at the clinic can’t do anything to reverse this situation. So my country people, please stay active and do some stretching during long hours of flight.

  29. What the experts are saying is that sitting in cramped conditions over long hours causes clot formation in the deep veins of the legs which can migrate to the lung circulation causing sudden shotness of breath, chest pain or death.
    This is popularly known as the “Economy Class Syndrome” although it can occur in any other class for that matter and even on long travel overland.
    The preventive measures are :

    ” Get up and walk about at least once an hour (a challenge, given the food carts).
    While seated, flex your ankles and move your feet around to stimulate blood circulation.
    Remain hydrated.
    Consider wearing support stockings or elastic wraps to keep blood from settling in the veins in your legs.”

  30. What is new in Ethiopia, people pass away every day for not getting simple medical intervention. You talk to people and they tell you the same story – “I lost my brother while running from one clinic to another clinic asking for help”.
    My advise to those who travel to Ethiopia is, please be careful, prepare for the worst, don’t get surprised for what can happen to you. If you have medical issue, have better preparation before you travel.

  31. I agreed completely with the detail medical explanation of Wase. But I would like to add another medical diagnosis that could be the likely cuase of Tilahun’s demise. That is Pulmonary embolism (PE). As Wase explained it well Tilahun had multiple medical problems that can make him prone for MI, Sudden VF or VT. But his long flight with out major mobility can expose him to DEEP VAIN TROMBOSIS (DVT). Once he completed his flight, arrived back home and begun moving, the deep clot in his legs could break and moved to his lung and causes massive PE with the symptom of shortness of breath, increase heart rate and chest pain. I hope Ethiopian physicians will find out what was the cause of this great singer’s death. At the same time, I would like to leave my advice with this opportunity that taking Asprin, vitamin E and moving the lower extremities by being mobile during long flight can save from this kind of sudden death.

  32. Dear Dr. Wase,

    I have heard many stories that foreign Doctors and many great Ethiopian Doctors from the US organize and travel to Ethiopia to help the health system of Ethiopia from time to time out of their goodwill. Have you ever participated in anyone of them? What did you do to help your country other than berating the so called expert analysis supporting your detractor friend Elias Kifle?

    Please people – let us stop the bla-bla thing and ask ourselves what did I do to my country before pointing a finger to the people who are working day & night for the betterment of Ethiopia. May God rest the Soul of the Legend in Peace!
    Tazabi

  33. I also agree with the medical and political explanation of Wase on unexpected death of the legendary Tilahun Gessesse. I believe it was preventable, or at least, his life could have been prolonged. When someone come to the emergency department or to the admission triage area with shortness of breath gasping for air, any medical practitioner’s first action should be the airway. The acronym ABC (Airway, Breathing and Circulation) is used to memorize this in a difficult, fast paced situation like this to guide the care and this is not even an American born concept. It is an international, primary medical care to establize any critical patient arriving with shortness of breath, or bleeding. Obviously Tilahun was talking although gasping for air and therefore, the Airway part is clear, but his Breathing wasn’t normal so the first thing probably as Wase preluded it, give oxygen supplement and may be after a quick focused history, give some aspirin and nitro pills. This are pretty standard and available in Addis Ababa’s booming clinics and hospitals. The question is what are you going to do after that? If no expert on site such as Cardiologist, it seems the end point will be unfortunate death. Those interventions I mentioned as first line can only sustain or prolong the life of the patient for few hours. If indeed the diagnosis is either PE or Coronary artery disease that resulted in the death of the portion of heart muscles, an aggressive thrombolitic therapy or Cardiac catheterization, respectively , needed to get a better result, which I doubt is available at any of the healthcare facilities in Addis Ababa, at least the cardiac cath part. So, the question boils down to the government supervising body that regulate private healthcare system, how competent they are and what facilities they have before opening their door for patients. It also goes to the question of training competent doctors and nurses in the country who take responsibility in what they do every dya of their life on duty. If doctors are eating Khat, intoxicated with alcohol and get to work see patients, I believe something need to be done. I have same opinion as many of this forum members and ask the same question as Wase did: If Tilahun, as legendary as he is, dies wandering to get to a hospital in Addis Ababa, can you imagine what is happening to the poor millions like Shemsu in Welqitae or Zelelew in North Shewa?

    WeyraAmbaw

  34. The author didn’t seem to even consider Pulmonary Embolism (PE)(clott in the lung) as his differential, given his recent transcontinental flight.
    In my expert opinion, PE should be the first to consider, even prior to MI (or heart attack).

    Even here in USA, P.E kills, and so does MI (heart attack).

    May Dr Tilahun, rest in peace.

  35. Where were all these comments up to today? All Ethiopians have been treated the same way, or worse than this. Many die without any of help. Is this not true? So Tilahun like Every Ethiopian has succumbed to it. The Woyanne regime is be responsible for the extreme poor health care delivery system. Let’s deliberate on the loss of our ETHIOPIAN HERO. It is very rare to openly mourn the death of a hero in Ethiopia.

  36. We lost the dearest diamond, the glorious and the popular world wide vocalist Tilahun Gessesse.
    I herein would like to pass my condolance to his family and the whole ethiopans in all over the world.
    Ethiopia has lost one of its true legend son, Tilahun’s death ofcourse can not be prevented, it was his time and fate has decided it so.
    May soul body be under the mercy of the Almighty God.
    Jamal Ahmed

  37. May his soul rest in peace, in the mean time, there is something I want to point out or maybe ask, why are we so emotional about his death? What gives him the right to get all the condolences from virtually everyone? Because he was a great singer and some kind of vocal Ethiopian identity? Well and good but right at this moment, everyone must remember that there were many great Ethiopians, way greater than Tilahun who have bled and worked restlessly hard for our mother land but who passed away without even been recognized for their deeds and some even left betrayed, our hearts should remember them too during this moment, we should also remember who are living in hardships and in complete pain due to lack of justice and ofcourse due to lack of proper health care, by remembering the poor and the forgotten at this moment, we can actually celebrate the great singer of all time, Tilahun’s life better and please our God at the same time since all humans are equal in front of GOD,
    Thank You
    May The Holy Trinity, One God Bless Ethiopia

  38. I am very sad and angry that tilahun died with out getting any medical help .any acls cetified personel can handle this kinde of emergency.bot in ethiopia the mds needs to take thie education a bit further.

  39. Among others shortcomings the medical field is one of the major ones in Ethiopia. Let us stop pointing fingers and hopefully we will overcome our deficiency and be able to handle it better. In the mean time let us just remember our hero in our daily prayers and say he died of “Dengetegna”.

  40. Wase,
    i don’t know how you FAILED to mention PE.Tilahun’s presentation is a TEXT BOOK case of PE!!! (blood clot in the lung).While i agree with most of the things you have said all his acute symptoms are consistent with PE!! Don’t forget he just had a 16 hrs. flight that day.The fact that he is one leg amputee and acute presentaion of leg pain,SOB,racing heart makes again PE the most likely cause of his death.Appropriate treatment could have decreased the mortality rate from 30% to 2-8%.Again the only sure way you would tell cause of death is by performing Autopsy.I wish they did one.Lastly who to blame??? starts from ourselves.I don’t think we have a moral ground to blame others puttin in 6 and seven digit figures in a foreign land.

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