Actor James Gandolfini was just one of the thousands of Americans who die while traveling abroad each year. Their survivors need to not only cope with grief, but also the logistics of trying to repatriate the body.
For Azia Ludwig, 22, the tragedy of her father's death from a fall hours after her wedding in Mexico was only the beginning. Her experience included a funeral home she felt was unscrupulous and a Spanish death certificate that wasn't accepted by all the U.S. banks and insurance companies she's had to deal with.
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"It was a nightmare. I had the best day of my life and I woke up to the very worst day," she said in a telephone interview from her home in Midville, Utah. "You're never really prepared, but here was a language barrier."
It's impossible to know how many Americans die outside of the country each year, but in 2012, the U.S. State Department assisted the survivors of nearly 11,000 U.S. citizens by notifying next of kin, helping with returning the body and keeping the family informed of any investigations, said Beth Finan, a spokeswoman for the agency's Bureau of Consular Affairs.
Gandolfini's body was flown back four days after his death, the process expedited by U.S. Secretary of State John Kerry. But for average folks, the process can take much longer, and may include hassles ranging from bureaucratic hurdles to high (and sometimes questionable) fees. The State Department or a U.S. Consulate may be able to assist with advice and arrangements, as can many funeral homes. If the deceased had life insurance or travel insurance, those companies should be consulted as well to see what help might be available, and what type of documentation is required to claim benefits.
Ludwig decided to cremate her father, Rob Wiscombe, a 43-year-old businessman and chef from Pocatello, Idaho, since there are fewer issues involved in transporting ashes than transporting a body. "If we waited to get my dad's body home I would have had to be there for several weeks and the body would be shipped back like luggage," said Ludwig. She was warned, however, that sometimes the urn is opened and contents inspected at the airport.
Ludwig believes it was the hotel manager in at the resort in Playa del Carmen who contacted a funeral home on her behalf. Ludwig said they were first told that cremation would cost $2,000, then after the manager left, the price was raised to $4,000 with $500 cash up front.
"We kept asking why and there was a language barrier. For some reason they couldn't explain it to us," she said.
They scraped together the cash and when the funeral home refused to provide a receipt, they asked the hotel desk clerk to witness the transaction.
The next day, they called the U.S. Consulate, which intervened along with an apologetic hotel manager.
Nevertheless, the funeral home was several hours late for a meeting, and in a surreal moment in a cafe, the man from the funeral home, while holding Wiscombe's ashes, said, "There was a problem with the cremation," she recalled. Although she never got the details, she eventually worked out a final, firm price -- $2,500 -- and was able to fly home with the urn on her original ticket, three days after her father's death.
But there was another problem: The autopsy report and death certificate were in Spanish, complicating the paperwork for her father's estate. Her insurance agent set up a FedEx account to facilitate getting the paperwork from Mexico and the consulate eventually sent an English Certificate of Death Abroad, but she gave up trying to get English copies of the police and autopsy reports.
Ludwig, a student and waitress, believes her father flipped over a low third-floor balcony railing when he took a wrong turn after a night of celebrating following her wedding this past May.
Those who choose to send back a body face other challenges.
"The body has to be embalmed and in a sealed container and a shipping crate," said Carol Williams, executive director for the National Funeral Directors and Morticians Association, based in Atlanta.
She said usually a bereaved family will contact their funeral home of choice, and it will then call the consulate for the country where the person died to determine that country's requirements. The funeral home can also make the transportation arrangements for the body.
Pricing should be available within 24 hours, she said. Cremation is more economical, as repatriating and flying a body can cost thousands of dollars. She advises people to make sure they have travel insurance.
"With that insurance, it will provide the funds to get that body home," she explained.
Williams said funeral directors in St. Maarten, a Caribbean island popular with cruise ships, once told her that they were frequently involved in returning the remains of passengers who died on vacation.
"Especially now because people are traveling more, they are older, retired and some of them have health conditions," she said.
Tullia Marcolongo, director of programs and development in for the International Association for Medical Assistance to Travellers, said she believes people traveling may be reluctant to seek medical help for ailments they perceive as minor.
"They don't want to interrupt their trip schedule. There is a perceived lack of time," she said from her office in Niagara, N.Y. She said people may not want to wait in a foreign emergency room, or ask for help navigating an unfamiliar health system.
The reluctance "may be amplified with the language issue," she said.
She cited a new study published by the Centers for Disease Control and Prevention that examined traveler habits from 2000 to 2010 and found that 50 percent of 940 million international tourists became ill, but only 8 percent sought medical care during or after their trip.
Gandolfini died of a heart attack at the age of 51 on June 19 while on a trip to Italy.
When someone dies abroad, "It can be devastation for a family," said Williams. "Especially trying to deal with the loss and the expense."