Beverly Coon visited Oahu every November until she was diagnosed with breast cancer.

The 65-year-old former systems analyst for the U.S. Department of Defense loved going to the North Shore to watch surf contests. She enjoyed local food and sipping mai tais while watching the sunset from the Hale Koa Hotel in Waikiki.

When the cancer spread to brain, Coon’s doctor told her that her life was coming to an end. He gave her two weeks to live, maybe eight.

She booked a month-long trip to her “favorite place on earth” with her boyfriend.

“It was her all-time favorite place to go,” says Dawn Stout, Coon’s daughter. “I think she had it in her mind that that’s where she wanted to die.”

Stout and her husband, Greg, followed Coon to Hawaii. They spent several days with her before returning to Indiana.

Coon died less than a week later, on Sept. 24, 2014. It took two weeks of dealing with officials in Hawaii and Indiana to get her body back home.

“We kind of had it in the back of our minds that it might be the last time we saw her alive,” Stout said.

Letters from Loved Ones

Nine months ago today, you came to my rescue after the sudden death of my beloved husband, Bill. You gave me peace from the first moment I spoke to you on the telephone at Straub Hospital.

Coon was one of dozens of visitors who die in Hawaii each year. Some are killed in accidents, including drownings, falls while hiking or car wrecks. But, like Coon, many others pass away from an illness or health problem.

But whether a sudden accident or a terminal illness, it’s the relatives who must deal with the sad details of getting the body home for a funeral or memorial service.

It’s an often tedious process and one that can also be costly — as much as $10,000, according to organizations that help the grieving families whose loved one has died far from home.

When the worst happens, “the one thing that all the visitors have in common is they want to get the body back as soon as possible,” said Jessica Lani Rich, president and CEO of the nonprofit Visitor Aloha Society of Hawaii.

Based on Oahu, the society works closely with visitors when something bad happens during a vacation, including when someone dies or is hospitalized.

Rich’s organization has been helping families for more than a decade. It’s often the first to get a call from the Honolulu Police Department or the Medical Examiner’s Office.

“Usually on a Sunday I’ll get a call to come to the ER … that a visitor has passed away,” Rich said. “We’re primarily there … for moral support at first, just to let them have a shoulder to cry on.”

If a visitor dies while traveling alone, the Medical Examiner’s Office will notify relatives back home.

But most of the time visitors are traveling with relatives or friends, so it’s easy to identify the deceased and notify the family.

Rich helps by coordinating transportation between hospitals, hotels and mortuaries for grieving travel companions.

“A lot of times I’ve taken them to the mortuary, (especially) if it’s a woman alone to make the arrangements, because it’s very painful,” Rich said. “I’m even there when they put the body in the bag, and the wife will watch the husband go away, and that’s really difficult.”

Letters from Loved Ones

 I would love to thank this organization for their help with my sister, who lost her husband while visiting the islands. She was all alone trying to deal with this and this organization stepped up and gave her a lifeline for her to cling to.

The mortuary handles the details of sending bodies home.

Blanca Acevez, a funeral director and embalmer at the nonprofit Oahu Mortuary, says she works with at least one visitor every couple weeks. She said she tries to get bodies home in the quickest, least expensive way possible.

But that can take weeks, Acevez said.

The medical examiner performs an autopsy even if the death is apparently from natural causes.

Cremation is the simplest option, and costs less than $1,000. It costs about $3,000 to embalm and send a body to the mainland, which includes the cost of air travel, Acevez says.

Normally, Acevez sends loved ones back to the mainland in an “alternative container” — a reinforced cardboard box — to keep shipping costs down.

Sending a body to a foreign country is more complicated, depending on that country’s requirements, Acevez said. All bodies sent abroad must be embalmed and transported in a sealed casket, which costs more because of the added weight.

A few weeks ago, Acevez helped send a man’s body back to Australia. It was an “easy” process that took about five days and cost the family $7,000, she said.

If families choose a for-profit mortuary, costs can start at around $7,000 to get their loved one back to the mainland. Either way, the family is also responsible for the funeral costs back home.

Letters from Loved Ones

 My step-father passed away on a flight that had to be returned to Honolulu (in October) and I just wanted to acknowledge the kindness, support and assistance your organization gave to my mom.

Tullia Marcolongo, director of programs and development for the International Association for Medical Assistance to Travellers, recommends that visitors, especially those with pre-existing conditions, buy travel health insurance that would adequately cover expenses in the event of health problems or death. 

“They may find themselves in a difficult situation having to pay for medical bills that they thought were covered,” Marcolongo said.

Most people traveling to Hawaii aren’t thinking they’ll get sick or or die on vacation. But in fact, the risk of health problems actually rises on trips like these.

For one thing, vacationers may be less likely to seek medical care for ailments that initially seem minor.

According to a study by the Centers for Disease Control and Prevention that analyzed travelers’ behavior from 2000 to 2010, nearly half of more than 900 million international tourists became ill at some point while traveling. But only 8 percent sought medical care.

Nearly half of Hawaii’s visitors who drowned in the last 10 years had pre-existing heart conditions.

“Language barriers, including the inability to be understood, different medical standards, and anxiety navigating the local health system are some challenges that travelers face,” Marcolongo said. “Some travelers may decide that they are not sick enough to seek medical attention.”