What Killed Noelene and Yvana Bischoff?

Surely not food poisoning.

Following reports that an Australian woman Noelene Bischoff and her 14 year old daughter Yvana died in Bali after falling ill only hours after checking in to room 7 at the Padang Bai Resort, I was curious.

Food poisoning was suspected but I've frequently been ill after eating in Bali and couldn't imagine, not just one, but two people dying  from food poisoning within seven hours of becoming unwell? So I visited the Padang Bai Resort.

After first seeming to know nothing of the incident, as she'd been off that day, the lady on reception advised she was unaware which room they had become sick in. When asked specifically for room 7 she advised it was unavailable but we could have room 6. I'd already seen 7 was unoccupied but she said it was booked.



Padang Bai is a small harbour in Bali from which boats leave to neighbouring Lombok and which features diving, snorkeling and a modest coral reef.



Traders along the waterfront were confident that nothing bad had occurred in Padang Bai, suggesting the  Bischoffs had become ill elsewhere and merely arrived in Padang Bai before the effects became severe. They were also sure the fish served in Padang Bai was healthy as it was caught locally. In press reports the resort manager Mr Bareato had also said the resort buys fresh fish from local fishermen each day. The enthusiasm of locals to maintain the reputation of their community I've found common in Bali, as well as a tendency to blame Javanese when there is trouble. This attitude minimises robbery and violence, as mostly people are looking out for visitors which may in part, stem from recollections of economic devastation in the wake of the bombings. A terrible time for locals, but a period of heavily discounted abundance for visitors that weren't discouraged.

Twelve hours before their deaths, Sunshine Coast mum and daughter Noelene and Yvana Bischoff laughed and joked with waitstaff over a seafood lunch in Ubud and this meal was thought unlikely to have been related to their demise.

Just metres from room 7 is the Buddha Restaurant which the lady on reception had advised was a separate business to the hotel. It was here they ate dinner around 7 pm. So we tried it for lunch.



We asked the waiter about the Bischoffs but he knew nothing about the incident. The press reported the Bischoff's had ordered mahi mahi fish, chicken curry and vegetarian pizza. Just six and a half hours after the meal, Noelene was dead. It was the mahi mahi fish which doctors say is the main suspect.

A day later another Australian, Heath Barclay, fell ill five hours after eating a ham pizza. A Facebook friend mentioned the Bischoffs, "I then check the net and to my horror I had eaten at the same place and had fallen violently ill," Mr Barclay said. "With the police [crime scene] tape in full view of my room at the hotel it was a living hell – I thought I could be next." The 34-year-old plasterer rushed himself to a Denpasar hospital where he was put on an intravenous drip for nine hours. "I was blood tested and told I had severe dehydration and a bacterial infection from food," he said. "I don't really know what would have happened if I didn't go to hospital. If it was the same thing, I can't imagine how terrible it would have been for a 14-year-old girl." However, I can imagine his colleagues on the building site having fun comparing his reaction to that of a 14-year-old girl. Of course it wasn't "the same thing", just the usual unpleasantness of food poisoning combined with the uncertainty of where it originated when he, as I usually have done, ate in more than one place over the previous couple of days. However, it raised suspicions of the pizza and the cleanliness of the kitchen. I glanced in the kitchen and it looked spotless and better equipped than most Bali restaurants. I asked the chef about the Bischoffs but she said she knew nothing and had been rostered off that night. Most staff in Bali work punishing 10 - 12 hour shifts, six days a week so you can be pretty confident of meeting someone that works in a business by turning up at any random time. Padang Bai Resort seems far more generous with leave provisions than most or perhaps we were unlucky. Like Heath Barclay, so far we'd learned nothing more than what had been in the papers.

At lunch Jarrod, in the foreground, couldn't be persuaded from his perennial favourite, sweet and sour pork. Jenny, on the right ordered the vegetarian pizza, but it was only available after 6 pm. Not desiring chicken curry, she settled on leek and potato soup. I requested the mahi mahi (pictured below).



Jenny reported the soup tasted as good as it looked.



The mahi mahi was served with chips and a side salad. It too was lovely. Following a pleasant lunch we went snorkelling and sightseeing. There were no ill effects.



The sudden and mysterious death of two family members was undoubtedly distressing. ‘‘We want the truth,’’ the family spokesperson said. ‘‘We want to know if it was an accident, or if it wasn't an accident. Were they poisoned, or was it something else? ... "We’re worried that there will be a cover-up if the autopsy is done in Bali." Indonesian authorities respected the Bischoff family's request and allowed the bodies to be returned home for autopsy.

A colleague suggested it was probably medication administered in response to initial symptoms that was the culprit but we'd left Bali, none the wiser. Eventually the preliminary autopsy finding was that they died from a combination of food poisoning and existing medical conditions after they ate fish". It was reported that "Malcolm Bischoff, Noelene's brother, said it appeared they both suffered from scombroid food poisoning that, coupled with their asthma and, in Noelene's case, migraine medication had formed a fatal cocktail." My colleague hadn't got it quite right but it was a prescient observation.

Malcolm Bischoff stated "I'm sure we wouldn't have got that answer if the autopsies had been held over there [in Bali]" I'm not so sure, but the Indonesian authorities were wise because Malcolm would likely have been sceptical of the same findings from them. Having accepted the results, Malcolm said "scombroid food poisoning can result from eating spoiled fish, meaning the restaurant's preparation could have made no difference". This defence of the restaurant might be helpful as there was only one other patron having lunch when we were there. He hadn't heard of the Bischoffs and, better informed, some of my party would have preferred to eat elsewhere.

According to the Courier Mail, "scombroid food poisoning occurs when fish like tuna, mackerel, sardines and mahi mahi, is left in temperatures over 5 degrees. After the fish has died, naturally-occurring bacteria can then convert the amino acid histidine into the toxic histamine which can cause severe, allergy-like symptoms." Histamine is not destroyed by normal cooking temperatures, so even properly cooked fish can be affected.

While the autopsy is not yet finalised it seems that the Bischoffs were unlucky. The other people that ate the same fish included the resort manager Giovanni Bareato. They probably didn't have the complicating factors and scombroid concentration varies in different parts of the flesh.  None reported ill effect.

Despite the confidence of the traders that no one from Padang Bai was involved, it does implicate the fisherman who supplied the fish. Had the fish been refrigerated there would not have been scombroid and I'm surprised I've not seen this angle pursued. I don't know the practises in Padang Bai but I've seen fisherman elsewhere in Indonesia selling their daily catch straight from the boat without ice or refrigeration. Convincing fishermen of a need to change this practice is probably a difficult task but, as with Heath Barclay and the Bali bombings, human reaction to tragedy is rarely nuanced, tending to indifference or panic. I'm sure the traders of Padang Bai want to avoid the latter and another scombroid death might provoke it, even though motorbikes is the more common source of tragedy.