The week here at AMREF Flying Doctors has seen a welcome respite from war and human conflict. However, human-animal conflict has taken its place, with cases including severe malaria, a hyena attack and a crocodile attack! Its been a busy and challenging week with flights to destinations including Cameroon, South Africa, South Sudan, Uganda and Tanzania.
Malaria remains a huge problem globally. In 2010 the WHO documented 216 million cases with over 600 thousand deaths. This is also likely to be a gross underestimate as many cases go unreported in very poor areas lacking in healthcare facilities. Malaria is caused by a micro-organism called Plasmodium which has several sub-species and is transmitted to humans by the female Anopheles mosquito (the more friendly males feed on plant nectar!). The disease can vary in severity from a relatively mild flu-like illness to severe cerebral malaria with complications including kidney failure (black water fever), convulsions and death.
I’ve seen the full range of severity in malaria this week. On a long flight to southern Tanzania with a mud-pack bush airstrip, we needed to use our Cessna Caravan aircraft which can land on almost anything. The aircraft however is relatively slow (130 knots or so) and has a non-pressurised cabin. Flying at 13,500 feet, I tested my own blood oxygen level at 88% which is low and not a level you would want to sustain without proper acclimatisation. After a 5 hour flight with a refueling stop in the Tanzanian capital Dodoma, the patient was able to walk onto the aircraft carrying his bag. He needed only oxygen, intravenous fluid and monitoring for the return trip.
Two other cases of malaria however were at the opposite end of the spectrum. Both were cases of suspected severe cerebral malaria in Cameroon and South Sudan, requiring advanced ventilatory support. One involved a volunteer consultant paediatrician working for Medicines Sans Frontiers in a remote area. We evacuated both safely and they are making a good recovery here in Nairobi.
Road traffic accidents are a common occurrence in Kenya. During one of the malaria missions, a mini-van carrying 22 school children (capacity should be around 10) overturned on the highway right outside our office. Thankfully everyone escaped with cuts and bruises only. On my way back to the house at 1am from one of these flights I saw two cars in a ditch by the highway. We stopped and I looked for casualties – there seemed to be just two men involved, who were arguing by the roadside. Staggering around, they both stank of alcohol while I asked them in Kiswahili if they were ok. One of them looked at me and said in perfect English, ‘we are fine but please tell this man not to drink and drive!
Photo below is a cumulonimbus thunder cloud from close quarters…
The mission to evacuate a man involved in a hyena attack was book-ended by two contrasting trips to Uganda. On the first, we evacuated a 49 year old woman with a brain haemorrhage from a district hospital lacking in facilities. She required intubation and mechanical ventilation which proved to be very difficult due to her condition and body shape. We got her safely to Nairobi but I worry that her outlook is bleak. The second Uganda mission involved evacuating a young man with a mental health disorder. He required constant gentle reassurance and his hand holding for the 2 hour trip.
The hyena attack was a sad story. A woman carrying a baby was attacked by a rabid hyena in northern Kenya. The animal had become rabid, we believe, after eating a dog with the condition. A man from the village went to help but sadly the woman and baby were both killed, the man sustaining very severe injuries to the face, head and both arms and hands. He had lost a lot of blood and needed extensive treatment when we arrived. I don’t want to elaborate more on his injuries here, suffice to say that he will be in hospital for a long time. I am hopeful however that he will survive with a decent quality of life. We evacuated him as part of our charity work and his hospital fees are being paid by the Kenya Wildlife Service.
So ends another week and I am halfway through my time here… I’m continuing to love my work and feel very fortunate to have this opportunity. It’s hard work (I have flown over 20 missions and I am on-call 24/7) and can be emotionally draining sometimes, but I wouldn’t have it any other way.
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Below: refuelling stop in South Sudan. The UN and World Food Programme have a major presence there.