Its been an eventful week at AMREF Flying Doctors. My own contribution has included 6 flights, treating and evacuating 9 patients across 5 countries, ranging in age from 11 months to 72 years. I’m beginning to wish I was accumulating air miles…
The staff here have been friendly and welcoming – I feel very much part of the team and It feels more like a month than the 7 days since I started. It’s been a tiring week at times, but never less than very satisfying.
Cameroon is a long way from Nairobi. On the other side of the continent, in fact. It was a 10 hour round trip to evacuate a patient from a very remote area in the north of the country, with limited health care facilities – to Yaounde, the capital. The patient had suffered from a stroke, was unable to move the left side of his body and was unable to communicate verbally. I knew my main challenge was to prevent further damage to already injured brain cells from the relatively low-oxygen environment present when in flight.
The airport at Garoua was like a relic from a bygone age. Once, it may have been an impressive sight, with a large terminal building and expansive apron. The buildings now though, were in a state of crumbling disrepair. The rusting covered walkways protruding from the terminal, with no aircraft attached, like partially amputated limbs. Inside, the abandoned luggage carousels eerily quiet and motionless with a solitary person, listlessly mopping the floor in a comically futile gesture.
The only aircraft present was our small jet. The entire airport staff seemed to number about half a dozen. I struggled to communicate and remember the rudimentary French that I regretted having given up learning years before. We got by with a combination of broken French, broken English and hand gestures. It seems that kindness, openness and a smile can achieve a lot in these situations.
When the patient arrived, he was quite stable and although my spoken French was limited, he did not speak English, and could not verbalise, we communicated well enough. Following initial assessment, we carefully loaded him into the aircraft, attached monitoring and sufficient oxygen and transferred him uneventfully to Yaounde.
At the most basic human level, I believe we are all very much the same. To me, our core motivating factors are to be happy and to avoid suffering. This is never more apparent than working as a doctor – especially in the ‘developing’ world. When someone is ill, all of those layers of wealth, status, race, religion, gender, politics, language etc are stripped away. Communication is often at that very basic level and simple empathy and compassion can go a long way
The previous day, we had a call to evacuate an 11 month old baby girl with severe bronchiolitis from Addis Ababa in Ethiopia. Small children in this kind of situation are prone to deteriorate very quickly. The condition often causes breathing difficulties and can result in dangerously low-levels of blood-oxygen. I was apprehensive, having not treated children this small for some time. We had some time while awaiting flight clearance and I was glad of the opportunity to fully prepare.
I downloaded the most current clinical guidelines from SIGN (Scottish Intercollegiate Guidelines Network) and calculated all of the drug doses I might need, (from the Royal Manchester Children’s Hospital utility crashcall.net) based on the weight of the baby which the doctor in Ethiopia had provided. I knew also that the baby’s oxygen saturations, without supplemental oxygen were around 80%, which is very low.
Ethiopia is a country with proud traditions and a proud population, being pretty much the only African state not colonised during the imperial times of the past. I remember clearly the devastating scenes of famine and hunger from the 6 o’clock news of my childhood. As we waited on the apron, parked next to a UN World Food Aircraft, those memories were fresh in my mind.
During my preparation, I had discovered that Addis lies at an altitude of 2350m. This is quite similar to the altitude present in the pressurised cabin of our jet, so I knew the baby’s oxygenation should not deteriorate during transfer.
When she arrived, the baby’s condition was better than I had anticipated. On oxygen, she was able to breast feed and was not in any respiratory distress. After initial assessment, it was important to have the baby (and mother) as calm as possible so as to reduce the baby’s demand for oxygen. We got them settled on the aircraft, the baby was comfortable and feeding with oxygen via nasal cannulae and we transferred them safely back Nairobi.
I am loving being here, doing this job. Thanks everyone for your kind comments and encouragement. I will send another blog next week. You can also follow me on Twitter for live updates on @siforrington or @AMREFFlyingDocs. If you are interested please also check out http://www.flydoc.org and http://www.AMREF.org