Monthly Archives: October 2012

A beginning and an end – week 8

My final week here at AMREF Flying Doctors has not been a gentle wind-down. We evacuated a premature neonate from South Sudan as well as flights to Johannesburg, Madagascar, The Seychelles and Cape Town. In total I have flown 38 missions covering more than 40,000 miles around Africa.

We’ve treated patients from Cairo to Cape Town, the Seychelles to Cameroon. Its been a challenge at times but always rewarding and enjoyable. The team at AMREF Flying Doctors are an amazing group of professionals and I am privileged to have worked with them.

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In South Sudan we evacuated a baby boy born the day before, 2 months premature. These babies often have breathing difficulties as their lungs are not fully developed. The clinic, in a very remote area had done a great job with baby Jordan, setting up a very creative positive airways pressure device. They had rigged some plastic tubing from the baby’s nose to a jug of water, creating a very literal 4cm of water pressure to help inflate his lungs. It was clearly not practical for him to continue on this set-up though, not least because we would have had water all over the floor of our jeep and later our aircraft. Looking after neonates is a little intimidating, its not my speciality and everything is just so small. When things go wrong, they go wrong very quickly. I was worried about how the little man would cope in the relatively hypoxic environment of the aircraft cabin. After some thought, I managed to recreate the airway pressure using close-fitting nasal cannulae and an increased oxygen flow rate, while keeping a close eye on oxygenation as overdoing it can also be harmful (particularly to the development of the eyes). It was a nervous flight, using our incubator for temperature control, managing the breathing as above and staying on top of his blood glucose and electrolytes, which can be difficult in very small babies. Thankfully we got him to the neonatal intensive care unit in Nairobi in good shape.

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Island hoping in the Indian Ocean saw us evacuate an American tourist from Madagascar with a fractured femur and a critically ill German lady from the Seychelles. She had suffered from a serious but undiagnosed insult to the brain, she had been fitting and was unconscious. She required intubation and mechanical ventilation in order to be safely evacuated. I was so focused on this that I forgot to get an exit stamp in my passport before departure. I’m still there in the Seychelles as far as their immigration knows! I guess I’ll have to call the embassy to avoid becoming an international fugitive!

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Cape Town was my final flight and the evacuation of a patient with intestinal failure. It was a straight forwards clinical mission and gave us time to have some fresh seafood at Victoria Quay in the shadow of Table Mountain – a great way to finish my trip.

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Thanks everyone for your support.. this blog has had 1000 visits or so up to now. Please consider helping AMREF with a donation or volunteering yourself. Email me for more information on siforrington@fastmail.net

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Below : with Omar – captain, pilot and friend on the flight deck of our Cessna Citation Bravo

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The banquet – week 7

We’ve had some long and eventful flights this week. Two lengthy trips in the Cessna Caravan set the tone. These tend to be very tiring flights, the Caravan is non-pressurised and although we give oxygen to our patients, we do not use it ourselves. We often spend several hours at altitudes over 10,000 feet with correspondingly low blood oxygen. The nature of the bush airstrips often necessitates the use of these aircraft, which are designed to land almost anywhere.

On a flight to South Sudan, the airstrip was particularly ‘traditional’ with a crashed aircraft adorning the flank of the runway (see photo below). Before starting work with the flying doctors, I was not the most relaxed of flyers, not enjoying the lack of control and especially the turbulence. I learned to overcome any fear very quickly however; our pilots are some of the best in the business and if you have no personal control, why worry about it? It serves no purpose.

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On the approach to the airstrip in South Sudan, we needed to make a low-level fly-by in order scare away the goats, cows and people from the runway. We were still very much a novelty in these parts and many of the locals who greeted us were wearing more piercings than clothes. Our patient, a Japanese NGO worker with malaria was safely delivered to hospital in Nairobi.

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The other Caravan trip took us to western Tanzania. It’s such a beautiful country, flying south over lake Tanganyika, and then over rolling green hills punctuated with mud huts and blood red rivers. I was met at the air field by a volunteer Australian doctor who had been living there for 2 years. Our patient had a base of skull fracture following a road accident, but his evacuation was straight forwards and went without incident. He will make a full recovery.

The longest evacuation of my time here took 3 days at the end of last week. We used the Cessna Citation Excel which is a larger jet and I couldn’t help but feel a little like a rock star, travelling in luxury and a great contrast to the Caravan. We retrieved Mahmoud, a 55 year old Egyptian national from Luanda in Angola, southwestern Africa and flew him to Cairo in northeastern Africa.

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We suffered both logistical and clinical difficulties in Angola. The local language is predominantly Portuguese and few people speak English. My command of Portuguese amounts to 2 words. It took us 2 hours to arrange a ground ambulance to get to the ICU. Once there, the patient was very sick with (apologies to the non medics for the jargon) bronchial carcinoma in the right main bronchus causing full collapse, liver metastasis, acute renal failure and vasopressor-dependent cardiovascular failure. His overall prognosis was incredibly poor and it did make me wonder what the meaning of it all was and what we were achieving on this mission. I satisfied myself in the knowledge that he would be passing away in his own country, surrounded by his family and friends who would themselves be allowed a better opportunity to grieve.

After moving him onto our transfer equipment and ensuring he was as stable as I could make him, we travelled back to the airport. At this point we realised he had no passport or other documentation. All we could obtain were some rudimentary documents from his employer. The immigration authorities were understandably reluctant about this, but changed their mind when I told them that if they didn’t allow us to leave soon, they may have a dead patient in their airport. We were on the ground in Angola for a total of around 5 hours.

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During flight, it was full time job just to keep him alive. I had to manage hypoxia, hypercarbia, mixed respiratory and metabolic acidosis, hyperkalaemia, hypocalcaemia, arrhythmia… I was relieved to finally get to Cairo where we had to wait a further hour before Immigration decided to let us into the country. On arrival at the hospital we had perhaps 40 minutes of oxygen left. His family were there to greet us and although they were very grateful, they were unaware of the seriousness of his condition. My final job of the mission was to break the bad news to them as gently as possible. We arrived at the hotel at 430am, exactly 23 hours after first setting out from my base in Nairobi. The pilots were in the bar and had beers waiting for me. I went to bed at 7am.

At 10am I was up to take Joel, our Kenyan flight nurse to the pyramids. He has rarely had the chance to explore beyond Kenya, or the boundaries of the airports at our destinations. He was like an enthusiastic child seeing the world for the first time with wonderment in his eyes. I will always remember when he thanked me and said, ‘Simon, for me life is like a banquet every day.’

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Below: with Joel in Cairo, a pyramid and a sunset from 45,000 feet

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The rich, the powerful and the hip – week 6

It’s been a relatively quiet week here at AMREF Flying Doctors. The evacuations have for the most part been insurance work. We work with some of the largest providers and underwriters of international travel insurance in the world. Some of these missions involve evacuating tourists or aid workers from remote parts of Africa to the hospitals of Nairobi and some flights involve medical repatriations to home countries. The insurance work helps us to cover our costs, pays for our charity evacuations and anything left over goes to AMREF’s other humanitarian / aid work. We are a non-profit making organisation and the general philosophy and work ethic here really is admirable.

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At the beginning of the week I evacuated an individual from the beautiful Lake Baringo area of Kenya. He is well known in Kenya and beyond for important work in paleoanthropology and wildlife conservation. It was a relatively minor incident and he is recovering well here in Nairobi.

Later in the week I was asked to transfer two patients from a remote hospital in the west of Kenya to one of the main centres in Nairobi. They had been involved in a major road traffic accident and had sustained very severe injuries. Transferring one of these patients would have had its risks, but taking both was a major challenge. Kenya however, and AMREF Flying Doctors in particular have a real ‘can do’ attitude which tends to help make things happen, even in very difficult circumstances. The transfer did not go without incident, but both patients were safely delivered to Nairobi, where I was met and thanked by the Kenyan Prime Minister and his wife. The patients were both well-known to the PM and they were very grateful and complimentary about our work. At times its been an incredibly humbling and rewarding experience to be here.

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Other missions this week have included evacuating an 86 year old French lady with a broken hip from Zanzibar. It’s a beautiful place and I was slightly disappointed to see only the airport on this visit. I was last there in 2005 at the end of a 3 month stint working in a small hospital in Tanzania. Fortunately, she was fine and needed only pain relief from us.. although communicating with my rudimentary French and her non-existent English was probably the most difficult thing.

This week the launch of our new ground ambulance was attended by the Minister of Tourism and head of the Kenyan Tourist Board and our Board Meeting welcomed doctors from the Australian Royal Flying Doctors and an internationally renowned aviation medicine expert from the UK, Doctor Terry Martin.

I have 2 more weeks here before returning to the UK to resume my career in Anaesthesia and Intensive Care Medicine. Thanks for all of the comments on here and on Twitter (@siforrington, @AMREFFlyingDocs). More next week.

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New Frontiers – week 5

This week I’ve been able to enjoy flying to some new destinations. Our clinical workload remains high, but the complexity has been lower in the last few days. Cases have included trauma from more road traffic accidents, acute renal failure and gastrointestinal bleeding. On one busy day, we evacuated patients from the Democratic Republic of Congo in the morning and from the interior of Somalia in the afternoon.

Below, two shots taken close to the Tanzanian border – an active volcano and soda lake.

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Formerly known as Zaire, DR Congo which lies right in the centre of the continent and at two-thirds the size of Western Europe, is Africa’s largest country. It has huge natural resources but has been blighted by many years of war and corruption. It is still seen by many as a failed state, with the government unable to provide decent education or healthcare facilities. Known by some as Africa’s ‘World War,’ DR Congo has been a battleground with militias backed by rival surrounding states including Angola, Namibia and Zimbabwe who support the government and the rebels who have been backed by Uganda and Rwanda. This complex situation has led to a loss of life in the millions and the UN’s largest peace-keeping force. It is bottom of the UN’s development index of 187 countries, has a life expectancy of 48 years and an annual average income of $300. This is in the context of having 70% of the world’s coltan (needed for the manufacture of mobile phones) and 14% of the entire world hydro power potential; this would be enough to provide power to most of the continent, yet only 9% of the population has access to electricity. *

As we descended through the clouds I could see thousands of feet below, the lush green Congolese mountainsides, dramatic volcanoes on the Rwandan border and meandering rivers like blood red ribbons snaking through the landscape. This was ‘gorillas in the mist’ country and was beautiful. The lake sparkled in the morning sun as we swooped down to land. An aircraft graveyard was prominent next to the runway with relics from a bygone age… I was later to realise some of these relics were still flying which goes part of the way to explaining why DRC has the worst air crash record in the world. We had to stop at a large regional airport first, to clear customs etc, before departing for a smaller, more remote area to collect our patient. The place had an understandably hostile and edgy to feel to it, with a steady stream of ‘officials’ with dollar signs in their eyes, asking to see our documents and demanding payment for various reasons. As we taxied to the runway for the second leg of our journey, I noticed a number of Russian-manufactured Hind helicopter gunships amongst the plethora of UN aircraft. As it turned out, the evacuation proceeded uneventfully and I was glad to return to Nairobi. Upon arrival I was given my next job of the day – an evacuation of African Union troops from the interior of Somalia…

Somalia is in flux. The situation on the ground is definitely improving, with the recent advances made by the AMISOM troops in the south of the country. That said, it was still a little disconcerting to see the lines of tanks and artillery positions beside the runway as we landed. We scooped up two soldiers and quickly turned around to head back towards Kenya. AMREF Flying Doctors is a very professional organisation and we do not take any risks with our evacuations. However, it felt good to be back in Nairobi at the end of that day, following visits to two of the most turbulent states in the world.

On a gentler note it was great to go back to the Massai Mara National Park on another evacuation this week. I’ve now been lucky enough to travel there by road, hot air balloon and fixed-wing aircraft. We evacuated three Mara Conservancy employees whose vehicle had overturned while chasing poachers the previous evening. One had a badly broken leg, another a suspected fractured pelvis. They needed pain-relief and very gentle handling to prevent any further complications. This week, in addition to flying, I’ve also been emailing insurance companies to help with the commercial part of our operation, which in turn funds our charity work. I took my first day off in 5 weeks yesterday and enjoyed a few cold Tuskers with my friends at the fantastic Wildebeest Eco Camp.

Thanks again for reading. More next week.

*Facts and figures from the BBC, UN and World Bank

Below, evacuation from Massai Mara National Park

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