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.’

www.flydoc.org

www.amref.org

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

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