Category Archives: Flying Doctors

December 2013 Back at AMREF

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I pushed open the door of our twin-prop Kingair and stepped out into the heat. Dadaab was smoldering in the midday sun and the open, dusty expanse of desert felt like the base of a fire pit. The airstrip was deserted, save for a decaying UN World Food Programme aircraft, its engines missing and windows broken. Scattered thorn bushes clung to the dry red earth, their roots fighting to soak up any last vestiges of water, sheltering deep underground from the devil sun. We waited in the heat, squinting out at the desert landscape through the shimmering air.

Eventually, the ubiquitous Toyota Landcruiser drew up and I climbed into the back. Our patient, a large middle-aged African woman with severe malaria groaned a reply to my Swahili greeting. With difficulty we lifted her into the back of the aircraft, it was hot inside, but mercifully out of the direct sunlight from above. Vital signs showed that she was pyrexial, tachycardic and very dehydrated. An IV line was fixed, fluid administered and oxygen delivered before we started the engines. A blast of air conditioning bathed the cabin and dried the sweat on our brows.

We bumped along the bush airstrip, finally lurching into the air and banking hard left, looking down on the huge UNHCR refugee camp spread out below. Home to a half-million displaced souls, this is largest refugee camp in the world and sits on the desert plane just south of the Somali-Kenyan border. With fluid, oxygen and medication, the patient was beginning to improve during the 1 hour flight back to Nairobi. At Wilson Airport we moved her into the back of our ground ambulance and sped off to Nairobi Hospital where she would receive definitive care.

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So ended my first rescue and retrieval mission of this placement with AMREF Flying Doctors (AFD). I had arrived the day before from the cold of a wintery Manchester to spend 3 weeks with my friends at AFD in the run-up to Christmas.

As I write, I’m due to head back to England tomorrow after a busy second stint as a volunteer flight physician. The 14 missions on this trip have covered some 14,000 miles, more than halfway around the globe. We have treated patients ranging in age from 14 months to 68 years. I’ve now flown more than 50 missions for AFD and I’m beginning to feel like part of the furniture. A pale-skinned and reserved Englishman I may be, but when Africa gets in your bones, it stays there…

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Today’s evacuation saw us fly out to Voi National Park in a Cessna Caravan. The Kenya Wildlife Service who work in the bush do a difficult job trying to protect the animals from poachers and attempt to mitigate the inevitable conflict between humans wanting more land and animals needing space to live. An unfortunate accident had happened there this morning, a so-called ‘friendly fire’ incident where one of the Rangers had been badly injured in a shooting incident with a colleague. The bullet had entered the left side of his abdomen, passed all of the way through, with a large exit wound on the right. The bullet had finally come to rest in his right forearm. He was in a bad way, with internal bleeding and damaged bowel. He needed to get to the operating theatre urgently so we worked quickly, gaining IV access, administering ketamine analgesia, antibiotics, fluid and oxygen. His wounds were cleaned, packed and pressure dressings applied. He remained fairly stable during the flight, although very sick. After handing over at Karen Hospital he went to theatre and is now on the Intensive Care Unit where I hope he will make a good recovery.

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Between those two missions I found myself in Johannesburg during the Mandela memorial, evacuating a man from Tanzania following an acid attack in a bar. I was in the Central African Republic during the outbreak of ethnic violence, and saw hundreds of refugees taking shelter at the airport. We evacuated a Belgian man with a traumatic head injury, but it makes you shake your head at the world when rescuing a single European as we flew over the massed ranks of refugees, living in squalor below.

Other destinations on this trip have included Rwanda, Burundi, Djibouti, Tanzania and various locations around Kenya. I could write a full blog about each but I’m running out of time before flying home and will leave it there for now. It’s been a great 3 weeks and I’m already looking forwards to coming back at some point….

Thanks to all at AFD. You do a great job.

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First trip report 2012 – a holiday and my first day with AMREF

It was great to finally return to East Africa after months of hammering the locum shifts. I’m here in Kenya for 10 weeks, primarily to volunteer for AMREF Flying Doctors; more on that later. The never-ending locums before coming out were to pay the mortgage while I’m away… travel is not quite as care-free as it used to be when I was a student, it seems.

AMREF (African Medical Research Foundation) is a large NGO based in Nairobi which provides a range of health initiatives across Africa. They were originally founded back in the 50’s by 3 western doctors and have since won many awards. The Flying Doctors Service is based at Wilson Airport in Nairobi and will be my home until November.

We provide aeromedical evacuation services across East Africa and beyond, with transfers to the modern hospitals in Nairobi or occasionally, repatriations across the world. We run a combination of flights funded by an insurance scheme (in the region of $20US per year for local people, more for foreigners) and charity flights for Kenyans who cannot afford to pay. Any surplus from the insurance scheme is put back into AMREF’s public health work. I am the medical cover here for 8 weeks and will, in theory, be on-call 24/7 for that time. If there are concurrent flights (or on the occasions when I might need some sleep!) then local doctors are employed as locums, but this is very expensive for the organisation.

I needed a short holiday before starting work and really made the most of my couple of weeks off… the first for a long time. On a trip to the Massai Mara National Reserve, I saw some of the annual migration of the 1.5 million wildebeest and took an incredible hot air balloon ride.. drifting 500 feet above the savannah at dawn, gazing down on a herd of elephants was an experience I’ll never forget. After the Massai Mara, I did some mountain biking through Hells Gate National Park in the company of giraffe and zebra. I’ve spent the last few days on the Indian Ocean coast enjoying the diamond white beaches and snorkelling in the clear blue sea.

Yesterday (01/09) was my first day here at AMREF. I was picked up from the Wildebeest Eco Camp; which is a great place and my Nairobi base for the last 2 weeks, at 9am. Amazingly, I was in the air, zooming through the clouds above central Kenya by 10.15! The Beechcraft 200, one of AMREF’s medium-range aircraft had enough room for, in addition to our medical kit, 2 pilots, the AMREF employed Kenyan nurse and myself. We were heading for Juba, the capital of the world’s newest independent state – South Sudan. All we knew of what to expect at the other end was ‘a 67 year old patient, fluctuating conscious level, possibly unconscious).

South Sudan gained its independence from Sudan last summer, following the ‘end’ of Africa’s longest running civil war. It remains one of the poorest countries in the world. Most of the population are subsistence farmers and have a difficult life, contending with regular drought and shortages of basic care. Sudan’s chief export is oil and 75% of the reserves lie in South Sudan. However, the oil pipelines all run north and conflict on this issue persists.

Flying over the East African plains towards South Sudan, I felt totally elated… it felt like the culmination of 12 years of work. I had decided to study medicine at the age of 27 while cycling around South Asia. Now here I was.. I am a Flying Doctor in Africa – and I knew I had to deal with whatever awaited me in 2 hours time. I felt nervous, but mostly just excited about the challenges ahead.

We had quickly checked all of the kit before departure and did so again now. We skimmed over the Blue Nile before touching down at Juma airport, two and half hours after leaving Nairobi. An ambulance arrived on the apron but unfortunately they were expecting us to deliver them a patient! Welcome to African healthcare.

Eventually a second ambulance arrived, this time with our patient. It turns out (as is often the case) that the triage information was totally misleading. The patient was fully conscious but suffering from acute liver failure. I carried out my initial assessment, gained intravenous access and took some blood for analysis. We moved him with some difficulty into the aircraft, commenced some IV fluid and pain relief. Full monitoring was attached and my blood sample analysed. We took off again, needing to give oxygen for the drop in air pressure and monitored the patient closely. In the end, it was a fairly uneventful transfer and we got him safely to the High Dependency Unit at one of Nairobi’s hospitals.

I am staying in a small house near the airport and went back there to unpack my things, eat and get some sleep. Today is Sunday and all is quiet so far… I feel privileged to be here and I’m very much looking forwards to what the next 8 weeks has in store…

Thanks for taking the time to read this – hope you enjoyed it, there’ll be more to come..

simon

PS if you are interested in donating to AMREF or just want to find out more: AMREFhttp://www.amref.org

The photos below show:

1. Wildebeest Eco Camp
2. Ballooning at dawn over the Mara
3. Diani Beach
4. En-route to Nairobi from Juba
5. Transfer in Nairobi

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