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.

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.

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!

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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

Animal attacks – week 4

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.
Thanks everyone for your continued support – the blog is proving to be quite popular with over 500 visits. Please spread the word – AMREF needs all of the support they can get.

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Below: refuelling stop in South Sudan. The UN and World Food Programme have a major presence there.

Wars, mountains and beer – week 3

The world can seem like a serene and beautiful place from 40,000 feet. On the Horn of Africa however, a different story unfolds on the ground. We flew north along the Somali coast, the tin roofs of the village sparkling like diamond dust in the sunlight, thousands of feet below. We descended steeply and banked out hard right over the Indian Ocean, swooping in low once again to the fiery furnace that is Mogadishu in the afternoon heat.

We had two casualties on this occasion. Their contrasting injuries, for me, illustrating something of the lives of the AMISOM troops in Somalia. The first patient was suffering from multiple gun shot wounds and was in a bad way. The second patient had a fractured patella from playing volleyball. The gunshot wounds had been inflicted in a so called ‘friendly fire’ incident and although I cant really elaborate more on that here, it didn’t seem very friendly to me. The bullets had caused compound fractures to both arms, the right arm having no blood flow now at the wrist and the hand was contracted into the claw of an ulnar nerve injury. I suspect he will later loose the arm. The small, clean entry hole of the bullet just below the rib cage on the right was in contrast to the much larger exit wound a few inches around the side. The bullet seemed to have just missed the liver, lung and diaphragm.

I have long been a proponent of non-violence and nowhere do I feel that conviction more strongly than I do here. To my mind, its time that we learn from our many mistakes and make a greater effort to settle our differences through negotiation and mutual understanding; rather than through killing and wounding one another. The end does not justify the means. War begets more war. As Mahatma Gandhi said, ‘the means are like a seed, the end is like a tree.’ Maybe I am a hopeless idealist, I don’t know. What I do know is that AMREF Flying Doctors make a contribution in picking up the pieces of the shattered lives of war and I’m glad to play a small part in that.

Its not been all war, doom and gloom. As a flying doctor, I’m privileged to witness some incredible scenery and experiences. As we flew south on another mission yesterday, Mounts Kilimanjaro and Meru were standing proud ahead of us, like sentinels at the gates of Tanzania. These are Tanzania’s two highest peaks (Kili being the highest in Africa) and I had climbed both seven years earlier on a trip with Jagged Globe Mountaineering. We landed at Kilimanjaro Airport to be met by welcoming, friendly locals, grateful for our evacuation of a young man who had literally fallen off a cliff. He was fortunate and got away with lung and kidney contusions only.

This week I’ve also had the opportunity to give some teaching to the AMREF nurses, help with the preparation of a conference presentation and spent some time relaxing with a Tusker beer at the Aero Flying Club of East Africa. Life is good.

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Necks, burns and malaria – week 2

Last week proved to be a gentle introduction. At least least from a clinical perspective. The majority of my patients required simple interventions to be safely evacuated.They certainly didn’t require critical care. Medicine works differently out here and evacuation by air ambulance can serve other purposes from back home.

The temptation is to think that it was not worthwhile flying five hours to Cameroon; to evacuate a man with a stroke from a remote area – for the one hour flight to hospital in the country’s capital. But you realise that the 400km distance would have taken several days by road and the lack of resources would have meant a medically-accompanied escort would have been unlikely. Distances by road in Africa are measured more realistically in time, rather than by miles. Air remains the most sensible form of medical transport in many areas.

This week however, our work has increased markedly in complexity and clinical severity. Cases have included spinal injuries – one from a gunshot wound, severe, life-threatening burns and cerebral malaria. Its been a busy and challenging week.

A suspected spinal injury was sustained by a Kenyan man in a motorcycle accident in Shimba Hills National Reserve. They were a long way from a landing strip and so we had a 4 hour round-trip in a helicopter in order to safely evacuate him. Flying low over Kenyan Game Reserves, spotting zebras and gazelles on route was a great experience. We had a large audience when we touched down at the village. In stifling heat, I assessed the mans injuries, immobilised his spine, gave him pain relief and awkwardly loaded him into the cramped helicopter. He was discharged from hospital the following day.

Another incident involved evacuating a man from Mogadishu who was injured during the suicide attack last week. Somalia is just beginning to emerge from being a failed state for over 20 years. It has had no functioning government for that length of time and has been one of the most dangerous, turbulent places in the world. However, AMISOM (African Union Mission In Somalia) has been trying to establish peace for some time now. A new president has recently been elected and it was he who was targeted in the attack last week.

Mogadishu lies on the indian ocean coast and the on-going security situation demands that we approach the airport low and fast over the sea, rather than flying over the city. Taking off, we also fly out to sea. The man we evacuated had been shot in the neck, he was paralysed and was breathing with his diaphragm only – as his other breathing muscles were also paralysed. We stabilised him on the ground and evacuated him to Nairobi. Sadly, he passed away in hospital a few days later. War is such a futile business and wrecks so many young lives.

The photographs below show AMISOM soldiers at Mogadishu airport and loading the patient into the aircraft.

Unfortunately, the burns patient is also in a bad way. He was the sole survivor of 4 in an air crash, shortly after take off. He sustained very serious burns (around 60-70% body surface area), fractures and lacerations. We evacuated him to intensive care in Nairobi and he remains very poorly. His chances are not high, but there is always hope.

My final mission from last week was to evacuate a young Kenyan lady with very severe cerebral malaria (P. Falciparam) from South Sudan. She required some resuscitation at the airport as she was in a poor state, but we safely evacuated her to Nairobi where she is still being treated in hospital. Her chances are good.

I had time to relax at the weekend on a hike up a local mountain with some of the staff from the office and a trip to the cinema yesterday afternoon. Thanks for reading. Live updates (Twitter) on @siforrington and @AMREFflyingdocs

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AMREF Flying Doctors – week 1

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