Adventures with AMREF Flying Doctors
The Calm Before the Storm – Part 1
Matt Edwards Blog working in remote medicine
One of our locum doctors was on his way in to help out but was a little way off in the infamous Nairobi traffic. The tiny Cessna plane arrived from Lewa and taxied to us. The little girl had improved on the journey and was now wriggling away from stimulus. It was a good sign; lots of little kids respond like that after a significant head injury. I see mostly insignificant head injuries in children back home, and often I have to physically catch them from the play-area in the waiting room to assess them. We packaged her up while calming the parents and sent her off to the hospital for a scan of her head to exclude a neurosurgical issue. I am told she awoke fully on the way to the hospital and is doing fine.
It took about an hour to get to this gold-mining town in Kahama, Tanzania and on the way, while being bumped around by the thermals coming off the baked ground, we did our standard checks and discussed our plan. Given that we were expecting to be escorted to the patients bedside, we thought we would have a little time to assess and plan in the relatively safe and sheltered environment of the hospital. As we taxied around at the dusty runway, I noticed an ambulance sitting just outside the gates on the other side of the airstrip. I wandered off in the baking heat to have a pee (I am always totally convinced I am going to get bitten by a snake when I do this) and Kisito the flight nurse explained to the airstrip’s official that the ambulance needed clearance to enter. It seems no matter where you go in the world you will find irritating ‘jobsworths’. It’s just that in Africa they tend to back up their obstinate behaviour with an AK-47. Kisito gave up and beckoned the ambulance to bring some people to help us hump the equipment the 500m over to the gate. I lifted a few pieces of equipment out of the aircraft and then noticed he had started running towards them.
Unfortunately the relatives could only afford a flight with our caravan. We could have been there in 20 minutes in a jet. Two hours and a bumpy road journey later we were at the patient’s side to discover the doctors had intubated him despite the advice of the guys in the radio-room. They had intubated and sedated him but had no capacity to give him positive pressure ventilation. So he was basically in a worse state than if he had been left to his own devices. He was sedated, driving down his own appropriate urge to breathe rapidly and the tube was merely providing an extra long windpipe, like a rather thin snorkel, just making the work of breathing more difficult with the froth from his chest bubbling out the end periodically. I’ve never seen this done to a patient before. Without the benefit of assisted ventilation I simply don’t understand what they were hoping to achieve.
As I settled down to a well-earned sleep that night, little did I know that, across the other side of the country, something terrible had just happened. The storm was about to get worse…
Stay tuned for the next signal….
About; AMREF’s vision is for lasting health change in Africa: communities with the knowledge, skills and means to maintain their good health and break the cycle of poor health and poverty. We believe in the inherent power within African communities – that the power for lasting transformation of Africa’s health lies within its communities.
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