EWM Facualty Dr Matt Edwards report on his day hob with AMREF

Dr Matt Edwards, part of the Expedition & Wilderness Medicine’s faculty team has taken up a post with AMREF Flying Doctors based in Kenya see Matts Blog in full….

Having recovered from travelling the length and breadth of the the continent last week, I’ve been doing a few shorter retrievals into the wild expanses of Kenya’s neighbor to the south – Tanzania. I’ve done a few medevacs from there in the last month but haven’t written much about it. But as I seemed to be spending more and more time buzzing around it’s vast landscapes in the co-pilot seat of a Cessna caravan, I thought I’d expand on my experiences there.

I was first called out to a young man stuck in the middle of the game reserve of Katavi, the other side of Tanzania and close to Lake Tanganyika, with resistant malaria. Now if I’ve learnt to respect one thing out here it’s malaria. I suppose I am exposed to a pretty severe case-mix to be fair. If the local treatment isn’t working or they are in a collapsed state we get involved. Some of these guys are impressively sick and I suppose, now I reflect on it, I think what is actually affecting me about this is the number of young people with critical illness I’m seeing on this placement. Working in the UK I’m so used to critically unwell elderly patients but I’ve just not been asked to manage many elderly patients here. Well apart from the minister in Musoma and the jogging octogenarian rose farmer who had broken his hip in Kampala but they don’t count as really ill. They could both beat your average middle aged Brit in a race, even with a fractured neck of femur.

I was lucky enough to be allowed to sit in the co-pilot seat for the trip there. It was a long journey in the caravan but you simply couldn’t get bored with that view. We flew past the famous Ngorongoro crater into the wide open plains of the Serengeti. I was told on the way that the crater is an incredible, almost ‘locked-in’ ecosystem of a huge variety of animals. Even though Sir Arthur Conan Doyle’s Lost World was based in South America, it’s tempting to believe the crater could have been an inspiration for the tale. It is truly vast and few animals, especially the lions, seem to see the need to cross the rim. As we made our way into the Serengeti plains I could not stop humming Toto’s rock ballad ‘Africa’ – it drove me mad.

 My second mission over the weekend was to attend to an unfortunate gentleman tourist who had collapsed and had had a ‘cardiac arrest’ with ROSC (Return Of Spontaneous Circulation) while at a remote retreat in Grumeti, just over the Kenyan border and within the Serengeti Park. Again you don’t need to be a doctor to realise that having a cardiac arrest in a place like that is likely to have a poor outcome. I’ve heard of AMREF arriving to a situation in which the poor bystanders have been doing CPR for a few hours, only to tell them that any continuation would be futile. However if someone gets a pulse back after a short period of basic life support in the field then we could really do some good with post-arrest care (if we get there quickly enough).We had to fly fairly high over the Serengeti National Park and so any animals were tiny specks down on the ground but you could see the impressive migration trails made by the herds. From above you could get a scale of how many thousands of these beasts must march along these tracks every year. It must be incredible to see. I wonder if somehow I will get a chance. It can be put on my ‘bucket list’ for the future if not.

Soon we were landing in Tabora for a fuel stop and then continued south west towards Lake Tanganyika. The landscape became relatively featureless and it reminded me of flying in Antarctica. The huge marshlands of the Katavi National Park came into view – the home of a huge number of hippos and billions of bloody tsetse flies unfortunately. At least when you went to see Antarctic wildlife you didn’t have to cope with their irritating, disease-spreading, insect entourage.

We managed to find the secluded airstrip and did a dummy run to clear it of about five impala. No wonder cheetahs struggle to catch those things – they move incredibly fast. At most of the Tanzanian airstrips we have to get rid of a number of large animals standing in the way. Not something most pilots normally need to worry about. There are certain interesting considerations to this animal clearing such as; if you are going to land between two herd animals, bail out and climb. If it is just one, it will run away so you can land. The instinct to herd is so strong when they are threatened, that they will run together. So if the plane is landing between them, the likelihood is that one of them will run into the path of the plane and that would be sub-optimal for a landing.

Our patient was not too bad so was quickly popped into the plane and connected up to some fluids etc. I am told he has been treated for recurrent malaria and is recovering well.

This was a shorter journey and the route was thronged with wildebeest (with a couple happily grazing on the airstrip). When we arrived on the beautifully secluded airstrip we found our patient, who was alive, cheerful and looked pretty chipper! We examined the circumstances surrounding this cardiac arrest and it was very short, while he was witnessed drifting off to sleep. It is possible that someone’s heart can stop due to an abnormal heart rhythm briefly and then it reverts to normal when someone starts thumping on their chest. It’s possible. If that was the case, then he is one lucky guy. For our years and years of research into the outcomes of out-of-hospital cardiac arrest, we know that the only people who have a reasonable chance of walking out of hospital with an intact brain are those who are witnessed to collapse and have good early bystander CPR. Just look at the survival outcomes they achieved in Las Vegas! (Valenzuela, NEJM 2000) The situation is slightly different in the middle of the Serengeti I’m afraid. There are many different explanations to what happened to this chap, including the fact he might have just been asleep, but the key fact was that someone was at his side and and started life saving actions immediately. I can only hope that, in the event of  a sudden collapse for myself or my loved ones, someone close-by acts as promptly.

Who are AMREF?

In 1956, three doctors – Michael Wood, Archibald McIndoe and Tom Rees – drew up a ground-breaking plan to provide medical assistance to remote regions of East Africa, where they had all worked for many years as reconstructive surgeons.

Spurred by what they had seen of the combined effects of poverty, tropical disease and a lack of adequate health services in East Africa, their collective vision was born in the foothills Mt Kilimanjaro.

At that time, there was one doctor to every 30,000 people in East Africa – in Britain it was 1:1,000. Medical facilities were sparse, with rough terrain and often impassable roads making access to medical care difficult for people in rural and remote areas. As this was where the majority of the population lived, Archie, Tom and Michael saw an air-based service as the only way to get health care to remote communities.

AMREF Flying Doctors provides air evacuation services in medical emergencies across East Africa, as well as air ambulance transfers between medical facilities.

We are Africa’s leading provider of air ambulance services and operate across many East African countries including Uganda, Kenya and Tanzania and, when clearance can be obtained, most neighbouring countries including the Democratic Republic of Congo, Eritrea, Somalia, Ethiopia, Rwanda and Burundi. Subject to flight clearances, AMREF Flying Doctors will carry out evacuations from anywhere on the African continent.

In addition, patients can be repatriated via an AMREF Flying Doctors aircraft to Europe, Asia and North America or a medical escort can be provided on commercial carriers.   AMREF Flying Doctors operates 24 hours a day, 365 days a year. As a vital link between remote areas and AMREF’s Control Centre at Wilson Airport in Nairobi, AMREF has established a radio network that comprises over 100 HF radio stations across East Africa, making it the largest two-way radio network in Africa.

As well as emergency evacuations, AMREF Flying Doctors provides a medial outreach programme, taking essential health care to some of the most impoverished and remote areas of Africa.   AMREF Flying Doctors, part of the African Medical and Research Foundation, is based in Nairobi, Kenya and has been delivering health care to some of the most remote areas of east Africa since its formation in 1957 by Sir Michael Wood.

AMREF Flying Doctors is committed to providing world-class medical services to the people of Africa.