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Part 2 of medically challenging week in Kenya with Dr Matt Edwards

Adventures with AMREF Flying Doctors

The Calm Before the Storm – Part 2 Matt Edwards

Matt Edwards Blog working in remote medicine

About 1900 in a place called Kisii, close to Kisumu on Lake Victoria, an over laden bus full of about 70 teenagers attending a sporting event had crashed at high speed. There were about 8 dead at the scene including the teachers and 10 or so critically injured and the other 50 with an assortment of walking wounded. The local population had mobilised and were dragging the casualties to the local hospitals including to the larger nearby town of Kisumu. The pictures and footage at the scene depict what you would expect: people running about haphazardly carrying people in bedsheets, rushing off with them in the back of pick ups and taxis, a couple of local policemen completely overwhelmed and no sign of a fire service or any ambulances. Mass casualty disasters like that must be terrifying, especially if you know that no help is coming. When you know there will be no flashing lights, no big boys in uniform telling you what to do and no one to assess and triage the injured. As I slept peacefully, Kisii had turned to complete chaos.

The local hospitals did their best but the majority of the critically injured succumbed to their injuries overnight. With current advances in trauma care I can reasonably claim that most of the critical initial survivors would not had died if there was an early, coordinated Emergency Medical Service, Fire and Police response taking them to a well-resourced major trauma centre. In the same week there has been two similarly horrific events occur in the first world – a train crash in France and an oil tanker explosion in Canada. I have watched those stories unfold on the BBC World News, CNN and Al Jezeera. I bet you didn’t even know about this tragic loss of life in Kenya though, despite it being officially declared a ‘national disaster’ by the Government or the fact that there was a worse crash back in February killing 35. The tragic thing is that Kenya has enthusiastic people with the skills and the resources to provide a better response. This is the kind of horror story that my new friends at KCEMT (the Kenyan Council of Emergency Medical Technicians), the CDC and John Hopkins University are working so hard to make a thing of the past.
This should be the part of the story in which I explain how we were mobilised and ready at first light with two planes fully equipped to go and stabilise and retrieve the most critical from the disaster. Unfortunately we had no idea of the scale of the tragedy that morning and I was sent off early to Kismayo to pick up a load of injured but stable soldiers. It was only as we were setting off back to Nairobi that we learned that the regional governor for Kisii had informed the Government’s ‘disaster control centre’. The reason for the delay is unclear. Then this plea for help was escalated to the President himself who officially declared it a disaster.
It still took a while for AMREF FD to be authorised to send a caravan plane out to Kisii, along with a few police helicopters and bring the patients back to Nairobi. Kenya’s Red Cross ambulance service were also heavily involved but they could not cope with the situation on their own. They are a paramedic staffed ambulance provider and are simply not geared up for the safe transfer of severely injured patients. AMREF FD is the only certified air ambulance in East Africa that can do the kind of highly skilled rapid triage, treatment and evacuation of the most critical casualties. I hope that the Kenyan people are starting to recognise this. I do hope that the government can now understand that AMREF FD is a specialist resource that can be used to save lives if they are allowed to be involved early enough.
Personally I found all this out after we had handed over our soldiers in Nairobi and one of our caravans had already headed out for Kisii. Frustrated I had missed the action, I was put on standby in case they needed another team. Our guys had already made it the hospital to find that ‘most of the local population seemed to have taken up residence in the hospital’. People from all over the region rushed there after the accident to look after their relatives or probably just to have a good look at the tragic story. The ambulance was unable to even get to the entrance of the hospital because the main road had become a car park with empty vehicles. Then inside the hospital there was barely room to assess and transfer the patients along the corridors, it was so packed with people. It was a perfect example of why the police are so vital to control the crowds and ensure access and egress from the scenes of major incidents. In the end they managed to get in and triage the 53 patients concluding that only 4 needed to be airlifted to Nairobi. The rest could be safely treated where they were.

As we waited at Wilson by our hanger it became busier and busier. Soon there was a massive crowd of news media, the Red Cross chaps, members of parliament and the Kenyan police. I thought it was a rather big turnout for just four patients. Then someone explained to me that nearly 20 injured patients were being airlifted because the President had declared a disaster. Therefore all the injured must come to the Government hospital in Nairobi.

As the cameras clicked away Charles and I took the first multi trauma case (head and chest injuries) to Kenyatta hospital. I had never been there before and we greeted by even more media. We were soon joined by more and more ambulances dropping off their patients and the already stretched A+E was suddenly swamped. Our staff and the Red Cross paramedics were impressed by how many staff had been diverted to come and take their patients. It’s true, we did not need to hang around. The patients from the incident were all seen very quickly. But I saw how busy the A+E Department was before we arrived and I wonder how the other patients fared while this influx inundated the hospital.
As I returned to Wilson airport, we were asked to head straight out to Kisumu (not far from Kisii) where one of the young girls involved in the crash had been taken. Strangely, we were stood down at the last minute. Apparently new arrangements had been made. I was surprised and assumed that she must have passed away. I was even more surprised when, the next day, Kizito and I were instructed to retrieve the poor girl again. What had happened became clear when we arrived. We were told by the staff at Kisumu that a police helicopter had turned up instead of AMREF FD with just a mattress in the back and no medical personnel. Thankfully the medical staff at Kisumu stood their ground and refused to allow such a critically ill young girl to get airlifted like that. Again I have to emphasise that when there is a resource like AMREF FD, capable of stabilising and safely transporting such a patient, sitting on your doorstep, ready to go at a moment’s notice, then it must be used. Unfortunately another 24 hours had been wasted.
By the time we were at her bedside, her conscious level had deteriorated further. She was now only responding to painful stimuli by inwardly twisting and extending her arms, which is a sign of quite considerable neurological impairment. She was certainly not protecting her own airway so, yet again, Kisito and I set to intubating, sedating and ventilating her and trying to protect her brain as best we could. I think we were reasonably successful as the high spikes in pulse, respiratory rate and blood pressure she was having on the ward, settled with us and she was nice and easy to manage on transfer.
Upon arrival we were met by the CEO of Kenyatta hospital who was extremely grateful for the safe transfer. I think that he clearly understands that now, when the police or Nairobi’s ambulance services can’t handle it, he knows who to call.

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.

Interested in working in remote medicine?  Courses of interest

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MSF in Syria: Treating major burns patients

The team working in one of Médecins Sans Frontières/Doctors Without Borders’ (MSF) hospitals in northern Syria has learned to adapt to a changing situation. As the front lines have moved further away, the influx of patients has decreased. But, in the last months, the number of burns victims has grown.   Article © Médecins Sans Frontières/Doctors Without Borders’ (MSF)

During the winter, families rely on rudimentary stoves for heat. Domestic accidents occurr frequently or gunfire causes panic. In these moments, stoves may explode or fuel canisters may catch fire.

“Burns patients arrive several times a week,” explains Dr. Anne-Marie Pegg, an MSF emergency physician. “Their faces and hands are always the most affected.”

Major burns

When a major burn patient arrives in the emergency room, the first step is to treat the pain because the wounds are agonising. The patient is then placed on a drip to replace lost fluids.

The wounds and dead skin must also be cleaned, as they are a source of infection, and then bandaged. This can be done only in the operating room under anesthesia.

The surgeon lays down sterile compresses coated with sulfadiazine, an anti-bacterial cream, so that the dressings can be changed every two or three days without tearing the skin.

The team’s physical therapist often participates in the procedure and may splint the knee, for example, so that it remains extended.

That way, retraction will not occur as the skin scars, leading to loss of mobility that results when the affected part of the body heals in the wrong position.

Treating burns patients

That’s what the team had to do in the case of a six-year old girl with burns across her knee.  Another child was burned on the hands and face. “To treat the burns on the palm of the hand, I placed a little roll in the middle of the palm to maintain the functional position, which is necessary to carry out the activities of daily life,” explains Ricardo, MSF’s physical therapist.

Treating the face was more complicated. A thermoforming mask was required to prevent skin retraction during scarring and preserve facial features.

“I covered the child’s face with sterile compresses and used a thermoforming plate to make a mold, emphasising the injured areas.

“Then I made a plaster mask, which was my positive. I hollowed out the plaster around the eyelids, nostrils and the corners of the mouth,” added Ricardo.

The next step involved setting another thermoforming plate over the positive to obtain the mask, which was placed, in turn, over the face – under anesthesia, of course.

The mask is then adjusted as the scarring process proceeds. “When the swelling lessens, you have to hollow out around the cheeks, dimples and the chin in order to reshape the facial features.”

Nutritional needs

Treating major burns patients also requires following very strict rules of hygiene as these patients are at great risk of infection. Their nutritional needs are also twice the normal amount.

“Their diet must include a lot of protein,” Dr. Pegg says. “If the children want cake, we are happy to give it to them. They can eat everything they want. Eating properly is key to healing.”

But that’s not always enough. The surgeon may have to perform skin grafts and healing is a lengthy process. Even when a major burn patient leaves the hospital, he or she must return approximately every three days to have the dressings changed and for physical therapy.

But winter is coming to an end. The MSF team treated 85 major burn patients between January and March. And maybe that number will decline.

 

Off interest

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EWM's Facebook group smashes the 20,000 'likes' barrier

Wow! 20,000 followers on Facebook!! – our supporters out there must like what we do as much as we love doing it which is great and we will continue to innovate, improve our courses and present the latest in remote medicine so that we not only keep what we are presenting fresh but also continue to keep it cutting edge and exciting for ourselves as that the reason we started all this over a decade ago!!

If you havent already found our Facebook page you can do so by following this link…. https://www.facebook.com/ExpeditionMedicine, its really a very useful area presenting the latest in remote medicine jobs, interesting links and discussion, discounts on courses and leavened with a dose of legendary EWM humour!!

To celebrate we are offering some once-in-a-EWM-lifetime  (or at least until we get the next milestone that we feel like throwing our hats into the air for!) discounts which will last for a total limited of 20 hours so early afternoon tomorrow GMT cus that how we rock our marketing world here – we love the share the joy!   Visit the Facebook page and ‘like’ is to get the get the very best news and views!

*only applies to new bookings and is limited in number.

Expedition & Wilderness Medicine Facebook Page

Use these codes at checkout on the EWM website

20 % off the next PYB course Expedition Medicine Course  ‘PYB20FBhorray 20’
10% off the next Dartmoor Expedition Medicine Course ‘FB20dartmoor13 10’
5% off our Diving & Marine Medicine Course in the MaldivesFB20diving13 5
5% off the iconic Jungle Medicine course in Costa Rica, not the fainthearted! ‘fb20jungle13 5’
5% off Mountain Medicine in Nepal led by Everest ER founder Dr Luanne Freer ‘FB20mountain12’
Use these codes on the Extreme Medicine Conference website
10% off any class of ticket for the Extreme Medicine Conference at Harvard Medical School, Cambridge, MASS ‘FB20extrememed13’
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MSF in action in the Congo, Early Bird tickets sales for Harvard Extreme Medicine and more…

Expedition & Wilderness Medicine

Expedition & Wilderness Medicine

MSF in action in the Congo, Early Bird tickets sales for Harvard Extreme Medicine and more…

Médecins Sans Frontières in action

Médecins Sans Frontières (MSF) Surgeon David Lauter reports from the DRC

It’s late in the evening and I’m on call overnight again. After a busy day in the operating room (OR) there hasn’t been much activity since 9pm. I ate a late dinner (late for me that is; the French and the Congolese here both like to take dinner at 8pm) with R, one of the Congolese nurse anesthetists here. She has worked for MSF for several years, spending a month at a time in Rutshuru between time at home in Goma with her husband and two daughters…

Read the full article here…  Article © msf.org

Of interest – Pre Hospital Trauma 2 day course.

Wilderness Medicine Course

Expedition Medicine course at the National Mountain Centre, Wales

20 May 2013 to 23 May 2013
Join the eclectic and diverse EWM team at the next iconic course on the slopes of Snowdon.  Great fun, great learning and superb networking…

16.3% as ‘very good’, 82% rated the course as ‘excellent’, and 1.7% as ‘good’

Course staff were fantastic, well organised, enthusiastic, informative and delivered the lectures with technical ability. Best course I’ve been on.’

RACGP features Dr John Apps

RACGP features Dr John Apps, Course Director Polar Medicine, New Zealand.

Dr John Apps’ career in wilderness medicine has taken him on some extraordinary adventures. He now passes on his skills to other doctors.
There aren’t many people in the world who can run a marathon, let alone one at nearly 5000 metres elevation through the Himalayas. Rarer yet is a doctor who can keep up with the runners and tend to them in harsh conditions if anything goes wrong. John Apps is such a doctor. Overseeing the medical services for the Everest Marathon is all in a day’s work for the British-born adventure doctor and part-time GP.  Read the full article here…

To find out more details about Polar Medicine NZ 21-26 July 2013 please follow this link …. Polar Medicine CME 

Register for your place.  Email Catherine Harding

Extreme Medicine Conference at Harvard Medical School

Harvard Extreme Medicine Conference

EarlyBird Ticket sales ends soon

With the tragedy of the Boston Bombings fresh in our minds it seems a lit bit odd to mentioning that early bird tickets sales end of this month but the importance of pre hospital care and disaster management is clear.

Make sure you secure the best tickets for this conference by booking now….

boston.extrememedicineexpo.com

Thank you for reading our news!

If you require any further information on any of our courses or how you can get invovled please contact us.

Email admin@expeditionmedicine.co.uk or
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International Extreme Medicine Conference & Expo

Why this medical conference is important for You:

  • Your opportunity to gain knowledge from the world’s most experienced and senior extreme medicine professionals
  • Benefit from a comprehensive and highly informative programme of presentations
  • Assess practical strategies for the pre-hospital care of trauma patients
  • Enhance your understanding of the range of issues involved in international emergency assistance
  • Identify world class practices for quicker and better diagnosis
  • Discover effective techniques that will improve your medical skills in extreme conditions
  • Earn valuable CME credits

 

EXTREME MEDICINE CONFERENCE WEBSITE

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International Extreme Medicine Conference & Expo

Why this medical conference is important for You:

  • Your opportunity to gain knowledge from the world’s most experienced and senior extreme medicine professionals
  • Benefit from a comprehensive and highly informative programme of presentations
  • Assess practical strategies for the pre-hospital care of trauma patients
  • Enhance your understanding of the range of issues involved in international emergency assistance
  • Identify world class practices for quicker and better diagnosis
  • Discover effective techniques that will improve your medical skills in extreme conditions
  • Earn valuable CME credits

 

EXTREME MEDICINE CONFERENCE WEBSITE

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