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 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'
|Migration trails out of the Serengeti|
\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.
|That's a hippo, honest.|
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.
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).
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 acheived 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.