tag:blogger.com,1999:blog-74924134888803365592024-03-13T17:20:12.633-07:00Adventures with AMREF Flying Doctors3 months in the Kenyan cloudsMatt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-7492413488880336559.post-67769433648913195042013-07-30T16:27:00.000-07:002013-08-05T03:32:21.244-07:00Coming home<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD2MNWLQOQu51bI5nhS4m-0VtKlAlwfW1ChxCrHjdd9pLmUvHc3ldxa3IphzyqDqSMNxJkCZjZpy7Kq55MXYHMy7OIElmETrMuyi7eZOj3u8GCYMmYOKLKDuWY7QAjIQGxPP6x72d37DM/s1600/The+group.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="242" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD2MNWLQOQu51bI5nhS4m-0VtKlAlwfW1ChxCrHjdd9pLmUvHc3ldxa3IphzyqDqSMNxJkCZjZpy7Kq55MXYHMy7OIElmETrMuyi7eZOj3u8GCYMmYOKLKDuWY7QAjIQGxPP6x72d37DM/s320/The+group.JPG" width="320" /></a>BA flight 060 has left Nairobi and I’m once again in the
African skies. But this time I am not in my own private jet and I will not be
retrieving some unfortunate soul from the depths of the continent. My time with AMREF Flying Doctors has come to
an end and I will soon be back on home soil in Heathrow. The time has streamed
by in steady flow of little adventures that, no sooner had I started to reflect
on one, I was whisked off on another. </div>
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It was not all that long ago I was in a
similar aircraft approaching Nairobi and, to be blunt, utterly bricking myself.
Since then I relaxed into my role and was embraced into the AFD family. The
variety and frequency of the strange situations flash
through my mind like someone rapidly flicking through a comic book. It’s so difficult
to pick them out from each other. I’m now so glad I started writing the blog so
I can revive the memories for years to </div>
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come. I’ve thoroughly enjoyed writing
the stories and I’m really chuffed so many of you have enjoyed reading them. To
date over 7000 people have read these posts and I find it hard to believe my
mother was responsible for all of them! I would love to continue writing them
but life as an emergency physician in St Mary’s hospital is less conducive to
attention grabbing headlines. ‘Woman gets offended when told her sore throat is
not an emergency’ is just not as exciting as ‘Buffalo attack wake up
call’.<br />
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The guys were able to summarise the work which I have done
over the last three months and it has surprised even me: - <o:p></o:p></div>
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<ul style="text-align: left;">
<li>Countries visited – Iraq, UAE, Sudan, South Sudan, Ethiopia,
Djibouti, Somalia, DRCongo, Uganda, Rwanda, Burundi, Tanzania, Chad, Zanzibar,
Madagascar, South Africa and all over Kenya.</li>
<li>73,000 miles flown, which is nearly three times around the
world.</li>
<li>My work as a volunteer has provided over $33,000 USD which
has been saved by the charity.</li>
</ul>
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<o:p></o:p></div>
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It has been an exceptional time, providing me with some of
the most heartwarming, bizarre, frustrating, terrifying and challenging medical
experiences of my life. I’ve learnt a huge amount as a clinician. I’ve learnt
about teamwork and timework, suffering and salvation, injustice and
incompetence, African cultures and corruption. I’ve been so privileged to be involved in
some of these stories and would urge any of you, who have the appropriate
skills, to seriously think about taking this job on. I would imagine this is my
last post for AMREF Flying Doctors and thanks again for following the blog. It’s
been emotional.<o:p></o:p></div>
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Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com4tag:blogger.com,1999:blog-7492413488880336559.post-58206942510575874172013-07-30T15:16:00.000-07:002013-07-31T04:34:30.491-07:00Somalia, Kenya and the African Union<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgT060-cujVuVKeJsf-pMfl6xL7AMETb8kZC4Fb-hDe1DTtP1g0b33gRFjHJsSSfmdBgClfhg3oPWHBomVxfm6PanLa5LYrsR8LjbQ7YJVVorL2d-3MwcKD42JHH2q6MbRNiPZQ0eAQ_OQ/s1600/Kisamayo+medic.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgT060-cujVuVKeJsf-pMfl6xL7AMETb8kZC4Fb-hDe1DTtP1g0b33gRFjHJsSSfmdBgClfhg3oPWHBomVxfm6PanLa5LYrsR8LjbQ7YJVVorL2d-3MwcKD42JHH2q6MbRNiPZQ0eAQ_OQ/s320/Kisamayo+medic.JPG" width="242" /></a></div>
Having just been to pick up a few more sick and injured soldiers
out of Somalia I thought I would reflect a little on the ongoing military
situation in this troubled little corner of the world. I was involved in
military casevacs very quick; in fact, my first medevac with AMREF FD was
retrieving injured Kenyan soldiers out of Kismayo on the Southern coast of
Somalia. It has been fascinating to watch the African Union, the Kenyan forces
and the UN combining their efforts to bring something resembling stability to
the region. I’ve seen the results of this conflict in many different spheres: -<o:p></o:p></div>
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I’ve seen the vast refugee
camps of Daadaab, retrieved injured Kenyans out of Kismayo, treated African
Union troops in Liboi in North Kenya, visited the Somalian army training camps
in Uganda, seen the aftermath of the UN compound bombing and a myriad of other
terrorist attacks in Mogadishu, chased US drone aircraft along the coast and
listened to friends recounting stories of terrifying hostage situations, piracy
payoffs and a load more I shouldn’t probably know about. It’s phenomenally complex.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilaU7JcJ58dCwvkaPopmGf90y83cOGazQeMLgRx9YoXR16COLHZ16qtghY7Cp7cSLbnVCD-XMyNnuWYu_tC2C-6KezvKVJ1FfXBdiOiCLOXLwctfMtTHuXe4xU4bekjI2riERGSIEjknc/s1600/Liboi+%25282%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilaU7JcJ58dCwvkaPopmGf90y83cOGazQeMLgRx9YoXR16COLHZ16qtghY7Cp7cSLbnVCD-XMyNnuWYu_tC2C-6KezvKVJ1FfXBdiOiCLOXLwctfMtTHuXe4xU4bekjI2riERGSIEjknc/s320/Liboi+%25282%2529.JPG" width="320" /></a></div>
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I didn’t realise how controversial the Kenyan presence in
Kismayo actually is. The ruling on the African Union interventions is that only
remote African nations can form part of the armed forces. Therefore it can’t be
seen to be an invasion by a bordering country.
For example, the Ethiopian troops backing the Transitional Government,
really shouldn’t be there under the rules of the AU and have only now pulled
out completely. The occupation in the south was more of a unilateral decision by
Kenya that the AU and the rest of the world chose to ignore (or actively assist
in by levelling the Al Shabaab positions using remote drones). You couldn’t blame
them for taking the matter into their own hands. The constant flow of refugees,
<o:p></o:p></div>
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the insecurity along the border and piracy along the coast was really starting
to piss the Kenyans off. No one was really doing much about it and then there
was a high profile abduction from Lamu by Somali pirates which scared off the
tourist trade. I’m told, that was it. Abducting people from within Kenya was
simply not on and the army was mobilised and advanced into southern Somalia as
far north as Kismayo (there may also be a lot of mineral wealth there too, how
lucky!). For most of my time here it has been pretty stable but there has been
more action recently.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDAbZRZaCLD1pXIQWwAg1tZDb9TM7EfEkXDN1wycKdAVEUIsX9FrStvjdnxtPAG5a8iaWWFUzkOu-IH-ktdpNRvO-8ZaKKOuxlOrehwACXRlrFQla4KYi1nr1738KYL8A6h8Q5n6lvolA/s1600/Kisamayo+stencil.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDAbZRZaCLD1pXIQWwAg1tZDb9TM7EfEkXDN1wycKdAVEUIsX9FrStvjdnxtPAG5a8iaWWFUzkOu-IH-ktdpNRvO-8ZaKKOuxlOrehwACXRlrFQla4KYi1nr1738KYL8A6h8Q5n6lvolA/s320/Kisamayo+stencil.JPG" width="320" /></a></div>
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I’m not a military doctor. I’ve never experienced anything
like this before. But I’ve got more used to the accounts of IEDs, sniper fire
and skirmishes. I’ve got more used to our crazy low level flights across the
sea into ‘Moga-disco!’ I’ve developed a real affection these African troops.
Whenever we arrive they are smiling and courteous and are doing the absolute best
for their comrades, whether they be Ugandan, Burundian or Kenyan. And my word,
they are tough cookies. It’s strange seeing these brave smiling faces with
injuries that are causing severe pain, and then their relief when we get their
pain under control and they know they are getting out. I know the medics are
doing their best but from what I know of our capabilities in places like Camp
Bastion, I know that these guys won’t have anywhere near the chance of survival
after trauma that our troops can expect in places like Afghanistan.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8FK4j-UO2tXd4vVqumUk9KejvVskvBtI4dxOYF1hRm5pU7U7dcDrLbN_bs9EZXYpX2DwFlukD8MgbV9Gj0TZHHjh4xuoVCO5kJ6yhBnw1Pm6bkCXRGWUwpo-v3gmD-FRjb1qQca2XfEc/s1600/Chilling+under+the+chopper.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8FK4j-UO2tXd4vVqumUk9KejvVskvBtI4dxOYF1hRm5pU7U7dcDrLbN_bs9EZXYpX2DwFlukD8MgbV9Gj0TZHHjh4xuoVCO5kJ6yhBnw1Pm6bkCXRGWUwpo-v3gmD-FRjb1qQca2XfEc/s320/Chilling+under+the+chopper.JPG" width="320" /></a>It’s all seems to be getting interesting again. There was
the fantastic news that the two Medicin San Frontieres aid workers have just
been released after a couple of years held captive. The so-called father figure
of the Al-Shabaab and jihadist ideology in Somalia, Hassan Dahir Aweys, the
chap with the fetching bright ginger goatie, has recently surrendered himself.
There is a lot of speculation as to why he has done this but the overriding
theory seems to be that Al-Shabaab is becoming split in its ideology and Aweys
is fearing for his life. He has been rather vocal denouncing many in Al-Shabaab
<o:p></o:p><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="clear: right; float: left; margin-bottom: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfUPBpYtHegq8cOxzc5DI8ljzwhjL8eDZD1VGrV4OQjkS0N8_OWqudgbxAaYrtsQF71l4uY8hvpmn-Y0hKbbAE0_sGyb3TD3ppAKumgWWzzqf9nK1nVx-phiTqH7kDWK-x0w-BPr6Saqk/s1600/GSW+to+tib+fib.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfUPBpYtHegq8cOxzc5DI8ljzwhjL8eDZD1VGrV4OQjkS0N8_OWqudgbxAaYrtsQF71l4uY8hvpmn-Y0hKbbAE0_sGyb3TD3ppAKumgWWzzqf9nK1nVx-phiTqH7kDWK-x0w-BPr6Saqk/s320/GSW+to+tib+fib.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A bullet through the tibia and fibula, ouch.</td></tr>
</tbody></table>
for "acting in a manner unbecoming of upright jihadists". I am
curious to know where ethics and a code of conduct comes in to it but such talk
seems to have been his undoing. There seems to have been a hostile takeover by the Afghan-trained Ahmed Abdi Godane and there has been
a string of assassinations from within. People are saying they may be on a
course of self-destruction but that sounds rather optimistic to me. It sounds
like just another tale of one warlord usurping another to me; same old same
old. But stories filter through that the new wave are more interested in
martyrdom than power or politics. Apparently foreign jihadists are being
rejected, or being told to do' undesirable work' and going home. If that’s all true, then hopefully they will manage to
extinguish themselves pretty soon. If that’s true, then those men seeking death
and glory but with no strategy for seizing power, no interest in winning
popular support, and fractionating themeslves from foreign supporters,
will get their death wish and go out with a bang. Unfortunately the bang will
involve more civilians and the peacekeepers with the AU, UN, Bancroft, RMSI,
and AMREF FD picking up the pieces.</div>
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Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-16855912823406685282013-07-28T13:08:00.000-07:002013-07-28T13:08:27.186-07:00Tragedy in the Aberdare Mountains<div dir="ltr" style="text-align: left;" trbidi="on">
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Late Thursday night I received word that we would be part of
a Search and Rescue team entering the Aberdare mountain range at first light. We
would be searching for a small Cessna 206 '5Y-BUG' single engine plane which had not returned
to Wilson airport after picking up two clients in the Laikipia region north west of
Mount Kenya. </div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhgAreCuoaVyc9t9HesCCU_M6IqldnW4yqvgpRjLX0WLZC4hUHtVVhA89uuThKLeGnc_GrXYtUAkT_6WM4uxJLnl2o0XUMIq2To___nqpSdUqfbE51wJ3NC9VtbcOI3rsnOb5zRfW8h6o/s1600/100_1466.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhgAreCuoaVyc9t9HesCCU_M6IqldnW4yqvgpRjLX0WLZC4hUHtVVhA89uuThKLeGnc_GrXYtUAkT_6WM4uxJLnl2o0XUMIq2To___nqpSdUqfbE51wJ3NC9VtbcOI3rsnOb5zRfW8h6o/s400/100_1466.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Aberdare range as the cloud broke up</td></tr>
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There had been activation of the aircraft’s Emergency Locator Transmitter
(ELT) which sends an automatic distress call out to South Africa, and meant it
had definitely crashed. But the signal had stopped, presumably because of low
battery, and getting a pinpoint on its location was proving very difficult. For
one, the best estimate on its location was in a highly populated area to the
west of the range, making the estimate from South Africa very unlikely. People
tend to notice air crashes in their back gardens. So charting a path from the
last known location to Wilson, the most likely location was within the dense
forest of the Aberdare mountains.<o:p></o:p></div>
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There were three souls on board - an extremely experienced
and well known pilot, and two female tourists. There had been no contact or
distress calls indicating they had had trouble. Phone reception up in those hills
would be poor. After my last plane crash experience I was cautiously optimistic we would find them alive,
others were less so. There are tales of pilots walking out of that forest five
days after the search had been abandoned, so while there was still hope of
finding survivors, we were going along. We would also serve as an extra pair
of eyes scouring the treetops. <o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicayGtBiX258f4kOY-3QvX5gyIc3UTu-sC5whSr2GY2O62tujmEkDHF2Li5hcgDUOdTACYOwXvbtJtxv1GfHpG_fydAvg0kenvt6x_L-ue5ODBDFGrdJZ7X5qQteuvThH94T3Wi3lsKso/s1600/100_1459.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicayGtBiX258f4kOY-3QvX5gyIc3UTu-sC5whSr2GY2O62tujmEkDHF2Li5hcgDUOdTACYOwXvbtJtxv1GfHpG_fydAvg0kenvt6x_L-ue5ODBDFGrdJZ7X5qQteuvThH94T3Wi3lsKso/s400/100_1459.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Low cloud down to the inhabited areas</td></tr>
</tbody></table>
<br />
Daylight came and the weather was not good. Dense cloud
clung low to the hills and there was little hope of penetrating up to the
summit. A couple of planes passed over and were unable to find the ELT signal
but they reported the cloud was breaking up a little so we set off. We briefly
went to look and confirmed that a crash over the far west side of the mountains
would not have gone unnoticed, and then advanced up into the hills. Meanwhile,
on ground, supposedly there was a search party
which was entering the areas on the east side. Without a more accurate idea of
where to look, they had little chance of finding anything. The forest is a vast
area to search on foot. A British fighter plane was apparently accidentally
found there 60 years after it had crashed.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfoMXVJBuIFySjwz-CbJSO9oPoQOGiqwWnKHbQ7oGZoWmz4kgmeOjuJn-24uxl4vBu3HevYMXvfpMC8uIvwhiXgPtsjf4Ayumh7D8CTnk-hqAWFikveU61hdoohA8Wyshpw793NJhq8ek/s1600/100_1469.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfoMXVJBuIFySjwz-CbJSO9oPoQOGiqwWnKHbQ7oGZoWmz4kgmeOjuJn-24uxl4vBu3HevYMXvfpMC8uIvwhiXgPtsjf4Ayumh7D8CTnk-hqAWFikveU61hdoohA8Wyshpw793NJhq8ek/s640/100_1469.JPG" width="640" /></a></div>
<div class="MsoNormal">
Indeed the cloud began to lift and break but, as our pilot
Chris expertly guided the chopper into the forest, my heart sank. It would be
like looking for a needle in a haystack. The forest was so dense that, for the
most part, all you could see was canopy. Subtle damage to the treetops would be
very difficult to spot. Where there were no trees, it was dense bamboo. As I
watched a group of elephants making their way through it, I could see that, if
a plane went down there, the flexible bamboo would just close over and swallow
them. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We stopped off to ask a few National Park rangers whether
they had heard a plane the day before but they said they hadn’t. They also told
us that the cloud was very heavy and all over the hills. The idea of an engine
failure was becoming more and more unlikely. No distress call implied a sudden
event. An event like getting caught in low cloud among steep hills and having
no instruments to guide you. That’s when small aircraft crash into the sides of
mountains.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgZyU3Hl9C-b5U_QcZ_ryfebsFZD2_yHAn2Nyt3JNTtWrKYJcfSFWvQ3ksHRO2dtcRe8oVInHq2Us7iFoADUw86I-WfGUT5_si3OHyuQRKWuf782yS0_BNYge1lcfuBbTCuiWIcIAGUIA/s1600/100_1473.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgZyU3Hl9C-b5U_QcZ_ryfebsFZD2_yHAn2Nyt3JNTtWrKYJcfSFWvQ3ksHRO2dtcRe8oVInHq2Us7iFoADUw86I-WfGUT5_si3OHyuQRKWuf782yS0_BNYge1lcfuBbTCuiWIcIAGUIA/s320/100_1473.JPG" width="320" /></a></div>
<div class="MsoNormal">
The pilots used their experience to guess where their
colleague would have flown if he was in trouble and we searched for an hour or
so. Anthony (the AMREF flight nurse) and I hung out of the open helicopter doors in harnesses to get a
good look below us but soon the fuel was running low. We all realised that
without a better plan we had no chance of finding them and headed to Nanyuki to refuel and regroup with the rest of the search party.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The group was tired, really tired. Anthony and I had been up
since 5 but many of these guys, particularly Rob Link, had been up all night
trying to get more information about what had happened to their friend and his
clients. It was heartening to work alongside these guys, obviously upset,
stressed and exhausted, but all the while able to create a dynamic and sensible
strategy to continue the search. There was now more information allowing us to
triangulate a smaller area of the western side of the hills. We had the last
signal from the ELT, which we had already established was probably a couple of miles
off and we had the last radar point in which the aircraft was being tracked by
Jomo Kenyatta airport. Now, in addition the telephone company was able to give
us an approximate location on one of the women’s cell phone. It had been
ringing and ringing but no answer. It was also a very bad sign
and fitted with our growing fear of a sudden lethal event up there. My optimism
of finding anyone alive was fading.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I listened to Rob and the others drawing up a plan, a
series of promising reports started coming in. The wreckage had been spotted
and the police were walking on foot towards it! We got the location and headed
out immediately. As we moved up the hills again, it became clear that this was
all unsubstantiated rumour and hearsay. On the move, Rob and Chris managed to
work out, it had been heard from someone, who heard it from someone else, and
the trail ran dry. The head of the land-based police search had no idea what we
were talking about. What amazed me was that the rumour had such detail and it
obviously infuriated us all because we had been led on another wild-goose chase
and wasted more time and another tank of fuel.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlXS5ikvRPKrmtG_nSezFEj8fvllM7FBsQ7gv1EPg4pHunRD7l5n4kPRvRi6mfh5VfNCmWFkwYsKAA3PmBhL7Z_kIe9HtP_S3qzOfhb8mQpbKdzJ0SzZhPu0pqQW0NGubhGjO8lvtQGrI/s1600/100_1476.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlXS5ikvRPKrmtG_nSezFEj8fvllM7FBsQ7gv1EPg4pHunRD7l5n4kPRvRi6mfh5VfNCmWFkwYsKAA3PmBhL7Z_kIe9HtP_S3qzOfhb8mQpbKdzJ0SzZhPu0pqQW0NGubhGjO8lvtQGrI/s400/100_1476.JPG" width="400" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So we went back to the original plan and divided the area
into grids and using three helicopters scoured the area. I have no idea about
what was going on down on the ground (I certainly saw no evidence of a ground search from the sky) but I’ve since seen some footage on
youtube (see below) indicating they were probably making little progress. But as the hours
ticked by, and we scrutinised each suspicious patch of foliage, it became
obvious neither were we. The cloud rolled in, obscuring the hills, it started
to rain and the light began to fade. We had to give up. We had been searching
for 9 hours straight.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was called on Saturday morning to let me know a pilot from
the Kenyan Wildlife Service had found the wreckage. There were no survivors. My
biggest fear had been that we had been flying over the site and they had still been
alive, able to hear us but unable to show us where they were. We had to
terminate our search imagining that we had looked but not seen. But my
colleagues tell me, from the look of the wreckage and the bodies, they all died
on impact. Frustratingly the wreckage was in plain view on the very top of the
hills that we couldn’t get to in the cloud, about 2 miles from where we were
searching.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp3Wd16Qs4NeOtiH_T82YWJuAL7cSzWg1J2wisufGF2Mep4-2eqkvebFfXYJKpvWfsbKa4mcPjZ1Btc92NEgEyj5y0O_Mtggd2oHOP_1O3mXxqPFGU4axH6mVqYvap_zAcn4Qgb2WU5FM/s1600/Search.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhp3Wd16Qs4NeOtiH_T82YWJuAL7cSzWg1J2wisufGF2Mep4-2eqkvebFfXYJKpvWfsbKa4mcPjZ1Btc92NEgEyj5y0O_Mtggd2oHOP_1O3mXxqPFGU4axH6mVqYvap_zAcn4Qgb2WU5FM/s320/Search.png" width="320" /></a></div>
<div class="MsoNormal">
Unsurprisingly this story has been across the news here in
Kenya. Rob Link and the guys from Yellow Wings really led this SAR exercise.
Without their tireless efforts the wreckage never would have been found. The
wildlife service never would have known where to look. Rob, who flew with me
all Friday, was also giving press statements as events unfolded. The impressive
government/police effort can be seen on this news report as well. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="http://www.youtube.com/watch?v=fgRM2VO8L4k">http://www.youtube.com/watch?v=fgRM2VO8L4k</a><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
The bodies were brought back to Wilson Airport today and the
whole place became subdued in the morning drizzle. The pilot (whose name has
been officially announced) Harro Trempaneu is a well-known and well-loved
figure at Wilson Airport and was the chairman of the Aeroclub of East Africa. It
is a tight-knit group of aviators here and they have all been shocked by these
events.</div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhydu2x7lKi_pMHKeWn6SYicK-4btaXslYwCdHqkKmctgZshJ0cuS2Bf9ENkCvME37js3wUtMW3wr2rDlI3euQRBg3fe8e2z_u1wERqTauYWPIgU5hnq73ZXLVH6VICeWYdtK5zetncJ1g/s1600/Harro.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhydu2x7lKi_pMHKeWn6SYicK-4btaXslYwCdHqkKmctgZshJ0cuS2Bf9ENkCvME37js3wUtMW3wr2rDlI3euQRBg3fe8e2z_u1wERqTauYWPIgU5hnq73ZXLVH6VICeWYdtK5zetncJ1g/s320/Harro.png" width="306" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Harro Trempaneu</td></tr>
</tbody></table>
<div class="MsoNormal">
<b>"Harro, an aviator through and through and a larger than life personality, was one of the industry's prime sources of information, combative, eloquent and never shy to call a spade a spade, which earned him the admiration of most within the aviation fraternity"</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I understand the relatives of the two women in the crash have now
arrived as well. It is extremely sad and reminds us all that even the best can
be caught out by bad weather and bad luck in the sky. Rest in peace.<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-17179019274349468462013-07-24T07:14:00.002-07:002013-07-24T08:22:40.605-07:00Buffalo attack wake up call<div dir="ltr" style="text-align: left;" trbidi="on">
(warning - there is a gruesome picture)<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPryNs1y6he64nH4RPqdgKp5zbp7sIijY42THLfA_6HrbmHR2TBLF7M75CosBCwuBX98HUWdfjrLUX235vfKIjEvnzpUcBQgJzFPbjLpV70xadPSplP4Gqt1fgwjIXT0Paq7fVmy9HYGE/s1600/Cape-buffalo-calling.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPryNs1y6he64nH4RPqdgKp5zbp7sIijY42THLfA_6HrbmHR2TBLF7M75CosBCwuBX98HUWdfjrLUX235vfKIjEvnzpUcBQgJzFPbjLpV70xadPSplP4Gqt1fgwjIXT0Paq7fVmy9HYGE/s320/Cape-buffalo-calling.jpg" width="320" /></a></div>
<div class="MsoNormal">
“Daktari… …immediately… …Buffalo attack… …Magadi.” That’s
about as much information as filtered through into my brain as I answered the
bleeting phone at 05:00 this morning. Before I was really aware I was not
dreaming I had my trousers on inside out and was ineffectually attempting to
fight my way out of my mosquito net in the darkness. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
About 03:30 in the morning, a park ranger in a reserve close
to Magadi, about 75km South West of Nairobi was on patrol when a buffalo
attacked him. I am now reliably informed by my friends here that ‘Don’t worry
about lions and snakes. Buffalo are one
of the only beasts around here that will attack you for no reason.’ And they
can cause some nasty damage. They are not as invariably lethal as the elephants
but they will charge and impale you with their horns. This poor chap in
question was charged before any shots could be fired. Apparently it dragged and
threw him before attacking him on the ground and ran off into the night. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGQ7Rg-eCrW-VVIJ2rFIK79QMyyQx0KjM5NPlPUo99ux9Prk9XkeBMYZSnWP6gt71b2d4CEBzT-Wr-VXy3fhsmLcHKGhHdOtMdmoDwmYxIJzf5p2AcEpQSzZ9pvUJl74dJ0EkcaTfQPbo/s1600/100_1416.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGQ7Rg-eCrW-VVIJ2rFIK79QMyyQx0KjM5NPlPUo99ux9Prk9XkeBMYZSnWP6gt71b2d4CEBzT-Wr-VXy3fhsmLcHKGhHdOtMdmoDwmYxIJzf5p2AcEpQSzZ9pvUJl74dJ0EkcaTfQPbo/s320/100_1416.JPG" width="320" /></a></div>
<br />
He was rushed back to the camp where the nurse there tried
her best to stem the bleeding from the huge wounds in his shoulder, his thigh
and his head. She did a good job with little equipment and established IV
access and gave him painkillers and a tetanus shot. Throughout the ordeal he never
lost consciousness.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
With the scanty information of ‘buffalo attack, head injury,
severe bleeding’ we prepared for the worst (always a good bet for AMREF FD as I
have said <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsV36QyTwe7PofACzgWUk2xGQGzLvfiulBFRG8sRBB0BBg7h-2NloKPldbQxsK3DJ-5GTD6-dzAwruBdsbi4olkI1_TAygJ0SIJrqFLPa7t6GmZ11Wb4C3wXmEh53TbZDgNfxdu1CBHtQ/s1600/100_1418.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsV36QyTwe7PofACzgWUk2xGQGzLvfiulBFRG8sRBB0BBg7h-2NloKPldbQxsK3DJ-5GTD6-dzAwruBdsbi4olkI1_TAygJ0SIJrqFLPa7t6GmZ11Wb4C3wXmEh53TbZDgNfxdu1CBHtQ/s320/100_1418.JPG" width="223" /></a></div>
before). As we took off into the dawn, Phyllis and I drew up basic drugs
ready for a critically ill patient and very soon we were circling over the
remote little airstrip in the Rift Valley. On ground we were greeted by a group
of concerned looking rangers and staff from the park. Some of them obviously
very shook up by the nights events. Others less so. I suppose, in general,
there isn’t much to be worried about when you are carrying an absurdly massive
gun. <br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We were all driven with our equipment through the bush to
their camp and we were relieved to find a young man, in pain and bleeding admittedly,
but conscious and orientated. The buffalo had managed to leave him without critical
head, spinal, chest, abdominal or pelvic injuries. He had a few minor head
wounds and a large thigh wound without underlying fracture. It had stopped
bleeding and exposing it showed how very close the buffalo’s horn had come to
tearing open his femoral artery. I doubt he would be alive if it had.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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</div>
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJIp1Q2IZPuLy5voeC02Mq7o2WAveJnv7hyfWviljvgPFC4AsYq_egwEMXYH710JempLjlJ2CVf9WZCwDc5rtiP5TRXQFaZQfphc88MAjfxourJQC0-S3a8niuO7DBP3L62g_RuNxnqjg/s1600/100_1425.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJIp1Q2IZPuLy5voeC02Mq7o2WAveJnv7hyfWviljvgPFC4AsYq_egwEMXYH710JempLjlJ2CVf9WZCwDc5rtiP5TRXQFaZQfphc88MAjfxourJQC0-S3a8niuO7DBP3L62g_RuNxnqjg/s320/100_1425.JPG" width="320" /></a></div>
His biggest problems was a horrendous right shoulder injury.
The animal’s horn had punctured through one side of the shoulder, shattering
the proximal humerus bone as it went and torn through to the other side.
Unfortunately he is right hand dominant. His pulse at the elbow was pretty weak
but, amazingly, he had preserved sensation to his fingers and upper arm. The
wounds were still oozing profusely and the arm was at a horrible angle. It was
time to introduce him to my good friend Ketamine.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ketamine is a fantastic drug for the pre-hospital
environment and I think it would be one of your ‘must have’ drugs for remote
medicine. It is ‘remarkably safe and is certainly the safest anaesthetic if you
are inexperienced’ as, one of my old bosses Dr Sinclair wrote in his book on
basic bush anaesthesia for AMREF ‘Ketamine is particularly useful in developing
countries’. It’s a potent sedative, analgesic, bronchodilator and best thing
about it is that you can give it to patients who had lost a lot of blood
without their blood pressure plummeting. Most of the other strong analgesics
and anaesthetics will do that, so you run a tightrope of cardiovascular
instability if you use them in trauma. <o:p></o:p></div>
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<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It has its side effects of course. Some of you may know it
as Special K for its exciting hallucinatory effects that probably make clubbing
vaguely interesting. Those waking from the sedative effects of high dose
ketamine often have crazy ‘emergence phenomenon’ which effect different people
very differently. Last chap I gave it to, to extricate him out the back of
landrover, stared at me and asked ‘Are you God? I am dead. You are angels’. Kids
often have fun with their hallucinations but adults have a greater tendency to
freak out. Children generally have an overactive imagination anyway, meaning
that <o:p></o:p></div>
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seeing a dragon at the end of your bed is quite cool, but as an adult you
might start climbing the wall.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The other stumbling block for using ketamine in trauma is
that the majority of the medical world thinks it will make patients’ heads
explode. If you have sustained a head injury, due to a couple of case series
written up in the 70s, ketamine is strictly not allowed as it was thought to detrimentally
increase the pressure in the head. Making them explode! I’m not sure how many
more review papers, head-to-head comparisons (excuse the pun) or research
papers into its potential neuroprotective qualities in head injury need to be
performed to revise the dogma. Doctors across the world are still far happier
using drugs which dangerously drop blood pressure, an effect shown definitely to
worsen outcomes in head injury, than use evil ketamine. It is so engrained into
medical culture that I still feel uneasy about giving it. Not because I think
it’s going to cause harm but more because of the stern criticism I can expect
from other colleagues, utterly convinced I have made the patient’s HEAD
EXPLODE!<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We popped in another IV line, attached him to monitoring and
I gave a mild dose of sedative in the vain hope that we wouldn’t get emergence
issues. Then something a bit weird happened...</div>
<br />
<o:p></o:p>
<div class="MsoNormal">
There is an old medical proverb that ‘if you hear hoofs
coming down the corridor, don’t assume it is a zebra’. Which basically means,
think of the common stuff first before rushing to weird and wonderful diagnoses.
Real medicine is not like House MD, more’s the pity. So imagine my surprise as,
having just administered the ketamine, I heard hoofs, turned round and was face
to face with a curious zebra. It was watching me work as I knelt beside the
patient. I had a double take, making sure I hadn’t inadvertently given the hallucinogenic
drug to myself. ‘Nope, that’s a zebra alright.’ Now none of my medical mentors ever
told me what to do if there is actually a zebra in the corridor. I pondered
this for a second as the zebra and I stared back at each other. The surreal but
beautiful little moment was broken as he was shooed away by one the rangers and
we carried on.<o:p></o:p></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGbE2AuMvGk9X02k3ZBVGjHqnde3GrEVMveEtqIRs8ulJOmr00opSW1MnlegCPZmOSXh2kB0HUX3V08YJY-DHBsBNXOlDJUCoFmLDN1CTInyq_AmZXks7l4WsG0aU6llQKnMmWnmYoauU/s1600/Zebra+at+scene.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGbE2AuMvGk9X02k3ZBVGjHqnde3GrEVMveEtqIRs8ulJOmr00opSW1MnlegCPZmOSXh2kB0HUX3V08YJY-DHBsBNXOlDJUCoFmLDN1CTInyq_AmZXks7l4WsG0aU6llQKnMmWnmYoauU/s320/Zebra+at+scene.png" width="320" /></a></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXcP0nhodwai7-_OG2gvQKvI_dmcZ-RG9cLHdOi0X1WLKXmjUDPNAmbpaPFvwwptsa-m7fbJF7w4mfrkUOOi68diQLImDV_dmHuNQIas1YEuHNhDGZzKs73wBHR47NTtnIu8Szo7wVGMU/s1600/100_1431.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXcP0nhodwai7-_OG2gvQKvI_dmcZ-RG9cLHdOi0X1WLKXmjUDPNAmbpaPFvwwptsa-m7fbJF7w4mfrkUOOi68diQLImDV_dmHuNQIas1YEuHNhDGZzKs73wBHR47NTtnIu8Szo7wVGMU/s320/100_1431.JPG" width="320" /></a></div>
I gave traction to the horribly crunchy upper arm as Phyllis
applied a battlefield style dressing, splintage and a sling. The patient didn’t
even flinch but I think his colleagues were slightly concerned by his fixed disembodied
gaze at the sky. They do that. Soon we had control of the haemorrhage and the
patient was packaged up and ready to move. We rang ahead to warn the receiving hospital
that we had a limb threatening injury and to let their surgical teams know.
With a 30 minute flight time we were in their emergency room in about an hour.
The patient was taken for imaging and I understand he is now in theatre.
Neither I nor the orthopaedic surgeon were particularly optimistic about the future
function of that arm but, after all, stranger things have happened. Like zebras watching you at work for example.</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-89596956266372954852013-07-18T10:34:00.001-07:002013-07-18T10:34:28.867-07:00The Aviators<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
<br /><a href="http://www.youtube.com/watch?v=c0995Pok7l0">http://www.youtube.com/watch?v=c0995Pok7l0</a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
I've put together a little film about flying with AMREF FD set to the wonderful piece 'The Aviators' by Helen Jane Long. I'm sure anyone who loves flying will enjoy it. Click the link above.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6SQisS_VQz0D8lTR6PyN1cDIeB1Fjl2RnWaCNYZGfc74ruwl5Eiweco3Ot8iY2dpSVOSsYEM0WQ_jR8FA8V75VT-t5N3YOvby9bdavwGqCGdqoG-7LpeNe0V4edTM_PZMvqBi4JQxKF4/s1600/The+hinterland+between+stratus+and+altostratus.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6SQisS_VQz0D8lTR6PyN1cDIeB1Fjl2RnWaCNYZGfc74ruwl5Eiweco3Ot8iY2dpSVOSsYEM0WQ_jR8FA8V75VT-t5N3YOvby9bdavwGqCGdqoG-7LpeNe0V4edTM_PZMvqBi4JQxKF4/s400/The+hinterland+between+stratus+and+altostratus.JPG" width="298" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The hinterland between stratus and altostratus</td></tr>
</tbody></table>
<br /></div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-56971953041323433712013-07-15T23:52:00.001-07:002013-07-15T23:52:46.245-07:00The Kisii Bus Crash - Sample of the Twitter conversations<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
In addition, the kind of contemporaneous response we had on
twitter from the families and friends was heart-warming:-<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>“Girl still bad state. Neurosurgeon needed to clear blood
clot in the head. Evacuation only solution to KNH” <o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>“The police aircraft couldn't manage this delicate transfer,
now we can fully appreciate!”<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>“Ready for airport transfer. The AMREF doctor has briefed us
well.”<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>“AMREF doctors are just awesome. Tears of Joy. RT get well
soon!”<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>“A 24/7 Working control centre, prompt Twitter Handle to all
emergencies. That's AMREF Flying Doctors.” </i>Sir Maseme Machuka <o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5Hkn8I4AbkESqU3lg297DhLyO9ZfOCzP9YeG6iJC8mZ5D56_ojYzt8Vjzw9dr8zITCNbJ3bKYT1oD4gThHgIRG0IYBssT-BGHvz2VcNqmrEs-IuI20luCI5vw115ACou4h0uO7O1Hgms/s1600/Stencil+king+air.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5Hkn8I4AbkESqU3lg297DhLyO9ZfOCzP9YeG6iJC8mZ5D56_ojYzt8Vjzw9dr8zITCNbJ3bKYT1oD4gThHgIRG0IYBssT-BGHvz2VcNqmrEs-IuI20luCI5vw115ACou4h0uO7O1Hgms/s320/Stencil+king+air.JPG" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
I just hope that next time something like this happens (it
is only a matter of time I’m afraid) AMREF Flying Doctors is involved
immediately. Then we can do what we do best, for the best possible results.<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-71109994607964201972013-07-14T15:00:00.000-07:002013-07-16T00:14:02.552-07:00The Calm Before the Storm - Part 2<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<div class="MsoNormal">
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.<o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7NnwN-Mo8NVyCRYOlbhsCnLl2JPBcEp6zrCsz0mblcx4L-jbU4B2GdcBNzkePvUxbSPxNGQtb9UO8trN4baJPf4xIZLeMlUgAViRhyphenhyphen7Lxw7IgrojClNAeHdmXOl0ji0fyo5zpI74vEY/s1600/Kisii+crash.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja7NnwN-Mo8NVyCRYOlbhsCnLl2JPBcEp6zrCsz0mblcx4L-jbU4B2GdcBNzkePvUxbSPxNGQtb9UO8trN4baJPf4xIZLeMlUgAViRhyphenhyphen7Lxw7IgrojClNAeHdmXOl0ji0fyo5zpI74vEY/s320/Kisii+crash.png" width="320" /></a></div>
<div class="MsoNormal">
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.<br />
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYldFxrmRgL786d4BdgO9-R5UTlM2VUMb3IWjfbo5g6PJkACmVNFaQWtJdnPbY6BvbnLN4swjCDxpPb3qrEcUKiCju3BBPJZLNub90_5XjTsG4dpWXnHnUbzo1d22IF_TNkurFT6esfBI/s1600/Survivor.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYldFxrmRgL786d4BdgO9-R5UTlM2VUMb3IWjfbo5g6PJkACmVNFaQWtJdnPbY6BvbnLN4swjCDxpPb3qrEcUKiCju3BBPJZLNub90_5XjTsG4dpWXnHnUbzo1d22IF_TNkurFT6esfBI/s320/Survivor.png" width="320" /></a></div>
<div class="MsoNormal">
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. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7s477zcA9Czhwt5U-JQKWgje4GDJRsJa4YFLaJj7RNp8rvWm3jFXyqIKVdG2ikYp2WdZtcqUWrZNtYfYiA9gs5W9vbZSLy6StB2tshHrc-ONWDhOjj86zPtb6TUhyphenhyphenJ193NvQpZowhMMw/s1600/Wilson+-+AMREF+plane.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7s477zcA9Czhwt5U-JQKWgje4GDJRsJa4YFLaJj7RNp8rvWm3jFXyqIKVdG2ikYp2WdZtcqUWrZNtYfYiA9gs5W9vbZSLy6StB2tshHrc-ONWDhOjj86zPtb6TUhyphenhyphenJ193NvQpZowhMMw/s320/Wilson+-+AMREF+plane.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Caravan Plane used in the evacuation</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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. <o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiobfLiqcKOyqYDC90WPs0YwVYVg5HU6iIUdoMqxuRfb1vcxLvi5EAfpkIStNgydelNp6POowEJ8LBFV_ibrt8r1EILiOtlF377KJCjM7LS1NFe6Qu2jPfMtVjaGoemD9C496BanVfHEh0/s1600/100_1289.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiobfLiqcKOyqYDC90WPs0YwVYVg5HU6iIUdoMqxuRfb1vcxLvi5EAfpkIStNgydelNp6POowEJ8LBFV_ibrt8r1EILiOtlF377KJCjM7LS1NFe6Qu2jPfMtVjaGoemD9C496BanVfHEh0/s320/100_1289.JPG" width="320" /></a></div>
<br />
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.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEoBdBee2Skcn3YfxsxF5e0_TvxtQkQUGcWyvUEfqDF8EI0A0UjX_2OMAD88HONYOs0saDFN4C_DeqJDSn8D_-5WEfOIbSh2Mp2mwDV1ItFfQtdT70AYRIK9RzYtT19Yybx85RViV34Y/s1600/Police+choppre.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFEoBdBee2Skcn3YfxsxF5e0_TvxtQkQUGcWyvUEfqDF8EI0A0UjX_2OMAD88HONYOs0saDFN4C_DeqJDSn8D_-5WEfOIbSh2Mp2mwDV1ItFfQtdT70AYRIK9RzYtT19Yybx85RViV34Y/s320/Police+choppre.png" width="320" /></a></div>
<div class="MsoNormal">
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.<br />
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnIduqTnhA4Uzj7EIVTyM1OP6khuXHBV0RAOluHrnS7tjpo16yHzzahPZM5cO-nQLR9qt3o5xc6TPKdN2QUUgsEiQtODseIpDbNr2kjKWa5lvN_cwmSUY4tx4ex3gIlrxQdKTTIaugUWo/s1600/100_1312.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnIduqTnhA4Uzj7EIVTyM1OP6khuXHBV0RAOluHrnS7tjpo16yHzzahPZM5cO-nQLR9qt3o5xc6TPKdN2QUUgsEiQtODseIpDbNr2kjKWa5lvN_cwmSUY4tx4ex3gIlrxQdKTTIaugUWo/s320/100_1312.JPG" width="268" /></a></div>
<div class="MsoNormal">
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.</div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
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. <o:p></o:p></div>
</div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-31432708901232962062013-07-13T12:54:00.000-07:002013-07-16T07:07:38.264-07:00The Calm Before the Storm - Part 1<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvUw1GkQm7zE2eDKaQOVR14LGBpoo0YJMjg20vCxNKkI2CxfZpmVl7pM0hEi0gEy1S9ID4-tji5TxCVUmPr4BbXvTyPAKKz5A8kcydxkNuN72rpgi5McPUdVxEyxJfiTNy1REiBDCobI4/s1600/King+air+launch.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvUw1GkQm7zE2eDKaQOVR14LGBpoo0YJMjg20vCxNKkI2CxfZpmVl7pM0hEi0gEy1S9ID4-tji5TxCVUmPr4BbXvTyPAKKz5A8kcydxkNuN72rpgi5McPUdVxEyxJfiTNy1REiBDCobI4/s320/King+air+launch.png" width="320" /></a></div>
<div class="MsoNormal">
The past week at AMREF has been one of strange contrasts.
There were no flights at all for three days and it was making the staff
twitchy. It just doesn’t feel right to have nothing going on. In actual fact
there was quite a bit going on at AMREF FD headquarters, just no flying. We had
the official launch of the new Beechcraft King Air air ambulance on Monday. It
was an impressive event with the dignitaries and guests sitting in the hanger
alongside the beautiful new plane. Proudly I watched as my <o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiID5k-60sA4a0JkmlMW-AREOSZ9eesfhIAQqx3TvfQ9XCp7M6dDZWewItJODXXcVyxZSLPmsfnsUJ8E0BrSq7U85cm7da2BtyEmZMIKlvOFbvl8nfjQgigr0HZTHg1cwXqOiyzcWOVzVg/s1600/100_1257.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiID5k-60sA4a0JkmlMW-AREOSZ9eesfhIAQqx3TvfQ9XCp7M6dDZWewItJODXXcVyxZSLPmsfnsUJ8E0BrSq7U85cm7da2BtyEmZMIKlvOFbvl8nfjQgigr0HZTHg1cwXqOiyzcWOVzVg/s320/100_1257.JPG" width="320" /></a></div>
film was being shown
on repeat in the background. Dr Bettina Vadera, a representative from AMREF and
the visiting MP all made speeches with a compare from Nairobi radio. She did a
fantastic job of helping market the Maisha cover plan. It is the AMREF FD new insurance
policy which is affordable to a large proportion of Kenyans and they then can
get rescued from wherever they are in East Africa. <br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But after the banners and tables were cleared we sat around
twiddling our thumbs for the rest of Monday and then Tuesday. Then suddenly on
Wednesday morning, we had three urgent medevac flights requests simultaneously. Then during the next two days AMREF FD would take on 9 flights, many of them extremely sick patients.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I
entered the office I was ushered to the waiting Cessna Caravan to do our checks
as we had to fly out to <o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
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Lewa (north of Mt Kenya) where an 8 year old girl had fallen from her horse
and was unconscious. There really is nothing like paediatric trauma to brush
off the morning cobwebs. Far more effective than coffee.<br />
<br />
As I was busy agonising over whether I should be using the (A+4)x2 or the (Ax3)+7 calculation for her
weight and the plane was about to start up, we were suddenly stood down. We were informed the girl was
being brought straight to Wilson in a small plane with the parents. But we waited to recieve to resuscitate as required and pop her in our
ambulance to take her straight to hospital. But I was now needed on another urgent flight into Tanzania. The storm was looming.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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 run and 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.<o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj26UG1z0lJAUx1Ccjrn8ztmvXGrdyTjdoH0YbohJ0FxrnYwxbY9FGR-q9F-jN0M1R_aR7IAt4_3MSvMbxcqFFVTwfce6_G9bOBUjLnX5DUgXKsI_p3H5HakflqO40JnU7V01izVOJfRKg/s1600/100_1266.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj26UG1z0lJAUx1Ccjrn8ztmvXGrdyTjdoH0YbohJ0FxrnYwxbY9FGR-q9F-jN0M1R_aR7IAt4_3MSvMbxcqFFVTwfce6_G9bOBUjLnX5DUgXKsI_p3H5HakflqO40JnU7V01izVOJfRKg/s320/100_1266.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Kahama, Tanzania</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So as we popped her in the ambulance the King Air was
brought around and had been loaded ready for us to head into Tanzania straight away. A young
girl of 15 had been involved in a nasty car accident and was critically ill.
She had been unrestrained in
the back seat of her father’s car as they hit a pot hole, breaking the axle and
the car rolled several times. The father was fine but his daughter had been
ejected though the front window and was lay unconscious on the road. Once they got to the local
hospital, we were contacted. As far as they could tell she only had a head
injury (always a dangerous assumption) and she was still unconscious. All they
could do was wait for us and give her strong medication to suck fluid out of
the cells in her brain and halt the swelling going on inside. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpv_oclMTI1ESGZp3UVWpZCG309DSvFvOOFRV3bg40QlRumDtw6SioXnps5eWnRh106E0CajfyP25hzHraD-KHCJ36gH-hk_VSQgseFFNomHvTNqQ464xC3hKLWx31aVcAbnWO4HeKSL0/s1600/100_1267.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpv_oclMTI1ESGZp3UVWpZCG309DSvFvOOFRV3bg40QlRumDtw6SioXnps5eWnRh106E0CajfyP25hzHraD-KHCJ36gH-hk_VSQgseFFNomHvTNqQ464xC3hKLWx31aVcAbnWO4HeKSL0/s320/100_1267.JPG" width="320" /></a></div>
It took about an hour to get to this gold-mining town of Kahama and 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 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 Kizito 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. Kizito 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.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSAl5vyKXDRRbxP0WG9Te7xnGYDnDVa2PfaUPu-Z2g-LqVTzSUhV5UiQoGSl6OOx2P9_u719ZEn1yPNb9Mm4txwSA8WITifeDm8beU_nHG3ovzRhztUmcoUzqE1ODGDZA35B0BsL8w-xk/s1600/100_1268.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSAl5vyKXDRRbxP0WG9Te7xnGYDnDVa2PfaUPu-Z2g-LqVTzSUhV5UiQoGSl6OOx2P9_u719ZEn1yPNb9Mm4txwSA8WITifeDm8beU_nHG3ovzRhztUmcoUzqE1ODGDZA35B0BsL8w-xk/s320/100_1268.JPG" width="320" /></a></div>
<div class="MsoNormal">
It took me a little while to work out what the problem was
through the heat haze. Then I could make out a little group of people hurriedly
carrying a small body on a stretcher. ‘Oh bugg*r’ I thought and quickly
followed Kisito. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A rapid sequence induction on a critical patient in the
pre-hospital environment can be one of the most stressful situations you
can encounter as a doctor. But it still needs to be calm, clear and systematic process with
good communication between the intubator and the assistant. So many things can
go wrong; the powerful drugs you use to render the patient amnesic and unaware
of the whole process, to reduce the stress response to having the breathing
tube put down their throat and to paralyse their muscles, can easily put them
into cardiac arrest. And if you can’t get the tube down and can’t breathe for
them then they will asphyxiate. In a critically ill patient the time you have
to get a breath into the patient can be only seconds before the oxygen in their
blood is used up. The pre-hospital environment makes this procedure even more
difficult especially in injured patients with potentially broken necks, damaged
lungs and occult internal blood loss.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
From one look at this girl, you did not need to be a doctor
to see she was in a bad way. She was unresponsive with a partially obstructed
airway, breathing extremely fast with a pulse rate of 170. Her blood pressure
was actually slightly elevated, as young people often do before it starts
dropping. Her head was bandaged and she had signs of a facial fracture. Kizito
and I did not need to spend long deciding what we needed to do and we placed the patient in the shade under the wing of the aircraft. Soon Kizito had established a large IV
line and was getting one of the crowd (of course there was a crowd) to squeeze
a bag of fluid into her, while I drew up the necessary drugs. Soon we had her
assessed, oxygenated and her pulse rate was sensible. I was prepared for it all
going horribly wrong but the tube passed simply and she did not respond
adversely to the medication. We continued to optimise her chances of
neurological recovery as best we could on our way back to Nairobi but I’m
afraid the prognosis for such injuries is not very good. <o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZkjkqJZqcDjLb9ySpZtOv7-FLZixLSRhLMEQTXsHd8vg0i4ogga49pdLRoq61ZVTYpGsPFEH1VHGhpq5OyejTqOoYMQZ5C7zvRb4MiTBrzx3ILG80hsNOpRuvkZi6ncZSv4rRfAt3QrQ/s1600/100_1302.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZkjkqJZqcDjLb9ySpZtOv7-FLZixLSRhLMEQTXsHd8vg0i4ogga49pdLRoq61ZVTYpGsPFEH1VHGhpq5OyejTqOoYMQZ5C7zvRb4MiTBrzx3ILG80hsNOpRuvkZi6ncZSv4rRfAt3QrQ/s320/100_1302.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mount Kili on our back</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Just as we were handing over in Nairobi we were instructed
to return urgently as we were needed in Kisumu next to Lake Victoria. A
normally sprightly elderly man had had a heart attack the day before and was
not doing well. We had had a non-urgent enquiry about a transfer for him to
have cardiac catheterisation earlier in the day. The clot busting and cardiac
support drugs he had been given had seemed to be working. But then as his heart
started to fail and the pressure started backing up, he had started to drown in
his own fluid. This is not an uncommon occurrence for us in the emergency
department and we deal with ‘crashing pulmonary oedema’ pretty regularly.
Nitrates and ‘non-invasive assisted ventilation’ works pretty well. Obviously
this was not available in Kisumu hospital. They also couldn’t do an echocardiogram
because the machine is owned by one of the other physicians and apparently it
can only be used on his patients. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Our radio room informed us that the patient was
deteriorating and we needed to get a move on. </div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi86pdplAFScuhB6icOuzW48Mjqz2XM50KWJqVY0QYM4D_iFDQkZ4VjZQShevfb5N8ahL3ERE8hLeQhVvifisLP04oLWXmQu6qEusNKL3vSAGEmQ_nObJd__OBIqOEUL0gAIKrB4t69DgI/s1600/100_1309.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi86pdplAFScuhB6icOuzW48Mjqz2XM50KWJqVY0QYM4D_iFDQkZ4VjZQShevfb5N8ahL3ERE8hLeQhVvifisLP04oLWXmQu6qEusNKL3vSAGEmQ_nObJd__OBIqOEUL0gAIKrB4t69DgI/s320/100_1309.JPG" width="320" /></a></div>
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.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For the second time in the day Kizito and I exchanged glances,
shrugged and got to work. Thirty minutes later we had this chap settled on the
vent and his chest was already improving. We had to contend with his heart
doing some weird things as we ascended but with a little tweaking and strong
cardiac drugs we had them solved by the time we handed him over back in Nairobi
to go have his angiogram.</div>
<br />
<div class="MsoNormal">
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…<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-15335127322038881562013-07-07T05:52:00.000-07:002013-07-07T06:03:23.286-07:00The inverse Swiss cheese model of Success!<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFcAyvVhHoTJag_HQEzzuQ2cHekacD8mfGsBMED9X0LM-oFiEhK7OJqAgcRy9f-S-hhidvQfqBwnUU2kNSePXp9hyn3VgpwBhhMKZd8SvieLBC5pKIFp271y1hI0sZOs0FiHDWnEh0uPU/s1600/sw_not_aligned.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="237" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFcAyvVhHoTJag_HQEzzuQ2cHekacD8mfGsBMED9X0LM-oFiEhK7OJqAgcRy9f-S-hhidvQfqBwnUU2kNSePXp9hyn3VgpwBhhMKZd8SvieLBC5pKIFp271y1hI0sZOs0FiHDWnEh0uPU/s320/sw_not_aligned.gif" width="320" /></a></div>
I have been shown the
Swiss cheese model for error or disaster many times in my career. But I wonder if there is
a Swiss cheese model for success? So instead of the multiple holes lining up to
allow an environment for disaster, all the right holes line up allowing you to
sail through against all the odds and come out the other side with a truly
excellent result. If there is not such a model, I would like to propose it now
and give you an example that happened just the other day.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have written little about the staff and expertise that goes
on behind the scenes allowing AMREF FD to do its job. They made those first layers of Swiss
cheese line up, just in time.</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Coming from a first world country and working at AMREF you
become very acutely aware of the different medical capabilities in the third
world and how incredibly remote (geographically and logistically) some of these
places are. And that’s coming from someone who has worked in Antarctica! If
taken ill in one of these places you had better cross your fingers and hope
your own body can sort it out. While out here I have often thought about one of
my medical school colleagues, who tragically succumbed to a severe illness in
the bush of Africa on her elective. I wonder if she would still be with
us if AMREF FD had been there and able to pick her up in time.<o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKNSmj1EvhDvjqda6nDnh9K11cDZV9hERs1BLkL6j_f5RNzPTK4wBZT2f-dzEs-P9YLGddFtos0KBjra_OjuTmbdmfQyaqSMMYw9eIpVR0AsbcZAuJ_0Y0HRy6F9_ef1UokbmlRQPPSbM/s1600/100_1149.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKNSmj1EvhDvjqda6nDnh9K11cDZV9hERs1BLkL6j_f5RNzPTK4wBZT2f-dzEs-P9YLGddFtos0KBjra_OjuTmbdmfQyaqSMMYw9eIpVR0AsbcZAuJ_0Y0HRy6F9_ef1UokbmlRQPPSbM/s400/100_1149.JPG" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The landscape of northern Ethiopia</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We received word of a young man travelling in a remote area
of Ethiopia who had become extremely sick. They thought it was probably malaria
but could not confirm. He had had a pretty classic malarial course with a few
days of very high fevers, rigors and then started to develop dark urine and
jaundiced skin. He seemed to improve on a dose of artemether (administered by
another member of the group he was with) and then during the night became
drowsy, confused and convulsed. He had not regained consciousness since. The
doctors in the small clinic there had neither the supply of medication, nor the facilities
to treat such a severe illness. Their experience of severe malaria like that in
their local population is that it is invariably fatal. They just expect to watch
people pass away.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When a distress emergency call like this comes into AMREF a
number of things need to happen before we can get going. One of the first
things is getting confirmation from the insurance that they will pay and the
patient is covered for what we propose to do. Then we need to get the guys at
Phoenix to work out how to get us there. That requires knowledge of the
airspace, the airstrips in the region and, crucially in this case, their
opening hours. Our operations team need to get immigration to agree to let the
patient into the country and get clearance for our aircraft to enter the countries
airspace and land.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOzAqR49-4zfRjFBIPdnkS4VoMm15ALcctkql2yticoirqsy8HZSRi_cAkhGx9E9Z7mpXeR5J9B14Ux8dmuZggeN_5ZrShSBEhO7TDCoGw85unm6nu64JwLLra7s6vW02FKLyqvxTDH8Y/s1600/Bet_Giyorgis_church_Lalibela_01.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOzAqR49-4zfRjFBIPdnkS4VoMm15ALcctkql2yticoirqsy8HZSRi_cAkhGx9E9Z7mpXeR5J9B14Ux8dmuZggeN_5ZrShSBEhO7TDCoGw85unm6nu64JwLLra7s6vW02FKLyqvxTDH8Y/s320/Bet_Giyorgis_church_Lalibela_01.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">From Wiki - a monolithic rock-hewn church in Lalibela</td></tr>
</tbody></table>
<div class="MsoNormal">
In this particular case, the challenge was that the call came
through about lunchtime and the airstrip we were flying to could not support
night flights. Lalibela is a site of considerable beauty and cultural heritage
in Ethiopia attracting a large amount of pilgrims and tourists alike, so the
runway is tarmac and well maintained, allowing us to get there is a jet. But
immigration dictates we cannot go straight there; we use first stop in the
capital Addis Ababa to process the paperwork. Only in extremely rare
circumstances is that wavered in any country, not just Ethiopia. (For example, because of a prior agreement, we can fly straight to any airstrip in Tanzania
without going to Dar Es Salaam). So given that it’s two hours from Nairobi to
Addis Ababa, then about 30 mins until we can set off to Lalibela which takes
45minutes and shuts at 18:00, we were looking at a cut-off time of 14:30. If we
missed it we would have to wait until morning. The medical report strongly
suggested that the patient would not survive such a delay.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As our Operations staff battled with Ethiopian immigration
and badgered to gain clearance for the flight, our radio room in desperation tried
to charter a flight in Ethiopia to go get the patient and bring him to Addis
(which is open 24 hrs) then we could pick him up there, but we couldn’t get a
doctor or nurse to do the escort. At 13:45 it was looking like this young man’s
life was slipping through our fingers. All we could do as the medical team was
sit with our equipment, ready to go and hoping the operations team could pull
it off in time. It just seemed crazy to me that this red tape can’t be sorted
out while we are on our way or even once we had picked him up, but that just
isn’t the way it works.<o:p></o:p></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH5lj9J1g5nrJ8f2PClXsb062IK3r_-0W46j6WDiV0Ndd-N7NMoxPkWz6uYgIXunnNINQCPxG0criNDzeCsv8qSaIp5gp0wDBmuztetaYvE6AbD-f3idNINZ3pcH1zQtIbVGaaTf5eSmU/s1600/100_1144.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH5lj9J1g5nrJ8f2PClXsb062IK3r_-0W46j6WDiV0Ndd-N7NMoxPkWz6uYgIXunnNINQCPxG0criNDzeCsv8qSaIp5gp0wDBmuztetaYvE6AbD-f3idNINZ3pcH1zQtIbVGaaTf5eSmU/s640/100_1144.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The carcass of a DC3 plane at Addis Ababa Airport</td></tr>
</tbody></table>
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At 14:10 we got the call the clearance had been granted, the
insurance had confirmed they were happy, the patient’s travel documents had
been found and we started up the jet. It was still going to be tight. It was
entirely dependent on the immigration officials at Addis Ababa. Airport officials
here seem to behave a little like ‘Rheopectic liquids’ i.e. they become 'slower and thicker over time when shaken, agitated, or otherwise stressed'. Utter
deference to their lofty status and prostrated begging normally works better
for the fluid dynamics of the situation.</div>
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<o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMGey-HyiReotX2SAFNDF9871SfJfGQJIuczccw7b_cdY9BGDL_KPgH3YIVRTCxnBZnLfejkDDpWHQFfOwLqigIfDPh4lF4S__GGNXUE-olAY0QM57TVavNpPOX-4qFYDoHiOR_fpF9cQ/s1600/100_1151.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMGey-HyiReotX2SAFNDF9871SfJfGQJIuczccw7b_cdY9BGDL_KPgH3YIVRTCxnBZnLfejkDDpWHQFfOwLqigIfDPh4lF4S__GGNXUE-olAY0QM57TVavNpPOX-4qFYDoHiOR_fpF9cQ/s320/100_1151.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A deep canyon under the clouds</td></tr>
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In Addis we were able to speak to the doctor treating this
chap. He was worried. Really worried. He said his respiratory pattern was
changing indicating he was not long for this world. This news came as the pilot
did his calculations and worked out we would have about 30 minutes on ground. We told the
doctor to him to get him to the airstrip, we couldn’t come to
him. He was reluctant but it was the only way. <o:p></o:p></div>
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The flight into Lalibela was about 45 minutes. As Clement
the flight nurse and I drew up drugs and set up the ventilator I caught
glimpses out the window of an incredible landscape. If the only pictures of
Ethiopia you have ever seen have been from Oxfam adverts, the country has been
rather misrepresented. This particular region is breath-taking, with vast undulating
valleys, deep canyons and lush green cultivated fields. From that elevation I missed any of the famous temples carved out of the ground and canyon walls but I could see the scattered village buildings resembling little mushroom plantations. Soon we were banking hard around a
valley rim and on finals into Lalibela.<o:p></o:p></div>
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxtXxiq25hyBTgApxyeFJFs0e39K3X1ugtA06_Hl2FRwANokdQPi__8TvADi83xdGMPRpl0CADjiZWO0_ucpQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
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The patient had been brought to the airstrip and he looked
worse than I imagined. His travelling companions were obviously incredibly
worried and glad to see us. Like any of these situations a little crowd of locals
had gathered to watch. It’s annoying and intrusive but you get used to it.
There simply is no point telling them it isn’t a spectator sport. Because it is
really. You just have to get on with it and they can be useful on occasions as
another pair of hands to help lift things. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Clement and I set to our resuscitation (being given our
absolute max time of 45 minutes) and the pilots were incredibly helpful and
just became members of the medical team. When rushed in a situation like this where
there is no one to bail you out like in hospital, it is even more critical you
keep your head, calm down and go through your checklists. Communication is key
and despite not having worked with Clement for long (he is one of our newest flight
nurses) we gelled and did a bloody good job if I do say so myself. Within our allotted
45 minutes we had more IV lines in him with improving oxygenation, a blood pressure,
and had established him on the ventilator without any complications. We settled
him into the plane with all our pumps, drips and machines and were taking off
from the beautiful Lalibela just as the light was fading. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDEQNr0cVjqs7HAP3nFN63SqbslcP_DNpJ-S75DfFVOQXcWFbXK53-RjjoWP14AWdglzS1k0wqNhyphenhyphenVesCCdJHCuJSpSYvdv7mwsMOWhfKKsoPV-HDdKsjP5ChyjiINrqq1AICo0I-d5HM/s1600/100_1158.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDEQNr0cVjqs7HAP3nFN63SqbslcP_DNpJ-S75DfFVOQXcWFbXK53-RjjoWP14AWdglzS1k0wqNhyphenhyphenVesCCdJHCuJSpSYvdv7mwsMOWhfKKsoPV-HDdKsjP5ChyjiINrqq1AICo0I-d5HM/s400/100_1158.JPG" width="400" /></a></div>
<br />
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With all our kit we were able to invasively monitor his progress
as we treated and correct his various issues. As he improved he started to
require more sedation to help him cope with the ventilator which is a promising
sign that his brain was coming back on line. By the time we arrived in the hospital
in Nairobi we performed a blood gas test which showed he had massively improved
and was even breathing for himself. I am told he is now stable and improving in
intensive care and the doctors are very positive about his prognosis.
Discussing the case, we all agree that had it not been for the actions of our
dedicated operations team busting through that red-tape and our pilots 'pushing the envelope', the story would have
been very different. But for this lucky young man, all the holes in the Swiss
cheese lined up just in time.<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-79169924256244848302013-07-02T23:10:00.000-07:002013-07-02T23:10:13.116-07:00The Lewa Downs Safaricom Marathon<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB6jAVitRUVdgrnclM3CC1ZPbGM7ee7kp_Bh3WIz1BYCGWOMM_nkCT_UWC4CXOpnyWRjNTHvMKrCl3HG9YmF_eIJ05RjyUXaIhl7LYbWX44rRah05F1yMmX4MO4GOe0Gir7XIMu9_uB84/s1600/100_1035.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="336" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB6jAVitRUVdgrnclM3CC1ZPbGM7ee7kp_Bh3WIz1BYCGWOMM_nkCT_UWC4CXOpnyWRjNTHvMKrCl3HG9YmF_eIJ05RjyUXaIhl7LYbWX44rRah05F1yMmX4MO4GOe0Gir7XIMu9_uB84/s640/100_1035.JPG" width="640" /></a></div>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDK1NhCHwF_duCeYct1EauGAJGO2umn-wKGMPDU5VewIzW7US9O3ESqapAucSPJgnMhGvfzAuDUzFueu4bod_PgiExwEjaxXZ7w9mgb-Aa3y5rForAQa8SebLaH3CxpVVx_T-Pyw0-g5Y/s1600/100_1005.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDK1NhCHwF_duCeYct1EauGAJGO2umn-wKGMPDU5VewIzW7US9O3ESqapAucSPJgnMhGvfzAuDUzFueu4bod_PgiExwEjaxXZ7w9mgb-Aa3y5rForAQa8SebLaH3CxpVVx_T-Pyw0-g5Y/s200/100_1005.JPG" width="143" /></a>Last weekend I was lucky enough to be part of the team giving medical
support to the Lewa Downs Safaricom Marathon. This marathon has
been placed among the 10 ‘must-do marathons’ in the world. It has a cap of 1000
runners and it is an extremely popular yet formidable challenge. A marathon
distance is difficult enough for most people but this particular jog through
the bush also involves the dry heat, high altitude, tough terrain and a host of
local beasts trying their best to interfere with the curious long line of
humans running through their home.</div>
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<o:p></o:p></div>
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I have been involved in medical support for a few endurance
events and I would like to start by congratulating the organisers on a slick
and effective job. I would urge anyone reading this blog – if you are looking
for a unique endurance event with stunning scenery and a great party
atmosphere, not to mention the opportunity to see some of the fastest long
distance runners in the world disappear into the distance, this is the race for
you.<br />
<br />
The medical support came from multiple different groups, local ambulance providers, local hospitals and even a couple of medics from the British Army (I never got a chance to say thanks to those guys, but they were brilliant the whole day) coming together to provide excellent care for anything from muscle sprains to head injuries.</div>
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I had the opportunity to fly around the race course in a
helicopter looking for collapsed runners. As you <o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRC3WAxdUqpH0l7RktllhW5d-rFM1eBezwPd9iTav-Tp9RrLDp8BjKqgKfgJOatVZtCvYBECujyjJdYlEzzD9tcCFMiSHjSXS3ySIGVh8MnXNYaRGl2NdSuL6Vt0iKbrRETNYnZx5COVE/s1600/100_1041.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRC3WAxdUqpH0l7RktllhW5d-rFM1eBezwPd9iTav-Tp9RrLDp8BjKqgKfgJOatVZtCvYBECujyjJdYlEzzD9tcCFMiSHjSXS3ySIGVh8MnXNYaRGl2NdSuL6Vt0iKbrRETNYnZx5COVE/s320/100_1041.JPG" width="320" /></a></div>
probably imagine from the
description of the race above, there are generally quite a few to scoop up. The
same problems keep cropping up but there are a few unique hazards on this race.
We had to spend the first hour of the race scaring off elephants, buffalo and
rhinos from the course. Some of these runners are fast but I guarantee none can
outrun an angry bull elephant. I’ve learned that they can be horrible creatures
when they want to be. Apparently they will smash your body against a tree or
the ground, then grind you into the dust with their back legs. There is often
little left that is recognizable human anatomy after a fatal encounter with an
elephant. So Pooh was right to be scared of heffalumps. He wouldn't have been
quite as anxious if he and Piglet had been shooing them off in an awesome
helicopter.<br />
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It was not long before we were called to one runner after
the next. One poor chap had collapsed unconscious into some bushes with his
neck flexed partially obstructing his airway. We got to him in minutes and he
looked terrible. He had that horrible see-saw breathing showing not a lot was
getting past his pharynx. It’s a shame to think that bystanders hadn’t cottoned
to the fact that all he needed was a minor shift in the position of his head
and he would probably have come round. His blood oxygen saturations were only
65% (they should be 95%) and he was deeply unconscious. We sorted his <o:p></o:p><br />
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airway
quickly and put him on oxygen fully expecting him to need further resuscitation
back at the finish tent. Wonderfully he gradually regained consciousness as we
landed and I left him trying to work out where on earth he was. He genuinely
had no idea he hadn’t crossed the finish line. </div>
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The next patient was a classic heat-stroke, staggering
about, confused with skin as dry as parchment and a temperature of about 40. Just
like in extreme cold you will lose the ability to shiver, in extreme heat you
can lose the ability to sweat. Just when you need to the most! He did well
after we liberally coated him with water and then blasted along the bush with
him in the helicopter. One of the best <o:p></o:p><br />
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ways to prepare for such a race is to acclimatise
for a couple of weeks and build up your tolerance to exercising in the heat.
But people rarely do this. I can see why. I’m not going off running in the bush
when I might get mashed by an elephant, gored by wildebeest, torn to bits by
hyenas, bitten by snakes or robbed by bandits. No thanks.</div>
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When we arrived at the resuscitation tent I was greeted to
find a patient who had been brought by land ambulance in a collapsed state. He
had regained consciousness only to go completely ballistic, screaming the place
down. It had taken a large dose of sedative to control him. My best guess
diagnosis on this chap, was of brain swelling secondary to low sodium, however
that is yet to be <o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT9vVIvOtbC-ikPs7BbGw_BrbXVdjwMWW9xKoUhwdFF0gBXZ_IGAv5mbWiiQJxatvHlIIovlGq-SklyIa6mGP65Vlcgg3cA-hhfdqgCLQSBoEYw5l-108O2RyQkXxv_NGNL0H73wgbzTk/s1600/100_1092.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT9vVIvOtbC-ikPs7BbGw_BrbXVdjwMWW9xKoUhwdFF0gBXZ_IGAv5mbWiiQJxatvHlIIovlGq-SklyIa6mGP65Vlcgg3cA-hhfdqgCLQSBoEYw5l-108O2RyQkXxv_NGNL0H73wgbzTk/s320/100_1092.JPG" width="320" /></a></div>
confirmed. The safest thing for this chap was to sedate,
paralyse and transfer him back to Nairobi in the Caravan air plane. The team worked brilliantly together including our exceptional pilot Emmanuel for whom nothing was too much trouble. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9lmqBpdgtBKkdLxLVjUIe2xMczvk0sSxli5Gcj6j3-jfSOvfublxU0LjMslNstTOFsx1Eecq2_5ceHNvIYq6Vjy7HONeaN3rmH2mwpVcKAqpOAHaUO6i0yXYLZcgR9cDua_QRYdGorto/s1600/100_1073.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9lmqBpdgtBKkdLxLVjUIe2xMczvk0sSxli5Gcj6j3-jfSOvfublxU0LjMslNstTOFsx1Eecq2_5ceHNvIYq6Vjy7HONeaN3rmH2mwpVcKAqpOAHaUO6i0yXYLZcgR9cDua_QRYdGorto/s320/100_1073.JPG" width="320" /></a>It difficult to confirm if low sodium was his particular problem. Low sodium or hyponatraemia in marathon runners is caused by
them drinking too much water. Check out Dr Tim Noakes book ‘Waterlogged’ if you
are a runner and want to know more about this, but the dogma that sports drink
manufacturers would love you to believe about fluid replacement is pretty much
garbage. Imagine our ancestors, cultural endurance athletes, I very much doubt they drank 3 litres of fluid when covering the same distances. Dehydration maybe a matter of performance but rarely a matter of life
and death. Your sensation of thirst is a pretty good driver of behaviour to top
yourself up just like your drive to get warm when it is cold. Unfortunately the
strange sensations associated with water excess, make people believe they must be dehydrated and so they drink even more! In a study of Boston marathon runners in the NEJM (<a href="http://www.ed.bmc.org/library/core-curriculum/NEJMhyponatremia.pdf"><span style="color: black; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-color: black;">http://www.ed.bmc.org/library/core-curriculum/NEJMhyponatremia.pdf</span></a>)
13% had moderate hyponatremia, with 0.6 percent had critical hyponatraemia
which could easily cause seizures, coma and death. Nearly every year I hear
about a London marathon runner dying from this entirely preventable cause. The
anti-ecstasy drug campaigners would also love you to believe that these high
profile tragic deaths of teenagers in night clubs was down to the drugs when it
was actually due to harmless old H20. Occasionally I even see someone, who in
the midst of a bizarre psychosis, has taken it upon themselves to drink gallons
of water with the same dire consequences. Who would have thought water could be
so dangerous.<br />
<o:p></o:p></div>
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So if you want to give this marathon a try, and I thoroughly
recommend it, take my advice: - train hard, acclimatise somehow, keep your
airway patent, drink when you are thirsty and bring a camera!<o:p></o:p></div>
<br />
<br />
(and for those who enjoyed the last little film, I have put together another 5 min long one, purely about the marathon)<br />
<br />
<a href="http://www.youtube.com/watch?v=N-ompKAWivc">http://www.youtube.com/watch?v=N-ompKAWivc</a><br />
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Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com4tag:blogger.com,1999:blog-7492413488880336559.post-71644515854564489412013-06-27T22:57:00.001-07:002013-06-27T22:57:16.353-07:00Mattdocfilms and AMREF FD<div dir="ltr" style="text-align: left;" trbidi="on">
Amazingly I've managed to get myself entangled in quite a few projects over the past couple of months with a few of them coming to a head this week, hence the delay in posting stuff. Last week I was involved in the official symposium with government officials, the CDC and John Hopkins University to discuss the progression towards an integrated EMS response in Kenya as I discussed in 'Fledgling Paramedics' post last month. I'll write a bit more about that later. For now, I'm writing the Handbook for volunteer physicians, completing an audit looking into critical care patients and creating an induction and continuing training programme for the staff using a few lessons from our pilots.<br />
<br />
However one thing I have been doing has been collating a montage of video clips of my time with AMREF FD. I have put it on my youtube channel ' mattdocfilms' and I thought I would share that instead of doing another story. Enjoy!<br />
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<a href="http://www.youtube.com/watch?v=QeogQHIibl4">http://www.youtube.com/watch?v=QeogQHIibl4</a><br />
<br />
(ps - if anyone is free and has the appropriate experience, AMREF FD is looking for a volunteer physician next month.Go to flydoc.org if you are interested, I know it is short notice due to a late drop out.)</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-774796302870861712013-06-20T01:38:00.000-07:002013-06-20T01:41:14.746-07:00Plane Crash in the Rift Valley<div dir="ltr" style="text-align: left;" trbidi="on">
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<i>“Mayday, Mayday, small aircraft has crashed at Waso Airstrip.
Plane destroyed. No fire. Four casualties taken to Entasopia clinic in a pickup
truck. All have survived. Pilot has a bad head injury. One passenger severe
back pain. The other two have limb injuries. Please send air ambulance to
Entasopia airstrip immediately.”</i><o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGRyjF9OnZfVcajWPS0okEvCt1o-jByz6ls8epIQU11U4e3n2r-NYyLbnF-sdzxx7YgbGO-4W2V3YhsYoOX0q3GAw37OpIxs_up5h1zjagRC2P9QYito8HnPBsOWpqsw7H_z9kYd0pUjw/s1600/100_0003.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGRyjF9OnZfVcajWPS0okEvCt1o-jByz6ls8epIQU11U4e3n2r-NYyLbnF-sdzxx7YgbGO-4W2V3YhsYoOX0q3GAw37OpIxs_up5h1zjagRC2P9QYito8HnPBsOWpqsw7H_z9kYd0pUjw/s200/100_0003.JPG" width="200" /></a>So that’s my Monday afternoon call. I had spent the morning
lazily looking through some case notes when this pulse-quickening call came
through. Air crashes of small aircraft are not all that uncommon out here. The
combination of poorly tended airstrips, poorly maintained aircraft and poorly
trained pilots means that AMREF FD attend at least one air-crash per year. Of
course, some good pilots in good planes can just be unlucky. Freak winds, dust
devils and large animals are just some of the hazards a pilot must face working
out here. But really, given the distances and quality of the roads, flying is
the only way to do it! Kenya has such a wonderful tradition of small aircraft
aviation and there are so many little airstrips that it just makes sense. If
you come to Nairobi, come down to Wilson Airport and visit the Aeroclub of East
Africa to get a glimpse into the crazy ex-colonial aviation history of the
place.<br />
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<tr><td class="tr-caption" style="text-align: center;">Locals came from all around to take a look</td></tr>
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Both Waso and Entasopia are pretty close to Nairobi, down in
the Rift Valley about 25 minutes in the slow but versatile Cessna caravan. For
their closeness they may as well be on another planet. It’s a stunning area but
rather poor, inhabited by mostly Masai pastoralists. It seems that 4 chaps who
worked for a tourist lodge further toward the hills, were in the process of
doing a resupply in the little company airplane. On take-off , at the level of the low tree tops, for some reason the plane was witnessed to veer off to the left side of the runway and bits of plane were all that was left. On our way in we were rushing to the patients, so didn't get a chance to inspect the crashsite. Mercifully the wreck had not burst into flames or it would have been
a more familiar story of four critical or, more likely, dead patients.<br />
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We loaded and were leaving Wilson airport within 30 minutes.
I was entirely expecting to do two runs back and forth for both pairs of
patients especially if any of them were critical. We were told to fly
into Entasopia airstrip and while Kisito and I were in the back preparing for
the worst case scenario, our pilot Phil started banking back and forth trying to find it. I’m
generally pretty good with motion sickness but after the third aggressive, tree
skimming, banking maneuver trying to find this airstrip, I was on the verge of
re-examining my lunch. Soon Phil found it and lined up like he was going to
take a crack at landing there. As we descended Kisito’s eyes widened and he
said “That’s not a runway; that’s a driveway!” Calling it a driveway was
generous. That strip had not been used for years. It was overgrown with bushes,
bumpy and completely unsuitable to land a plane. Phil already knew this of course.
He had no intention of attempting a landing, he just wanted a closer look. I
wished he had told me that before I considered adopting the brace position and
kissing my arse goodbye. As we flew very low along the old runway we terrified
three Masai tribesmen who jumped from the bushes and ran for their lives. Whoever
had told us there was a usable strip at Entasopia needed to do some more research! <o:p></o:p><br />
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<tr><td class="tr-caption" style="text-align: center;">For all those with a 4x4 in London - this is what they are for!</td></tr>
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We flew over to look at the nearby airstrip at Waso where the
crash had actually occurred and found it clear and usable so we landed there. We were
met by a friendly conservationist who is currently studying lions; working out
ways to stop them killing livestock and therefore keeping both man and lion
separate and safer. He offered to drive us to Entasopia with our kit and we
could also use the pick up there to bring the guys back. Phil offered to call
in a helicopter as well but we opted to check out the patients first.<br />
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The road
was as bad as I’m sure you can imagine and wound its way uncomfortably through
the stunning countryside. There was a giraffe standing by the side of the road,
and chewing contentedly, watched us go by with all the outward anxiety I would expect from
a Devonshire cow. We passed small herds
of livestock with their tenders until it took us into the village where they
were replaced by small herds of children instead. There was a big crowd
gathered at the clinic. I don’t care where you are, a plane crash is pretty big
news and the word had definitely got around. We were greeted by the AMREF
clinic nurse who had done a grand job on her own for <o:p></o:p><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmIRJPEISUpnsqFAMsSCmwCmrgznw4Ge-lVcXXFXT_k4WxE03gq95IlEpmvQ-6Szgc5l2D1fEhXSCcotJiM7W8pP2kIi4dL6ay_nmV2tzaB-utzffwMrwMPlRLKCePYXFq2WF3y6Zo3sQ/s1600/100_0822.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmIRJPEISUpnsqFAMsSCmwCmrgznw4Ge-lVcXXFXT_k4WxE03gq95IlEpmvQ-6Szgc5l2D1fEhXSCcotJiM7W8pP2kIi4dL6ay_nmV2tzaB-utzffwMrwMPlRLKCePYXFq2WF3y6Zo3sQ/s320/100_0822.JPG" width="320" /></a>the four men. The first,
the pilot, had suffered a head wound and had briefly blacked out after the
crash. But now he was orientated and able to tell us that he had had a brief period of unconsciousness but now just had a headache. He had a
slightly mashed left arm but otherwise was unscathed. Given the mechanism of
injury was such that (by most normal rules of the universe) he should be dead,
we were unable to rule out an injury to his cervical spine according to the
Nexus/Canadian C-spine protocols. So he had to go in a collar. He really didn't want to go in a collar. Protesting to us that his neck was fine. 'Look' he said, as he happily rolled his head around and up and down. Now this causes EMS providers a dilemma...<br />
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Now I really shouldn't go into my feelings about routine spinal
immobilisation (the collar, head blocks etc) on the basis of mechanism of trauma alone but, at the moment, that’s the
rule so that's what you do as a pre-hospital provider. Imagine you have been in a car crash and have got yourself out of the vehicle. You are walking around, even chatting on your mobile. Then the paramedics come along. Even if you have no pain, no tenderness on examination, no problem with
your nerves, have a full free range of neck movement and are completely
conscious, paramedics will still probably strap you down, force your neck into a collar
and you will stare at the sky/ceiling until someone has taken some pictures in hospital. I
am never surprised I have so many irritable, claustrophobic, uncomfortable
patients brought in to the Emergency Department by paramedics. Don't get me wrong, there's still a tiny tiny chance you could have an occult fracture but it really won't be unstable, the collar provides little benefit in those cases and can often cause harm (especially in the elderly, I've written a paper about that incidentally) <o:p></o:p><br />
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and there is no evidence to say that comfortable conscious patients can't be allowed to sit up and just keep their head still if they really want. Their head will not fall off, trust me. Anyway, I think
I may be drifting into a characteristic controversial Dr Edwards rant about Evidence Based
Medicine, pseudoaxioms and my issues with the medical behemoth that is Advanced
Trauma Life Support so I will stop. I would like you to enjoy reading my blog and I suspect I may have just lost you.</div>
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So, back to the story, Kisito managed to persuade him that, quite rightly, he had just been in a horrible plane crash, we couldn't 100% exclude neck injury and the road was really bumpy and his head probably would fall off, so he accepted the collar. The other stretcher case had some para-spinal tenderness
in the lumbar region but no suggestion of spinal injury or an unstable fracture. He was
otherwise unharmed. The other two men<o:p></o:p><br />
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between them, had a hand injury and some mild lower rib
pain but that was it. So we took two out on stretchers, utilising the local
tribesmen as extra manpower and the other two men simply walked out to the 4x4.<br />
<br />
On the long ride back to the plane, the pilot was able to explain to us what had happened. As the plane left the ground, the pilot’s seat lost its grip on its runners and suddenly slid backwards. All he was holding onto was the controls so they went back with him and the plane's nose pitched up. He lost control of the plane and a wing clipped a tree. The fuselage rolled along the side of the runway about three times coming to rest in some shrubs having thrown off its other wing, the tail and the engine. It was a sorry sight and difficult to imagine how anyone had survived. I don't use the word miracle but they were lucky beyond anything I've ever seen. Look at the picture below and you will see what I mean. So maybe the neck collar wasn't such a bad idea after all, (he says rather sheepishly.)<br />
I can tell you they are all making a full recovery with only minor fractures and two are already discharged.<br />
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Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-55386735360897127732013-06-14T04:03:00.000-07:002013-06-14T15:10:39.509-07:00Into the wilds of Tanzania<div dir="ltr" style="text-align: left;" trbidi="on">
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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.<br />
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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.<br />
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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' <br />
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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.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0dDlwOM4yC-VdK5yoqiN7yYPJcU6qX4ewcBiF-4Ur9K7QsD_3_AbK3RbetZ9fAmI_96ugolUYPlxL_JMtyfGelnC-jYllyrNRXjomjx4cKWE7xu0hopBqyt95yTkVGLM259kFse9qtBI/s1600/Migration+tracks+out+of+the+Serengeti.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0dDlwOM4yC-VdK5yoqiN7yYPJcU6qX4ewcBiF-4Ur9K7QsD_3_AbK3RbetZ9fAmI_96ugolUYPlxL_JMtyfGelnC-jYllyrNRXjomjx4cKWE7xu0hopBqyt95yTkVGLM259kFse9qtBI/s320/Migration+tracks+out+of+the+Serengeti.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Migration trails out of the Serengeti</td></tr>
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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.<br />
<br />
\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.<br />
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<tr><td class="tr-caption" style="text-align: center;">That's a hippo, honest.</td></tr>
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<br />
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.<br />
<br />
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.<br />
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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).<br />
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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.</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-58478821932298719482013-06-09T03:23:00.000-07:002013-06-09T10:04:02.351-07:00Critical in the Congo<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFjDIyr_S9L_pH9Z6NsFWMSLPsAz4p7FtX2aN6eSOGI7CKlg8icu2zE6uaNfidRBSd9_cwYZWbGpBHsSMvkQCUg3gzzb3gQdwmeaPD7h0XGzzMn-MVxBkmDUdsBqZzi-IESlvozdKz-Y/s1600/100_0621.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFjDIyr_S9L_pH9Z6NsFWMSLPsAz4p7FtX2aN6eSOGI7CKlg8icu2zE6uaNfidRBSd9_cwYZWbGpBHsSMvkQCUg3gzzb3gQdwmeaPD7h0XGzzMn-MVxBkmDUdsBqZzi-IESlvozdKz-Y/s400/100_0621.JPG" width="400" /></a></div>
I’ve had about 36 hours of extremes mostly involving the
Congo. I’m amazed how I seem to end up doing evacuations from one country for a
few days then don’t go there again for ages. For example I’ve not been back to
Somalia for two weeks. Well the latest theme country has been another hotbed of
discontent and political exasperation, the Democratic Republic of the Congo. <o:p></o:p></div>
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This series of patients had a theme of miscommunication.
Assumption really is the mother of all f*£k ups, and hence why we prepare for
the worst case scenario. Even with that modus operandi, our time in Congo took
the biscuit for surprises. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD2n7XkCigwMXD8H71HgSElqbvpgvmWZUFgqpH7R1NRo_I7JV-7TnppzeUFwf1m5R0ujXDqlM8Q0mJQGaEqeIziI62R-6tlh1E7uzJ_YPhYhpF0CWlEj-1fij6-lSNgpYsgjd4omaSly0/s1600/100_0626.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD2n7XkCigwMXD8H71HgSElqbvpgvmWZUFgqpH7R1NRo_I7JV-7TnppzeUFwf1m5R0ujXDqlM8Q0mJQGaEqeIziI62R-6tlh1E7uzJ_YPhYhpF0CWlEj-1fij6-lSNgpYsgjd4omaSly0/s320/100_0626.JPG" width="320" /></a>My first flight at 0700 took me into the airstrip of Goma in
the Congo, on the Rwandan border. It's yet another interesting African town with links to the Rwandan genocide and still rather bubbly with political violence. Only last year it was seized by rebel forces and hence why we do not retrieve patients from the hospital, no matter their condition. We were going to retrieve a man who had been involved in a RTA on a motorbike and
had was supposed to have sustained nasty facial fractures and suspected other
injuries. With that information we were expecting a patient with multitrauma
and a swollen difficult airway so we prepared for a critical patient with all
the toppings. <o:p></o:p></div>
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After about an hour of wrangling with self-important airport
officials in French, we were approached by another two men. I asked if the
patient was on his way, in my best pigeon French to be told by one of the men,
with a hearty handshake and a smile, that he was the patient. It seemed he
sustained ‘suspected’ facial fractures after bumping his face into his friend’s
motorcycle helmet when they fell off at low speed a week ago. He had even
driven himself from home! So not exactly requiring of a critical care transfer. Oh well
I had some work to do on my laptop anyway.<o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;">Nyiragongo simmers in the background</td></tr>
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The most striking thing about Goma is the Nyiragongo volcano and cleared piles of volcanic rock alongside the airstrip. I am told
that about 10 years ago the volcano erupted spewing lava straight through the
surrounding town destroying about half of it and right along the runway down to the Lake Kivu. It killed many people through asphyxiation and
rendered the airport completely incapacitated. It took a long time to clear enough of the rubble to get the airport
operating again but it still only functions with about 2/3rds of its original length runway. It also has a reputation of being phenomenally dangerous with
a way-over-average number of aircrashes with a plane overshooting the runway in 2008 smashing through a market and another nasty one in March of this year!<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEighSLusqIuvwWh0lj8EwUY7zEUq2wqvlsKlYFOHFZxclTci5725vIH22q6arOMr-B9aWOXTnGct23eQCiGvhR_dUxcfhbukfTjhx3VpvMpyOWfWIUnO_teUxLSl97d-fZFD_xC2HXUTzc/s1600/100_0639.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEighSLusqIuvwWh0lj8EwUY7zEUq2wqvlsKlYFOHFZxclTci5725vIH22q6arOMr-B9aWOXTnGct23eQCiGvhR_dUxcfhbukfTjhx3VpvMpyOWfWIUnO_teUxLSl97d-fZFD_xC2HXUTzc/s400/100_0639.JPG" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrKhkJw3IKPGxvuQNA162b8TlwSvYXMb8mbOLzayHQf2s_cIl6pDb1kgVtPd3brNVoi_SGVPCnwn6WemGdnqekwUfPDV6jh73aHWZedLmKsaIPcbgixQD0wQDrZ267wTym5-yZprwY3HE/s1600/100_0645.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrKhkJw3IKPGxvuQNA162b8TlwSvYXMb8mbOLzayHQf2s_cIl6pDb1kgVtPd3brNVoi_SGVPCnwn6WemGdnqekwUfPDV6jh73aHWZedLmKsaIPcbgixQD0wQDrZ267wTym5-yZprwY3HE/s320/100_0645.JPG" width="320" /></a>After this unexciting medical case we were called out to a
little dirt airstrip out in the sticks of Tanzania to pick up a member of
Raleigh International. I am currently trying to persuade my little cousin to do
something useful with her gap year and Raleigh are one of the organisations I’m
looking into for her. It was interesting
to hear more about what they are up to from the horse’s mouth. I particularly
like their ability to focus on the personal development of young people from
all sorts of backgrounds in the UK and combine that with sustainable projects
for these rural populations. Crucially
they have a good reputation for safety with excellent logistics and medical
support. So the information we had from these guys about the casualty was
exemplary. The casevac went extremely smoothly with a beautiful low level
flight across the plains and hills in the Cessna Caravan. <o:p></o:p><br />
<br /></div>
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Just when we thought the medevacs had wound up for the day
we received word of an urgent case needing transport from Kinshasa in the DRC going
to Johannesburg. ‘Malaria and bronchopneumonia. Condition deteriorating.’ was
all the information we had prior to take off. I tried to get more but nothing
was forthcoming. Flying all night across the Congo in a small aircraft is not
something you want to do unless it is absolutely necessary. One of the reasons
for this is that this area is known for some of the most aggressive and tallest
cumulonimbus storm clouds on the planet some climbing up to 60,000 ft. Radar is
a great help but the pilots really want to see what is going on around them.
These clouds can tear planes apart. Added to which, there are few alternates on
that route that you can safely land a jet at night.<o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiXB_TZqbX1qilb8vIwd6KDVc5DVA1tJMkQvFUri3lN39VD9j_bfG3IuXF-QYGm6E4DAU7lcEbwNhoY-rWzgtDm3hVISR7kEbKPnGHiztoU_SHOyF1dPS53i5Gs_Tk9s5dKRIYbmXx62Q/s1600/100_0619.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiXB_TZqbX1qilb8vIwd6KDVc5DVA1tJMkQvFUri3lN39VD9j_bfG3IuXF-QYGm6E4DAU7lcEbwNhoY-rWzgtDm3hVISR7kEbKPnGHiztoU_SHOyF1dPS53i5Gs_Tk9s5dKRIYbmXx62Q/s400/100_0619.JPG" width="288" /></a>We set off about 2230 and flew towards the jungles of the
Congo and the unknown. We requested the patient be brought to the airport in
time for us to quickly land, fuel, package up the patient and head south for the
4 hour trip to SA. Upon arrival, however, we were told that the ambulance crew
would not leave the hospital until we had touched down. This does happen from
time to time and it is rather frustrating. We are left waiting airside at the
airport twiddling our thumbs when we could be sorting and settling the patient.
For some reason this time it made me uneasy. Why would they want an absolute
guarantee that we were here and waiting before setting off? I asked our liaison
about the state of the patient and he assured us she was stable but requiring
oxygen pointing to his nose implying nasal prongs. So we relaxed and I sat back
watching the aerobatics above us as bats pursued bugs around the floodlights. <o:p></o:p><br />
<br /></div>
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Soon the ambulance arrived and sped towards the plane. That
was also odd, normally it’s a rather sedate affair. The ambulance backed
towards us and the back doors swung open to reveal a rather big surprise. Three
medical staff removed themselves from the back and were dressed head to foot in
masks and infectious disease protective equipment. Maurice the flight nurse and
I looked at each other. Then back into the ambulance where we could the
familiar waveforms of an Oxylog 3000 ventilator. This woman needed more than a
bit of oxygen! She was a critical care patient with maximal oxygen requirements
and circulatory drug support. My eyes widened even further as her medical
discharge note was handed to me. In French of course. Now my French was good
enough to translate the gist of the case. It looked like she had been given a
diagnosis of malaria with a high parasite load and then in hospital became
increasingly short of breath. A CT scan of her chest showed that some process
was obliterating her lungs and she was intubated. Despite maximal ventilator
pressure settings, to the point of risking popping her lungs, they were unable
to adequately oxygenate her. Hence why they were transferring her to South
Africa intensive care to see if things like Nitrous Oxide might help her. NO is
a lighter gas reducing the work of breathing but last I read on it, it has very
little evidence of benefit in such cases. Nevertheless how they thought a long
duration, high-risk transfer in the middle of the night was in her best
interests is beyond me but that’s what the doctors and family wanted. <o:p></o:p><br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimu6T_2y56vMRyKe5vggCyyI0y3Y7QcVXNlRSbMHlasfLu8I3zNqHnEmUTFYGpqo21TR8TS-sdToQIDdJKLWDl7f3XHMDdGqHzVnd4_1RBAFWtLcOxA9X6r9w-VtMyIGfK-46mzrx0Pjg/s1600/100_0059.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimu6T_2y56vMRyKe5vggCyyI0y3Y7QcVXNlRSbMHlasfLu8I3zNqHnEmUTFYGpqo21TR8TS-sdToQIDdJKLWDl7f3XHMDdGqHzVnd4_1RBAFWtLcOxA9X6r9w-VtMyIGfK-46mzrx0Pjg/s320/100_0059.JPG" width="244" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">To go or not to go?</td></tr>
</tbody></table>
<br /></div>
<div class="MsoNormal">
At that point one of pilots came around from checking the
fueling and said “What the f*£k are they wearing those masks for? There is no
way that patient is getting in my plane with some freaky disease that we are
all gonna catch. No way!” I asked the medical team to explain the barrier
protection and failed to get a decent explanation. It seemed that this was just
their standard practice for any patient who was short of breath. There was
nothing they were specifically worried about but for a time I felt like I was
in the introductory scenes of some Hollywood apocalyptic outbreak movie.
Conversations between the concerned pilot and one of the medical team became
more heated (despite the fact neither could understand the other) as I pawed
through the medical notes and the CT scan to work out what the hell was going
on. I couldn’t believe I was standing there in the middle of the Congo in the
dark surrounded by bats, bugs, masked medics, irate pilots and concerned
relatives trying to make this decision about a woman who could take no part in
it.<o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
The case seemed like a pneumonia with probable ARDS (Acute
Respiratory Distress Syndrome) complicating malaria with profound anaemia. I
explained to our team that if she was breathing for herself, coughing away on
the plane with ‘some freaky disease’ then yes we would be at risk. But she was
already on a ventilator with a filter and a closed circuit so we were about as
safe as we could get. In fact if I was significantly concerned about
communicable disease in a conscious breathless patient, ventilating them for
the flight might be reasonable to protect myself and the crew from whatever
they had caught.<o:p></o:p></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqPosHR-3aNPIbyTxgmb6QAxoGRju75-GtzsJ7lwPd7Bwt1lg2MLEbqdVbfH4llleF2zjBmYUzukKpUcaio7ujSuXn8ziIe6dZ1C71HSNftJaWrncoK3p2o_pvRLJTNyfbJ9e8PlzZHj8/s1600/kinshasa+evac.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqPosHR-3aNPIbyTxgmb6QAxoGRju75-GtzsJ7lwPd7Bwt1lg2MLEbqdVbfH4llleF2zjBmYUzukKpUcaio7ujSuXn8ziIe6dZ1C71HSNftJaWrncoK3p2o_pvRLJTNyfbJ9e8PlzZHj8/s320/kinshasa+evac.JPG" width="320" /></a>While all this was going on Maurice had been beavering about
setting up our ventilator, pumps, drugs and stretcher. Having an experienced
unflappable ICU flight nurse like Maurice was absolutely vital and there’s no
way I could have done it without him. In addition the medics there had made
some weird decisions about the drugs they were using and there was a virtual
Christmas tree of infusion pumps going into this poor woman. It was all pretty
complex in English, let alone trying to work it out in French!<br />
<o:p></o:p><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
</div>
<div class="MsoNormal">
We managed eventually to sort it out and started lifting her
and all her bits and pieces into the plane. Of course then as we were about to
lift her, a massive ugly flying bug landed on the patient’s chest. Three of my
assistants jumped and nearly dropped her! <o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
Every time you transfer a ventilated patient there is a risk
of displacing the tube in their throat. For her that would have probably have
been fatal. This ladies oxygenation was so critical that, when we had to detach
her from the ventilator for less than 20 seconds to change a cylinder for
example, her saturations plummeted down to the mid 60s. To explain how bad this
is, if you give a normal adult pure oxygen to breathe and then stop them
breathing, a drop in saturations won’t happen for several minutes. Pop a probe
on your finger and try to get your oxygen saturations down to 60% by holding
your breath. I’m sure it will take longer than you can tolerate. So if her tube
had come out from an accidental tug I doubt there wouldn’t have been enough
time to ventilate her via a mask effectively or intubate her again before her
oxygenation dropped to the point she would have had a cardiac arrest. <o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9jced6nxtlfbhQQKevOzWKiiXhRUqosulsJTTzXHLyjvngmvU0Rqd3YqePwPoVFqwB7IjKCOYKoySsGG_0huMCUyC5wxKGtZM15DcWqaRgrvMaVT5pFo5OUwsSQhirsJk3tmNewMF4io/s1600/sunrise+over+angola.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9jced6nxtlfbhQQKevOzWKiiXhRUqosulsJTTzXHLyjvngmvU0Rqd3YqePwPoVFqwB7IjKCOYKoySsGG_0huMCUyC5wxKGtZM15DcWqaRgrvMaVT5pFo5OUwsSQhirsJk3tmNewMF4io/s400/sunrise+over+angola.JPG" width="296" /></a>After about half an hour of fiddling in the plane we had
sorted the spaghetti of wires and were ready to get the hell out of there. On
the flight she was a classic ‘spinning plate’ critical care patient. No sooner
had you sorted one thing out, something else started going wrong; the kind of
ICU patient you spend all night tinkering to try to stop their spiral around
the plughole. I’d like to claim that normally I’m pretty good at being
proactive rather than reactive but that night I felt like I was chasing my
tail. <o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
At one point I took the opportunity to look out the window
as the sun started to rise. In the midst of the <o:p></o:p><br />
stress and exhaustion (we were
close to 24 hours solid flying by that point) it was one of the most beautiful scenes
I’ve ever seen. In amongst a perfect panorama of stars, the moon hung
directly above the spreading orange and blue glow of the breaking dawn with a
bright thin crescent marking its lower rim. (My camera was dead but I think someone
managed to get a shot with their iPhone.)</div>
<br />
<div class="MsoNormal">
After what seemed like an age we arrived in South Africa and
managed to get the patient to their resuscitation bay in one piece. We handed
over as much as we knew about the case, advising them that a French translator
might not be a bad idea. We stepped out of the hospital into the sunshine
finally free after 30 hours of solid flights. We got to our hotel, ate our fill
and slept like the dead.<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-44734188620789385512013-06-04T12:26:00.001-07:002013-06-04T12:26:56.553-07:00 Peter and the Lost Boys - Seriously Sick in South Sudan - Part 2<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="MsoNormal">
When I returned from my exciting trip to Yei my housemate
Peter excitedly told me that his family were from Yei district. It seems a good
point to tell you a bit of Peter’s story; a remarkable man who I have been
lucky enough to live alongside for the last month. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I may have mentioned that I have been living with three chaps
who have been attending a residential course at the main AMREF training centre.
They all work for or with NGOs concerned with African health or development.
Abdi, I have mentioned already, is from Somaliland, Kebba, who I will come to
later, is from The Gambia and then there is Peter from South Sudan. I had the
privilege of sitting with these guys for dinner most evenings and I learnt so
much about African politics, life, the universe and everything. <o:p></o:p></div>
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5s4ka-SiqtzaQIusxngi23s3C3dlx8F5kHIUpMPh45yHMtDBlvjigJC7Rn0_-XXDB9GS4mvsbF510aAcuxxDKPSerHY2CLektaxTWMQ111nX2jSh1KKLccTDFiyUaUpVbaBSJE9eORfk/s1600/100_0401.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5s4ka-SiqtzaQIusxngi23s3C3dlx8F5kHIUpMPh45yHMtDBlvjigJC7Rn0_-XXDB9GS4mvsbF510aAcuxxDKPSerHY2CLektaxTWMQ111nX2jSh1KKLccTDFiyUaUpVbaBSJE9eORfk/s320/100_0401.JPG" width="320" /></a></div>
<br /></div>
<div class="MsoNormal">
One of the things I notice among a lot of Africans I meet is
the ability to tell a story. Holding a small audience is a respected skill it
seems and one I feel our multimedia-based society may be losing. I think it
should be goal in life to be able to sit around a table, hold a group’s focus and
massively exaggerate stories like our grandfathers. Peter would sit at the
table, two fingers raised waggling back and forth as he made his point or his
punchline. Often he would get the giggles as he was on the verge of finishing
his story. Which inevitably set us off laughing as well. I think we actually
heard only about 50% of the end of his stories. He would suddenly come out with
some wonderful comments, two of my favourites being: - <o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
“Explain this to me about you mzungus (white guys). You all
only have two children. What exactly is your problem?”<o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
“This guy came back to the village and had been studying in
Denmark. He had a PhD! We were very impressed until he told us it was in
bee-keeping! We couldn’t stop laughing. Any fool with a box can keep bees.” <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkFJKkm7HWZukOGnS7IMqj7-eqN6Q4b1VuSYP1rBRwzRZ874tH2WsWH4e16BqBJaAl21hDFlAvwOhLbgjtDaYF-JaeKpDGYWWiPgmcjm2wCgM8EEUHpyDE5VlUVzoAqg2pbAgTXIhiQaQ/s1600/100_0470.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkFJKkm7HWZukOGnS7IMqj7-eqN6Q4b1VuSYP1rBRwzRZ874tH2WsWH4e16BqBJaAl21hDFlAvwOhLbgjtDaYF-JaeKpDGYWWiPgmcjm2wCgM8EEUHpyDE5VlUVzoAqg2pbAgTXIhiQaQ/s320/100_0470.JPG" width="320" /></a>Peter is an electrical engineer by trade but has been doing
the course with AMREF on monitoring and evaluation of health programs. One day
he insisted on escorting me to the local barbers for a haircut. On the way he
told me the story of his life in exile around the Sudanese civil war. It’s a
story of one man’s struggle to get educated in the face of tremendous odds. As
a boy he understood education and training was the only way out of the
impoverished situation of his immediate family. I was not aware until then that
I was in the presence of one of South Sudan’s ‘Lost Boys’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAgpZyKrUJlvkShcHqhB-ZzWv3HElxlIKMgfCQ6U6lo9C5B480FDKhpWTBPpyJ20uwoxCt_YGgHCvC3rM3h4nzBDX1MX-bnvgEO7xCWdVaTr-FquZpZde6DS6Fx8CF3H15zHITKJJTa24/s1600/peter's+journey.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAgpZyKrUJlvkShcHqhB-ZzWv3HElxlIKMgfCQ6U6lo9C5B480FDKhpWTBPpyJ20uwoxCt_YGgHCvC3rM3h4nzBDX1MX-bnvgEO7xCWdVaTr-FquZpZde6DS6Fx8CF3H15zHITKJJTa24/s400/peter's+journey.jpg" width="315" /></a>He was born in Morobo, in-between Yei and the Ugandan
border. He was one of ten children, six brothers and four sisters born to a
‘peasant farmer’ as he put it. Unfortunately two of his sisters and his father
died when he was young, either in traffic trauma or due to ‘a sickness’. He was
certainly one of the smartest of the siblings and so was sent to school in
Kanyara. Like many in Africa this involved long walks in barefoot everyday. In
his early-teens the rebel forces took the town and he was unable to get to
school. No one was getting in or out. So he and his friend Isac (he hasn’t seen
Isac in many years. Last he heard he was in Libya and fears he is probably dead)
decided to make their way to Juba the capital and try to finish their schooling
there. Peter had sold his only cow to make this journey and pay his way seeking
an education. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The situation in Juba was not much better. A generation of
young adults were being deprived of a good start by instability and insecurity.
Isac had family in the town of Atbara up in the north of between Kartoum and
the Egyptian border. The situation was said to be better there. So they managed
to pay their way onto a cargo flight to Khartoum. They travelled to Atbara on
top of a train but Peter was unable to establish himself there for reasons I
can’t remember so he left his friend and he made his way back to Khartoum to try his
luck there. By this point the war with the south was intensifying and they
introduced conscription in Khartoum. Young men and even children were being
rounded up all over town to fight the rebels. Sympathising with the rebels
cause and having no intention of fighting his own countrymen Peter fled
Khartoum.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg55fo_zFbRHkPcPOC7GcwWy8pE_rLMCsH8Sm3943DFbY0Bfccp4KMRcrgALxalIHULEeIJ5bkBdTLlbbBJ3u1foxJNiEq2MTsneIv8RB5I5uz1bL7bKFZn3d4812udIzsqPKBAgmcadws/s1600/100_0469.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg55fo_zFbRHkPcPOC7GcwWy8pE_rLMCsH8Sm3943DFbY0Bfccp4KMRcrgALxalIHULEeIJ5bkBdTLlbbBJ3u1foxJNiEq2MTsneIv8RB5I5uz1bL7bKFZn3d4812udIzsqPKBAgmcadws/s320/100_0469.JPG" width="320" /></a></div>
This was the period many in South Sudan went into ‘exile’ as
he called it. During this civil war it is estimated 2.5 million were killed and
further millions displaced. His family had fled south from the conflict into neighbouring
Uganda. The clan he is from ‘the Kakwa’ are also very common in north Uganda so
they found themselves among friends. Peter knew his family would head south with their Kakwa brethren so knew where to aim for. Peter fled across Sudan from
Khartoum into the Congo. He traveled with other South Sudanese boys and mostly at
night. Colloquially these displaced fleeing young boys and men were known as
the ‘Lost Boys of Sudan’ by international aid workers. It most often refered to
the young boys who escaped the slaughter in the villages because they were out
with the cattle. Or frequently they had also been taken by forces on either side
as child soldiers (the militias telling the parents they were getting safe escort to school) and some managed to escape. Thousands scattered into refugee camps in Kenya and Ethiopia
in particular. As we sat there waiting for my turn to get my hair cut, he told me me 'It was a scary time.'</div>
<div class="MsoNormal">
<br /></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo7X9L7KmwsvYf1osGe407sy8kRgw_-JRx5VfMoEBjU7-Sus8w_HIYR-epSSqUDJoTQz2bz0YPILhlyrPnggqt2dS1T8pqhTW47RYIG4d3njC5pdGv8CG3Yx1aFyIQ7buKAEj3k67LQp8/s1600/100_0553.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo7X9L7KmwsvYf1osGe407sy8kRgw_-JRx5VfMoEBjU7-Sus8w_HIYR-epSSqUDJoTQz2bz0YPILhlyrPnggqt2dS1T8pqhTW47RYIG4d3njC5pdGv8CG3Yx1aFyIQ7buKAEj3k67LQp8/s320/100_0553.JPG" width="246" /></a></div>
He managed to make his way
along the border to Uganda and with the assistance of UNICEF managed to <o:p></o:p><br />
find
his displaced family. They remain in northern Uganda to this day and Peter
managed to get his education. He qualified in electrical engineering is now
married with six children. His eldest daughter is doing extremely well at
school and wishes one day to become a doctor so he says.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s a rather humbling story and yet another reminder of how
much I should be thankful for in my own upbringing and education. I wonder what
I was doing as a teenager while Peter and the other Lost Boys were jumping
borders in the dark and dodging the torches of Sudanese soldiers? To look at
him now you would never know he has been through so much to get where he is. <o:p></o:p></div>
<br />
<div class="MsoNormal">
<br /></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com2tag:blogger.com,1999:blog-7492413488880336559.post-43548738312155042152013-06-04T06:59:00.000-07:002013-06-04T07:01:51.502-07:00Seriously sick in South Sudan - Part 1<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhISHWloi_29DN0hAINn2V5_LC8Rt7CVOpBWjnU2_WNw55Vs3zXjerzqCAmw7lDq58n2PUUmX8pRbEtAMJKX1mpmmcm2mNzpd9LH6x5kYfDebbYcE4UfYeCmO0LI4lKYr2IDEWwcBFON4M/s1600/100_0127.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhISHWloi_29DN0hAINn2V5_LC8Rt7CVOpBWjnU2_WNw55Vs3zXjerzqCAmw7lDq58n2PUUmX8pRbEtAMJKX1mpmmcm2mNzpd9LH6x5kYfDebbYcE4UfYeCmO0LI4lKYr2IDEWwcBFON4M/s320/100_0127.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Juba from above</td></tr>
</tbody></table>
In the last few weeks I have ended up in South Sudan on a
fairly regular basis. Most will be aware of the terrible civil war and of its recent divorce from Sudan in 2011. Obviously its partner in the
north has been the news considerably more frequently recently in regard to the
humanitarian crisis in Dafur.
Unsurprisingly for this region of Africa, bordering the Congo and Somalia,
South Sudan is not an exemplar of peace and equality since its hard fought
separation but it is working on it so I'm told. Both sides in that conflict were responsible for horrific slaughter and human rights violations during the civil war and then there is always the continuing tension with the north about the contested
region of Abyei slap bang in the middle of the two.<br />
<div class="MsoNormal">
<o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu8CKb04i0Jqn_QlM_tBCPz63P9ghd-8-7AMZB2Z2z8r0Owz6vJX7ZxJ10ntKVdZMOmwmfUVZfwkqUns-oo2uy8xPV8ttkHAWMhIGfFl7kL3_VFyY_0IYrBnT5GyhIIlgVjV6vUoc_GBY/s1600/100_0129.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu8CKb04i0Jqn_QlM_tBCPz63P9ghd-8-7AMZB2Z2z8r0Owz6vJX7ZxJ10ntKVdZMOmwmfUVZfwkqUns-oo2uy8xPV8ttkHAWMhIGfFl7kL3_VFyY_0IYrBnT5GyhIIlgVjV6vUoc_GBY/s320/100_0129.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Juba from the ground</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The two nations maintain their prickly symbiotic
relationship with a flow of oil and other mineral resources. South Sudan is
rich with resources and no good way to export them, whereas Sudan is relatively
poor in mineral wealth but has access to a massive port and maintains the
pipelines from the oilfields in the south. I do wonder what will happen if
Kenya makes good on President Kenyatta’s recent pledge to build pipelines
across to South Sudan from their northern coastline. A bit of competition will
be interesting (possibly about as interesting as kicking a hornets nest) but I
would be surprised if it actually happens.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
Anyone who has been to countries in this area will be
starkly aware that, no matter their huge mineral wealth, very little of this
trickles its way to the ordinary man on the street (if there is anything
resembling a street). That applies particularly to healthcare. The only
reasonably functioning healthcare facilities I’ve visited have been private
clinics in the capital Juba (which seem to mostly serve foreign technical
staff, businessmen and diplomats) and missionary hospitals out in the sticks
like the town of Yei.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I’ve picked up some extremely sick patients from Juba,
mostly European nationals. The medical staff
there work extremely hard and do a great job despite the limitations. When the stars align
correctly we are probably minimum 4 hours from call-out to bedside in Juba and
considerably more to the smaller airstrips. There is very little critical care
equipment and expertise, so getting seriously ill in South Sudan has a pretty
high mortality. Despite our vaccinations, prophylactic medication, alcohol
cleaning gels and ‘health and safety’ culture, we foreign nationals seem to get
ill or injured quite a lot in these places. One thing I have noticed is we
often do some pretty stupid things. Perhaps this is because we lapse into a
state of false security and stop doing things because they are not routine
practice in the cultures we find ourselves in; like wearing seatbelts or
helmets, not drinking and driving, taking malaria prophylaxis, practicing safe
sex and so on. Or decide that South Sudan is the perfect place to learn how to
ride a motorbike. Enough said.<o:p></o:p></div>
<div class="MsoNormal">
<o:p> <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEPg3w-rQv7bwgar06apKTvrybbpiLMXmClsm78PA2YwS3oj0Vh5J5pmLbBM3vmKNmuRHRop5B2CoI3ZWwslekKyBCA8RCOdT1566nxvFCpb5UbkLH9yC1DHzZ6zMSWkFMzgdTGjScUvs/s1600/Yei+%252813%2529.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEPg3w-rQv7bwgar06apKTvrybbpiLMXmClsm78PA2YwS3oj0Vh5J5pmLbBM3vmKNmuRHRop5B2CoI3ZWwslekKyBCA8RCOdT1566nxvFCpb5UbkLH9yC1DHzZ6zMSWkFMzgdTGjScUvs/s320/Yei+%252813%2529.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Yei airstrip</td></tr>
</tbody></table>
</o:p></div>
<div class="MsoNormal">
In the rural town of Yei I was called to evacuate a poor
young lady who was being cared for by the inspirational doctors and nurses
working at the Harvesters ‘Bet Emin’ maternal and paediatric hospital. It is a
missionary hospital and is doing some remarkable work for the local population.
This lady was not pregnant but had been cared for there as she had links to the
charity. She had developed the relatively rare condition known as Guillain
Barre’s syndrome. It is a classically post infective autoimmune, demyelinating,
ascending polyneuropathy. It’s classically associated with outbreaks of
Campylobacter Jejuni gastroenteritis or certain viral respiratory infections
which are nasty enough in their own right, but then, just when you thought you
were getting better, you start losing feeling and strength in your legs. Then
your arms become effected and it starts to creep towards your core, potentially
getting so far as to effect the nerves operating your heart rate, your lungs
and your ability to control your own swallow. It shouldn’t take a medical
degree to work out that, unless you do something for someone whose own immune
system has rendered them paralysed, unable to breathe or swallow, they will not
be long for this world. Luckily in the vast majority of cases, they don’t get
to that stage or if they do, they recover eventually as the little supporting cells
that surround their nerves start to grow back. I’ve seen three cases requiring
intensive care and ventilator support back in the UK and from what I understood
of the medical report, this lady was going to be my forth. But as often happens
with aeromedical cases, the case had considerations far more complex than the
underlying pathological process.</div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhou8rwuwlhZhZcUmxu32BePN1W4EuFHv6pAQZezG8v6IwXFw1iqzQmF4x1pothHuMB_NUHI_pO4vl4BkuB78DmYPxyMgUUF9fHJwg2v0xXJTJMh1Anlt2TxewNkiTRrE9Zq09-Y5qdtZw/s1600/100_0385.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhou8rwuwlhZhZcUmxu32BePN1W4EuFHv6pAQZezG8v6IwXFw1iqzQmF4x1pothHuMB_NUHI_pO4vl4BkuB78DmYPxyMgUUF9fHJwg2v0xXJTJMh1Anlt2TxewNkiTRrE9Zq09-Y5qdtZw/s400/100_0385.JPG" width="400" /></a><o:p> </o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_seN8SrKVDYgZgNDbo6pJStx_xysqbk2ehaCfFmlmKXaa6Ty97yOYpWe-LjR26AcJ2eMZeoW8js12HYDyju8OQ0atQLZJFfNoxo5kh4CBM7Hh9l4YNWZNzup5f3lMZ5LKonX4aX4uqEc/s1600/Yei+%25281%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_seN8SrKVDYgZgNDbo6pJStx_xysqbk2ehaCfFmlmKXaa6Ty97yOYpWe-LjR26AcJ2eMZeoW8js12HYDyju8OQ0atQLZJFfNoxo5kh4CBM7Hh9l4YNWZNzup5f3lMZ5LKonX4aX4uqEc/s320/Yei+%25281%2529.JPG" width="320" /></a></div>
<br />
<div class="MsoNormal">
The funding for her treatment was coming from a charity and
I did not know whether they were at all clued up about the potential length of
her ICU stay. If these patients need ICU, it’s often for a long time. Like our
long stay patients with critical illness polyneuropathy, they can sit on the
unit for weeks, even months. Patients and their families luckily do not need to
consider that in the NHS but they do here. It is not an infrequent occurrence
for a patient to ‘stepped down’ prematurely from the ICU to the ward because
the policy will no longer cover or family can no longer pay the bills.<o:p></o:p></div>
<div class="MsoNormal">
<o:p> <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRGoFV3T28v0Uxgyl7n32ces8uYtPYa2gAHUD3riAJb4J1EKvw8Xi88LbMf5SPScNd-R5j62BpbHLFwk0IS4GOZCKwmdSUt3rpuqHQPLBQlgEF7ZHoMdwnxhyaDx7sRPpGbzmINITlDNg/s1600/Yei+%25282%2529.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRGoFV3T28v0Uxgyl7n32ces8uYtPYa2gAHUD3riAJb4J1EKvw8Xi88LbMf5SPScNd-R5j62BpbHLFwk0IS4GOZCKwmdSUt3rpuqHQPLBQlgEF7ZHoMdwnxhyaDx7sRPpGbzmINITlDNg/s320/Yei+%25282%2529.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Downtown Yei</td></tr>
</tbody></table>
</o:p></div>
<div class="MsoNormal">
Also this lady was Sudanese with poor English and no
passport. We had got clearance for her but her husband’s clearance was more
problematic. Our window of opportunity was closing fast and we could not
reliably establish whether these things had been taken care of before we
starting loading the plane. The worst case future scenario we could consider
was of a poor lady paralysed on a ventilator without her spouse, unable to
understand those around her and eventually passing away in a foreign country as
her funding ran out.<o:p></o:p></div>
<div class="MsoNormal">
<o:p> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3lnVhZpAKmRINggI7WZhHBjOB3tY_GFHQM5FOIfo1yS0hIfKhLrydIRXicx1m_H6ojmTLu3XXKSHxu5sK2TEp8ps3vKbJdDXfRexmyQlTg9MFfiLr1J5r2MfaCk0swGm9SvmQDd-trw0/s1600/Yei+%25283%2529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3lnVhZpAKmRINggI7WZhHBjOB3tY_GFHQM5FOIfo1yS0hIfKhLrydIRXicx1m_H6ojmTLu3XXKSHxu5sK2TEp8ps3vKbJdDXfRexmyQlTg9MFfiLr1J5r2MfaCk0swGm9SvmQDd-trw0/s320/Yei+%25283%2529.JPG" width="253" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Where are we going?</td></tr>
</tbody></table>
</o:p></div>
<div class="MsoNormal">
Fortunately we got word as we touched down on the dirt
airstrip that the charity was committed to the care no matter the length and
her husband would be joining her. This was so far the most rural setting I had
visited since being with AMREF and it was remarkable. The pictures do the
experience more justice than I can. But at that time, with every pothole and
twist of the track, I was more concerned about how I was going to safely get
this lady on a ventilator all the way from the mission hospital to the plane.
Fortunately she had improved and had enough strength and vital capacity to cope
with the trip on only oxygen. Dr Edwards dodges another bullet.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiy7WBZpNrGjXWf1qPySCx2nVpGPT4pKqxESSuTOq_yK8uHcOD8HSY8SURvOK4EapLSIBSAScyCsCxF2XDOX5XHdN8HQrsASkdgrW0ogUCZtL2zdPxA4EBJeAV0hcDjDUCVEOvns80kms/s1600/Yei+%25284%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiy7WBZpNrGjXWf1qPySCx2nVpGPT4pKqxESSuTOq_yK8uHcOD8HSY8SURvOK4EapLSIBSAScyCsCxF2XDOX5XHdN8HQrsASkdgrW0ogUCZtL2zdPxA4EBJeAV0hcDjDUCVEOvns80kms/s320/Yei+%25284%2529.JPG" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
While we assessed and prepared the patient for transport,
the doctors at the hospital gave me a quick tour and even tried to pick my
brain on a few cases. Given these were either post-partum or paediatric cases
(not exactly my forte) I’m afraid they got slim pickings but I suppose it’s
always nice to discuss a case with a colleague. The current medical director Dr
Graham Poole originally trained in Tazmania, has been doing some incredible
work there and kindly took me to see one of his success stories.<o:p></o:p></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBxk8rxC1ZdjmH51M00XxMf9LpGLqED3SFZRKl-fN_nMAeR_bD_kvEXEPZTlcJOSTBn66_FWKZhL1jFZgw7-IUrpsU-2VTMqBT-sHU-YMP3u-jIKIW9jxkvhoI3TaBfnDPDEqcPKyMOIA/s1600/Yei+%25288%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBxk8rxC1ZdjmH51M00XxMf9LpGLqED3SFZRKl-fN_nMAeR_bD_kvEXEPZTlcJOSTBn66_FWKZhL1jFZgw7-IUrpsU-2VTMqBT-sHU-YMP3u-jIKIW9jxkvhoI3TaBfnDPDEqcPKyMOIA/s320/Yei+%25288%2529.JPG" width="320" /></a><o:p> </o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5Wcsv4tbBpOu2B7byqPbzoChP7rExNSWXAQw6YEKqYF2FDyZBUktjEixFL0hZ5LNXdXRgQTd10fZdgXghWO-aYjX5itI0wRcmtJErOikRM0jcHrKW7Mrj7ka_fBSXqk9ZJOCxOpdisNY/s1600/Yei+%25287%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5Wcsv4tbBpOu2B7byqPbzoChP7rExNSWXAQw6YEKqYF2FDyZBUktjEixFL0hZ5LNXdXRgQTd10fZdgXghWO-aYjX5itI0wRcmtJErOikRM0jcHrKW7Mrj7ka_fBSXqk9ZJOCxOpdisNY/s320/Yei+%25287%2529.JPG" width="320" /></a></div>
<br />
<br />
<div class="MsoNormal">
I was taken to see a 9 year old lad who had arrived with
them out of the bush about a month ago. Even for a child in one of the poorest
regions on the planet he had his cards stacked against him. His father had
died, his mother was an alcoholic and his frail grandfather was looking after
him. Then he became ill with an expanding growth exuding from the left side of
his face. It had reached the size of a mango by the time his grandfather took
him to seek help. Burkitt’s lymphoma is the most common childhood malignancy in
Africa but you may have never heard of it. From what I remember a combination of
genetic factors in equatorial Africans and environmental factors chronic malnutrition,
malaria, Epstein Barr Virus and HIV, make it extremely prevalent. It responds
well to chemotherapy but that’s in rather short supply in East Africa. His
grandfather was told nothing could be done and, I forget the details, but the
boy disappeared. After a while when he couldn’t be found and given the severity
of his illness, it was assumed that he had died. In fact they even had a
funeral for him in his village. But news of his death had been greatly
exaggerated and, after what must have been days of walking, he arrived alone and
weak at the Harvester’s hospital in Yei.<o:p></o:p></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLhaaGyaveoMrPyokhSwJOFl1QUCXLTWVm8x7igZYiOBBy0BnjXbDf2vxoZjTEMTa27NcIEUOoiqfGpCHwCSpLa0eano5pRIugQCYQnqHDXDQ0LUInGA8T6XgTmB9kQM2X-0B68oQmBw8/s1600/Yei+%25286%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLhaaGyaveoMrPyokhSwJOFl1QUCXLTWVm8x7igZYiOBBy0BnjXbDf2vxoZjTEMTa27NcIEUOoiqfGpCHwCSpLa0eano5pRIugQCYQnqHDXDQ0LUInGA8T6XgTmB9kQM2X-0B68oQmBw8/s320/Yei+%25286%2529.JPG" width="320" /></a></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
With little hope of a good outcome given his general
condition, Dr Poole started treating him and a few months later the growth has
completely receded and he is slowly regaining his strength. The picture shows
the facial damage the lymphoma has left in its wake. His grandfather visits
frequently, overjoyed that his grandson managed to make it to someone who could
help.</div>
<o:p></o:p></div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-38461040687073284022013-05-28T14:47:00.003-07:002013-05-28T14:47:51.421-07:00Why is Kili a Killer?<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0nvf-e4tSbEnRlW0ciJywRezREbOXdf9qAGEXHbMoX7caoY1J4Vtfkjl7O3hkTRVSPZxo8ETW6hDyHAML1hVCdddx_OunKhhyphenhyphenMs4JyMM8CkDIfQ722ZZupj61L4HpaUJuNImqQig4D9E/s1600/Chopper+to+kili+(5).JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0nvf-e4tSbEnRlW0ciJywRezREbOXdf9qAGEXHbMoX7caoY1J4Vtfkjl7O3hkTRVSPZxo8ETW6hDyHAML1hVCdddx_OunKhhyphenhyphenMs4JyMM8CkDIfQ722ZZupj61L4HpaUJuNImqQig4D9E/s320/Chopper+to+kili+(5).JPG" width="320" /></a>This weekend I was given the call to attend to a sick
climber who was on his way down from summiting Mount Kilimanjaro. He seemed to
be suffering badly from altitude sickness, but with no medical personnel on his
trek it was difficult to get an idea of his severity. Given that these
retrievals require a helicopter with extremely limited space and limited on
weight, we can take very limited equipment. Also with it getting later in the
day, we were getting extremely limited on time. As Tanzania warms up throughout
the day, cloud tends to roll up Kili towards the afternoon and so the
helicopters can’t get up there.<o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ZP-YzSB59aWt4OjnUOKgiZn4zOHDCiHOiQNqI_PhQ8nHrWeFBP3aP_Oz6thDX6hEiEW4qjcjoHRR0w3xXb4AAWvYJ_cLpabPFAbsMrclTY3soboPuv4a1DzhYQhL3YbMdVF8lQek_is/s1600/Chopper+to+kili+(15).JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6ZP-YzSB59aWt4OjnUOKgiZn4zOHDCiHOiQNqI_PhQ8nHrWeFBP3aP_Oz6thDX6hEiEW4qjcjoHRR0w3xXb4AAWvYJ_cLpabPFAbsMrclTY3soboPuv4a1DzhYQhL3YbMdVF8lQek_is/s320/Chopper+to+kili+(15).JPG" width="320" /></a>Kili has been getting a bad reputation in the last few years
for climbers becoming extremely sick up there and a handful of deaths each year.
I’ve never climbed it but I know that most people consider it a simple trek and therefore not worthy of the respect such an altitude deserves. It’s the kind of
charity event that a city executive might jog around the park a couple of time
to train for and then bumble his way up and down (with a small army of porters
I might add). So why are people running into problems? I am told that the medic
often doesn’t summit because they are looking after the clients who fall by the
wayside. Having worked alongside a lot of expedition doctors who have done it,
the problems are multifactorial:-</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTY4V1bfZEC0PibVqGVaE08NuO41dLbPL1hWAd16cjtgalMAZnD9rO0_Y9e0PiKXj9TIGnv-8J_HcxbIYKGCfRSD1WJw1KuxhCAUpmAO8SIaSaib50jkTVZgxinicJys0RPgAcuCv8kDY/s1600/Chopper+to+kili+(17).JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTY4V1bfZEC0PibVqGVaE08NuO41dLbPL1hWAd16cjtgalMAZnD9rO0_Y9e0PiKXj9TIGnv-8J_HcxbIYKGCfRSD1WJw1KuxhCAUpmAO8SIaSaib50jkTVZgxinicJys0RPgAcuCv8kDY/s320/Chopper+to+kili+(17).JPG" width="320" /></a>1)<span style="font-size: 7pt;">
</span><!--[endif]-->The ascent is extremely quick. Most groups will dash
for the summit from 4600m to 5895m in one day. The safe recommended ascent rate
is only 300m per day in order to acclimatise. The route is fairly
straightforward so it can be done pretty fast. My friends tell me to expect at
least 80% of the clients to have signs of moderate altitude sickness by the
summit. <o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->2)<span style="font-size: 7pt;">
</span><!--[endif]-->The group mentality. People always explain away
their symptoms by dehydration, a change in diet, bright sunlight causing
headaches etc etc. So they press on despite often quite severe symptoms. With
mild symptoms you can stop and acclimatise and you will be fine. But if you
ascend you could be in all sorts of problems. However we don’t want to look
weak in front of the group, we don’t want to hold people up and the guides want
to get you to the top. <o:p></o:p></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidZhpGsRDY44JWdKtz98D1DMq6ve0TJGKgc-XpEHfnaIiqsDFEHZmTCve-09WY_E5WiiMFdkDcdOozIdg6fvJBLsAPYexYRKRxym2hTc5j_PEU5gG0Ogvj9aIJZN9uD7owdL9hivxtkIY/s1600/Chopper+to+kili+%252821%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidZhpGsRDY44JWdKtz98D1DMq6ve0TJGKgc-XpEHfnaIiqsDFEHZmTCve-09WY_E5WiiMFdkDcdOozIdg6fvJBLsAPYexYRKRxym2hTc5j_PEU5gG0Ogvj9aIJZN9uD7owdL9hivxtkIY/s320/Chopper+to+kili+%252821%2529.JPG" width="320" /></a></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->3)<span style="font-size: 7pt;">
</span><!--[endif]--> A lack of
appreciation or understanding of the risks of altitude sickness. Most of the
people I speak to <o:p></o:p></div>
believe that if you are strong, fit and fast you are less
likely to get AMS. Wrong. You are more likely to run into problems. Slow and
steady types tend to fare much better. And probably more importantly, it can
happen to anyone. <br />
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->4)<span style="font-size: 7pt;">
</span><!--[endif]-->Genetically, unlike the indigenous people of the
Himalaya or the Andes, Africans are no better at coping with altitude than you
or I. Also they cope poorly with the cold and are rarely equipped properly. If
it weren’t for a load of strange white folks insistent on climbing up things,
it’s rather unlikely they would have bothered. As Peter, my friend from South
Sudan said at dinner “What is with you Mzungus (white guys)? Why climb to the
top of mountains making your life difficult for no reason?” So the porters,
keen to make money, push themselves extremely <o:p></o:p></div>
hard and frequently run into problems,
especially the new ones.<br />
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]-->5)<span style="font-size: 7pt;">
</span><!--[endif]-->Then there is the concurrent common issue of
trauma. Kili is non-technical, i.e. ropes, crampons, harnesses etc not required
but if you are staggering around with poor coordination due to a mix of
fatigue, dehydration and AMS you can easily lose your footing and you can
imagine the rest.<o:p></o:p></div>
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<br /></div>
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So what is Acute Mountain
Sickness? I’ll be brief but it’s a fascinating subject. It’s basically a
syndrome caused by prolonged exposure and physical activity in a low pressure
atmosphere. At altitude there is less of all the atmospheric gases, not just
oxygen but you feel the effects of the hypoxia (not enough oxygen) very
quickly. To demonstrate, if I immediately took you to the top of Everest from
sea level you would have a couple of minutes of useful consciousness then pass
out and die if we didn’t get you some O2. Hence why airplane stewardesses say
“In the event of cabin depressurisation, oxygen masks will fall from the panel
above your heads. Make sure you put your own mask on before attending to your
children.” (Children are basically rubbish in a crisis) But we climb mountains
very slowly and acclimatise. Over minutes, we breathe faster. Over hours, our
kidneys adjust things to cope with the changes in blood alkalinity. Over days our
haemoglobin changes to deliver oxygen at lower atmospheric levels. Over weeks,
we start producing more red blood cells to cope with less O2 and over
generations we recruit/alter genes that allow this process to work more
efficiently. <o:p></o:p></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEierS51UviTewzpGOV5MjXANwnfwfJ1KjGE1fNPmZnbQ0_6iN0EeyKbbZknE5ODO0ZI4rHZq_yW9T47TmNZi1EP-hFHicu9pdvH1v6WiVjNG3cBJtEg3fwm5el9vx5xSCFZmok5zSGbR6w/s1600/PC087678.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEierS51UviTewzpGOV5MjXANwnfwfJ1KjGE1fNPmZnbQ0_6iN0EeyKbbZknE5ODO0ZI4rHZq_yW9T47TmNZi1EP-hFHicu9pdvH1v6WiVjNG3cBJtEg3fwm5el9vx5xSCFZmok5zSGbR6w/s320/PC087678.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">My own oxygen saturations were 77% at Everest BC</td></tr>
</tbody></table>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Most people will have some
symptoms above 3500m and eventually be able to comfortably tolerate levels of
hypoxia which would make them pass out at sea level. See picture right<o:p></o:p></div>
. The symptoms
include headaches, nausea, fatigue which are all pretty non-specific and common
for lots of people who has just been a few days in new country, so they are
easy to brush off. I’m not sure of what current research says but it used to be
thought of as slight brain swelling and the direct precursor to its far uglier grown
up sister, full blown cerebral oedema where the swelling gets out of control.
These patients start stumbling about and becoming more and more confused until
they slip into a coma. <br />
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip9h3ThnY3PNTYsc_6B2Cmbexz-S7SRe6PcGblBmL9vPfuhKoJF-wo81m7B1f1sHu4Ln6-WqXbAqQ6LYrsEsccR9rZQD8DPLh1QGSQi7k4dWTO1igSgLEfp2DoMGANE-KbjEiSYsLcAL0/s1600/Chopper+to+kili+%252825%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEip9h3ThnY3PNTYsc_6B2Cmbexz-S7SRe6PcGblBmL9vPfuhKoJF-wo81m7B1f1sHu4Ln6-WqXbAqQ6LYrsEsccR9rZQD8DPLh1QGSQi7k4dWTO1igSgLEfp2DoMGANE-KbjEiSYsLcAL0/s320/Chopper+to+kili+%252825%2529.JPG" width="320" /></a></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Then there is ‘pulmonary oedema’ which
is basically drowning in your own tissue fluid as it secretes out into your
lungs. It’s not clear why one person develops this and the next doesn’t. The
best way of understanding this is as having overly sensitive blood vessels in
your lungs which constrict in response to the drop in oxygen. This isn’t weird,
they are meant to do this. Sitting here writing this I use about 600ml per
breath even though I have about a 7.5litre lung capacity. So the 7 litres of
lung tissue I’m not using gets shut down (the vessels constrict) when I don’t
need it. And it’s that reaction that is thought to go a bit haywire in reaction
to the low O2 levels at altitude. Constricting your lung’s vessels is fine when
you don’t need them, but when you do (like when you are starved of oxygen
climbing a mountain for example) you become very short of breath, the right
side of your heart gets strained and fluid and even blood starts getting forced
out of your blood vessels into your lungs. Which then further reduces available
oxygen making the problem worse and you spiral the plughole as your lungs fill up.
Not a nice way to go. I remember evacuating a poor girl from Gokyo Ri in Nepal,
who went from bounding up the rocks like a mountain goat and two days later
couldn’t walk across the room.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HajQfda5ry3T4oDKvpIf05uuKRF6cppNKqw6oDvG-AlD0wjJfmDDX-HoGORveVozLdU3ks-Eia9aeEThtVxewziTBH4OVJFK1HNybC1TY0AQuE0wBKR_vvGd3WROe0LaDs1yatV_ABM/s1600/Chopper+to+kili+%252823%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7HajQfda5ry3T4oDKvpIf05uuKRF6cppNKqw6oDvG-AlD0wjJfmDDX-HoGORveVozLdU3ks-Eia9aeEThtVxewziTBH4OVJFK1HNybC1TY0AQuE0wBKR_vvGd3WROe0LaDs1yatV_ABM/s320/Chopper+to+kili+%252823%2529.JPG" width="320" /></a>Well the best treatment for all
of them is descent, more oxygen or more pressure. Any of these will sort them
out in the vast majority of cases. Other treatments can help, for example
Diamox, steroids, nifedipine and even Viagra (yes Viagra, but an erection in a
climbing harness is never fun). But what do you do if you are really sick and
you can’t descend, you have no O2 bottles and no portable hyperbaric chamber?
You are screwed frankly. Or someone comes along in a helicopter and saves you.
Weather permitting of course.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsx1Rqe4ijXwSprj88Zlx88FE72jBm1JJ46gp4IMR2zn5klatbIKmFm1l7CK_sHCK08Aq0EFpiK2Exmqb4cqXuWcoqHNKrTi0BGGPZ2gGjqSbxeD59tvbSDy5qmG2xAu68ikg-sowUawY/s1600/Chopper+to+kili+%252811%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsx1Rqe4ijXwSprj88Zlx88FE72jBm1JJ46gp4IMR2zn5klatbIKmFm1l7CK_sHCK08Aq0EFpiK2Exmqb4cqXuWcoqHNKrTi0BGGPZ2gGjqSbxeD59tvbSDy5qmG2xAu68ikg-sowUawY/s320/Chopper+to+kili+%252811%2529.JPG" width="230" /></a></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
So back to the evacuation. With
this scanty information we set off across the stunning plains of southern Kenya
towards Tanzania and the looming cone of Mount Kilimanjaro in the distance. As
we bombed along at about 2000ft we passed over giraffes, ostriches, elephants
and seemed to scare the crap out of a heard of wildebeest. In between the fauna
sightings we discussed our plan for the evacuation. With the cloud thickening
we decided the best plan was a ‘scoop and run’. Chuck him on the stretcher, fix
the monitoring, get him on oxygen and get off the mountain. We were all agreed;
whatever his status, he was far better off about 1000m further down.</div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
As we
approached Kili we saw our window of opportunity was narrow if it hadn’t
already passed. Kim our pilot skilfully wound his way around the clouds to the
western slopes and climbed through above the clouds. More and more of the
impressive peak loomed into view and we could soon see snow and the summit. We
passed over one camp fairly low which raised a few cameras from the trekkers
and headed higher towards the given coordinates. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The guides and patient were close
to the helipad and Kim pointed out the cloud below us. He told us that “It’s
marching up the hill pretty bloody quick. I can give you 2 minutes to assess
the patient.” Unreasonable demands from the stressed; it was like being
in the Emergency Department again! Luckily the patient had improved and could
walk. We basically grabbed him with the blades roaring above our heads and
chucked him on the stretcher. Monitoring and O2 on, all back in the helicopter
(after I managed to sneak a quick shot) and we took off. We had to fly higher
up the mountain and Kim displayed some nifty piloting around the slopes until
we were above the cloud and looking for a gap to descend through. <o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6WPQmwrWBEzOt1w5alKJHumn0i-jmFDMnKy1bn2N6-frmkvI2Zw0r7XerEmEhrVGqhKBCZnjQdS0nDEulOaxPuhiQvupiI5F9sMRv9S7-lSiS_CFmW0WDSA0K4xreyEnT5Vs9FXrm1i4/s1600/Chopper+to+kili+%252827%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6WPQmwrWBEzOt1w5alKJHumn0i-jmFDMnKy1bn2N6-frmkvI2Zw0r7XerEmEhrVGqhKBCZnjQdS0nDEulOaxPuhiQvupiI5F9sMRv9S7-lSiS_CFmW0WDSA0K4xreyEnT5Vs9FXrm1i4/s320/Chopper+to+kili+%252827%2529.JPG" width="240" /></a></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The patient improved and we all
enjoyed a beautiful flight back to Wilson with the gentle orange hue<o:p></o:p></div>
from the low
sun projecting long shadows across the plains. This really is a tough job.Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-7285530318209116632013-05-25T12:24:00.002-07:002013-05-25T12:24:58.955-07:00Trips to the Moge - part 2 - For the love of Lasix<div class="MsoNormal">
My first trip to Mogadishu (bless you) was to pick up a poor
chap in his 30s who had gone into complete <o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4z1PXl4Z1ee_jB53p5okKaa7mYZ7dWb5Muvi5tN2IlThMb3lxfDix11cgoUpHQYQmh1dR52fk2WFAhiKLBflz8sQWcvo8Ero-v6HgjO7bcD4L8ifnLHzl0byPVUfRmQXAJymRoQ0JM5Y/s1600/Da+Moge+(9).JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4z1PXl4Z1ee_jB53p5okKaa7mYZ7dWb5Muvi5tN2IlThMb3lxfDix11cgoUpHQYQmh1dR52fk2WFAhiKLBflz8sQWcvo8Ero-v6HgjO7bcD4L8ifnLHzl0byPVUfRmQXAJymRoQ0JM5Y/s320/Da+Moge+(9).JPG" width="320" /></a></div>
bowel obstruction. An abdomen full
of trapped gas is not something you want when you are ascending in a plane as it expands. He needed a lot of fluid resuscitation and a nasogastric tube on
the ground but apart from that transferred ok. As predicted the gas expansion
caused cramps and a further reduction in his lung capacity so he needed O2,
analgesia, buscopan and lots more fluid - something I’m discovering that health
care providers in this area of the world are rather stingy with. But my oh my
they love their Lasix (Frusemide, a diuretic – good if you are a boggy cardiac
patient with fluid backing up everywhere, but a disaster if you are already a
crisp.) In the end he had a ‘twisted sigmoid colon’ sorted laparoscopically. My
referral from where he was treated in Mogadishu had as it’s top, and only, differential diagnosis <i>‘psychosomatic pseudo-obstruction’</i>. Poor chap, unless he was able to twist his colon with the power of his mind that was a rather unfair call. He’s making a good recovery now in Nairobi.<br />
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<div class="MsoNormal">
Then the next day I had a far more complex situation. One transport, three
patients; one a spinal fracture with unilateral leg weakness, one an epigastic
pain of unclear origin and the third was one of the sickest conscious patients
I’ve ever seen. A poor chap who had diabetes and had been on ARVs for about a
decade presented with chest pain after a 11K run the morning previously. He had
widespread changes on his ECG apparently (I did not get sent them so couldn’t
see) possibly ischeamic, possibly a more suspicious cardiomyopathy with a large
heart on CXR. It’s all a bit confusing but he got catheterised and was not
passing urine. Someone, somewhere obviously told these guys ‘if the patient has
a cardiac problem and doesn’t pee – he needs Lasix. Lots of Lasix.’ Which is
exactly what they did. Regardless of the fact that he had just run 11K in the
friggin desert! If you squeeze a dry sponge you will yield little water, but
you may well tear the sponge to bits. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNJBqTL8zejXMB9ikuu8jGKdP__PKKXv6X80IJSgjw8tyWDRk-y36qGyYlfpt14pYNyAAfWLGu9C8E_hWOvTgAMToxEa4PmACte0w-mXQx1Irfgiee2V-N2zEO1_0XstD7_s7awLXEGg8/s1600/100_0181.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNJBqTL8zejXMB9ikuu8jGKdP__PKKXv6X80IJSgjw8tyWDRk-y36qGyYlfpt14pYNyAAfWLGu9C8E_hWOvTgAMToxEa4PmACte0w-mXQx1Irfgiee2V-N2zEO1_0XstD7_s7awLXEGg8/s320/100_0181.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The airframe equivalent of his kidneys</td></tr>
</tbody></table>
<div class="MsoNormal">
So when got to him airside in Mogadishu (bless you) he was
alert, breathing four times the normal rate, chest clear with good saturations,
a crappy BP and a bizarre broad junctional bradycardia. Given our prior info about his renal failure, a stonking
potassium was my first bet so we threw the kitchen sink at him. Atropine,
bicarbonate, Calcium, insulin and filled up him with fluid as best we could.
For the medics reading this, his pH was 6.8! I’ve only ever seen corpses with
blood that acidic. His blood was so full of acid (probably a good mix of
uraemia, ketones and lactate) as his kidneys had packed in that his lungs were
the only thing keeping him alive by blowing off CO2. If he stopped breathing
for a nanosecond he was highly likely to crash as the acid took over. I was
asked about whether we needed to intubate and put him a ventilator. While his lungs were working so well the
resounding answer to that is ‘no’. If we stopped his breathing to get a tube
down his throat and ventilate, his acidosis would worsen to a level
incompatible with life. Patients like this have a cardiac arrest as you put
them to sleep. <o:p></o:p></div>
No, what this man needed was to be attached to an artificial
kidney in Nairobi and everything else we were doing was just temporising the
situation but not for long. We managed to get him to call his wife for what I
strongly suspected would be the last time. <br />
<br />
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<br /></div>
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<div class="MsoNormal">
With a lot of hard work we got a more normal looking ECG
trace, a reasonable BP and his lungs kept doing a good job. We delivered him to
the emergency department with a glimmer of a chance of survival. That’s when we
had to leave him. Unfortunately getting a patient on a heamofiltration
apparently requires a specialist nephrologist consult and in the delay his time
ran out. He needed ventilation and had a cardiac arrest as they intubated. All
for the love of Lasix. Stupid drug.<o:p></o:p></div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com1tag:blogger.com,1999:blog-7492413488880336559.post-65318538163727383032013-05-25T11:51:00.002-07:002013-05-25T11:51:47.839-07:00Trips to the Moge - part 1 - an inadequate historyMy latest two medevacs have taken me into the famously
unsettled city of Mogadishu in Somalia. Before I start I’ll just reassure my
mother who will be reading this, that Mogadishu airport is probably the safest
we fly into. The UN security is phenomenally tight now. It must be, the
paperwork and checks to get in and out are extremely laborious and detailed.
I’m sure these reports I heard about suicide bombers were actually people
spontaneously combusting in frustration. Right well now I’m sure I have the CIA
reading this, hi guys, keep up the good work.<br />
<div>
<br />
<div class="MsoNormal">
<o:p></o:p></div>
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My friend Abdi from Somalia tells me that, back in the early
80s Mogadishu was a stunning city, prosperous and cosmopolitan. Before the war
it was even a great holiday destination. It has long beautiful beaches with a
nice reliable wind, perfect for watersports. (I wouldn’t get your kitesurfers
out just yet though. I’m told there’s still a large population of sharks that
skulk about there ever since the war. They must have had a good supply of meat
and are still wondering when the buffet is opening again.) There is a book
written about the war-torn city called ‘The Lost Paradise’ and seeing the old
photos and comparing with the shabby bullet pocked buildings left standing, I
can understand the sentiment. However I probably shouldn't show my photos of the airport and UN presence in Mogadishu. I might get in a wee bit of trouble.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So my potted understanding of the conflict goes something
like this. As most of the conflicts in Africa, it starts with clans and colonies.
You may not know that Italy once had an empire, and I am not referring to the
Romans. There was a time when our tiny island of Great Britain had a rather big
empire and lots of European countries wanted a piece of world domination as
well. Africa became a real game of ‘Risk’. </div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZVq0dd0GY4ou0ffheWZ_LvvtWW3bWbmGrMQbP4AEv-TXTS87tvHRoDBrSQatE1iL_J7MunG3FF6M9Zq9cZDEcByaJuEKUATr4BQZyctm0_XnUX4mhBsWJ12lJpGzRBxT5Q7CVWy8ypYk/s1600/Da+Moge+(6).JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZVq0dd0GY4ou0ffheWZ_LvvtWW3bWbmGrMQbP4AEv-TXTS87tvHRoDBrSQatE1iL_J7MunG3FF6M9Zq9cZDEcByaJuEKUATr4BQZyctm0_XnUX4mhBsWJ12lJpGzRBxT5Q7CVWy8ypYk/s320/Da+Moge+(6).JPG" width="320" /></a>Somalia was divided with the
Italians in the north (now known as Somaliland) and with the British in the
south. During WWII we captured Somaliland from the Italians and it stayed under
British rule until independence in 1960. Then there was a bit of a problem as
there often is in a power vacuum. The clans supposedly united under one flag
even though apparently the British advised the Isaaq of Somaliland to stay a separate
nation. But they were rather excited about re-uniting the ‘five stars of Somalia’
which are the Somali people of Djibouti, Ethiopia, Southcentral Somalia,
Somaliland and Kenya. Uniting Somaliland and Somali seemed like a good start.
There was peace until the early 1980s when the people of Somaliland started
getting marginalised by the Somali government in Mogadishu, they started getting
angry with the incumbent president Said Barre (who had ruled with an iron fist for
about 20 years) and formed a separatist movement called Somali National
Movement (in London interestingly) and that’s pretty much where the trouble started. The military wing of the SNM started attacking from Ethiopia but then
as the President became more annoyed the Ethiopians officially withdrew their
support (but they didn’t really). The SNM could support themselves by this
point anyway and started an insurgency capturing cities in the north. Here’s
where it gets complicated.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh31D22EDfQu2o_suo8UlvODADr1-p4nBY2Vx7KsfEIhzjqK1vilOoHHUIDqhxReNu_B_AVr1atALB60YgPmD83bEBncouB2t2KHs8Kifir8L8n5ZZ1ust-CEpvgiMmrzRG7snHLaie-b0/s1600/Judean+People's+Front.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh31D22EDfQu2o_suo8UlvODADr1-p4nBY2Vx7KsfEIhzjqK1vilOoHHUIDqhxReNu_B_AVr1atALB60YgPmD83bEBncouB2t2KHs8Kifir8L8n5ZZ1ust-CEpvgiMmrzRG7snHLaie-b0/s320/Judean+People's+Front.jpg" width="320" /></a></div>
Do you remember the scene in The Life of Brian in which John
Cleese’s rebel group can’t remember if they are the Judean People’s Front or
the Judean Popular Front? Just before they agree to fight for the right for
Eric Idle to have babies? Well the various clans and sub-clans in Somalia
cottoned on to the SNMs successful campaign and wanted a piece of the action.
From north to south the United Somali Front, the Somali Democratic Alliance,
the Somali National Movement, the United Somali Party, the Somali Salvation
Democratic Front, the United Somali Congress, the Somali African Muke
Organisation, the Somali National Front, the Somali Manifesto Group, the Somali
Democratic Movement and the Somali Patriotic Movement (breathe) all started
kicking off to get rid of the President’s military dictatorship.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxMr2zV-o5h8KhoSGVDJRTPp9q4um9m3o_pAygAoSI8PgFeE0Aa1AunqmuMIUuFQfZzYcaTdETw-mMgndxLWNOona-paWrgZFC4uhQrpDtfrYvQKNiKR9BKX1WxiqK7u2-BoVt66IQdQE/s1600/Da+Moge+(5).JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxMr2zV-o5h8KhoSGVDJRTPp9q4um9m3o_pAygAoSI8PgFeE0Aa1AunqmuMIUuFQfZzYcaTdETw-mMgndxLWNOona-paWrgZFC4uhQrpDtfrYvQKNiKR9BKX1WxiqK7u2-BoVt66IQdQE/s320/Da+Moge+(5).JPG" width="320" /></a>The result? The dictatorship crumbled leaving a wonderfully
complex shifting series of clan/militia alliances, grudges and conflicts which
have raged ever since. The US made a wonderful pigs-ear of trying to stabilise
Mogadishu by capturing the warlord Aidid in 1993 (the film Black Hawk Down) and
had to pull out in 1995. It was chaos. Every town had its warlord. Boys with
guns everywhere. So two independent solutions to the problem emerged; an
Islamic fundamentalist movement (the ICU) enforcing Sharia law in the South and
the African Union (particularly the Ethiopian troops who were rather heavy
handed by all accounts) the UN and the US backed Transitional Federal
Government in Mogadishu. The Isaaq in Somaliland to the north were quite happy
by this point and started working on distancing themselves from all the mess
down south hence the continued drive to create an independent state now (just
like we told them they should back in the 60s). </div>
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<br /></div>
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So then guess what, the Islamic
Courts Union along with an aggressively militant splinter group called Al
<o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3-WDVzfV7jeonfDAM3bH2B3Iqx0f_qUIw-3jCqpzndkPTmb_PVXD4LQ7XQIMOJLhvF1abU-UTJ_gw-Ij81HM9d0nU8my53UQJwggBuAGp8eL71HZ_YiW_uHNu68v3X3YVR2BYI7bAUUo/s1600/old+style+-+kisamayo.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3-WDVzfV7jeonfDAM3bH2B3Iqx0f_qUIw-3jCqpzndkPTmb_PVXD4LQ7XQIMOJLhvF1abU-UTJ_gw-Ij81HM9d0nU8my53UQJwggBuAGp8eL71HZ_YiW_uHNu68v3X3YVR2BYI7bAUUo/s320/old+style+-+kisamayo.JPG" width="320" /></a></div>
Shabaab (the Youth) drove out the largely Ethiopian military force from
Mogadishu. The TFG had lost their force and the whole place fell into chaos
again. By this time the whole world and particularly Kenya were getting pretty
tired of all this insecurity and lawlessness and by the end of 2011 the Kenyan
forces had driven Al Shabaab out of the south up to Kismaayo stabilising their
border and the UN/government forces had driven Al Shabaab out of Mogadishu.</div>
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So now we have the UN and the AU keeping things stable in
Mogadishu, the US keeping an eye on the pirates from Djibouti to the north and the
Kenyan forces (praying for the day the nation is stable enough that the
hundreds of thousands of refugees can go home) fighting with Al Shabaab
periodically in Kismaayo in the far south. And then there’s me, flying around
them all, picking up their patients and wondering what the hell is going on.<br />
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<o:p></o:p></div>
</div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-73918178269614393762013-05-21T00:18:00.000-07:002013-05-21T00:18:04.554-07:00Fledgling Paramedics<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNLs5V0RrPq2YyLfbcLUAmMtvekmTT1p9Xukd5GQiGZ0CyVPeMOdDvh5wHe1NS-ZfF8qQcgOFi8f9iHO0vZr07_sovbx_upKOoCmMV-x4ibP26Lt3-lx9pENZZAaP8k3z7le1cFnq6Bf0/s1600/100_0176.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNLs5V0RrPq2YyLfbcLUAmMtvekmTT1p9Xukd5GQiGZ0CyVPeMOdDvh5wHe1NS-ZfF8qQcgOFi8f9iHO0vZr07_sovbx_upKOoCmMV-x4ibP26Lt3-lx9pENZZAaP8k3z7le1cFnq6Bf0/s320/100_0176.JPG" width="240" /></a></div>
It’s been a remarkably varied week. I’ve popped about on a
couple of interesting retrievals, my favourite being for a poor sick young girl
needing medevac out of Arusha in Tanzania next to Mt Kilimanjaro. We flew in
the unpressurised Caravan plane and stayed low under the air traffic. I had
stunning views across to the Rift Valley and the landscape was laid out like an
incredibly detailed model. The tiny farms and homesteads could easily be made
out with tiny people fussing around their tiny livestock (just to clarify, they
aren’t actually tiny, they were just very far away) and I got a few good snaps
from above.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjis69iGBwW-ImU8DekwQiwbuHcvkmwfNzmMgiKRVjHRPUF0hs1GIfm5LNeay3uuuiJ7VuvxZB98_bc7qlWo-jGyHCvlSX41MP2eUSXyn2ANeHEZ9lzxe_hnA7LKZO4rv9-pyFMrAC_yY/s1600/100_0158.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjis69iGBwW-ImU8DekwQiwbuHcvkmwfNzmMgiKRVjHRPUF0hs1GIfm5LNeay3uuuiJ7VuvxZB98_bc7qlWo-jGyHCvlSX41MP2eUSXyn2ANeHEZ9lzxe_hnA7LKZO4rv9-pyFMrAC_yY/s320/100_0158.JPG" width="320" /></a></div>
<br />
<br />
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
I also had a late night retrieval into Addis Ababa in
Ethiopia which was horrendous and I won’t go into. Maybe I’ll tell you over a
beer someday (or more likely while lying on a therapist couch) but suffice to say it all turned out ok in the end. <o:p></o:p></div>
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Through our mutual friend Dr Stevan Bruijns I met up with
one of the senior Emergency Physicains at Aga Khan Hospital Nairobi, Benjamin
Wachira and he asked if I would represent AMREF and help out <o:p></o:p></div>
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</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDuEIbLTDFClx46D7igMEw1I5F56Y16FQSLhPWBn1Qea6G5iJHoiAqFdfBs5eGh3eJOWtZWMOoAg1gN-RwwlIVflGX3jdRM7udSvnJ8RQdE0WkaIUo8-LtwDNlqOhnzFeVSpmwtjE5A8U/s1600/KCEMT+01.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDuEIbLTDFClx46D7igMEw1I5F56Y16FQSLhPWBn1Qea6G5iJHoiAqFdfBs5eGh3eJOWtZWMOoAg1gN-RwwlIVflGX3jdRM7udSvnJ8RQdE0WkaIUo8-LtwDNlqOhnzFeVSpmwtjE5A8U/s200/KCEMT+01.JPG" width="200" /></a></div>
with a teaching
conference for the Kenyan Council of Emergency Medical Technicians (ambulance
paramedics to you and I) as he was the Medical Director for the fledgling
organisation. It has been largely funded through the John Hopkins University in the USA.<br />
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Kenya has had it’s fair share of major incidents in the last
couple of decades. To name a few – the US embassy bombing in 1998 and the civil
violence in 2007, not to mention the thousands of able-bodied and </div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSbnnPYfEBZWzB-TZ42TIEaAraq346zIceoautkq9f2ow6DZgMEFPrzpOFa-VX7zbzaG0YntPVXmQZOgsRsuSjFZo88qvj8jic5N4xVqzhPgxzjRy8HFJ5m_0Fk-oLeKlXulT7VzgIoAM/s1600/KCEMT+%25283%2529.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSbnnPYfEBZWzB-TZ42TIEaAraq346zIceoautkq9f2ow6DZgMEFPrzpOFa-VX7zbzaG0YntPVXmQZOgsRsuSjFZo88qvj8jic5N4xVqzhPgxzjRy8HFJ5m_0Fk-oLeKlXulT7VzgIoAM/s320/KCEMT+%25283%2529.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The scenario set up by KC-EMT - remarkably realistic!</td></tr>
</tbody></table>
productive
members of Kenyan society who die on the roads every year. There has always
been one thing missing from the response capabilities and that has been the
lack of a recognised ambulance service. Currently there are only a few agencies
which train and deck out their own ambulances. There is no 999 you can call. They
are a bit like the A-team ‘If you have a problem, if no one else can help, and
if you can find them....maybe you can hire The Ambulance-Team’.<br />
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<br /></div>
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Following the
disaster in 1998, a group of people came together to train and become Emergency
Medical Technicians and last week I was privileged to watch them hand over the
accepted ‘standards’ for ambulance equipment and personnel to the government.
It will mean very little until the government actually fund ambulances and
recognise EMTs as skilled health workers. But Rome wasn’t built in a day. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWEGr4Co0BM68MZQfOlr2s1tSalr8nwFerK6XPu0DCgb01Re15KuYwCgY6ns6CcBStm8zzqNxmivwqOlzM82RNviz09ZzYqlhcJgOQbjAE05lpo7Kd3Li3iFB1YM2sv1FMyUddNlFeYuw/s1600/KCEMT+%25289%2529.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWEGr4Co0BM68MZQfOlr2s1tSalr8nwFerK6XPu0DCgb01Re15KuYwCgY6ns6CcBStm8zzqNxmivwqOlzM82RNviz09ZzYqlhcJgOQbjAE05lpo7Kd3Li3iFB1YM2sv1FMyUddNlFeYuw/s320/KCEMT+%25289%2529.JPG" width="320" /></a></div>
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The event was well attended by passionate EMTs, all hungry
to learn and it was a pleasure to be involved as the AMREF Flying Doctors
representative. The first day was spent in talks and teaching clinical skills stations
then the second day was the competition. The KCEMT put a great effort into
producing a realistic Road Traffic Accident scenario simulation for each of the
teams to demonstrate their skills. I was really impressed! The winners of the
competition could not have been faster at assessing and stabilising the scene.
They rapidly had the patients strapped up, as stable as they were going to get
and whisked off to the fake hospital.</div>
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<br /></div>
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The prize giving had typical African
flare with lots of speeches of thanks and some of the biggest trophies <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG4t1u2kkTqdMk0DyD5Xqhi0843sT2h_3ae_-AEcN5-bPtZy0RscbZ1-VUSD6uYEsxdBS3U0R0S8ufuqK7ZeNJ7V8bJppTKA1SUEIFuulWQ6EsJ-AKelh07m6GuU-88BIWmxrS1zx3ZpU/s1600/KCEMT+%25285%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgG4t1u2kkTqdMk0DyD5Xqhi0843sT2h_3ae_-AEcN5-bPtZy0RscbZ1-VUSD6uYEsxdBS3U0R0S8ufuqK7ZeNJ7V8bJppTKA1SUEIFuulWQ6EsJ-AKelh07m6GuU-88BIWmxrS1zx3ZpU/s320/KCEMT+%25285%2529.JPG" width="320" /></a></div>
I’ve
ever seen. Then just as I had escaped for lunch, the DJ got going and while I was discussing the future of Emergency Medicine in Kenya with the member from the MoH, everyone
started to dance apparently. It was certainly more fun than being an ALS
instructor!<br />
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<br /></div>
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I hope that the enthusiasm of the fledgling society
continues and gains momentum. One day soon, I hope that people in Kenya will
come to expect an Ambulance to come and rescue them in their hour of need. A
robust Emergency Medical Service simply cannot exist without skilled paramedics
to bring patients to us in their ambulances. It’s still a long way from Ben’s
vision of Emergency Care in Kenya but, as above, it’s the first steps and it’s
a very exciting future.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivgocBfZN3G-DVyDFbE1Wz4bDoEypG8UIVzdf1K_ChrdsAFM0grHYOKHesyWHML2dVdA3vISpi_pIazmlHrsoXjtrDnW_q7ifC9xExZIyZN_o_-0BJzQfJfHHgTpPsmSqkrJl9f0cBYX0/s1600/KCEMT+%25287%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivgocBfZN3G-DVyDFbE1Wz4bDoEypG8UIVzdf1K_ChrdsAFM0grHYOKHesyWHML2dVdA3vISpi_pIazmlHrsoXjtrDnW_q7ifC9xExZIyZN_o_-0BJzQfJfHHgTpPsmSqkrJl9f0cBYX0/s400/KCEMT+%25287%2529.JPG" width="400" /></a></div>
<o:p></o:p><br />
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com4tag:blogger.com,1999:blog-7492413488880336559.post-28280373018586122012013-05-11T11:17:00.000-07:002013-05-11T11:17:59.283-07:00Djibouti onto Dubai<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY57LJ1fLoK9oUDMl67vjuVWoSbdiw7mJfuOBaKBylGV9zuXQkLGwAggZKeaLjsYLQlyNX5nT3nLgPOi9xI48wF2Hc-w-0WNE53PhRTgZUwHr6gv6ZZr5Wo5gqevjtSyJoYPIx-JAvdDo/s1600/100_0078.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY57LJ1fLoK9oUDMl67vjuVWoSbdiw7mJfuOBaKBylGV9zuXQkLGwAggZKeaLjsYLQlyNX5nT3nLgPOi9xI48wF2Hc-w-0WNE53PhRTgZUwHr6gv6ZZr5Wo5gqevjtSyJoYPIx-JAvdDo/s320/100_0078.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The valleys of North Kenya</td></tr>
</tbody></table>
<div class="MsoNormal">
I’ve spent the last few days at AMREF flying around over the
desert of the horn of Africa and into the Middle East. A chap working in the
tiny but strategically significant country of Djibouti had suffered an MI, been
thrombolysed (given ‘clot-busters’) and needed medevac to Dubai. This was going
to require an overnight stay in Dubai so I selflessly volunteered. Soon we were
tearing across the sky in our very cool Cessna citation Bravo Jet approaching
Djibouti. On the way I was informed that Djibouti has, in its interior, one of
the hottest places on the planet. And not 'hot' in a hip and groovy kind of way,
more of a 'leave an egg out for <o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;">The coastal city of Djibouti</td></tr>
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10 mins and it’ll be hard boiled' kind of way. As
I stepped out the plane I believed it. It was certainly around 45. <br />
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Djibouti has an intimidating US military presence with all
sorts of impressive hardware lining the runway. I thought best not to put a
load of photos of it up here. I’ve already been arrested by the Egyptian military
for taking photos (accidentally) of a military installation and it is not an
experience I wish to repeat. (It’s a long embarrassing story.)</div>
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<tr><td class="tr-caption" style="text-align: center;">Downtown Djibouti</td></tr>
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Anyway the US have
obviously invested heavily in combating <o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3GbjUjQy_nEV5xqSMGiixRx88Cnl_hrj8-Gdgsh-4ReyE3FUQE9_QdIM1M5-AX-dgi782nzTSxjeRUic0rnwQrzTGu6vSNPWLAjX1TBvhloJiDmyZqYV8o54WSUNTN8ulmCwnykhULh4/s1600/100_0087.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3GbjUjQy_nEV5xqSMGiixRx88Cnl_hrj8-Gdgsh-4ReyE3FUQE9_QdIM1M5-AX-dgi782nzTSxjeRUic0rnwQrzTGu6vSNPWLAjX1TBvhloJiDmyZqYV8o54WSUNTN8ulmCwnykhULh4/s400/100_0087.JPG" width="300" /></a></div>
the scourge of Somalian pirates along
the coast of the horn of Africa. I was lucky enough to watch a few of their
fighter jets take off. I stood next to a massive American soldier with a ridiculous
trucker style moustache as these planes roared into the sky and I exclaimed “Yeehaw
Jester’s dead!” (a very famous victory call from Top Gun – if you don’t know
that, be ashamed) which was greeted by a slow head turn in my direction, an expressionless
stare from behind mirrored shades then a slow head turn back towards the
planes. I decided I would shut up and go sort out the patient.<br />
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Expecting a stable patient I was surprised as the ambulance
doors opened and I saw the poor chap looking dreadful. He was gasping, sweaty
and pale. Fortunately it was just because they had just had a problem with the air
conditioning so he was just being cooked alive. He was actually fine, just a
little toasty. So we popped him in the jet, cooled him off and blasted off
north into the Middle East. <o:p></o:p></div>
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The lush hills and towering cumulus congestus clouds of East
Africa had been left long behind us. The ripples of <o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsvRnk-9gx3oeg5-aewFQ5-MSHOlQffBCNTWijOTXF_8krWBoKfa3qR4GnVoFFDD-XgKE5VUrqbeEV9DsrskXRWQWLULzM6dUJZWLAB7dwBzYGYwfwiVDtcSOQf9YFKl6BWptOM2c53Rc/s1600/100_0101.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsvRnk-9gx3oeg5-aewFQ5-MSHOlQffBCNTWijOTXF_8krWBoKfa3qR4GnVoFFDD-XgKE5VUrqbeEV9DsrskXRWQWLULzM6dUJZWLAB7dwBzYGYwfwiVDtcSOQf9YFKl6BWptOM2c53Rc/s400/100_0101.JPG" width="300" /></a></div>
dunes spread out below us
with occasional lines of low small cumulus humilis following each other across
the sand. A sand storm far below soon obscured everything from view and
eventually merged with the dust that frequently blankets the wealthy city of
Dubai. Visibility was poor and the new Al Maktoum airport of Dubai was far too
far away to see its formidable spiked skyline. I had been looking forward to
seeing the Burj Khalifa building from the sky.</div>
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Notes about Dubai,<o:p></o:p></div>
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<a href="http://thumbs.dreamstime.com/x/dubai-skyline-14329235.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://thumbs.dreamstime.com/x/dubai-skyline-14329235.jpg" /></a><i>“We have delivered the patient to a private hospital in the
middle of Dubai. I’ve never seen so many expensive cars on our way into the
city. This hospital’s lobby and reception is more like a five star hotel!” </i><o:p></o:p></div>
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The emergency department was quiet, spacious, immaculate and
well-staffed. Within minutes of our arrival a full clinical team with two
nurses, an emergency doctor and soon after, a cardiology consultant, came to take
our handover. Apparently they are always on the lookout for Emergency
Physicians (isn’t everyone?) and offering very handsome payscales. The region's attendances
at Emergency Departments is rising and the escalating burden of obesity,
diabetes, hypertension and inactivity is thought to be to blame.<br />
<br />
My Somalian
friend (I will explain about my new house mates in my next update) explained to
me: -</div>
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“<i>It is Arabic culture. If you have money then you eat all day, you don’t
move, you grow fat. If you see a skinny rich man, everyone will think he is a
miser.”</i></div>
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I remember my time dealing with the children from rich Arabic families
when I worked in Paddington and it really does seem to be an issue. Especially
among the young lads. Take a wander around Harrods and you will see what I mean.<o:p></o:p></div>
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<i> “I wonder, would I
take a job in the wealthy spacious hospitals of Dubai in the middle of the
desert? I doubt you could pay me enough to work at the beckoned call of a load
of demanding millionaires who take no interest or responsibility for their own
health.” </i><o:p></o:p></div>
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But maybe I got the wrong end of the stick.<o:p></o:p></div>
Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-36375277772560617242013-05-07T13:59:00.000-07:002013-05-07T13:59:45.421-07:00Hospital Rwanda<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3b9Q4lrJRB8CBx3wbH9ZcA6vIu8i53dvXHQ9hSNiPwioPHTFR3kfu_Vd0DSrJCVHUIMEvlZU2YZJ1IrSZI_7ab-g2KJBcAT3Q1FkqZzXTsOPY-_s1rBlp7mRt1WoDsYHk7e1-WsnwIAA/s1600/100_0055.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3b9Q4lrJRB8CBx3wbH9ZcA6vIu8i53dvXHQ9hSNiPwioPHTFR3kfu_Vd0DSrJCVHUIMEvlZU2YZJ1IrSZI_7ab-g2KJBcAT3Q1FkqZzXTsOPY-_s1rBlp7mRt1WoDsYHk7e1-WsnwIAA/s400/100_0055.JPG" width="400" /></a>I managed to spend all Monday in Rwanda, stuck as the piggy in the middle between the local medical team and the patient on one side, the parents and the insurance company on the other side. It was a convoluted <span style="text-align: center;">drawn out affair that is still ongoing as I write. I obviously can go into no details but I learnt a great deal about African medical rivalries and politics. I also learnt a huge amount about medical travel insurance. All I will say is this - read your policy carefully. Depending on the very particular wording of your policy will depend on where you can be transferred to. There is a big difference between paying to repatriate you once you have been treated where you are (have a think about what that might entail i.e. where are you going?) and paying to air ambulance transfer by private jet to whatever country you desire. A lot of people will be under the impression that if they get sick/injured they will just get a medevac back home. Not necessarily I'm afraid...</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7G7xqW8ubkPZS_9VmUnWMT8TBnXFJLZUVuNin_tC4Sc9Hzwhn-fJzeYZaoemY0G7BgPqwlpqM1LHTZZx34etgSAAU99ufeGSBNOCZVPUSH98tvWjTebHvPM_VWi-1Fc_xNPIU4ffC2Eg/s1600/100_0073.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7G7xqW8ubkPZS_9VmUnWMT8TBnXFJLZUVuNin_tC4Sc9Hzwhn-fJzeYZaoemY0G7BgPqwlpqM1LHTZZx34etgSAAU99ufeGSBNOCZVPUSH98tvWjTebHvPM_VWi-1Fc_xNPIU4ffC2Eg/s320/100_0073.JPG" width="320" /></a>To cut a long story short, Morris and I spent 14 hours in Kigali waiting for a final decision and were eventually pulled out as the costs of having the pilots and the plane just sitting there at the airport was escalating beyond reasonable. We lost our ambulance and so had to get a pick up to take us back to the airport and then check in all our medical equipment through standard airport security. Explaining to the Rwandan airport security (both sets of them! - how exactly anyone is supposed to be able to generate any dangerous or illegal materials in the 250m between the two checks is beyond me) that we had delicate medical equipment that might damage the X-ray machine or explode was rather tricky. Note to self - don't make the universal sign language for explosion at Rwandan airport security again. Or tell them you have drugs.<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe0x_7j7aa7l7IMw2HP75mGPhTbJiSXl23Y5bUfS_EdWdtY6jPbDeFvQyirDaBNnfbiD2k0hE3BmP4SdWFpTC4H8XLCdYUUHjLDylhbNmbTHfULOyWNDfmpZeQjF8keBVA28K6ZLZT0UM/s1600/100_0072.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhe0x_7j7aa7l7IMw2HP75mGPhTbJiSXl23Y5bUfS_EdWdtY6jPbDeFvQyirDaBNnfbiD2k0hE3BmP4SdWFpTC4H8XLCdYUUHjLDylhbNmbTHfULOyWNDfmpZeQjF8keBVA28K6ZLZT0UM/s320/100_0072.JPG" width="240" /></a><br />
Two hours getting grilled in Kigali International Airport and we were free to go air-side. We had to carry all the stuff to a crowded shuttle bus, squeeze on and got driven from plane to plane until he made a detour for us to where the jet with the two very bored looking pilots Peter and Rob were distinctly unimpressed. I was also to learn that I missed a charity case evacuation of a 2 day old child with sepsis and a complex congenital colo-vesical abnormality. So not one of us was in a great mood.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVaWPkCil4wIVDMNhvC_eRej4dpyysJgL_ea3ZzbZWa0S8op15jXTPocQc-Y6uviAA4stEfWGWdh0C8KhKaidjs3oM3PFPLkl3oXimbltZaQxUP2EPFccYDx4VJiGOJH28SIGIgvcXz_w/s1600/100_0070.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVaWPkCil4wIVDMNhvC_eRej4dpyysJgL_ea3ZzbZWa0S8op15jXTPocQc-Y6uviAA4stEfWGWdh0C8KhKaidjs3oM3PFPLkl3oXimbltZaQxUP2EPFccYDx4VJiGOJH28SIGIgvcXz_w/s320/100_0070.JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVaWPkCil4wIVDMNhvC_eRej4dpyysJgL_ea3ZzbZWa0S8op15jXTPocQc-Y6uviAA4stEfWGWdh0C8KhKaidjs3oM3PFPLkl3oXimbltZaQxUP2EPFccYDx4VJiGOJH28SIGIgvcXz_w/s1600/100_0070.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><br /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVaWPkCil4wIVDMNhvC_eRej4dpyysJgL_ea3ZzbZWa0S8op15jXTPocQc-Y6uviAA4stEfWGWdh0C8KhKaidjs3oM3PFPLkl3oXimbltZaQxUP2EPFccYDx4VJiGOJH28SIGIgvcXz_w/s1600/100_0070.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><br /></a><br />
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The day did, however, have some positive aspects. I did get a good chance to get driven around Kigali which is a beautiful city if you ever get the chance to visit. Lush green hills, well made buildings along the hills and valleys, the roads and landscaping are immaculate. In fact there was hardly any refuse to see. Apparently the president of Rwanda has banned plastic bags. An interesting initiative, and as Peter the pilot said, "They don't have the Nairobi flower here." The Nairobi flower is the common site of a black thin plastic bag stuck flapping on a post or a wire. There were billboards up with interesting slogans such as 'CORRUPTION. It demeans us all. Sweep it away." It was a surprise to feel so safe and so impressed with a city that so recently was the site of so much horror.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQhXes4qYzyQpikId7-Kuqvpkbj5Z9HHOeLWwuzKo1HETp32s7n2fpmJZkBl2IrGxf-Y4AJ34PZMoq20ExnYEN-kxQLQOtJsEyefVktCbMYDZ2Fu_Q-BFENazrYpeRVmUQ2jivXPmdCuM/s1600/100_0060.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQhXes4qYzyQpikId7-Kuqvpkbj5Z9HHOeLWwuzKo1HETp32s7n2fpmJZkBl2IrGxf-Y4AJ34PZMoq20ExnYEN-kxQLQOtJsEyefVktCbMYDZ2Fu_Q-BFENazrYpeRVmUQ2jivXPmdCuM/s320/100_0060.JPG" width="320" /></a>There is a memorial museum about the genocide and the pilots told me it is difficult not to leave in tears. The biggest question people always leave with is 'How?' How can such extraordinary numbers of good people do such horrendous things to each other? From Milgram's electroshock experiment to Zimbardo's prison experiment, as unpalatable as they are, we know that unfortunately we all have such potential. It doesn't seem to take long or much prodding to influence it out of us either. As we waited by the plane and mused on the issues of moral relativism and the collective intentionality of something as horrific as genocide, I think I said something stupid like "Hopefully we can all learn from such events to stop them from happening again." to which one of the pilots said, "You mean like in Syria just last week." "Oh yeah." We stood there in silence for a bit, looking out across the mist rolling into the surrounding valleys of Kigali and then we flew back to Nairobi.Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-54502512292374038712013-05-05T12:44:00.000-07:002013-05-05T12:44:06.632-07:00A quiet weekendThis weekend on-call has yielded only one flight. Interesting that it still had a theme.<br />
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I've managed to catch up on some work, do some more reading and prepare some lectures and training scenarios for the flight nurses. As I've beavered away at the guest house (until now I was the only guest) Jane the hostess, busied herself about the place or watched some television. I've noticed that whenever the television is on it features back to back Christian programming. I wasn't really paying attention initially but I've never seen anything like it! Cartoons of the early life of Christ, adverts for a new game Bible Bingo and a energizing American preacher in a glittering yet rather over-the-top stage setup, bombarding his audience with the easy answers to the difficulties in the world. I am learning that Christianity is strong and vibrant in Kenya. My secular and atheist ways are, I've realised, rather odd around here. Jane asked me if I would be joining her at church on Sunday. I politely refused and explained I had no religion. She thought this very strange. In fact, as I explained my secular upbringing and my mistrust of the man-made imposition that is organised religion (things I have no problem explaining normally) it was rather distressing to see the look on her face. She clasped my hand and told me that what I was saying was causing her physical pain, in her heart. She has resolved to teach me what I missing. I think, in retrospect, I should have kept my big mouth shut. (Note to self - don't talk about religion again. Now look what you've done.)<br />
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It is funny that the next medevac I was called for was to assess and retrieve an elderly American-born Catholic priest from the town of Musoma in Tanzania on the bank of the massive Lake Victoria. He was a member of the Flying Doctors of East Africa (now the scheme known as Maisha) and so was eligible for transfer in the event of a life-threatening emergency. He had collapsed while giving morning mass after a week of non-specific ill health. He was confused and the mission nuns/nurses were concerned he had suffered a stroke. When we got the call I did point out that the differential for an elderly man with progressive confusion for a week, syncope and no focal neurology was unlikely to include a CVE so again (as they always do) we prepared for the worst.<br />
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Again time had been a healer and we were greeted at the runway by an extremely healthy looking octogenarian accompanied by a few concerned nuns. He walked out to the plane (albeit a little unsteadily) warmly greeted me and even scaled the steps into the plane unaided. This amazing man I was to learn, had lived in Tanzania for 57 years! He came out with a small group of missionaries in the 60s and just never left. So on assessment his observations were fine, his examination unremarkable and his ECG, blood glucose and venous blood gas were all unexciting. For a man who was supposedly confused he got 10/10 on the minimental test, admittedly I did have to change the questions about the Queen and WW2, to the president of Tanzania and the date of Kenyan independence. It's very important these questions are culturally relevant to the patient. The nuns thought he must have malaria. "It's not malaria I told them. I've had it six times!" I discovered that he had been struggling to remember things over the past week and struggled to give his sermon in Swahili so had to revert back to English. I wish I had longer to speak to him about his incredible life but I'd probably end up talking about religion which I had decided not to do again. I do hope that, after his recent lapse in mental functioning and the little scare he gave his congregation, he turns out to have a mild infection and he is back preaching in Swahili again soon.<br />
<br />Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-47491876274400821552013-05-04T11:25:00.000-07:002013-05-04T11:25:38.242-07:00Back to back retrievals I had been taken to Wilson airport the day previously and shown around. I also had a chance to review all the various bits of kit they use. It's a pretty impressive set up actually.<br />
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<i>"I feel strangely at home in this small airport. It's slightly larger than Kemble where I've been learning to fly myself and I find myself surrounded by twin otters and Dash planes. It's like being back at Rothera Antarctica."</i><br />
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I was barely able to get a quick introduction to the various members of the AMREF team when I was asked to fly out to pick up two sick Kenyan soldiers from south Somalia. I did a slight double take as you might imagine. "Don't worry from the medical report they are both very stable." Yes the medical issues were not what concerned me. Last thing I watched about Somalia was Black Hawk Down! "We just ask a doctor to go along just in case there are issues." Issues that have arisen before have included a nearby mortar attack which meant a sicker trauma patient bumped the original patient they were originally going for.<br />
The medevac went very smoothly actually but I'll admit I was nervous as we flew over the deserted south Somalian coastline.<br />
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<i>"15:00 I've just been struck with bizarre nature of my current situation. I'm flying along the coast of East Africa with two Kenyan Soldiers (both requiring hospital admission but mercifully stable) having just evacuated them from a military base in one of the most politically unstable countries in the world. It's a funny old game. Just days ago I was having a beer on the King's Road. I guess that's what makes for a rich life; a bit of variety."</i><br />
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The base consisted of shelters in between low shrubs and a few more robust but hastily erected buildings around the runway. There were customary bits of tanks and heavy artillery sitting about in the dust. An ambulance was waiting along the runway. We had a <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEho7l5xXlH8-f7kH7fKy92HmoZE3sO82B7XyBuOuL1GT3kl0IwAqZzISyHXg30R9nBVTKaEnBx-NNkjiCngo7N0IXu0JN-KtQNLwRyY_VJL6rflMWbTxFJwlecae6UWW88f05mcomKfEDM/s1600/Medevac+01+-+Kisamayo+-+Ready+to+go.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><br /></a> warm reception and, after a quick review and friendly chit-chat with the officers, the two sick privates were loaded on board. One poor lad had a nasty hand infection which needed theatre and a good wash out. And the other had what sounded very much like hepatitis A. Given the conditions the soldiers live in it was the most likely diagnosis. Not long ago a group of soldiers gradually became unwell and oedematous, stumping the medics on their base until they realised it was their diet and there was a combination of vitamin B deficiency and low protein. I'm rapidly learning each case I go to has a fascinating cultural aspect all of its own.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLlapVNx_8JK_kSlnGcsxEyni5CM9QtgDWqWeinZanyU2Bo6ZfYrL38FlRgE_U32LvJPVWNrxgb58WYNaUJ_R8w1JSqkwrYI6wXVUdvPqlt805wifmnCsQmtxKjcxRrBrK64w6nd9oN-4/s1600/Medevac+01+-+Kisamayo+-+Ready+to+go.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLlapVNx_8JK_kSlnGcsxEyni5CM9QtgDWqWeinZanyU2Bo6ZfYrL38FlRgE_U32LvJPVWNrxgb58WYNaUJ_R8w1JSqkwrYI6wXVUdvPqlt805wifmnCsQmtxKjcxRrBrK64w6nd9oN-4/s320/Medevac+01+-+Kisamayo+-+Ready+to+go.JPG" width="240" /></a></div>
I suppose what was most surprising for me was how cheerful both these young men were. At first I thought it was because they were getting out of there. Being stationed in the middle of nowhere, constantly under threat of Al Shabaab doesn't really sound like much fun. But apparently they were having a great time! Genuine sentiment or a gagging clause from their seniors, who knows. Soon we were back at Wilson and I was greeted with news that they needed me for another evacuation. "What now?" "Yes, now."<br />
<br />
So off we flew(I managed to get myself into the copilot seat for the ride) into north east Kenya where there was a young aid worker who had a high fever without a clear source and looked pretty sick according to the report. Malaria was obviously top of the differential. Malaria has a famous reputation for killing young people extremely quickly sometimes so we prepared (as they always are) for the worst.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZlPlju1ge23s5yxaD6iweThldDfP1g3X7vSRyE4Kuf4c6dUs9vEQ-E9MaS2J9JvJPaxhGTHF-e60QSOh4vRQS5xdY9eyA1uedwv42sJITD1OoPxbfbjWkb0jBjJ14JCs33NcrOubwStI/s1600/100_0031.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZlPlju1ge23s5yxaD6iweThldDfP1g3X7vSRyE4Kuf4c6dUs9vEQ-E9MaS2J9JvJPaxhGTHF-e60QSOh4vRQS5xdY9eyA1uedwv42sJITD1OoPxbfbjWkb0jBjJ14JCs33NcrOubwStI/s400/100_0031.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A cumulonimbus cloud yielding a rainbow in its downpour</td></tr>
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<span style="text-align: center;">The skies over the plain was beautiful, full of fluffy bright cumulus sitting with their flat bottoms at only 3000 ft. As we approached the refugee camp I was amazed by the expanse of featureless landscape. There were genuinely no bumps or undulations in it for as far as the eye could see. In a way it reminded me of flying around Antarctica!</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUPQKCeelTvMJQfsHEW_SrQAUjnsT_GYbcZMRIEUrK6zj7cTTBpJAWSnXVUZdAeO_olfh6g8BIjEaQWa_HCkvkgS-z1xb60SKaF-2GuZB6H3rv5B6hhMmFX-W1nsrKokrQoQHasJKNDwU/s1600/100_0035.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUPQKCeelTvMJQfsHEW_SrQAUjnsT_GYbcZMRIEUrK6zj7cTTBpJAWSnXVUZdAeO_olfh6g8BIjEaQWa_HCkvkgS-z1xb60SKaF-2GuZB6H3rv5B6hhMmFX-W1nsrKokrQoQHasJKNDwU/s320/100_0035.JPG" width="320" /></a>My stress levels settled with the dust blown up from the prop as I could make out the patient standing holding her own fluids by the runway. It appeared she had got much better in the few hours since we got the call on merely IV fluids and paracetamol. Her fever had broken and her worrying vital signs (that would have got her triaged straight into the resuscitation room in my Emergency Department) had all normalised. In fact she was fairly cheerful. There were no facilities to diagnose or treat malaria where she was so she still needed evacuation. She again was rather sorry to have to go.<br />
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As I handed over her case in Nairobi to the nurse the phone went again! Did I have the energy to squeeze in one more flight? There was a little girl in Tanzania who they were concerned had meningitis. The report did not suggest a critical patient at all but the doctors there were very worried about her due to the onset of an odd rash and a headache.<br />
<br />
So off we flew just as Wilson Airport closed and headed south east into the dark. Approaching Dar es Salaam I was enthralled by the lights of the city. It sparkled. Each light blinking at its own rate. It was stunning to watch. I don't know for sure, I tried to work it out as we descended, but I think there must be loads of short and leafless trees in between the single story buildings.<br />
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We waited in the claustrophobic stickiness of the evening watching the airport floodlights swarm with mosquitoes, massive bugs, bats and large cranes swooping back and forth out of the dark. A bird strike with one of those big birds would definitely down a small aircraft like ours. Luckily they were far too interested in the temporary floodlight ecosystem to bother with the gloomy runway.<br />
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Again we were greeted by a patient who was in considerably better shape than we had been led to believe. It seemed that during the course of the day the high dose of IV antibiotics, antipyretics, fluids and antiemetics had really turned her clinical state around. The rash was an innocent speckling of pink fading macules. Either the drugs had performed a miracle or this little girl did not have meningitis or any evidence of an serious bacterial infection. In fact she chatted with me and her mother the whole journey. It was difficult to get a word in edge-ways or write my notes she had so many questions! I trust she will now be doing just fine. After handing her case over at the children's hospital we took the ambulance back towards Wilson Airport and I reflected on my first day at work. Three transfers, four stable patients with little medical intervention required and visits to another two countries was not a bad initiation. I settled down to sleep at about 02:00 tired but buzzing. Or was that the anopheles mosquito that snuck into my room?Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0tag:blogger.com,1999:blog-7492413488880336559.post-79183773218300855152013-05-03T23:47:00.003-07:002013-05-03T23:47:45.648-07:00Images from the first week<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKmR3qpwx4QmB09FCdfRs6janBIQfUUHH9UlIIprUN1lgai6Pv0tCfFSKYo_6MMq6K8pmPGDDMa-AUDqCxD-Fb6z0Bg7TOpwEm4ZVfxDPS3WOMrCpEHgPYStnkRSwpVbbbibiOjEtBS-A/s1600/100_0032.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKmR3qpwx4QmB09FCdfRs6janBIQfUUHH9UlIIprUN1lgai6Pv0tCfFSKYo_6MMq6K8pmPGDDMa-AUDqCxD-Fb6z0Bg7TOpwEm4ZVfxDPS3WOMrCpEHgPYStnkRSwpVbbbibiOjEtBS-A/s640/100_0032.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The vast flat featureless land around Dadaab in north east Kenya. <br />(A comment from Kirk Watson, the great Antarctic and African explorer and film maker <br />"Aah the African plains and fair weather cumulus. Masuri sana.")</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">One of the many AMREF aircraft, flown and owned by Pheonix Air</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmQN90qjdPljkbpN6362_4G9Mp5ZHPFHZjFi9njDqPYwNd1VogaVKHegDkJSdVS-ug9WQ2qPhg-f65QNfqpeMFq_TowgH0bnu_bRd13OAnsgtjwjlieTP1CtO4MRYdgYnvDoVmO01yDzY/s1600/100_0029.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmQN90qjdPljkbpN6362_4G9Mp5ZHPFHZjFi9njDqPYwNd1VogaVKHegDkJSdVS-ug9WQ2qPhg-f65QNfqpeMFq_TowgH0bnu_bRd13OAnsgtjwjlieTP1CtO4MRYdgYnvDoVmO01yDzY/s640/100_0029.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The runway at Wilson Airport</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Flight nurse Festas and I wait for a patient at Dar es Salaam Tanzania</td></tr>
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<br />Matt Dochttp://www.blogger.com/profile/09282905519639395747noreply@blogger.com0