Back 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.

"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 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.
The medevac went very smoothly actually but I'll admit I was nervous as we flew over the deserted south Somalian coastline.

"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."

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

 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.

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."

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.

A cumulonimbus cloud yielding a rainbow in its downpour

 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!

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.

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.

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.

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.

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?