24th July, 2009
Stories from the Field: Emergency Flight from Kisumu
Flying Doctor Dr. Marc-David Munk recounts an emergency evacuation
Our days were beginning in the dark, and ending in the dark, with thousands of miles of air in between.
Generally, after a busy few days, things settle down. But, when my phone rang at 9 p.m., I knew it would be a busy night. Usually pilots won’t fly into the bush in the dark but in this case, our destination — Kisumu, Kenya — had a lit runway.
We landed and a ramshackle van ambulance and two drivers met us. Maurice, our nurse, and I loaded the van and set off for the regional hospital, a 45-minute drive through potholes by shanty towns devoid of light.
We had been called to evacuate a seizing, critically ill woman from the regional hospital. We would fly her to Nairobi for free — a service AMREF offers to doctors at Kenyan district hospitals who want to evacuate their sickest patients.
The hospital in Kisumu is a concrete, dark, official looking place. Our patient was a young woman, unconscious on a bare mattress, in a ward with ten other patients and two nurses. She lay on her side choking on her secretions.
What we did next was a sudden and stark contrast between what we can do in the West and what gets done for most Africans, As ten patients fought for their lives, Maurice and I provided Western ICU care to one lucky “lottery winner.”
Systematically, I still can’t reconcile this today. But from our patient’s perspective, our intervention was all that mattered. Doing all that we could to help was the only way to proceed. If not, she would be dead by morning.
We needed to get an airway to put a tube into her trachea. The ward was dim, everything improvised and reused. As 20 eyes in the ward looked on curiously, hungrily, fearfully, Maurice injected sedatives into her bloodstream. The room was dark, her mouth was fi lled with fluid.
I could see nothing. We suctioned hard, again, again. I pushed the tube in. My glasses slipped from my face and fell to the floor. We had no fancy confirmation tools, and blind, I used my stethoscope to listen for old-fashioned lung sounds. It was in. We had to rush. The pilot had called my cellphone: the traffic controller in the tower would close the airport if we waited any longer.
Our driver started the 20-year old van. Then, the unmistakable click of a dead battery. Our monitor’s batteries were low, our oxygen tank limited, our patient on a ventilator, and the only ambulance in northern Kenya wouldn’t start. Maurice looked only slightly inconvenienced.
Leaving me with our unconscious patient, he and three other guys pushed the van from behind as the driver popped the clutch. The engine came to life. It was nearly midnight and the Captain was itching to go. As we shot across the runway, I held the IV bag, pushed a sedative, and watched as the monitor went wild with the vibration and movement of the plane.
The runway lights were shut off even before we had left the ground. We headed for Nairobi — Maurice and I, two pilots, the patient’s parents, three probably malarious mosquitoes, and our young, sick, uncertain Kenyan patient.
Related: AMREF's Flying Doctor Service