Simon Forrington / Anaesthetics Registrar
Dr Simon Forrington is a UK anaesthetics registrar with a penchant for working high in the sky over Africa. Read about an AMREF patient evacuation of a critically injured patient after a Hyena attack, just one of his experience in East Africa last year.
Its 2am. The phone rings and I’m woken from a deep sleep. I clumsily reach under the mosquito net and feel around for the increasingly indignant machine. Through the fog of awakening I register the voice of the AMREF Flying Doctors Shift Coordinator and my mind immediately clears. We have an emergency aeromedical retrieval and must leave at first light. The patient has been attacked by a rabid hyena in a remote rural area of northern Kenya and is in a critical condition. The local hospital does not have the facilities to cope and it would be too dangerous to attempt a landing on the rutted field which masquerades as a bush airstrip at night. A taxi is arranged to ferry me to the airport at 6am and I sleep fitfully for the remainder of the night, my mind unwilling to let go of what the morning might bring.
I am in Nairobi, working as a volunteer physician for AMREF Flying Doctors, taking time out from my day job in the UK as a Senior Registrar in Anaesthesia and Intensive Care Medicine. I have been here for several weeks, flying missions across East Africa and beyond with a professional and highly skilled team of flight nurses and pilots.
I arrive at the airport as dawn is breaking and check our equipment with Maurice the Flight Nurse. The clinical information is often patchy and we prepare enough kit for most eventualities. We check our medication supplies, oxygen and ventilator and load everything carefully into the back of our single-engined Cessna Caravan. In the hands of our skilled pilots, these aircraft can land almost anywhere but they have an unpressurised cabin. The low oxygen environment this creates can compound the difficulties of evacuating critically unwell patients and we take this into account as we prepare our cylinders.
The engine roars as the pilot eases the throttle forward and we take off steeply, banking hard right over Nairobi National Park. I see an ostrich far below, standing unconcerned on the savannah and a small herd of Thomson’s Gazelles scatter at the noisy intrusion of our engine. My ears pop as we climb up through the clouds and I can see the familiar summits of Africa’s two highest peaks rising above an undulating white carpet. Mount Kenya to our left and Mount Kilimanjaro resplendent in the morning sun to our right.
Two hours later and we bump along the grassy airstrip, coming to a halt by a ramshackle collection of buildings. The place is deserted, already beginning to bake beneath an unforgiving equatorial sun. A few minutes go by and we check our equipment once more as a ubiquitous Toyota Land Cruiser draws up. I jump in the back to make an initial assessment of the patient and note that he is already intubated beneath heavy bandages which cover a badly injured face and head. The tube is not connected to a ventilator and the patient has not been sedated or given any pain relief for some time. His hands and arms are also heavily bandaged and I can only imagine the trauma of trying to fight off such a strong and dangerous animal. I try to put the thought out of my mind and concentrate on the job in hand.
The medical team in this remote outpost have done a good job but they are very limited in terms of resources. AMREF Flying Doctors however are very well equipped and following my primary survey, I set about attaching monitoring, securing intravenous lines, sedating the patient and establishing him on our Oxylog 3000 ventilator. Having accomplished this, we gently move him onto a stretcher and into the back of the aircraft. I am worried about the airway and about on-going bleeding and we carefully take down the dressings. I assess and optimise the position of the endotracheal tube and we carefully inspect the wounds, cleaning them thoroughly with betadine before applying haemostatic pressure dressings. He will require extensive surgery but my priority now is to get him safely and quickly to one of the large, well equipped hospitals in Nairobi.
Once airborne I take a venous blood gas which we can immediately analyse using our portable blood gas analyser. I administer antibiotics and set up infusions of propofol, fentanyl and, crystalloid fluid resuscitation. He has a haemoglobin of 60g/l but we have no blood to give; this is in very short supply in East Africa and often provided only by family members.
We land back at Wilson Airport two hours later and move our patient into AMREF Flying Doctors’ ground ambulance. Our driver weaves through the notorious Nairobi traffic and we arrive at the intensive care unit of a large Nairobi hospital. Having handed over his care to the team at the hospital, we head straight back to Wilson Airport. Shaun, our Operations Director is waiting for me on the airport apron with our Citation jet fully loaded and ready to go. A patient has severe malaria in the Democratic Republic of Congo. Here we go again.
Working with AMREF
I would encourage other appropriately qualified medical staff to consider volunteering: working with AMREF Flying Doctors has been one of the highlights of my medical career so far, and the team there are some of the most dedicated and professional people I have ever met. Evacuations as described above are paid for by the AMREF Flying Doctors, and in the above case, following a prolonged stay with several surgeries under Maxillo-facial and Plastic Surgeons, the patient’s hospital bill was settled by the Kenyan Wildlife Service.
For more information, please visit www.flydoc.org.
For more details and photographs of Si’s work in Africa, follow his blog.
