Pilot report: critical night flight

When life is at stake, our planes are air ambulances, speeding critically ill patients to hospital. Pilot Derek Reeh explores the nature of medical emergency flights - including an unusual night event...

written by Derek Reeh

What is a medevac?

Medevacs (medical evacuations) often feature prominently whenever people talk or write about MAF flying. Yet in Kenya, such flights comprise a tiny percentage of the total flying that we do.

Our routine flights contribute to the care of many thousands of people, bringing them Christian spiritual support and care in the form of programmes that address fundamental needs such as education, food sustainment, infant and maternal nutrition, and medical aid – programmes that save hundreds of lives each year.

Why then is it that medevacs, usually of just a single person, attract such a disproportionate amount of attention?

Probably the answer lies in the immediacy of the need. Our routine flights in the main are addressing long term deprivation.

With most medevacs the individual concerned is likely to die within days, if not hours, and getting the person promptly to a location where they can get the medical care they need becomes an overriding priority. Yes our routine flights help save lives – but in the long term. Medevacs save lives – now!

On call

Nairobi has the most capable hospitals in East Africa – with at least two that would not shame any city in the ‘developed’ world. Hence, with its base in Nairobi, the MAF Kenya programme tends to find itself being called regularly (two or three times per month – and sometimes more) to carry out medevac flights.

Very occasionally the medevac flights are an ad-hoc addition to more routine flights: the aircraft arrives at an airstrip in northern Kenya or Sudan to be met with a request to take a seriously sick or injured person to hospital. In such cases pilots do the best they can to accommodate the need and make the patient, who will normally be accompanied with a carer who may or may not be medically trained, as comfortable as possible.

However, in the main the programme partners with Intensive Care Air Ambulance (ICAA), a Nairobi-based organisation that, whilst it has no medical staff or aircraft of its own, project manages medical evacuations in the East Africa Region. ICAA have a small administrative staff who receive the call for the evacuation and then arrange the aircraft and a medical team to go to the closest suitable airport/airstrip to the patient’s location and bring them to Nairobi.

The medical team comprises a consultant anaesthetist and theatre nurse, who work in Nairobi hospitals and have agreed to be ‘on call’ for ICAA. Similarly, they select an air service provider from a list of airlines that are also prepared to be ‘on call’. To our credit, MAF is at the top of their list. {COL 1/3]

Evening emergency

One evening in 2008, I was telephoned at home in Nairobi by our duty Operations Coordinator and asked to fly that night to Kampala, Uganda, and bring a critically ill patient with kidney failure to Nairobi.

By the time that I arrived in the MAF hangar at Wilson airport, some 40 minutes later, the ICAA aircraft preparation team had arrived and, together with our Operations staff, were configuring the passenger cabin of one of our Caravans to turn it into an air ambulance and mobile intensive care unit.

Most of the seats had come out, some of the seats had been turned to face aft, a stretcher had been locked to the seat rails in the floor on one side of the cabin, and medical equipment such as a resuscitator and oxygen unit was being installed.

After hours

One of the challenges of night medevacs from Wilson airport is that the aerodrome closes at 8:30 PM. Hence, there is no air traffic control, no runway and taxiway lighting, nowhere to file an international flight plan and the people that drive the fuel tankers have gone home.

However, we do have contingency plans: we hold in stock a number of portable ‘roadwork’ lamps that we can put out to mark the runway edge; we have a procedure, approved by the Kenya Airports Authority, for using Wilson airport outside normal working hours; we can file the flight plan by telephone to the Nairobi control centre; and we hold sufficient fuel stock in 200 litre drums to refuel an aircraft completely. So while some of our team carried out the refuel, Douglas Kimanthi, our Operations manager and I, drove out on the airfield to inspect the runway and place the lamps at suitable points at the edge.

The airport security police came to check on our activities and gave us approval to depart; I spoke by radio to the radar controller at nearby Jomo Kenyatta airport to get an air traffic airways clearance; and finally at 10:40 PM the lights that Douglas and I have deployed slipped out of sight under the aircraft nose as we got airborne over the dark void of the Nairobi National Park and turned right for Entebbe airport some 400 miles to the west.

Dodging storms

As we head towards Lake Victoria at 12000 ft the weather radar shows the ominous red and purple returns from massive thunderstorms some 60 miles ahead. Looking outside the darkness is periodically illuminated by flashes of lightning that fill the upcoming clouds and illuminate the ground.

Even though we wend our way between the storm clouds the lightning looks perilously close. I know that the discharges are several miles away and would probably be invisible in daylight; but by night thunderstorms look much worse – or maybe by day ignorance is bliss!

A couple of hours after take-off the lights on the Uganda shore of the lake came into view and at 1:20 am, some 2 hours and 40 minutes from leaving Nairobi, we were taxiing to our stand at Entebbe airport. The doctor and the nurse were whisked away to the hospital in Kampala to collect the patient and I was left to pay the airport charges and file the return flight plan with a rather sleepy duty operations clerk.

It took a while for the medical team to return to the airport. At around 3:00 AM on the stand next to me the an Ethiopian Airlines flight arrived from Addis Ababa and at about 4:00 AM, at the stand on the other side, I watched a Kenya Airways crew carrying out pre-flight checks on the their Boeing 737 for the early morning flight to Nairobi.

A few minutes later the flashing blue lights reflecting off the windows of the terminal building heralded the arrival of an ambulance. The ICAA medical team transferred the patient to the stretcher in the aircraft and connected up monitors and drips.

We were airborne 10 minutes before the Kenya Airways flight and landed at Nairobi about an hour after them shortly after dawn on a rather cloudy and rainy Wednesday morning. An ambulance pulled up along side the Caravan as we arrived on the stand and the patient was rushed away with lights flashing and sirens blaring through the Nairobi rush hour traffic to the Aga Khan hospital. I went home to bed……..

I’m glad to say that the patient was discharged a few weeks later and returned to Kampala – this time in a seat, not a stretcher, and on Kenya Airways, not a MAF air ambulance.

Responding to need

In the Bible, Matthew chapter 25 is a rich source of direction for those called to MAF: verses 14 to 30 teach us to develop our talents; and verses 34 to 40 describe how we should respond to those in need.

In a previous life I was a test pilot playing a role in the development of the Eurofighter Typhoon. Expanding the flight envelope of the RAF’s latest fighter aircraft plus flying first flights on one of the prototypes and the RAF’s first production aircraft provided great job satisfaction.

However, it was nothing compared to the knowledge that one uses one’s skills, developed over 30 years of professional flying, occasionally to help save a life and daily to improve, both physically and spiritually, the lives of some of the world’s poorest people in the planet’s most inaccessible areas.