Interview: Dr Lucy Ng’ethe, Phoenix Air Ambulance

The African aeromedical industry is developing fast. What is your experience of this growth, and how do you think it will develop with regards to more comprehensive coverage?

As the leading air ambulance company in the African region, we have a great opportunity to set up the continent’s aeromedical service to global standards. The stage is ready for us to benchmark and conform with the safety and quality standards already in use across the globe.

The health system challenges faced in Africa will require organic, homegrown solutions if we are to provide more comprehensive coverage of aeromedical services.

What are the primary centres of medical excellence to which you often evacuate clients, and how do you choose medical partners?

Our main partners in Kenya are found in the cities of Nairobi and Mombasa – these are facilities that offer specialist services within the region.  

Other locations where PAL medical partners are located include Dubai, Turkey, Germany, UK, India and South Africa. Clients commonly request patient transfer to these destinations once initial treatment and stabilisation has taken place.

Most insurance and assistance companies already have preferred medical partners within the region that we often transfer their clients to. 

PAL medical partners are selected based on the patient medical needs such as availability of specialist services, facility medical capabilities, facility level of care, facility compliance to international standards and client preferences, such as location and proximity.

Working with international assistance and insurance companies requires complex coordination of multiple factors and people. What are the main hurdles when coordinating a repatriation from Africa – and how do you manage them?

Difficulties when coordinating medical repatriations out of Africa include health system challenges, such as limited resources and lack of standardisation, are quite glaring. As a rule, we always dispatch an ICU doctor and ICU nurse team, in full ICU mode, no matter the mission and location. We prepare for ‘worst-case scenarios’ at all times. This approach has proved quite valuable, as our mission team functions as a fully kitted and independent ICU unit.

We have also identified specific countries where problems often occur during retrieval, and sought partners that would then back-up and support our team, should they need additional help upon their arrival at the location of the patient. 

Time differences are another ever-present factor. The mission coordination team ensures that continuous briefings take place, while also keeping track of communication between the operations crew with clients and referring team, so that any change of plan, such as delays, are notified to all players. It is critical for everyone to be aware of the time-sensitive nature of medical evacuations, as every minute counts for patients and families.

Africa is a vast continent. Unlike Europe with the EU open skies, the African airspace is not open. This creates challenges obtaining flight and landing permits. Each country in Africa controls its airspace independently, requiring a permit for each state. As an example, a flight from Nairobi (Kenya) to Accra (Ghana) may need up to seven overflight and landing permits. Whereas the medical and flight team are ready for dispatch within 60 minutes, the flight can be delayed for hours, or even days, awaiting permits.

Do you sometimes find a lack of understanding from assistance company personnel, with regards to the complexities of aeromedical operations? How can such problems be solved?

Yes, we do face those situations. There is a need for assistance companies to understand the different markets around the world, and especially in the African region. It’s a vast continent, with individual countries ascribing to different regulations, infrastructure and network capabilities.

Collaborations with partners in different African regions are important to achieve our goal, which is smooth patient transfer.

It is also vital that engagements such as global and regional air medical conferences keep taking place, so that all players collectively contribute to educating each other and the world at large.

Is there a particularly challenging mission you’ve undertaken recently that highlights the unique nature of where you operate?

We were tasked to evacuate a 55-year-old man, who presented with persistent dry cough, fever, chest pain and shortness of breath for five days. He’d been treated for acute bronchitis as an outpatient case. His Covid vaccination status was unknown, while PCR testing wasn’t possible at the time of evacuation.

Our team received a sick-looking patient with oxygen saturation at 80 per cent and breathing difficulties. They determined that he was suffering from pneumonia and started him on oxygen therapy, saturations improved to 92 per cent on oxygen 15l/min, although difficulties persisted. The team initiated non-invasive ventilation, upon which the patient’s condition improved markedly.

The patient was evacuated to Nairobi and Covid-19 pneumonia treatment was initiated by a team of pulmonologists.