Case study: AMREF Flying Doctors transport a complex patient from Lubango in Angola

As with many missions for AMREF Flying Doctors, the pick-up destination was a rather unusual one, namely Lubango in Angola – a small town southwest of the capital, Luanda. The patient, a 50-year-old male, had been admitted to a local hospital with a multitude of challenges – including sepsis and intracerebral bleed – requiring a repatriation via air ambulance back to Porto, Portugal.

Perfectly equipped for all needs – both in the medical and aviation fields – AFD’s Air Ambulance Team immediately started its evaluation and obtained all required information from the client’s assistance division. At this point, it became clear that no confirmed diagnosis could be obtained, thus a pre-flight hospital visit by AFD’s medical team was planned upon landing – allowing for the medical crew to evaluate the patient’s situation, transport requirements, and initiate a pre-flight treatment on site.

Well-suited for such a mission, the Citation Sovereign 680 was prepared and ready for take-off the next day. Upon arrival at Lubango, it became immediately clear that the patient was indeed in worse condition than had been originally reported. Having deteriorated, AFD found a non-ventilated patient in hypotension, acidosis and severe respiratory distress in a small remote hospital. Despite the severity of the condition, local staff were hesitant to intubate the patient, creating a rather dangerous situation. After intensive consultation with the patient’s family, the assistance company’s medical team and the AFD Operations Center, it was decided that intubation was emergent, as the patient required urgent artificial ventilation and medication to control the blood pressure and acidosis – an otherwise potentially fatal situation.

While the patient was intubated by the AFD medical team on site, its operation team rescheduled and delayed the flight for the next day, allowing sufficient time for him to stabilise before being declared fit to fly. The team stayed at the bedside for hours, monitoring and adjusting medications and ventilator settings. This ensured that the patient got ideal pretransport critical care to minimise the risk of deterioration during transfer.

Unfortunately, very little support was received from local hospital staff, including borderline hostile behaviour towards the medical flight crew, who were desperately trying to provide the patient with the best possible care before transport. Thankfully, AFD was able to successfully intervene and stabilise the patient, allowing for the transport to be conducted the next day. During the mission, the patient was continuously monitored and on steady medication for the entire transfer period. Despite a rather long flight time of more than 10 hours, the larger cabin size of AFD’s Citation Sovereign 680 allowed for optimal treatment and a comfortable work environment for the medical team. The patient remained in relatively stable condition for the entire duration of the flight.

Touching down in the patient’s hometown of Porto, Portugal, the AFD Medical Team accompanied the patient to his receiving hospital. Its medical team had already been briefed by AFD’s Operations Center, so a safe and expeditious handover to the treating doctor could be performed. Thankfully, the patient’s condition improved marginally following his arrival back home, and he continues to receive extensive treatment and rehabilitation to this day.

It is often overlooked how challenging the work in remote areas for a specialised provider such as AFD can be. With decades of experience and a real ‘prepare for every situation’ approach, AFD’s Medical Crew, pilots and operations staff once again proved that teamwork, clear communication, excellent training and a trustworthy network allow for every mission to be completed successfully. The willingness to sacrifice and go the extra mile in challenging circumstances is a key value for AFD.