Company Profile: AMREF Flying Doctors
Dr Joseph Lelo, Medical Director at AMREF Flying Doctors, tells Hospitals & Healthcare about the company's operations in East Africa, also demonstrating the team's expertise and quick-thinking during a particularly trying case of medical evacuation in Mandera County, Kenya
Why charity evacuation missions?
Access to medical care can be expensive and challenging, especially in third-world countries. Sir Michael Wood, Archibald McIndoe, and Thomas Rees, the founders of AMREF, identified this gap in East Africa in 1957 and so launched the healthcare service for people in rural and remote areas. Over 60 years later, AMREF Flying Doctors, a subsidiary of Amref Health Africa, remains committed to providing a wide range of medical assistance services and emergency life support skills training, as well as supporting Amref's humanitarian work that aims to increase sustainable health access to communities and provide lasting health change in Africa.
AMREF Flying Doctors invests in the evacuation of patients in Kenya who need urgent medical attention but cannot afford it, such as those involved in road traffic accidents, pregnancy and birth complications, and inter-tribal wars. We also conduct regular missions on behalf of the Government of Kenya through the Kenya National Disaster Operation Centre (NDOC).
These charity missions are carried out under exceptional circumstances in partnership with the county government, rural medical facilities, Kenyatta National Hospital (Kenya's largest referral hospital) and other private medical institutions in Nairobi. Patients are flown to Nairobi as it is the centre of medical excellence in the region serving East and Central Africa, as well as parts of Western, Southern and Northern Africa, with proximity to the capital city of Kenya. Over the years, the existence of this humanitarian project has had a tremendous impact on various communities, evidenced by the number of successful charity missions completed.
In emergency situations, AMREF Flying Doctors is usually contacted by good samaritans, hospitals in remote areas with critical patients, or county government officials. The medical team then critically reviews the request (taking into account the patient's condition and the availability of a receiving hospital in Nairobi to treat the patient for free) and relays the information to management for the evacuation to be approved on a charity basis.
After approval, the medical team proceeds to create a case file containing all pertinent patient information, also ensuring that all necessary medical supplies to deal with any additional complications that may arise are on hand. Then, their aeromedical counterpart – the flight operations team – oversees the clearance of the mission, the aircraft required, the landing location, and the security measures that must be in place before dispatching the flight. They also collaborate with the local community to conduct a physical inspection of the landing area prior to take-off.
Patients are flown to Nairobi as it is the centre of medical excellence in the region
When the medical team arrives at the scene, they typically receive a case brief from the medical team on the ground attending to the patient before stabilising them for the flight. While onboard, they keep track of any additional signs and symptoms the patient exhibits by performing regular checkups.
Once in Nairobi, patients are received by the AMREF Flying Doctors’ Advanced Life Support Ground Ambulance at Wilson Airport and taken to the agreed hospital. In most charity evacuations, patients are typically transferred to Kenya's largest referral hospital for high-quality medical care.
On 24th March 2021, at about 12 noon, AMREF Flying Doctors received a distress call requesting an urgent airlift of patients from Koromey village, Mandera County, after at least five people were killed and several others injured when an improvised explosive device struck their bus. Mandera, an arid region in the northeastern part of Kenya, bordering Somalia and Ethiopia, is a frequent target of terrorist attacks.
The patients and other seriously wounded passengers were admitted to Mandera County Hospital shortly after the incident. However, as their medical conditions were dire and beyond the capacity of the medical facility, the Mandera District Hospital – in collaboration with the Mandera County Government – elicited the help of AMREF Flying Doctors to evacuate the patients to Nairobi. Following a virtual meeting led by AMREF Flying Doctors’ medical director, during which logistics and possibilities for a successful transfer were discussed, AMREF Flying Doctors agreed to cover the entire cost of the evacuations, which averaged around US$10,000 per mission.
Mandera, an arid region in the northeastern part of Kenya, bordering Somalia and Ethiopia, is a frequent target of terrorist attacks
It was 2 p.m. when the team agreed that the four patients would be transferred using our Pilatus PC-12 5YFDF and 5YFDP aircraft, which are the best suited to the environment, being fitted with double stretcher systems and capable of short take-offs and landings on bush airstrips. Soon after the medical team confirmed the availability of a receiving hospital, they started assembling all the necessary medical supplies. And, at the same time, the flight operations team collaborated with Mandera County officials, who conducted a physical inspection of the landing location and required security measures for the team.
With all preparations in place, the first plane took off at 2.40 p.m., followed by the second plane 20 minutes later. Our aircraft arrived two hours later at the Mandera airstrip, which is only operational during the day, where they converged with two ground ambulances from Mandera County Hospital.
The patients suffered spinal injuries, severe chest and limb pains, and one had a deep cut on their forehead. The medical team then began stabilising the patients for flight and compiling the patients’ medical reports with the assistance of the medical team at Mandera. Unfortunately, one of the patients died as a result of the injuries they sustained.
After approximately 1.5 hours on the ground, the team managed to take off just before dark. While inflight, our medical team took precautionary measures to ensure the three patients’ stability while maintaining air to ground communication with our operations and emergency center.
The first plane arrived at Wilson Airport at about 8.30 p.m. followed shortly by the second PC-12. The Advanced Life Support Ground Ambulance was on standby to safely transfer the three patients to Kenyatta National Hospital, where they were admitted and are receiving treatment for their injuries. ■