Interview: Dr Lucy Ng’ethe, Phoenix Air Ambulance
Mandy Langfield spoke to Dr Lucy Ng’ethe, Phoenix Air Ambulance, about the unique African operating environment and the challenges of working effectively with assistance providers
Firstly, could you tell us about Phoenix Air Ambulance (PAA) – its development and current status with regards to fleet, number of employees and area of operations?
PAA was started in the last quarter of 2019 and is the aeromedical service owned by Phoenix Aviation Ltd (PAL), which was founded in 1994. For over 20 years, Phoenix Aviation was the aviation partner providing aircraft, flight crew and equipment for another international air ambulance provider.
PAL has a 24/7 flight and medical operations control centre based at Wilson Airport, Kenya. We have a mixed aircraft fleet that includes one Cessna Citation C680 Sovereign, a Cessna Citation C560XL Excel, three Cessna Citation C550B Bravos, one Beechcraft King Air B300, two Beechcraft King Air B200s and one Cessna Grand Caravan C208B EX.
The medical team includes 12 ICU specialists, 14 ICU nurses and EMT ambulance drivers.
We carry out medical evacuations and repatriations to and from the entire continent of Africa, including the offshore Islands on the Atlantic and Indian Oceans, the Middle East, Asia, Far East and Europe.
What’s your background in emergency medicine, and what drew you to aviation?
I am a consultant anesthesiologist with an interest in prehospital and emergency care. I got into aviation medicine as a part-time flight physician in 2011. The opportunity to work as a volunteer physician in the industry materialised, allowing me more time and experience in this specialty. I got to interact with others passionate about aviation medicine and my fascination kept growing.
In 2019, I was invited to join Phoenix Aviation and steer the setting up of its aeromedical service. I took up the challenge and dived into full-time aviation medicine. It has been a four-year journey, filled with learning and development for myself and the Phoenix team.
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.