GARISSA, KENYA // The call comes in during the dark hours of morning, before the east African sun crests the horizon. An elderly woman from north-eastern Kenya is sick. Her stomach ulcers are bleeding and she is coughing up pools of blood.
She could take a chance on the local medical care in Garissa, a remote town near the Somali border. But hospitals in Kenya outside of the capital Nairobi are notoriously ill-equipped to handle even basic emergencies. Besides, the woman's son is a prominent politician, and he has called Africa's largest air ambulance service and requested a medical evacuation, or medevac, to airlift his mother to Nairobi.
At Nairobi's Wilson airport, a Cessna 208 Caravan is quickly loaded with emergency supplies. The plane is kitted out with an intensive care unit set-up including a stretcher, oxygen tanks and a heart rate monitor. James Mwaura, the flight nurse, tosses in a Thomas Pack, which is full of first aid gear, and other drugs. Time is precious. If the woman's internal bleeding is not stopped, she could die. Within an hour, the doctor, nurse and pilot are on board and the plane takes off into the morning sky. Kefa Kihara, the pilot, banks hard east toward the rising sun, heading for yet another emergency.
"Every day is different," he said as the plane reached cruising altitude. "It's challenging. When you go and help somebody, I get a lot of joy from that." This is a typical day for the Flying Doctors of the African Medical and Research Foundation (Amref). The Flying Doctors cover the whole of Africa, a vast continent where hospitals are few and far between. The organisation airlifts around 600 patients each year from remote corners of Africa to Nairobi or South Africa. The Flying Doctors also medevac patients to the Middle East, Europe and Asia.
"Africa desperately needs this service," said Bettina Vadera, director of emergency medical services for Amref. "The huge distances, poor roads and very few medical facilities literally screams for an air ambulance service." Each flight is different and there is no typical patient, according to Sean Culligan, the operations director. Some flights medevac tourists who have been gored by buffaloes or bitten by crocodiles in various game parks. Other missions extract wounded African Union peacekeepers in Somalia.
"We pick up people that will die if they don't get an evacuation," Mr Culligan said. "We have become quite important to a lot of people." The Flying Doctors also carry out medevacs for the United Nations and the United States military in the Horn of Africa. The US has a non-combat military presence here, so most of the soldiers' injuries are from macho on-base fist fights, Mr Culligan said. Insurance companies and members pay for the service and keep the Flying Doctors in business. But all of the profits as well as donations help fund the organisation's philanthropic endeavours including charity flights for the rural poor and an outreach programme.
The cost of running it comes in at US$7 million (Dh25.7m) a year. The outreach programme flies doctors into remote villages for a week at a time. Last year the doctors visited 150 bush hospitals and saw 26,000 patients. The Flying Doctors was founded by three western doctors in 1957, when there was one doctor for every 30,000 people in east Africa. It has since grown into a world class air ambulance service with seven on-call doctors, 10 inflight nurses and a pool of 18 pilots.
The radios, phone lines and e-mail are monitored 24 hours a day. With its partner Phoenix Aviation, the Flying Doctors have a fleet of three Cessna Caravans, four Beechcraft King Airs and three Citation Bravo jets. Helicopters are also available for rescuing injured climbers from Mt Kilimanjaro and Mt Kenya. There can be a lot of downtime between missions, but when a call comes in, the adrenalin starts pumping.
"Sometimes it's slow, but other times it's exciting," said Anthony Kihara, a flight nurse. "Nursing in a hospital and nursing in the air are two different things." The Caravan touches down at the Garissa airstrip, a cracked slab of tarmac surrounded by flat-topped acacia trees and dusty savannah. The elderly woman is driven to the airstrip. She appears weak and can barely stand. She is immediately loaded onto the stretcher, which is locked into place in the plane. Mr Mwaura, the nurse, hangs a bag of fluids attached to the woman's arm and connects her to the monitor while Dennis Muthuri, the doctor, looks at her chart and checks her vital signs.
In less than an hour, the plane is airborne again heading for Nairobi and the quality health care that will save the woman's life. Aden Duale, the woman's son and a member of parliament from Garissa, said the Flying Doctors fill a huge gap in health care in Kenya. "In the rural areas, there is a big challenge meeting medical needs," he said. "This service is needed. I trust them." firstname.lastname@example.org