Pushing the envelope of helicopter medevac…
on Random Uganda (Uganda), 23/Feb/2010 08:50, 34 days ago
kampala, looking east to lake victoriaMbarara district referral hospital in the right lower corner.Kampala's old taxi park (left lower corner), from the airDave flies the helicopter with a couple of patients lying next to himFebruary 21stIt’s Sunday afternoon and I’m visiting Guustaaf out in Ntiinda. I’ve decided to go climbing in the Rwenzoris next week and Guustaaf has been kind enough to lend me some of his gear.(Just in case you get worried that postings here are drying up and I’ve disappeared or checked into detox or something—no, I’ll just be in the mountains for 8 or 9 days.)Tom calls and asks if I want to fly to Mbarara. I say sure, but tell him I’m in Ntiinda (about 20 minutes by boda or 40 minutes by matatu from IHK). He says that they want to take off right away. I give him the option of sending Dr. Christine from OPD or waiting for me to boda over. He talks to Dr. Christine and tells me to get on a boda.It is pretty clear my boda driver has no idea where IHK is. I have to turn him around after he makes a turn on Kira road towards town. So we’re headed down the Lugogo bypass (picture a big white guy sitting on the back of a small motorcycle wearing a backpack with an iceaxe attached to it…) and another bigger motorcycle goes by, slows, looks at me, looks at the iceaxe. Turns out its Dave, the helicopter pilot. I tell my driver tofollow the guy with the yellow helmet and we make the illegal U-turn across Jinja road and scream through the industrial area. I show my driver the shortcut through the slum up onto Namuwongo road, so we beat Dave to the hospital by a good five seconds.It turns out that a 4x4 full of evangelists blew a front tire about 9am outside of Ntungamo and rolled several times. An elderly couple from Tennessee were pretty banged up and couldn’t walk and a couple of other people were injured as well. They wanted to know if we could fly all four to Kampala—in a helicopter designed to carry 5 passengers seated. Typically, if we fly for a patient that needs to lie down, we take out the front passenger seat and fold up the back seats—which barely allows room for a stretcher to be strapped to the floor. Dave did the numbers, though, and figured we could carry 3 patients and me and my medical gear. We decided that instead of the stretcher, (or spine board, or any of that crap) we would just put a bunch of cushions down on the floor and squeeze the two supine patients in between the control column and the door…While I was on the phone trying to track down the doctors in Mbarara, Dave was on the phone getting a guarantee of payment. (missionaries or no, the helicopter is a strictly mercenary business—Dave said he told the guy what the per hour charges were and how long the flight time, and the guy said okay, he’d pay for one hour of flight time, and Dave would just have to fly faster!) I managed to get one of the doctors at Mbarara district referral hospital on the phone. He said that hewas taking one of the patients to the theatre. He said we should come and pick the patient in four hours. I told him that in four hours it would be dark. And we don’t fly in the dark. He said something to the effect that we had a big problem. And hung up on me. And didn’t answer his phonethe next 4 times I called.Fortunately the thunder storms from Friday night had abated and we have clear flying to the football pitch across the road from the hospital. Fortunately, as well, the field is surrounded by fencing which keeps most of the Mbararans from running into the area where helicopter blades are spinning (although later on we had to shout at the spectators snapping pictures of the injured patients with their cell-phones). Moving the patients to the helicopter proved problematic. Actually even moving them through hospital—strangely enough not equipped with ramps for wheelchairs or gurneys—was difficult. But we managed to get them slid onto the floor of the hospitals ambulance and over to the football field without damaging them any further.Without being indiscreet, or violating patient confidentiality, let’s just say that our patients are not small people. And that getting them loaded into a space smaller than a twin mattress and getting the door shut took some doing.The flight back to Kampala was relatively uneventful. Dave’s record of 9 years of flight time and never having an airsick passenger was interrupted as the third patient (sitting next to me) hurled into a plastic bag that later proved leaky. And the other two patients kept complaining of being hot. As I tried to explain to them that both the windows were open as far as they went and the helicopter didn’t come with A/C.But we all survived the flight and managed to get them checked into the ICU without further drama or trauma and still able to move all their toes and fingers. Some where along the line, some perky 3rd year American internal medicine resident who somehow was related to the church sponsoring our patients showed up and started barking orders at the ICU nurses:‘why haven’t the neck x-rays been done?’; ‘what are the CBC results?’; ‘what do you mean they haven’t had a CT scan done yet?’; etc., etc. I had to take him outside and explain to him that one (in case it wasn’t painfully obvious) IHK is not Mass General, and two, he didn’t haveprivileges work in Uganda, let alone IHK, and that he should just shut up and enjoy the ride.As of this morning, the patients were doing well and getting ready to leave the ICU.For a very unflattering picture of me (that’s me bending over, stabilizing the patient’s head and neck as he vomits next to the helicopter) in one of Uganda’s national newspapers.