Despite the fact that the most common means of transport in Kenya is by road, the roads across the country are poorly maintained and monitored. This lack of basic repair and maintenance, coupled with reckless driving by motorists and an almost futile attempt by the government to legislate appropriately to minimise traffic accidents, combine to make road traffic accidents one of the leading causes of death in Kenya.
Public service vehicles are often driven hard and badly, with many drivers traveling enormous distances and long hours without adequate rest. The reduction in concentration and the desire to cover as many miles as possible as quickly as can be, causes reckless and ultimately dangerous driving techniques.
Around 0100 on January 19, 2009, along the Mombasa-Nairobi Highway around Makindu District, a driver of a bus was involved in a head on collision with a lorry, killing 24 passengers on the spot. The survivors, many of whom were severely injured, were rushed to the Makindu District Hospital.
Around 1230 pm AMREF Flying Doctor Service received a distress call from Dr Saidi, the medical superintendent at the Makindu hospital. The hospital was ‘overwhelmed’ by the number of the critically ill patients and medical supplies were almost exhausted. Even vital oxygen in the hospital had run out by 10 am that morning.
Dr Saidi had managed to give anti tetanus toxoid, taken basic x-rays of some of the patients, and had eked out the little stock of pain killers the hospital had, to be shared by the patients most in need. The Doctor advised that six of these patients were in a critical state and needed advanced life support, which the hospital did not have.
AMREF’s Medical Director, Dr Bettina Vadera made a quick decision to assist the victims, knowing it would require 3 of our aircraft to be able to bring all the patients to Nairobi where they could access specialized care.
Dr Vadera then decided to approach the Kenya Police to assist with a helicopter that could accommodate the six stretcher cases, which the police readily provided.
A medical team of 3 emergency flight nurses and two medical doctors [anesthetists] together with the support equipment and all the necessary supplies was prepared for the flight. The AMREF FDS team was divided in 2 groups, each comprising a nurse and a doctor, leaving one nurse in between to act as a ‘runner.’ The aircraft took off from Nairobi at 15.40hrs, landing at Makindu Airstrip 40 minutes later, where they were transported by the police to the hospital using two 2 pick ups.
On arrival at the hospital, Dr Saidi met the team and showed them two vehicles parked at the gate, each with sick patients as there was no room for them in the hospital.
In the first ambulance that team found an adult African female with a cut on the side of the head, already bleeding through the bandage. She had a severe head injury along with a skull fracture and was breathing with difficulty. Using the medical equipment the team had brought, which included vital oxygen, they were able to secure her airway by use of an endo tracheal tube [inserted through the mouth to the wind pipe to deliver oxygen to the lungs]; connect her to the ventilator [life support/breathing machine] and give her medication for the pain.
The patient in the other ambulance was an adult male. Although responding to verbal commands and to painful stimuli the patient was in a lot of pain from an injured right arm. Through an intravenous line he started receiving fluids and was also given pain killers.
The next patient was an African male, found in the Casualty department lying on the bed, totally still and barely breathing. The team secured his airway and connected him to a ventilator, adding a neck collar and fixing an intra venous line to give him vital fluids.
With all available beds already full, some patients were forced to lie on the floor. In the crowed male ward was an adult male, groaning in pain, the plaster on his right leg was stained with blood. His earlier x-ray had revealed a broken leg. He was given pain medication, IV fluids and supplemental oxygen.
Crouched in the corner next to him was a young boy, seated on the floor with his knees curled up to his chest. Although conscious and not crying or complaining he appeared quiet and distant. The tem examined him and found his abdomen very tender to the touch and he was more comfortable on his side lying in a curled up position. The team realised this suggested internal bleeding or damage to the internal abdominal organs and an immediate decision was made to bring him to Nairobi. He was given pain killers and fixed with an intravenous line.
Also on the male ward was an African man with a severe head injury and multiple facial lacerations. He appeared very pale and was put in a neck collar; his airway secured and connected up to yet another ventilator.
In the female ward they found an adult lady with a deep cut wound on the head and a severe head injury. She was breathing shallowly and making abnormal desperate outwards movement with her hands. The team quickly inserted an end tracheal tube and put her on a ventilator. An intravenous line was fixed and IV fluids commenced.
There were many other patients with various injures who would have benefited by being moved to Nairobi as soon as possible, but as the helicopter could only accommodate the sickest 7 patients the two teams made the difficult decisions on just who should be moved on to Kenyatta National Hospital and arranged their transport from the wards to the airstrip.
The Police provided great assistance in transporting the patients back to the aircraft and the entire team and patients were airborne to Nairobi at 18.40hrs.While in flight they continued monitoring the patients, giving more pain medication as required, and hydrating the patients using IV fluids. They also continued ventilation for the 4 patients who were unable to breath on their own and gave oxygen by face mask to the remaining ones who were able to breathe spontaneously.
At 7:30 pm, the aircraft landed at Wilson Airport and was met there by three of AMREF Flying Doctor Service ambulances and another from Kenyatta National Hospital. The patients were taken directly to Kenyatta National Hospital and were met at casualty by the surgical team. The AMREF Flying Doctor Service Medical Team gave a short medical history of each of the patient and the hospital allocated the different cases to each specialised area of the hospital.
Faced with a human tragedy with many contributing factors, the speedy response of AMREF Flying Doctor Service and the cooperation of the Police Air Wing supplemented the arduous work load that Makindu Hospital had been given. Together they provided a vital life line to ensure that at least some of the victims received the best possible treatment enabling them to begin the long road to recovery.
Medical Crew:
Dr Joseph Lelo, Dr. Thomas Klausnitzer, Anthony Kihara, Mildred Adhola, James Mwaura
