Humble beginnings

In 1957, spurred on by what they had seen of the combined effects of poverty, tropical diseases, and a lack of adequate health services in East Africa, the collective vision of three surgeons – Sir Michael Wood, Archibald McIndoe and Thomas Rees – was born in the foothills of Mount Kilimanjaro. At the time, there was one doctor for every 30,000 people in East Africa, with medical facilities being sparse, and this was compounded by rough terrain and often impassable roads, resulting in difficult access to medical care for people in rural and remote areas. As this was where the majority of the population lived, Archie, Tom and Michael saw an air-based service as the only way to get healthcare to remote communities.

Key goals

AFD’s main goals are to: deliver internationally accredited aeromedical and health assistance services in the best and fastest way possible; invest in its people; leverage the latest aviation and medical technology to ensure its patients receive the finest care; and support the work of Africa’s largest health development organization, Amref Health Africa, and offer its services free of charge where there is humanitarian need.

A unique service

AFD is a social enterprise that is different to most of its competitors in that it is fully owned by Amref Health Africa. Any surplus generated by AFD supports Amref Health Africa’s humanitarian work and is crucial in helping the organzation achieve its mission of effecting lasting health change in Africa.

A fully functioning fleet

AFD has a fully owned fleet of aircraft ranging from short-field Pilatus PC-12 to long-range jet aircraft including Citation Bravo and Citation XLS. This mix of turbo-prop and jet aircraft is available to evacuate patients from remote bush airstrips in the region, as well as for long distance repatriation to other continents.

Medevac missions

About 80 per cent of AFD’s medevac missions are secondary missions, where patients are evacuated from a facility with minimal medical care. This includes evacuations from rural health centers, remote facilities that have no medical specialization and only minimal, basic means. The other 20 per cent are primary missions where patients are evacuated directly from the scene of an accident or from a location where there is no medical care available.  

Innovative equipment

AFD uses state-of-the-art medical equipment and frequently upgrades depending on need. This year, it will upgrade all of its cardiac monitors to the latest Zoll X-series and add an ultrasound machine as part of the onboard equipment. It has also invested in handheld laboratory equipment (Istat) and a portable incubator.

Overcoming challenges

During the 60+ years that AFD has been in operation, it has acquired considerable experience and knowledge of the region and how to operate in and out of Africa as an air ambulance service provider. The company has steadily developed and progressed in the context of the difficulties that come with operating in Africa, including the medical and aviation challenges posed by the environment, border conflicts, corruption and other constraints. It has a clean safety record and has conveyed to the insurance and assistance industry, as well as local and regional communities, that it is here to stay and that they can trust and rely on AFD. Its proudest achievement to date is the successful growth and full ownership of its fleet, enabling AFD to transfer patients to better centers of medical care worldwide.

Reflecting on 2019

Last year was an important year for AFD, following the operationalization of two dedicated air ambulance jets that had been acquired in 2018. A significant moment during the year was the announcement of Dr Bettina Vadera’s resignation from her position as Chief Executive and Medical Director, effective 31 December 2019. After 21 years of service as an Emergency Flight Physician, Medical Director, and for the last eight years as CEO, Dr Vadera decided to relocate to Germany mid-2020 for family-related reasons. During her long service, she was instrumental in achieving great changes for the organization. Under her leadership as CEO, AFD developed from an aeromedical outreach program of Amref Health Africa into a successful, award-winning and accredited international air ambulance.

What’s next?

AFD now looks to an even brighter future with the incoming CEO, Stephen Gitau, who has worked closely with Bettina over the last eight years as Chief Finance and Administration Officer. Dr Joseph Lelo, who has been AFD’s Chief Medical Officer for over 10 years, will head up the Medical Department, and will continue to work with Dr Vadera who will support AFD on a consultancy basis as Chief Medical Advisor while she is still in Kenya. On the Aviation Operations side, Michael Black remains in the critical role of AFD’s Chief Operating Officer, ensuring quality, safety and efficient operations across the organization.

Looking ahead to the next five to 10 years, AFD will continue working to pursue the achievement of its vision: to be the leading Africa-based aeromedical and health assistance service provider, and will continue responding to its client needs by making appropriate investments in its people, systems and processes.

Ombuya recounts a particularly challenging mission in which AFD responded to a bandit attack in Kenya

On the afternoon of Sunday 25 August 2019, AFD’s control center received a distress call requesting for the urgent airlift of three critically wounded minors from Forole, a location on the Kenya-Ethiopian border, to be evacuated to the capital in Nairobi.

The three critically wounded included two boys (16 and 14 years old) and a girl (six years old), all of whom had sustained severe gunshot wounds following a bandit attack. Their medical condition was dire and beyond the capacity of the locally available medical facility, hence the request for the medevac. The three patients were therefore referred to Kenyatta National Hospital, which is the largest referral hospital in East Africa.

Unfortunately, relatives of the minors could not afford to pay for the cost of the crucial medevac, which was compounded further by the fact that road transport was not an option. This was due to the condition of the patients and the distance to be covered – over 700 km, or more than a 12-hour drive, as well as the dilapidated conditions of the roads.

The closest airstrip was approximately 120 km, or a two-hour drive, from the area of the attack. The condition of the airstrip for safe operations was unknown at the time of request for the medevac, and it was restricted to day operations only. This meant that the AFD operations team and control center had very limited time to plan all of the logistics, as well as dispatch the aircraft. Also concerning was the security situation on the ground following the bandit attack.

A small team comprising the medical director, medical co-ordinator, chief pilot, head of safety and the operations manager, was quickly formed to consider the totality of the request from a medical, operational and financial point of view. After a short discussion, it was decided that AFD would carry out the evacuation at no cost to the patients or their families, with the medical and operations team given clearance to proceed with the mission.

The operations team’s challenge was to confirm the condition of the airstrip as serviceable and ensure that flight operations would not go into the night. In this regard, it engaged a local community of contacts, who performed a physical inspection of the airstrip, with pictures and videos sent to the team in Nairobi via WhatsApp.

The medical team’s challenge was to have the patients moved between their current location and the airstrip without their condition deteriorating. In this regard, they engaged the local government health facility to assist in the ground transfer while maintaining vigilant contact with them during the movement.

The single-engine Pilatus PC-12 departed Nairobi at 15:30 hrs local time with a flight time of 1.4 hrs and a planned ground time of one hour to stabilise the three patients. Touchdown was at approximately 17:00 hrs local time; however, the patients were nowhere to be seen. The crew was briefed by a local representative that one ambulance with two patients was en route to the airstrip while a second one had been delayed due to a tyre puncture.

The first ambulance arrived an hour after the aircraft had landed and the medical team began to attend to the patients, immediately cognisant of the local sunset time of 18:30 hrs. The team managed to stabilise the two patients and load them onboard the aircraft in good time. Due to the time pressure, the captain decided to depart, leaving the third patient, who was yet to arrive at the airstrip, behind.

However, in the nick of time, as the pilot was starting up the aircraft, the second ambulance was seen approaching at a distance. The captain decided to wait so the second patient could be loaded. The medical team promptly stabilised the third patient and assisted by members of the public present at the airstrip, quickly loaded the patient into the aircraft. The aircraft was airborne barely after dusk, bound for the capital as the medical team continued to monitor the vital signs of the patients on board.

On touchdown at Wilson Airport at around 21:00 hrs, they were received by the AFD’s Advanced Life Support Ground Ambulance, in which the three patients in critical condition were rushed to and handed over at Kenyatta National Hospital.

AFD was founded on the principle of providing critical medical assistance to patients – mostly in remote parts of Eastern Africa – who are unable to afford it. As such, it continues in this tradition whenever called upon so it can keep doing what it does best – saving lives, irrespective of the individual being saved.