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Urgent Calls from distant places



The flight attendants made their rounds, collecting drinks and checking seatbelts. I checked that my elastic polyester document pouch was still strapped to my abdomen. In it was a passport, a few hundred US dollars, and a copy of my newly issued Kenyan medical license to show the authorities. I’d also brought a medium-sized canvas duffel bag that held enough clothes to last for a month—nothing fancy—plus some granola bars, mosquito repellent, and a pair of sturdy shoes. In a backpack, I carried my small laptop, mainly to Skype and to write a blog for friends. I’d told them I would regularly share my adventures doing medical evacuation work in East Africa over the next month. 
In an email to me, just before I left the US a day earlier, the coordinators at the AMREF Flying Doctors Service in Nairobi wrote that they were delighted that I would join them as a volunteer doctor. Get some rest, they had warned, because I’d be busy with my orientation sessions to the air ambulances and to the medical equipment in the morning. An emergency flight was always a possibility. 
I had never been to Africa, but I had worked in resource-poor settings before. I reminded myself that I was a solid emergency physician with good judgment. Also, I had exactly the right education needed to work abroad. I had staffed American air ambulances for years, and Flying Doctors had a great reputation. 
Sitting in that plane, waiting for our final descent, my concerns were less of a practical nature and more existential. What was I doing so far from home? Why was I voluntarily assuming the significant risks of staffing medevac flights in most-remote Africa? What did I hope to find? 
I was working on the answers. In moments of clarity, I felt that, somehow, I was where I needed to be. I wanted to clear my head and figure out what was to come next in a career that had left me in a dip, disillusioned with organized medicine at a young age. 
I had no illusions that I would make a meaningful dent in Africa’s health care problems. I was one person, new to the continent, there for a short time. Selfishly, I just wanted to get back to the fundamentals of being a good doctor, providing care to patients who desperately needed me, one at a time. Simple enough. 
The pilots circled Nairobi and prepared to land. In a few hours, I would begin a month on-duty as a flying doctor, responding to calls for emergency medical help from a dozen countries in East Africa. I had no idea what lay ahead. I hoped that I would find what I was looking for. 

(c) Marc-David Munk, 2023

Chapter 1 (Excerpt)
Little Boy

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"I first saw them waiting for the planes at the edge of the dirt runway in Tanzania. There were seven people, five of them children; all were injured to various degrees, but from a distance it looked like the kids were all moving. Except one. On the grassy earth, unconscious, lay one little boy. 
   Slowly, the story came together for me. There had been a celebration in Tanzania, just across the Kenyan border, the night before. Not far. The family had dressed up in their nice clothes, excited for a night out, and driven several hours to the party. They had eaten well and laughed with friends. When it got late, the mom and dad belatedly said goodbye to their hosts and carried their tired kids to the car. On the way home to Kenya, the children quickly fell asleep—like any kids would—lulled by the sound of the car engine. The night sky was pitch-black; it is unlikely that the car’s headlights were able to fully pierce the dark. The mom and dad opened a window to the fresh night air and kept the radio low, to avoid waking the kids. 
   Without warning, disaster struck. In a blind instant, the SUV hit—at full speed, and without braking—the back of an unlit tractor wending down the dark roadway. 
The children’s mother later told me that after the explosion of noise and airbags and broken glass, there was only lingering smoke and a profound silence. Then, in the back of the vehicle, the children began to scream. The adults, seated in the front, were most damaged; they had broken their arms, their legs, their backs, and their pelvises. Protected in the back, the children had fared better and been left bruised and pummeled, but not seriously injured. 
   Except there was one child who hadn’t been in the back. He was a little boy who had been sleeping in his mother’s arms. The mother didn’t remember the airbag. She said that, upon impact, the little boy had been launched from her arms into the windshield. When the dust settled, there was a crater in the glass. The little boy, sprawled on top of the dashboard, was unconscious. 
   What happened next was ugly. The noise of the crash had roused the locals, mostly subsistence farmers. Despite the dark and the lateness of the hour, people emerged from nearby huts and shanties and began milling around the car. Some tried to help; others only watched. While the stunned family crawled out of the wreckage through one of the SUV’s doors, thieves entered through the broken windows. They helped themselves to bags, phones, wallets, and everything else of value. 
   One good soul called the local tiny hospital for an ambulance. And, knowing that their wounds were severe, the injured husband managed to dial Flying Doctors in Nairobi directly, using a borrowed phone. 
   Hours passed as they waited for the clinic’s ambulance. When it arrived, the family —the wounded parents, the unconscious little boy, the panicked children—were taken to the small rural hospital nearby and were told that they must wait for treatment until morning. The doctors at the hospital couldn’t do much, and Flying Doctors wouldn’t fly until dawn. 
   Notified of the mission early that morning by the control center, I sat in a taxi that had idled in the dark outside the Aero Club as I finished my shower and found a uniform shirt, my boots, my crew ID badge, and my stethoscope. The hangar was busy. The flight coordinators had decided to send two planes for the seven patients, and the crew were busy stocking both planes. Nurse Michael and I would go on one King Air, and nurses Asher and Kione would take the other. The team moved with lightning efficiency; maybe twenty minutes had elapsed between my alarm clock and wheels-up.  
   Once in the air, the second plane stayed not far off our wing for most of the flight. Dawn arrived as we crossed into Tanzanian airspace, and I could see the rural homes awakening, movement in the fields, smoke starting to rise from cooking fires. Descending toward the crude runway cut into the savannah, the pilots of our plane circled several times to make sure the field was free of livestock and wild animals before lining up for a landing. We flew just above the trees, then lowered quickly into a clearing, which was really nothing more than a length of red earth scratched into the grass. We landed with a bump, decelerated quickly, and taxied over the rough ground to the far end of the strip. The pilots made a sharp turn, pointing our nose back toward the strip, and we hugged the edges of the field to give the next plane room to land. 
   The King Air is a big twin turboprop. Its wingspan is almost sixty feet. With its bright spotlights on, the second plane approached the strip at an angle to compensate for side winds. On its wings, warning lights alternated, right and left, flashes of bright white. Despite the plane’s width and speed, the pilots descended with total confidence above the trees and touched down without incident at the nearest edge of the field. 
   It’s hard to convey the immense power of that moment. I was struck by the sheer improbability of landing a massive turboprop like the King Air on such a small strip of grass, the confidence of the pilots, the absolute stability of the descent, and the plain competence of the entire operation. I was strangely moved by this moment of grace. The emotional detachment I carried on missions faded for a brief moment; I was simply awed by the awesome execution. 
   Once Kione and Asher’s plane pulled next to ours, it was time to work. After the pilots shut down the engines, we grabbed the equipment bags, and the four of us approached the muddy road next to the strip where two ambulances from the hospital had been waiting for us. As we got close, I could see several bandaged bodies lying on the grass next to the white vehicles; there were others sitting up next to them. When we got to the ambulances, we immediately opened the rear doors; inside, there were stretchers with more bodies on them. 
   They teach us that our priority, when walking into this sort of situation, is to make order from chaos. You need to quantify what the situation is: you must sort the injured into groups, prioritize the care each patient needs, and then—finally—make a plan for how to deal with the injured in relation to the greatest needs and the available resources.       
   There were seven patients. Our priority quickly became triage; we needed to figure out who was hurt and how badly. The protocols meant that those without a pulse (called “black”) would receive no care; critically ill (“red”) patients would become immediate priorities, followed by the moderately ill (“yellow”); and then the “walking wounded” (“green”) would be treated. We had one red, two yellow, and four green patients. Kione and Asher would manage six patients: they would start IVs, splint bones, immobilize necks, and bandage bleeding wounds. Michael and I would manage the sole “red” patient: the two-year-old boy who had been launched into the windshield and was now minutes from death...."
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