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55 1957 - 2012

Years of Service

ANNIVERSARY EDITION

Annual Report 2012


AMREF forms what will become a long time partnership with Kenyatta National Hospital, taking medical specialists by air to Wajir, Garissa and Mandera in Kenya.

On the foothills of Mount Kilimanjaro, AMREF Flying Doctors is founded by three reconstructive surgeons: Michael Wood, Archibald McIndoe and Tom Rees.

AMREF Flying Doctors Founder Sir Michael Wood receives a knighthood from Queen Elizabeth II.

Mobile Outreach Clinics are introduced to southern Kenya to treat nomadic Masai pastoralists.

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19 5 7 19 5 7

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AMREF’s Outreach Programme is launched, initially servicing four hospitals in remote Kenya.

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The first Cessna Grand Caravan is introduced into the AMREF Flying Doctors fleet.

AMREF founder Dr Michael Wood publishes his book “Go an extra mile”. Anne Spoerry, known as “Mama Daktari”, joins AMREF Flying Doctors.

The hangar at Wilson Airport, Nairobi, is expanded to cater for our larger fleet

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AMREF Flying Doctors welcomed the third Cessna Citation Bravo jet to the fleet.

In partnership with Phoenix Aviation, AMREF Flying Doctors begins to operate a Cessna Citation Bravo Jet.

AMREF Flying Doctors adds a second Cessna Grand Caravan to the fleet.

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2003

AMREF Flying Doctors becomes the first operator outside of Europe to receive “Full Accreditation – Special Care” from the European Aeromedical Institute (EURAMI).

2007 2007

AMREF Flying Doctors receives then ITIJ 2011 Air Ambulance Provider of the Year award.

2009 2007

2011 2010

2012

New Advanced Life Support Ground Ambulance

AMREF Flying Doctors celebrates the opening of its Visitors Centre by founder Tom Rees.

AMREF Flying Doctors acquires a third Cessna Grand Caravan.

AMREF’s Outreach Programme continues to expand, visiting 150 hospitals in Kenya, Tanzania, Uganda, Rwanda, Ethiopia, Somalia and Southern Sudan, training more than 6,200 doctors and nurses and undertaking over 26,000 consultations.

Maisha Air evacuation subscription Scheme launched

2012


A small child is carried carefully from the aircraft by a Flying Doctors nurse (archive photo)


Vision To be the most outstanding aero-medical provider for Africa and beyond, focusing in remote areas.

Mission To provide excellence in aero-medical services across the region. We are committed to save lives and relieve sickness and injury in the best and fastest way possible. We are available to all and extend our services free of charge where there is need.

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Contents 14 Michael Wood’s Report

19 Charity Evacuations

38 Volunteer Physician Programme

39 A day in the life of a Flying Doctor

Fold out sections: AMREF Flying Doctors Timeline Air Ambulance Services - Nationalities Evacuated Full Contents Vision and Mission Statements From the Management Our Board Members Background Anne Spoerry Michael Wood’s Report Jim Heather-Hayes Air Ambulance Services Objectives Charity Evacuations Case Study: El Wak to Nairobi Case Study: Illeret to Wamba Case Study: Mother of three, Lamu Case Study: Lodwar to Nairobi Aircraft Available Medical Standby Coverage Evacuation of Mo Amin Medical Advice and Communication The 24-Hour Control Centre Marketing Local and Regional Events Maisha Annual Air Evacuation Scheme Media Activities ITIJ & Waypoint Magazine Visitors Centre Volunteer Physician Programme Flying Doctors – A Day in the Life Assistance Services Royal Flying Doctors Service Quality Professional Medical Training First Aid Training Donations Professional Partners AMREF Outreach Programme Accounts

4 8 10 12 13 14 15 16 18 19 20 21 22 24 26 28 29 30 31 32 33 34 35 36 37 38 39 42 43 44 45 46 47 48 56 60

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From the Chairman

Anthony Durrant

From the CEO

Dr Bettina Vadera

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“I am pleased to report another year of progress and improvement in the aeromedical services AMREF Flying Doctors provides to people in Africa and beyond. This year, we have not only maintained a high level of flying hours, but have also significantly improved our efficiencies without in any way compromising the outstanding quality and reliability of our service. The recent incorporation of AMREF Flying Doctors within the AMREF family has allowed and encouraged our management to set fresh standards of accountability, broaden our horizons and extend our funding options. As the Chairman of the AFD Board, I have the privilege to lead a group of highly talented and experienced professionals who are committed to serving this Board. The priorities for our Board are to ensure a strategic direction of growth, good governance, solid financial reporting and the delivery of aero-medical services that meet high international standards. This Board also serves as an important inter-phase between the company and its sole owner AMREF, the humanitarian health organisation. We are

aware that a stable growth of AFD is crucial for AMREF to meet its funding needs. Another essential element remains our goal of supporting AMREF in bringing health services to remote communities through the clinical and surgical outreach, which was the foundation stone of AMREF itself over 50 years ago. Our pre-incorporation Aviation Director, Jim Heather-Hayes, retired in June 2012 after over 40 years with AMREF. I would like to recognise his enormous contribution to AMREF’s aviation activities over the years and wish him a busy, healthy and happy retirement. Finally, I would like to take this opportunity to thank our new CEO Dr. Bettina Vadera, the executive management team and all of the staff for their hard work and dedication and our customers, partners, donors and other stakeholders for their continuing support. We strive to remain, quite simply, the best in our field.”

This year has been a special one, as AMREF Flying Doctors (AFD) celebrated its 55th anniversary. It was also a year of important developments for us. Following its incorporation as a company in 2011, AFD launched its first annual air evacuation scheme under the name “Maisha”, meaning life. In the context of “saving, improving and cherishing life”, Maisha offers quality and affordable air evacuation services throughout Eastern Africa to a wide clientele. Our Marketing Team under the leadership of Catherine Ochola has been very active introducing Maisha in the market and make the public aware of the benefits of this new product. From its official launch in February 2012 through to end of December, nearly 9000 individual and corporate members subscribed to Maisha and over 28.000 tourists were registered with our evacuation service. Prior to the launch, AFD had signed an Underwriting Agreement with Chartis Kenya, now AIG, to provide comprehensive coverage of the new product. The demand for our air ambulance services in general and other associated services such as assistance to insurance companies continued to grow. As a consequence we continued to expand, increasing our fleet of ground ambulances

with another Advanced Life Support ambulance, purchasing sophisticated medical equipment items, modernising the communication equipment in our Control Centre and adding valuable resources to our Finance team led by the new Chief of Finance & Administration, Stephen Gitau. Our partnership with Phoenix Aviation is thriving. Their fleet of 13 aircraft, including 5 jets and 1 helicopter – which are exclusively available to us in air ambulance configuration – has become an essential asset to our success. In addition to this valuable support, AFD’s strategic plan foresees the expansion of its own aircraft fleet as a key priority for 2013. The Volunteer Physician Programme saw a peak of 10 international highly qualified and experienced physicians joining the AFD medical team. This programme has become increasingly popular and interested physicians have to join a waiting list or book up to a year in advance. Reflecting on the achievements of this year, I particularly want to acknowledge and praise all of the staff members of AFD, as they are the heart and soul of our operation and our success. It is their commitment and dedication that makes us go the extra mile.

Anthony (Tony) Durrant Chairman of the Board AMREF Flying Doctors

Dr Bettina Vadera Chief Executive Officer & Medical Director AMREF Flying Doctors


From one of the Founders

top right: Tom with Michael, the early years. (archive photo)

centre right: Tom with his wife, Nan. Sadly Nana died in 2012

bottom: Dr Tom Rees with a bronze bust of Sir Michael Wood.

hangar Dedication right: Dr Bettina Vadera, CEO & Medical Director AMREF Flying Doctors with professor pascoal Mocumi, Chairman, AMREF Board unveiling the dedication plaque to Dr Tom Rees

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ooking at the breadth and scope of the work of the Flying Doctors of East Africa today makes me very proud indeed, as I remember that 55 yrs ago I was flying around East Africa with Mike Wood in the Flying Doctors’ first small airplane, a single engine Piper Tripacer, visiting rural hospitals in East Africa. We were trying as best we could to bring our skills in reconstructive surgery to bear to treat deformities of all types including those caused by congenital deformities such as cleft lip, wounds resulting from trauma, (especially burns), cancer ablation, and leprosy patients, who were virtually social outcasts because of the paralytic effects of the leprosy bacillus resulting in unsightly facial disfigurement and paralysis of muscles of the hands, rendering them incapable of working and thus earning a living. We were well aware that no matter how many surgeries we performed, we were only touching the tip of the iceberg. However, our guiding principle was that of Dr. Albert Schweitzer---“it is better to light a single candle than curse the darkness”. Our limitations lead us to begin developing a program of recruiting volunteer reconstructive surgeons who could come to East Africa and help out. Today our surgical and medical teams are composed of other specialties including urology, otolaryngology, vesicovaginal fistula experts, general surgery, public health, and others. As we all know, during the ensuing years since our formal incorporation of AMREF and the Flying Doctors in 1957, the organization has evolved, providing many useful programs including emergency evacuations of ill or injured people from “the bush”, as well as much needed medical and surgical care via Outreach teams to many rural hospitals in East Africa and the Horn of Africa. These teams emphasize education of rural health providers, particularly in the unique

methods and techniques of providing skilled care in such rural settings. Of special interest, it should be noted that the great majority of these Outreach teams today are staffed by African professionals, many of whom are volunteers. In my “golden years”, I am justifiably proud of my role as one of the three co-founders of AMREF of which the Flying Doctors is an integral part. The Flying Doctors of East Africa has developed a useful template for similar programs in developing countries all over the World. An urgent priority is the formulation of practical strategies to deal with the health problems engendered by the relentless increase in population that is ongoing – especially in rural areas worldwide. Thomas D. Rees, M.D. Co-founder AMREF and the Flying Doctors

In recognition of Tom’s continuing work and contribution on behalf of AMREF Flying Doctors, it was our great pleasure, in March 2012, to dedicate the aircraft hangar especially to Tom.

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Our board members

Salim Amin Salim Amin is Chairman of Camerapix, founder and Chairman of the Mohamed Amin Foundation and co-founder and Chairman of A24 Media. As Executive Producer and Presenter, Salim made a documentary chronicling his father’s life in March 2006 entitled “Mo & Me” which has to date won ten awards for Best Documentary in the United States, Canada, India and on the African Continent, including the Grand Jury Award at the New York International Film Festival.

Scott Griffin Scott Griffin is the Chairman and Founder of a number of Canadian based international companies varying from engineering to publishing. His association with AMREF Flying Doctors goes back to 1995 when the aircraft Scott was piloting on a round-the-world trip stopped off in Nairobi. He stayed for two years, working closely with AMREF and planting the seeds of a reorganization plan for AMREF Flying Doctors. Scott’s memoir, “My Heart is Africa”, recounts that two-year aviation adventure. Scott was a member of the AMREF Canada Board as well as AMREF International Board before joining the AMREF Flying Doctors Board, initially as Chair of the interim Board.

Anthony Durrant (Chair) Anthony P.W.Durrant is a lawyer and senior finance executive with global experience in investment banking and business with a strong background in strategic business development, funding and public private partnerships in emerging markets, particularly in Africa. Mr Durrant worked for over 25 years with investment bank S.G.Warburg & Co Ltd, latterly as part of Swiss UBS Group, in Europe, Australasia and the USA and since 2005 he has been a Director of AMREF. Mr Durrant holds an LLB (Hons) from the University of London and is a Solicitor of the Supreme Court of England and Wales. He was raised in Kenya and retains close connections in the country.

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Dr Teguest Guerma Dr Teguest Guerma, an Ethiopian national with an extensive career in public health, is the Director General of AMREF. Dr Guerma, who was previously the Associate Director of HIV/AIDS for the World Health Organisation (WHO), began her career as a medical practitioner in Burundi in the mid1980s. Along with her wider public health work, she has been involved in the fight against AIDS throughout her career.


Our board members

Mrs Muthoni Kuria Muthoni Kuria is a general management practitioner with expertise in Finance. She is a Certified Public Accountant (K) and holds a Master of Business Administration from Leicester University. She left the Banking industry in 2009 having held positions of Managing Director in Southern Credit Bank, Executive Director and Chief Accountant, Senator Cards.. She is presently on the Boards of a number of companies including AMREF.

Raychelle Omamo Ambassador Raychelle Omamo is an advocate of the High Court of Kenya of 27 years standing and currently the Director of Mo-Consult Ltd, a consultancy form, providing conflict resolution services as well as governance and public policy advice.

Nicholas Nesbitt Nicholas Nesbitt is Chief Executive of KenCall, the leading international BPO/call centre outsourcing company in East Africa. KenCall outsources customer service and sales and technical support for American, UK and East African companies.

Clyde Spence Thomson GM

Dr Terry Martin Dr Terry Martin is an Associate Professor of Intensive Care Medicine and Anaesthesia, with strong background in Emergency Medicine, Aviation Physiology and Prehospital Care. He is also a helicopter pilot. Terry is considered to be an expert in the field of aeromedical medicine and has received many accolades and awards for his work, which has demonstrated his passion is the safe and efficient resuscitation, optimisation and transport of patients by air.

Clyde Thomson is the Executive Director of the Royal Flying Doctor Service of Australia (RFDS), South Eastern Section. RFDS is a not-for-profit charitable service providing aeromedical emergency and primary health care services to people who live, work and travel in regional and remote Australia. Clyde is also currently on the University of Sydney Department of Rural & Remote Health, Broken Hill and Dubbo Rural Campuses Advisory Committee as well as the Maari Ma Aboriginal Health Committee.

Further details of our Board Members are available via

www.flydoc.org/about-us/our-board 11


Background

drop quote drop quote drop quote drop quote drop quote drop quote

clockwise from top: Tom Rees, Michael Wood & Archie McIndoe; the Founders of AMREF Flying Doctors

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MREF Flying Doctors has committed itself to providing world-class medical services to the people of Africa for the past 55 years and remains Africa’s leading air ambulance service provider. Originally providing ‘under-the-wing’ clinics in the 1950s, AMREF Flying Doctors now provides emergency air evacuations with state-of-the-art technology, including an incubator to transport newborns. Operating a fleet of 2 aircraft of their own, and leasing a further 14, AMREF Flying Doctors pilots are highly trained and experienced in flying across East Africa through rugged terrain to remote locations and landing on bush airstrips. The main areas of operation continue to be Kenya, Tanzania and Uganda, however evacuation flights are frequently being carried out across other countries in East Africa and from the Horn of Africa including Sudan, South Sudan and Somalia. AMREF Flying Doctors also provides medical escorts on commercial airlines worldwide and repatriates patients across the globe by private air ambulance. AMREF Flying Doctors currently employs one physician and 11 flight nurses on a full-time basis, all of whom are cleared to be deployed at short notice. Additionally, 9 physicians are employed on an on-call arrangement to ensure that appropriate cover for emergency flights is available 24 hours a day, 365 days a year. The 24-hour Control Centre at Wilson

Airport is staffed with qualified medical personnel at all times, ready to provide emergency medical advice. AMREF Flying Doctors continues to ensure that their air evacuation services are available to people in disadvantaged and marginalised communities across East Africa by providing a Charity Evacuation program to those in need. AMREF Flying Doctors provides emergency evacuations free of charge in special circumstances, with a number of emergency evacuation flights per year taking place on a humanitarian basis. AMREF Flying Doctors also provides medical and logistical assistance for international health insurance companies.


Anne Spoerry “Mama Daktari”

clockwise from top: Anne assists Michael in an early years Outreach visit; Anne with her aircraft; Anne with Tom Rees

“Planning for a successful rescue mission requires a sound mind and the ethos of always being willing to go an extra mile, as well as planning ahead of time.” ChARlES ATEMBA FLIGHT NURSE

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n 1964 Flying Doctors was joined by Dr. Anne Spoerry. Born in May 1918 in Cannes, she qualified as a doctor in occupied Paris during World War II. Together with her brother she later joined the French Resistance movement and was caught by the Gestapo. She was sent to the Nazi concentration camp in Ravensbrück where she spent the last two years of the war. Immediately after her release, Anne gained her Diploma in Tropical Medicine in Basle, Switzerland. In 1948 she sailed for Aden. After working there for the Ministry of Health, she visited Ethiopia and then Kenya. She fell in love with Kenya, and in 1950 settled on a farm in Subukia. At 45 she took up flying and was convinced by Mike to join the Flying Doctors. Anne piloted her Piper Cherokee four-seater aeroplane to conduct what she called “mango-tree clinics” in Kajiado District, Lamu District and northern Kenya. Single all her life, Anne adopted mannish ways and dress, down to her trademark aviator’s cap and jacket. Her flying style was equally distinctive. She was known for almost vertical takeoffs from bush air strips and for her habit of setting the plane to automatic pilot and taking a nap. Anne passed away at 80. She continued to fly until a week before her death. In her own words,” I may not have had

any biological babies, but I have many children- all those I have helped to survive and grow up and still welcome me to their villages with glad cries of “Mama Daktari”. In Swahili “Mama” means Madam; it also means “Mother” and in my heart this is what it means to me”.

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Michael’s report on the first 25 years

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Aviation Director jim heather-hayes retires

clockwise from top: jim, the early years. having fun with “his” staff, the Engineers; Bettina Vadera presents jim with a photobook of his time with AMREF Flying Doctors; jim with Tom Rees and Bettina Vadera; Sean Culligan, Kefa Kihara, jim, Bettina Vadera and Stephen gitau; jim with the staff of AMREF Flying Doctors; jim helps offload a patient from a Cessna Caravan; jim with Tom Rees and Bettina Vadera; jim at the opening of the Visitors’ Centre

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viation Director Captain Jim Heather Hayes retires after over 45 years of dedicated service to AMREF Flying Doctors Jim Heather Hayes joined AMREF Flying Doctors almost straight from school, pausing only to obtain his pilot’s licence. Over the next 45 years, Jim rose to the position of Aviation Director and saw the Service grow from using small piston engine aircraft, predominantly operating locally and regionally, to the operational partnership with Phoenix Aviation and a fleet size of 14 aircraft including 5 jets. International evacuations thus became a regular event. Jim also oversaw the expansion of the Emergency Service from its offices in the AMREF Kenya Country Office and its migration to the current offices in the airside hangar. He leaves a lasting legacy to AMREF Flying Doctors we are all proud to have known and worked with him At a Farewell gathering of all the staff, Jim was presented with a photobook showing a history of past aircraft, evacuations and charting the development of AMREF Flying Doctors during his years with the Service.

“When else do you find something to smile about, other than after a job well done at AMREF Flying Doctors......of course!” jANE MUNYUA AEROMEDICAL COORDINATOR AND FLIGHT NURSE 15


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Air Ambulance Services

International Evacuations

Evacuation Categories

he Air Ambulance Service continues to cover the countries of East Africa (Kenya, Tanzania, Uganda) stretching to Ethiopia, Eritrea, Rwanda, Burundi, Somalia, DRC, South Sudan and other neighbouring countries. Increasingly the coverage has extended over the past few years to the whole of Africa, the Middle East, India, Europe and beyond. In 2012 AMREF Flying Doctors evacuated a total of 918 patients by air and/or ground ambulance. This was a 27% drop on last year’s figures and can be

attributed to the stability of Mogadishu and the decrease in multi-casualty evacuations from that area. The types of clients evacuated included 245 paid NonMember evacuations, 361 AMREF Flying Doctors registered clients, 13 AMREF Flying Doctors Maisha subscription clients, 21 AMREF Flying Doctors Tourist scheme clients, 39 evacuations of members of Flying Doctor Society of Africa, 25 free charity evacuations and over 200 others. During 2012 a total of 863,002 miles were flown on 613 evacuation flights.

During this year, AMREF Flying Doctors provided a total of 70 long distance evacuation flights to destinations in Europe, South Africa, West & Central Africa and to the Middle East /Asia using the Citation Bravo Jets. There was a definite decrease in flights to Europe, but a marked increase in request for flights to West, Central and Southern African destinations. In addition, AMREF Flying Doctors provided 17 international medical escorts on commercial flights to South Africa, West Africa, Europe and the USA, a 41% increase on last year’s figures.

AMREF Flying Doctors continued to work closely with leading European and Continental US-based air ambulance providers, carrying out a number of wingto-wing rescue operations, whereby an air ambulance evacuation is provided by two air ambulance operators from different countries meeting together at a mutually arranged spot to transfer the patient to another carrier. A total of 6 such flights were carried out during 2012. Partners in these wing-to-wing operations were MARS (Zimbabwe), REGA (Switzerland), Latitude (Canada) and ADAC (Germany)

90 Cardiovascular ailments

131 Others

84 Gastrointestinal diseases

2012 total number of evacuations

150 Traffic accidentrelated trauma

80 Other trauma

918 74 Infectious disease/ malaria

53 Cerebrovascular incidents 27 Psych/Neurological disorders

209 War/violence inflicted trauma

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13 Obs/Gynaecology cases 7 Animal attack-related injuries

Animal Attack Related Injury

7

Cardiovascular Ailment

90

Cerebrovascular Incident

53

Gastrointestinal Diseases

84


Air Ambulance Services

Registered Client 361 FDSA Member 39 Paid Non-Member 245 Free Charity Evacuations 25 Tourist Scheme B 21 UNSOA 687

Assistance tasks 445 Night evacuations 222 0

100

200

300

Others 200+

400

0

International Flights

150

300

450

600

70

2012

86

2011

45

2010

74

2009

64

2008

39

2007

0

Flying Miles

20

40

932,794 1,269,070

2010

748,051

2009

924,051

2008

2007

(x1000)

0

80

863,002

2012

2011

Despite the drop in actual miles covered during the year, there was a slight (3.8%) increase in flying hours during 2012. This reflected an increase in utilisation of both the Cessna Caravans and the Beechcraft King Airs as some of the destinations now in demand do not have runways suitable for the Citation jets. A reduction in the jet flying hours can also be attributed to reduced flying time on AMISOM medical evacuations.

60

560,367 300

600

900

1,200

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Objectives

We embrace change New computers and aircraft tracking equipment in our expanded 24 hour Control Room enables us to use the best technology to assist our clients.

We care for the uncared

We share our story Our 55 year history is captured in our Visitors’ Centre. Since its opening, over 4,000 schoolchildren have shared the experiences of AMREF Flying Doctors.

Our Charity Flight Programme evacuates patients free of charge from the most remote locations in Kenya, flying them to medical facilities where their lives could be saved.

We go where no one else goes The challenging environment of Africa with conflict zones, cross border operations, politics and bureaucracy are major hurdles to air evacuations.

We go the extra mile

We are innovative

Complex medical problems and logistical constraints are a regular occurrence for our staff. Together they work as a team, confident in the commitment they share.

The Volunteer Physician Programme keeps our staff up to date with teaching sessions and education on developments in emergency medicine.

We partner with local communities The AMREF Flying Doctors Outreach Programme supports 150 hospitals in 7 different countries.

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Charity Evacuations

An Overview of Charity Evacuation Considerations and Guideline

Under special circumstances, AMREF Flying Doctors also provides a Charity Evacuation service, whereby Flying Doctors will evacuate a patient in a serious medical condition free-of-charge. 25 such evacuations were carried out free of charge this year. This was a continued rise from the figure of 21 carried out in 2011 and the 16 flown in 2010. It reflects the increasingly vital need for such humanitarian support to the local population. The patients who benefited from this charity work were in serious medical conditions at the time the request was made. AMREF Flying Doctors evacuated these patients to medical facilities, where they received appropriate medical care. None of the patients would have been able to afford such a service and consequently their lives could have been lost. AMREF Flying Doctors is extremely appreciative of members of the community across the globe who fundraise for us so we can keep doing what we do best – saving lives.

1 Medical:

2 Social:

Is the patient in a life threatening condition, and does the patient have a good chance of surviving the evacuation flight? Is the prognosis for the patient likely to be significantly improved by air ambulance intervention?

Is the patient a supporter of dependants, especially children? Will the patient have the means to return home after the treatment? Will the event of death at a location far from home create an irrevocable burden to the family/ relatives?

3 Funding:

4 Other:

Is the patient covered by insurance or have any other means by which the flight can be paid for by a third party? Does the patient or family appear to have adequate funds to pay for the flight in part or full? Will the patient be able to contribute to the cost of treatment at the hospital?

Does AMREF have a suitable aircraft available? (AMREF will not normally charter aircraft for a free evacuation). Does the weather allow an immediate response?

Charity evacuations are supported from various sources: internationally by the staff of IBM Sweden and AMREF Italia and locally by the companies such as JW Seagon, a Nairobi-based insurance company that makes regular donations throughout the year, particularly to this programme.

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Charity Evacuations

As described in the following accounts, the process is one that requires a rapid response and the provision of the high-level medical care that has become the cornerstone of AMREF Flying Doctors’ assistance services.

Case Study El Wak to Nairobi Evacuation of two patients from El Wak with post-natal complications 01November 2012

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PILOT: CApT. E. WANYElA DOCTOR: DR. MAlCOM CORREIA AIRCRAFT: 5Y FDB CESSNA CARAVAN FLIGHT NURSE: MORRIS SIjENYI TOTAL COST: US$7080 20

l Wak is a small town on the Somalia-Kenya border. The Kenyan portion is located in Mandera District On the morning of 1 November 2012, the AMREF Flying Doctors Control Centre received a distressed call from the medical officer in charge of El Wak Sub District Hospital requesting urgent emergency aero-medical evacuation of two patients. Their medical condition was well beyond the capacity of staff at El Wak Sub District Hospital District Hospital to handle. The first patient, Saadia, a 20-year-old woman, had developed respiratory problems one month after delivery, prompting her relatives to take her to the hospital. The lady also had a severe infection that affected her breathing and kidney function. The second female patient, 30-year-old Habiba, 30 yrs of age had just delivered her baby under the care of a traditional birth attendant. The baby was delivered alive and well but the mother kept losing blood from her birth canal prompting her relatives to seek treatment at the hospital. She had bled significantly and the medical team at El Wak Sub District Hospital District Hospital had to transfuse 2 pints of blood to keep her alive. AMREF Flying Doctors team arrived to the relief of both relatives and the local medical

staff, who had done all they could within their set up. The patients were brought to the airstrip in a pickup truck – the makeshift ambulance for this community. Saadia was extremely emaciated, conscious but weak. She was stabilised and soon after lifted into the aircraft, where the medical staff put her on a life support machine as she was very weak. The team was soon airborne back to Nairobi and continued to monitor the vital signs of the two patients. Saadia got worse and the medical staff performed a cardiac compression and administered drugs to boost her heart condition. At 19.00 hours, the team landed at Wilson airport. The patients were taken to Kenyatta National Hospital Intensive Care Unit by our ground ambulance, where they were admitted.


Charity Evacuations Case Study Illeret to Wamba Crocodile attack in Lake Turkana 19 March 2012

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WRITTEN BY JOEL CHELUGUY, FLIGHT NURSE. NURSE: jOEl ChElUgUY DOCTOR: DR. MARTIzA CORINI, VOLUNTEER PHYSICIAN FROM ITALY PILOT: CApT MARCUS pOTgEITER AIRCRAFT: 5Y FDC CESSNA CARAVAN FLIGHT TIME: 4.7 hOURS COST: US$ 6252

lleret is in an undeveloped part of Kenya on the shores of Lake Turkana. The land is communally owned in form of government trust lands. There are no rains and people are in abject poverty. On 19 March at 1000hrs the Control Centre at AMREF Flying Doctors received a distress call from Illeret Health Centre about a patient who had been attacked by a crocodile. It was reported that the patient had sustained a fracture of the left leg and was bleeding a lot from bites on the left buttock, left elbow and left toes. The patient, Hille, was fishing in the cold waters of the Lake Turkana at 0300hrs when a crocodile was out hunting too. Crocodile attacks are not uncommon in this part of the globe, but the community and the crocodiles know that they must maintain a balance in search of food and water for both to live side by side. The most common crocodile tackling defense manoeuver is to stab the eyes in close range especially when the saw toothed canines have locked into human flesh—a technique well developed by the fishing community in this region. Hille attempted to bravely fight back by stabbing the crocodile in eye however he missed. Had Hille’s friends not acted quickly he would have forever sunk into the cold dark waters of Lake Turkana. Hille survived the attack but without treatment the bacteria in the animals’ filthy teeth would kill him. AMREF Flying Doctors took off from Nairobi to Illeret, a two hour flight in one of our Cessna Caravans, flying through the Aberdares on the left and Mount Kenya on the right. We had prepared for bleeding arteries and possible dehydration due to lack of fluid replacement and intense pain. There was also a possibility of infection, though this would be seen at a later date. On arrival at Illeret we found Hille in the

back seat of a pickup truck. He had bled significantly and looked dehydrated. We inserted an intravenous line, immediately giving him much needed fluids. We gave him pain medication and with the help of the curious onlookers lifted him out of the pickup on to our aircraft. We immobilized the limb, stopping the bleeding and made him comfortable so we could load him into the aircraft. Illeret feels like a furnace and the sweat coursed down our bodies unrestrained. There were naked children with only a thin thread round their waist. We mused maybe there was no need for the clothes in this part of the world after all with such high degrees of heat. We alerted the Control Centre that we were ready to depart to Wamba to drop off the patient. Wamba is an 80 minute flight in a Cessna Caravan from Illeret and is where the closest hospital is located. We continued to stabilize the patient with intravenous fluids and controlled his pain. Hellie drifted off to sleep and could not see the charred arid plains of the northern Kenya. We landed in Wamba and handed over the patient at the hospital. We took off for base at Nairobi Wilson airport and landed at 1700hrs—a day’s work successfully accomplished. We followed up with Wamba Hospital after the evacuation. X-rays showed no limb fracture but a dislocation of the left knee. A cast was put on and Hille was put on antibiotics and his many wounds were dressed daily. Blood tests revealed that Hille was also suffering from Malaria. “We were glad that finally one more life had been snatched from the Crocodile’s teeth and kept alive courtesy of AMREF Flying Doctors’ Donors and partners,” said Flight Nurse Joel.

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Charity Evacuations Case Study Mother of three in lamu 17 March 2012

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pregnancy is usually welcomed with a lot of joy and anticipation for the things to come. This was not so for Halima, a 35-year-old mother of three. Halima had given birth seven times with her first four children passing away between two days and two years of age. Halima had three remaining children, aged between three and seven and was 32 weeks pregnant. Halima hails from Lamu on the coast of Kenya, one of the most popular tourist destinations in the region. Lamu is a peaceful tropical island where life is lived at its own relaxed rhythm. It’s a place whose history is as mysterious and fascinating as the winding streets of its medieval stone town. There are no vehicles on this island—even ambulances—and donkeys and dhows remain the dominant form of transport. Lamu is one of the most underdeveloped towns in Kenya. There are no hospitals and poverty is extremely high. In Halima’s community, the Mpeketoni district, most of the men go to the mainland to look for employment to support their families. Halima’s husband was working miles away in Malindi at a ranch and would visit her and the children once a month after being paid. Halima was a housewife and fully dependant on her husband. Helima had been attending an antenatal clinic but not as regularly as recommended because of the long distance she had to walk to access the

service. During the visits, staff had noticed her haemoglobin was low. She was treated for this and advised on her diet. On 16 March Halima called her brother in high spirits. She had returned from the clinic where they told her that her haemoglobin level had returned to normal and that her pregnancy was progressing well. She also told him that her youngest child was also growing well, never leaving her side, not even with her older brothers. The little girl was completely dependent on her mother. Later in the afternoon, Halima started feeling some abdominal pains, similar to contractions. She continued to do chores until around 14.00 hrs when she started bleeding. She went to tell her mother who lived close by and then called her husband who tried to arrange a car to take her to Mpeketoni sub-district hospital, which is some distance away. They finally arranged transport and she arrived at the hospital at 21.00 hrs. Halima was received in the hospital by Dr Nyaboga who described her as “paper white” due to the amount of blood she had lost. The Doctor explained to Halima’s mother and neighbours who brought her in that she needed urgent surgery as her placenta had detached from the uterus and the baby had no heartbeat. She was immediately taken into theatre where the Doctor performed a caesarean section. As suspected, the baby had died. After the surgery, Halima was closely


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NURSE: hEllEN MUChAI DOCTOR: DR. MARzIA CORINI PILOT: CApTAIN MATThEW BROWN AIRCRAFT: 5Y-FDB FLIGHT TIME: 3.7 hOURS COST: US$5,020

monitored and was on a ventilator. Her uterus was not contracting and she did not stop bleeding so she was taken back to theatre for a hysterectomy (surgical removal of the uterus). After the second operation, Halima remained in the theatre, as the Mpeketoni Hospital has no Intensive Care Unit where she could be transferred for observation. The Doctor stayed with her and made attempts to extubate her, but these were difficult as she would deteriorate and arrest. The following day, AMREF Flying Doctors received a request for a Charity Evacuation from Mpeketoni Hospital just before midday. They wanted Halima to be transferred to the Intensive Care Unit in Kenyatta Hospital, Nairobi, where she could be more closely monitored, ventilated and be treated by intensive care experts. AMREF Flying Doctors negotiated a space in Kenyatta Hospital, the only referral hospital in Kenya, which serves a population of 40 million people. At 14.35hrs, as soon as a bed was secured, the medical team took off for Lamu. Less than two hours later the wheels were down at Lamu airstrip. Halima was already at the airstrip in a mkokoteni (hand pulled cart). When the doctor spoke to the AMREF Flying Doctors medical team he gave a sigh of relief, very happy in this sad situation that the team had come to try to save the life of this young mother. The AMREF Flying Doctors medical team were in shock and disbelief at the state of the patient. AMREF Flying Doctors reviewed the very

critical Halima and stabilised her for the flight. Dr Marzia Coroni, an AMREF Flying Doctors Visiting Volunteer Physician, updated the mother and the brother that she was very critical. They all boarded the flight for Nairobi. Halima’s mother was scared for the duration of the flight with her head bowed down the whole way. The flight back to Nairobi was quick and the aircraft landed at Wilson Airport at 17.05hrs. Halima was swiftly loaded into an AMREF Flying Doctors ground ambulance and rushed to the Intensive Care Unit at Kenyatta Hospital. Halima was handed over to the nurses, who were asked to keep AMREF Flying Doctors informed of her condition. Upon following up the next day, AMREF Flying Doctors were informed she had more blood transfusions, her brain had suffered hypoxia and was severely injured and most of her organs weren’t working properly. She commenced dialysis the following day. On the third day when AMREF Flying Doctors called for an update we were informed Halima passed away that morning. May she rest in peace.

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Aircraft Available Cessna 208 B Grand Caravan

CAPACITY: 13 pASSENgERS OR 4 STRETChERS

MAX RANGE: 1,700 KM SPEED: 260 KM/h

Beechcraft Super King Air B200

CAPACITY: 10 pASSENgERS OR 2 STRETChERS

MAX RANGE: 2,025 KM SPEED: 420 KM/h

Beechcraft Super King Air B350

The fleet available to AMREF Flying Doctors has come a long way since this press release from 1962. AMREF takes delivery of its second aircraft, a Cessna 182, delivered via a 64-hour flight from the USA. The article also refers to the first installation of hF radios in Mission hospitals. AMREF now has the largest hF radio network in Africa supporting its contact with hospitals, clinics, safari lodges and other organisations.

CAPACITY: 10 pASSENgERS OR 2 STRETChERS 24

MAX RANGE: 2,400 KM SPEED: 475 KM/h


Cessna 550 Citation Bravo

CAPACITY: 7 pASSENgERS OR 2 STRETChERS

MAX RANGE: 3,750 KM SPEED: 690 KM/h

Cessna 560 Citation Excel

CAPACITY: 8 pASSENgERS OR 2 STRETChERS

MAX RANGE: 3,750 KM SPEED: 750 KM/h

Eurocopter Ecureuil AS 350 B3

CAPACITY: 4 pASSENgERS OR 1 STRETChERS

MAX RANGE: 600 KM SPEED: 185 KM/h 25


Medical Standby Coverage During events with high-risk involvement for participants or the public, AMREF Flying Doctors offers medical coverage by ground ambulance, helicopter or fixed wing aircraft. Typical Kenyan sports events include the famous Safari Rally, the Lewa Downs Safaricom Marathon and regular horse shows in Nairobi or upcountry. The income generated through this service contributes towards paying AMREF Flying Doctors’ overhead costs.

Safaricom Marathon Held in the Lewa Wildlife Conservancy in Kenya last June, AMREF Flying Doctors provided medical support for the Safaricom Marathon. Through harsh terrain and weather conditions, more than 1,000 participants of varying fitness levels competed in the 21km loop. This year we treated 17 patients in our tent and evacuated one to Nairobi and one to Nanyuki Cottage Hospital for further treatment. Since its inception in 2000, the Safaricom Marathon has raised Ksh 150,000,000 (over US$2,000,000) for a range of education, community development, health and wildlife conservation projects across Kenya. This was the third year that

AMREF Flying Doctors attended, providing assistance to all participants on the day.

Gilgil Horse Show The Gilgil Horse Show, held in May 2012, was once again a popular event and AMREF Flying Doctors were pleased to stand ready to assist anyone in need. The

competitors consist of individuals who have travelled far and wide from Nanyuki, Naivasha, Kericho and Chulu Hills in Kenya to Entebbe, Tanzania, as well as Europe and the US. There were some 300 horses at this show. AMREF Flying Doctors’ staff treated four spectators and competitors.

2012 East African Safari Classic AMREF Flying Doctors was on standby to provide medical evacuations as needed

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during the 2012 East African Safari Classic motor rally, which took place in November 2012. The event is considered to be the toughest and most demanding motor rally in the world. Competitors drive classic rally cars, all pre-1978 vintage, for nine of the 10 days over the rugged roads of Kenya and Tanzania, with one day of rest in the middle of the programme. Two evacuations were completed, one for a participant who had sustained a back injury after their vehicle landed badly out of a jump, and the other was a spectator who had rolled his car. We are happy to report that both made a full recovery.


From the archives Evacuation of Mo Amin, Photographer 04 June 1991

right: British photographer and cameraman Mohamed Amin arrival at Nairobi

“Critical assessment, intervention and evaluation contributes to a successful patient outcome.” phYlIS KIMANYI AEROMEDICAL COORDINATOR AND FLIGHT NURSE

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irborne Service Around the clock…On 4 June, an urgent call came in to our Radio Room from Reuters News Agency in Addis Ababa, Ethiopia. World-renowned British photographer and cameraman Mohamed Amin had been wounded in an ammunition explosion that morning. Immediately AMREF’s largest aircraft, 5Y-DOC, headed North, carrying surgeon Dr Tom Raassen and Sister Marielyn Ogumbo and piloted by Capt Will Wood. He took extra fuel in jerry cans and within 30 minutes of landing they were on the way back to Nairobi. Amin lost his lower left arm but lost very little time in getting back to his usual heavy schedule. I was conscious during the flight from Addis Ababa. The entire emergency evacuation was handled extremely professionally by the AMREF office in Nairobi in dispatching the flight. Both in Addis Ababa, as well as during the flight back, was extreme care was taken about my condition. The doctor in particular put up with a lot of nonsense from me! Obviously I was quite uncomfortable because of various tubes stuck in my body but he was very encouraging, very kind, and was clearly doing his best for me. On arrival to Nairobi, Dr Raassen accompanied me to Nairobi Hospital and took care to ensure that the surgeons there were all briefed. I was impressed with the continued interest by AMREF until I was discharged from the hospital. I have always been a fan and supporter of

AMREF, so it may sound biased for me to say that AMREF is the best organization of its kind in East Africa. I would strongly recommend people who do any sort of travelling to be members of the Flying Doctors’ Society of East Africa.” Sadly, Mo Amin was later to die in a hijacked Ethiopian Airlines aircraft that crashed off the Comoros Islands.

Request for air evacuations came by whatever means possible. This 1966 request for a patient with appendicitis resulted in an aircraft being airborne within 15 minutes of the telegram being “delivered”

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Medical Advice & Communication

T Clockwise from top: The new AlS ambulance on display; Mike Duder, general Sales Manager, Mercedes Benz Commercial Vehicles hands over the keys to the new AlS to Dr Bettina Vadera, CEO & Medical Director; The interior of the new AlS ambulance.

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he Control Centre, located at Wilson Airport, Nairobi, is staffed 24-hours a day with qualified medical staff to provide emergency medical advice. Once a call is taken about a patient who requires emergency evacuation, staff start planning, with the assistance of the aviation team, the time for take-off and which aircraft to use, depending on the airstrip, the weather and the patient’s condition. After collecting the patient, the pilot relays the medical report to the Control Centre. Control Centre staff book the hospital, ensure medical staff are briefed and make sure an AMREF Flying Doctors ground ambulance is ready to transport the patient to a medical facility without delay. In 2012, AMREF Flying Doctors took delivery of a new Advanced Life Support Ground Ambulance allowing us to boost our road ambulance and airport/hospital transfer services The ambulance, acquired at a cost of KES 13 Million, is part of the on-going investments that AMREF Flying Doctors is making following the August 2011 incorporation as a not-for-profit company - part of and wholly owned by AMREF (African Medical & Research Foundation). Speaking during the delivery ceremony held at AMREF Flying Doctors premises at the Wilson Airport, Dr. Bettina Vadera, CEO and Medical Director, said: “We are excited about this new addition to the AMREF Flying Doctors’ fleet of ambulances. The delivery of this ambulance marks an important step in our ongoing expansion to meet the ever-

increasing demand for our services.” AMREF Flying Doctors is among the first institutions in the region to take delivery of this new ambulance which contains numerous innovations and enhancements that greatly enhances patients’ comfort. Mr Mike Duder General Sales Manager Mercedes Benz Commercial Vehicles said: “These custom-built Mercedes Sprinter 315 CDI are the most sophisticated ambulances available in the region. The interior is big enough to accommodate two nurses and a stretcher for the patient and they have been built with sufficient height for standing and plenty of space for drugs and emergency equipment.” In addition, the ambulance is fitted with a defibrillator that can re-start a heart that has stopped, and a cardiac monitor. There is also a piped-in oxygen supply, a ventilator and a suction machine for clearing airways. Nasal cannulars, masks and nebuliser kits and orthopaedic equipment are also available.”


The 24-hour Control Centre – Co-ordination & Communication Health facilities in remote areas can also contact AMREF Flying Doctors Emergency Control Center 24 hours a day for medical advice. On several occasions during the reported period, AMREF’s emergency physician or the nurse in our control center were able to give medical advice over the radio or telephone to rural medical centers, mission and district health facilities or remote tourist lodges. As a consequence, patients’ conditions were improved and unnecessary evacuations could be avoided. Medical advice can be obtained at our Control Center by anyone in need at no fee and irrespective of membership subscription.

Clockwise from top left: The Control Room in the mid – 1960’s; Michael Wood; AMREF ambulance - 1963; The modern 24/7/365 Control Room; One of the earliest radios used by the East African Flying Doctor Service.

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Marketing As our international profile grows, it becomes increasingly important for AMREF Flying Doctors to market and promote the services we offer. Our goal in the use of marketing and PR is to raise the profile of AMREF Flying Doctors to emphasise the quality of the service available and to drive the growth of donations. During 2012, AMREF Flying Doctors participated in a number of annual conferences, in some cases giving presentations to over 600 delegates at a time.

Clockwise from top: Sean Culligan’s presentation on the challenges faced in conflict areas was also of great interest to the delegates at Aeromed Africa; Dr Bettina Vadera addresses a gathering of Kenyan based travel agents introducing them to the Maisha Scheme. Mombasa, Kenya; Dr Bettina Vadera addresses delegates at the Aeromed Africa Conference in Cape Town South Africa; Sean Culligan presents to the CCAT (Critical Considerations in Aeromedical Transport) Advanced Course, Windsor, UK.

International Travel Insurance Conference (ITIC)

Left: Sean Culligan at ITIC Barcelona leading a forum discussion on “Air Ambulances and Ethics”. Right: Dr Bettina Vadera addresses the Medical Directors’ Forum at ITIC Barcelona

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local and Regional Events

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ocal and regional marketing efforts included detailed presentations to over 50 organizations that toured AMREF Flying Doctor facilities during the year, including a number of International donor agencies, as well as International Assistance and Insurance Companies on audit visits. The relationship with the Kenya Tourist Board (KTB), in conjunction with the AMREF Flying Doctors Tourist

Subscription scheme, continues to grow. The Magical Kenya Travel Expo, organised by the Kenya Tourism Board (KTB), is an annual, high profile international tourism exhibition) that attracts participation from both local and international trade partners as well as the Kenyan public. It was held in Nairobi in September 2012 and the AMREF Flying Doctors stand attracted considerable interest.

The AMREF Flying Doctors’ Stand at the Kenya Tourist Board Exhibition, 2012

Above right: VIp visitors included the visit of hRh Willem Alexander, Crown prince of the Netherlands, seen here with CEO Dr Bettina Vadera, and visiting the 24hour Control Centre

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egional visits included Arusha, Tanzania which is an important logistical hub for many NGOs and international aid agencies. Various local and international safari and tour operators also reviewed the operations of AMREF Flying Doctors at structured marketing events and presentations were made to the Kenya Civil Aviation Authority and local organisations and groups. These visits and presentations are important platforms for AMREF Flying Doctors for networking, strengthening international working relationships

and participating in the international discussions on standards and quality of Air Ambulance provision.

“Documentation – time to sum up excellent work! As the saying goes, what is not written is not done!!” MIlDRED ADhOlA FLIGHT NURSE 31


MAIShA ANNUAl air evacuation scheme

Below: XXX

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anuary 2012 saw the launch of Maisha, AMREF Flying Doctors’ new annual air ambulance subscription scheme “Maisha is just the beginning of a succession of commercial ventures that AMREF Flying Doctors plan to engage in over the next years. Our main objective is to help AMREF achieve its fundraising, financial and Outreach obligations. The transformation into a company paved the way to develop new and existing activities in order to generate more funds for AMREF and in particular the Outreach Programme,” said Dr Bettina Vadera, CEO and Medical Director of AMREF Flying Doctors, at the Maisha launch. Maisha offers different levels of subscription depending on the area of coverage, from Kenya only to the whole of

Cost

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Eastern Africa including Ethiopia & South Sudan, from as low as Ksh 1,800. The benefits Maisha offers include: 1. Two medical evacuation flights per year. 2. Two ground ambulance transfers per year, within Kenya. 3. Direct access to our 24-hour Control Centre for medical advice. 4. Direct Access to the air ambulance provider – no third party. So far 9,000 people have signed up to the scheme. TOURIST SChEME “B”

In 2010, AMREF Flying Doctors introduced our Tourist Scheme “B” for tour operators through the Kenya Association of Tour Operators (KATO). This scheme allows KATO members to contact AMREF Flying Doctors directly in the event of a medical emergency. Tourist Scheme“B” provides peace of mind to tour operators and clients as subscribers can access 24-hour medical advice through our Control Centre. Tourists are covered for a period of 30 days, with the tour operator being invoiced at the end of every month. All that is required from tour operators is a list of the names of their clients, arrival and departure dates, and the insurance details of the clients (if available at the time of registration). Tour operators that are not subscribed to the Tourist Evacuation Scheme risk delays in evacuations as AMREF Flying Doctors requires a 100% upfront payment prior to evacuation. Unused funds raised by this scheme help to support AMREF’s Outreach Programme and AMREF Flying Doctors’ Charity Evacuations. The Tourist Evacuation Scheme continued to expand in 2012, with nearly 300 tour operators joining including some enrolled with the Tanzanian Association of Tour Operators (TATO) and non-members of TATO and KATO. Over 28,250 tourists have joined the scheme this year.

Cost

Kenya, Tanzania and zanzibar

Kenya, Tanzania, Uganda, Rwanda and Burundi

KATO and TATO Members US$5 per person for 30 days

KATO and TATO Members US$9 per person for 30 days

Non-KATO and TATO Members US$10 per person for 30 days

Non-KATO and TATO Members US$18 per person for 30 days


Media activities

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here were a number of major media activities during the year. AMREF Flying Doctors was highlighted in both local and international magazines and newspapers. Several articles and profiles of various staff members appeared in international, regional and local media, sharing the stories of our life-saving work with the world.

AMREF Flying Doctors engaged a Kenyan communications firm to assist with raising the profile of the organisation, rebranding our services as a commercial entity and to assist us with engaging with more people through digital, print and radio media.

left to right: Catherine Ochola and Esther Wakahia of AMREF Flying Doctors with Tase Asetto of headline Communications

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his year saw AMREF Flying Doctors launch into social media, using both Twitter and Facebook to communicate to our supporters.

Contact us via on Twitter

@AMREFFlyingDocs twitter.yfrog.com/esgvksgj twitter.com/AMREFFlyingDocs

January 2012 also saw the launch of the new website:

www.ydoc.org

www.facebook.com/amrefflydoc

Marketing from the past – The UK based Daily Telegraph, March 1968

The advertising campaign for Maisha, our new annual air ambulance subscription, included billboards, radio, print and television advertising.

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International Travel Insurance journal

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n order to be successful in the competitive world of travel insurance and international air ambulance activities, we need an acknowledged expert in the field to guide and support us, given our limited budget. The International Travel Insurance Journal (ITIJ) has been just that to us for the last 10 years. “As publishers of the flagship industry magazines ITIJ (International Travel Insurance Journal) and Waypoint AirMed & Rescue, we are immensely proud to have been working with AMREF Flying Doctors for more than a decade. “From the beginning, our relationship has proven to be both mutually beneficial and inspiring; whether we are publishing case studies on the incredible work performed by AMREF Flying Doctors, running features that draw on their expertise, or designing marketing campaigns to help them reach our worldwide audience, it has always been a pleasure to help them in any way we can,”

said Mandy Aitchison, title editor of ITIJ. In terms of international exposure over the years, ITIJ was key in creating AMREF’s increased reach in the repatriation market place. It allowed the organisation to be seen by, and then keep, the attention of insurance providers and medical assistance companies across the globe and draw specific interest in the high-quality service delivered under challenging conditions. ITIJ is the original and only dedicated monthly trade journal for the travel insurance community. With a global audience of more than 20,000 readers, the Journal continues to be used as a guide to the industry and as a key reference point for the foremost organisations involved in the design, delivery and implementation of travel insurance products. The readership covers the entire chain of travel insurance delivery, all the way from underwriters and intermediaries through to the air ambulance crews saving lives every day.

Waypoint AirMed & Rescue Magazine

CONTACT: DAVID FITzpATRICK GROUP SALES MANAGER VOYAgEUR pUBlIShINg & EVENTS lTD. PHONE: +44 117 925 51 51 FAX: +44 117 929 20 23 EMAIL: DAVE@VOYAgEUR.CO.UK WEBSITE: WWW.VOYAgEUR.CO.UK 34

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aypoint AirMed & Rescue is the world’s only monthly international trade magazine for the aeromedical and rescue communities. With more than 25,000 readers worldwide, Waypoint is the first publication of its kind to cover all forms of aeromedicine, from fixedwing international patient transfers via commercial carriers and air ambulances, to HEMS, SAR and CSAR. Giving readers from across the globe a regular and comprehensive monthly digest of international developments in the aeromedical community, Waypoint also contains in-depth features, analysis and technical presentations.

The magazine is aimed primarily at both medical and flight personnel with an emphasis towards senior staff across HEMS, fixed-wing, military and public bodies. Hundreds of these readers will gather at London Oxford Airport, UK, this May to attend the magazine’s annual aeromedical air show, Waypoint AirMed & Rescue 2012. With static and live displays of fixed-wing and HEMS aircraft over two days by both private and military organisations, as well as an exciting educational agenda and exhibition, the two days in Oxford will host over 300 delegates from across the globe at Europe’s only annual event for the entire aeromedical community.


Visitors Centre

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MREF Flying Doctors’ Visitors Centre showcases AMREF’s history and raises awareness and support for AMREF Flying Doctors with members of the public. Since its opening in 2007 by Dr Tom Rees, the last surviving founder of AMREF Flying Doctors, the Centre has attracted a large

number of visitors, including more than 4,000 school children. The children are inspired by what has been achieved, and it often encourages many to consider a career in medical, engineering or aviation fields. Commencing with a 15-minute DVD, visitors follow the story of AMREF Flying Doctors from its foundation in 1957 to its impressive achievements today. Visitors tour the museum and then go to where the action takes place – the 24-hour Control Centre, where dedicated nurses take all of the calls. To finish the tour, visitors go into the hangar to view the aircraft. Tours must be arranged in advance and run for 45 minutes.

bottom right: Dr Bettina Vadera showing VIps around the Visitors’ Centre

TO ARRANGE A TOUR, PURCHASE AMREF FLYING DOCTORS MERCHANDISE, OR IF YOU HAVE ANY QUERIES, PLEASE CONTACT THE VISITORS CENTRE TEL: +254 20 699 2000 EMAIL: INFO@FlYDOC.ORg. VISITORS CENTRE OPENING HOURS: MONDAY TO FRIDAY 09:00–13:00 & 14:00–17:00. 35


Volunteer physician programme This program was started in 1997 to enable physicians from all over the world to work with the Flying Doctors on a voluntary basis. At the same time, it makes experienced emergency physicians from other countries available, to update AMREF’s aero-medical staff on developments in emergency care practices and to exchange experiences and skills. Each Volunteer Physician is required to provide at least one teaching lesson to AMREF staff. This year, AMREF Flying Doctors had 10 volunteer physicians from Germany, Zimbabwe, Italy, USA, Canada and the United Kingdom who participated in the program over a period of 3- 4 weeks each. Between them they flew over 230,000 miles to dozens of different countries. After returning to their home countries, AMREF Flying Doctors keeps in contact with the volunteer physicians and at different occasions in the past, AMREF National Offices were able to make use of these contacts for fund raising purposes or otherwise.

Further details are available on www.amref.org/flyingdoctors/volunteer-physicianprogramme/

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Dr Gerald Chitsunge

Dr Achim Roper

Dr Marc David Munk

Dr Thomas Barrett

Dr James Milligan

Dr Simon Forrington

Dr Marzia Corini

Dr Zina Semenovskaya

Dr Terry Martin

Dr Zoe Smith


Flying Doctors A Day in the Life

Top right: Dr Simon Forrington next to one of our Cessna Caravans. Below right: Simon intubates a seriously ill patient on board a Cessna Caravan.

“To touch people’s lives is the greatest gift I could ever have wished for.”

During Dr Forrington’s time here, he kept a blog. This is an extract from it…

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first-hand account from Dr. Simon Forrington, an emergency physician who just returned from 8 weeks volunteering with AMREF Flying Doctors Its 2am. The phone rings and I’m woken from a deep sleep. I clumsily reach under the mosquito net and feel around for the increasingly indignant machine. Through the fog of awakening I register the voice of the AMREF Flying Doctors Shift Coordinator and my mind immediately clears. We have an emergency aero-

medical retrieval and must leave at first light. The patient has been attacked by a rabid hyena in a remote rural area of northern Kenya and is in a critical condition. The local hospital does not have the facilities to cope and it would be too dangerous to attempt a landing on the rutted field that masquerades as a bush airstrip at night. A taxi is arranged to ferry me to the airport at 6am and I sleep fitfully for the remainder of the night, my mind unwilling to let go of what the morning might bring. I am in Nairobi, working as a volunteer physician for AMREF Flying Doctors, taking time out from my day job in the UK as a Senior Registrar in Anaesthesia and Intensive Care Medicine. I have been here for several weeks, flying missions across

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hOpE MASIKI ICT OFFICER 37


Flying Doctors A Day in the Life

East Africa and beyond with a professional and highly skilled team of flight nurses and pilots. I arrive at the airport as dawn is breaking and I check our equipment with Maurice the flight nurse. The clinical information is often patchy and we prepare enough kit for most eventualities. We check our medication supplies, oxygen and ventilator and load everything carefully into the back of our single engined Cessna Caravan. In the hands of our skilled pilots, these aircraft can land almost anywhere but they have an unpressurised cabin. The low oxygen environment this creates can compound the difficulties of evacuating critically unwell patients and we take this into account as we prepare our cylinders. The engine roars as the pilot eases the throttle forward and we take off steeply, banking hard right over Nairobi National Park. I see an ostrich far below, standing unconcerned on the savannah and a small herd of Thomson’s Gazelles scatter at the noisy intrusion of our engine. My ears pop as we climb up through the clouds and I can see the familiar summits of Africa’s two highest peaks rising above an undulating white carpet. Mount Kenya to our left and Mount Kilimanjaro resplendent in the morning sun to our right. Two hours later and we bump along the grassy airstrip, coming to a halt by a ramshackle collection of buildings. The place is deserted, already beginning to

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bake beneath an unforgiving equatorial sun. A few minutes go by and we check our equipment once more as the ubiquitous Toyota Land Cruiser draws up. I jump in the back to make an initial assessment of the patient and note that he has a breathing tube already inserted beneath heavy bandages which cover a badly injured face and head. The tube is not connected to a breathing machine and the patient has not been sedated or given any pain relief for some time. His hands and arms are also heavily bandaged and I can only imagine the trauma of trying to fight off such a strong and dangerous animal. I try to put the thought out of my mind and concentrate on the job in hand. The medical team have done a good job but they are very limited in terms of resources. AMREF Flying Doctors


however are very well equipped and I set about attaching monitoring, securing intravenous lines, sedating the patient and establishing him on our ventilator. Having accomplished this, we gently move him onto a stretcher and into the back of the aircraft. I am worried about the airway and about on-going bleeding and we carefully take down the dressings. I assess and optimise the position of the breathing tube and we carefully inspect the wounds,

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Top left: Dr Forrington attends to the patient in the aircraft.

Below right: Simon received the patient in a very poor state, brought to the aircraft in a pick up truck.

cleaning them thoroughly before applying special dressings designed to limit further bleeding. He will need extensive surgery and my priority now is to get him safely to one of the modern hospitals in Nairobi. Once airborne, I take a set of bloods, which we can immediately analyse using our portable blood gas analyser, administer antibiotics and set up infusions of sedatives, fluid and pain relief. We

land back at Wilson Airport two hours later and move our patient into the ground ambulance. Our skilled AMREF Flying Doctors driver weaves through the notorious Nairobi traffic and we arrive at the intensive care unit of a large Nairobi hospital. Having handed over his care to the team at the hospital, we head straight back to Wilson Airport. Sean, our Operations Director is waiting for me on the apron with our Citation jet fully loaded and ready to go. A patient has severe malaria in the Democratic Republic of Congo. Here we go again... The above patient, I understand, had a prolonged stay in hospital and underwent several surgeries. His evacuation was paid for by AMREF Flying Doctors as a charity case and his hospital bill was settled by the Kenyan Wildlife Service. He is now back in his village making a steady recovery. Working with AMREF Flying Doctors has been one of the highlights of my medical career so far and the team there are some of the most dedicated and professional people I have ever met. More details and photographs of my work with AFD can be found on my blog www.forringtonstravels.wordpress.com and I would encourage other appropriately qualified medical staff to consider volunteering. More details can be found at www.flydoc.org

“It a genuine pleasure to work with such a dedicated team of doctors, nurses, pilots and support staff.� ANThONY KIhARA FLIGHT NURSE 39


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MREF Flying Doctors also provides medical and logistical assistance locally to international insurance and assistance organizations. This can range from the follow up of medical reports for in-hospital patients, assessment of hospital

Assistance Services

Assistance services can include the following:

Funeral Assistance

To arrange a local coroner/undertaker to organise a funeral (burial or cremation), including the arrangement of necessary documentation. Special arrangements linked to the religion/cultural background will be organised where possible

Repatriation of human remains

To make all necessary arrangements for the transport of human remains. This includes: Official documents Preparation of the body and coffin for transport Delivery to the airport

Emergency Returns

To make flight and taxi arrangements to the airport in case the beneficiary has to return to his/her home country due to an unforeseen event

Accommodation

To arrange hotel accommodation for the beneficiary in case of an unforeseen emergency such as an accident, illness, death or crime. The same can be arranged for the patient after discharge from hospital, or for patient’s relatives

Assistance with lost or stolen documents/luggage

To assist the beneficiary with arrangement of local police formalities and renewal or substitute of documents.

Cash advance

To pay money to a beneficiary/patient in case of an unforeseen even such as an accident, illness, death or crime. Only available through contractual agreement with AMREF Flying Doctors.

hospital guarantee

To guarantee payment of hospital charges and other medical expenses in Kenya. Only available through contractual agreement with AMREF Flying Doctors

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bills, provision of transport for patients or relatives, booking hotel accommodation or air tickets, to the actual guarantee of medical or other case related expenses. Furthermore, AMREF Flying Doctors assesses medical facilities on request and advises insurance companies when medical evacuation or repatriation for their clients is recommended. These services are provided against a handling fee and are only rendered to clients with whom AMREF Flying Doctors has signed a “service provider agreement. This year, the number of Service Provider Agreements signed with leading international insurance/assistance companies has reached a total of 182, under which many regional companies and subsidiaries are covered. Registration Agreements are also formed between AMREF Flying Doctors and larger NGOs, parastatals, or insurance companies. Registration Agreements include an upfront Guarantee of Payment for evacuation flights, consequently giving clients fast access to AMREF Flying Doctors’ air ambulance service. This year the number of Service Provider Agreements signed with leading international insurance /assistance companies has reached a total of 375, under which many other regional companies and subsidiaries are covered. Over 450 individual cases were handled on behalf of those companies.

Top left: The two AMREF Flying Doctors’ Cessna Caravan 208B aircraft ready to respond.

Additionally, AMREF Flying Doctors increased the number of Registration Agreements, usually formed between AMREF Flying Doctors and larger NGOs, para-statals, insurance firms or companies mostly outside the membership radius, from 46 in 2004 to 165 in 2012. Registration Agreements include an upfront Guarantee of Payment for evacuation flights and consequently give clients a fast access to our air ambulance service.


Royal Flying Doctor Service

Right: RFDS president john Milhinch, AMREF Flying Doctors Board Chairman Tony Durrant and RFDS CEO Clyde Thompson being shown around the Visitors’ Centre by Dr Bettina Vadera

Australian Youth Ambassador for Development placements (AYAD)

A

MREF has had a very long and rewarding relationship with the world-renowned Royal Flying Doctor Service of Australia (RFDS). Since its inception in 1957, AMREF Flying Doctors has been able to call on the guidance, support and expertise of its Australian counterpart as it has developed into a fully fledged aeromedical service. With more than 80 years’ experience in Australia, the RFDS has been delighted to share the benefits of its experience with AMREF Flying Doctors and to learn about the particular challenges faced in Africa. Over more than 50 years, this special relationship has evolved into one of mutual exchange and collaboration, and over the last eight years, the RFDS has assisted AMREF Flying Doctors in a variety of ways. These have included sharing of management techniques, fundraising ideas and aeromedical advice.

A

MREF Flying Doctors was pleased to welcome two Australian volunteers to the organisation, funded by the Australian Government Aid Program, AusAID. The Australian Youth

The Executive Director of the RFDS South Eastern Section, Clyde Thomson GM, sits on the Board of AMREF Flying Doctors and has also been able to assist in business planning and direction for the organisation. For the first Annual Board Meeting of AMREF Flying Doctors in October 2012 Clyde Thompson was accompanied by the President of RFDS, John Milhinch. It was a pleasure to show them around the facilities and benefit from the advice and ideas they were both able to contribute during the visit.

Ambassador for Development (AYAD) Program provides an opportunity for young professionals to work in a developing country, helping to build the capacity of host organizations and encouraging skills transfers.

Right: Kate McBride completed some monitoring and evaluation work for AMREF Flying Doctors when she was on assignment with AMREF headquarters. pictured here with a new friend.

Far right: Rowena harbridge joined AMREF Flying Doctors in November 2011 and was with the organisation for nine months as a Communications Officer.

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Quality

letter of appreciation May 2012.

42

p

roviding aero-medical emergency and primary healthcare in remote areas is an inherently challenging business. Maintaining the highest standards of quality control is therefore essential to ensure safe operations. Monthly quality control and safety meeting are held both internally and with our close working partner Phoenix Aviation Limited. These meetings ensure that all matters affecting operations – both aviation and medical – are brought forward, discussed and actioned. Part of that quest for quality is ensured by adherence to the strict accreditation requirements of EURAMI (European Aeromedical Institute (www.eurami.org), one of only two organisations in the world who can officially assess the standards of service provided by air ambulance

organisations. In 2007, AMREF Flying Doctors was the first non-European, non US air rescue provider to receive an accreditation by EURAMI to the level of “Full Accreditation - special care” for air rescue providers. Reaccreditation was again granted in 2010 for a further three years. The involvement of AMREF Flying Doctors in the precepts of EURAMI continued in 2009 and again in 2012 with the election of Dr Bettina Vadera, the AMREF Flying Doctors CEO and Medical Director, to the Board of EURAMI. With over 900 evacuations annually, more than 5 % of which are charitable, AMREF Flying Doctors will continue to pave the way for quality care in patient management outside the hospital set up in Africa and beyond.

Charity Flights have always been a vital part of the work of AMREF Flying Doctorsd, as this press cutting from the East African Standard in 1963 shows.


professional Medical Training

Above right:

A

MREF Flying Doctors is frequently tasked with responding to emergencies in some of the most difficult and remote areas, presenting our pilots, flight nurses and doctors with challenging professional situations. Providing emergency and primary healthcare onboard an aircraft and in remote areas requires specialised and exceptional medical skills. Every AMREF Flying Doctors medical staff member is required to have an extremely high level of education and experience before joining us. They are also required to continually undergo further training to ensure they are able to provide the best care possible, both on the ground

and in the air. Advanced professional development is an ongoing priority, and all AMREF Flying Doctors nursing staff underwent training this year in pre-hospital trauma life support and trauma nursing Each year, two nurses are selected to attend the prestigious Clinical Considerations in Aeromedical Transport course in the UK. Taught by aviation physiology and retrieval medicine experts the course covers relevant issues of the special physical, physiological and psychological stresses that are important in the flight environment and trains our staff in the conditions that are susceptible to this form of transport and how patients may be safely and efficiently carried.

Dr Terry Martin holding a training session for the flight nurses on one of the Ecureuil B3 helicopters

Right: Dr Terry Martin holds a training session in the AMREF Flying Doctors’ Equipment Store.

“The patient comes first, and environment is secondary. This was an intervention under the wings.” MAURICE SIjENYI AEROMEDICAL COORDINATOR AND FLIGHT NURSE 43


First Aid Training AMREF Flying Doctors has designed a three day course in Emergency First Aid. Four of our flight nurses are assigned trainers for the First Aid Course and during the year, 7 courses were conducted.

Engineering Keeping Our Aircraft Flying Below: David Mutava, Chief Engineer - 1981

A

MREF Flying Doctors has a highly skilled engineering team working in our hangar at Wilson Airport. The team, consisting of engineers, trades people, stores and technical records staff, not only service our aircraft to ensure they are in perfect condition, but also maintain private aircraft, contributing to raising funds for AMREF’s charity work. Engineering staff work around the clock to ensure the safety for our

staff and patients and conduct routine maintenance checks, major checks and, when needed, detailed overhauls based on the manufacturers’ recommendations.

Flying Doctors is the organisation which has helped so many people and we hope it can continue doing its good work for everyone. All of the staff are so very proud to be part of this wonderful team DAVID MUTAVA CHIEF ENGINEER 44


Donations From the Archives

S

ince its inception, AMREF’s Flying Doctor service has relied on donations and gifts to survive. Funds have been raised by everything from high-profile social events

for the rich and famous, to schoolchildren collecting and donating pocket money. Some of the earliest funds and support came from within the families of the Founders, with special mention of Lady Susan Wood and Nan Rees. In an effort to raise funds for AMREF, Michael traveled to Europe and in 1963 managed to convince Leonore Semler, wife of Dr.Johannes Semler, a prominent politician with the European Community, to start AMREF Germany as a local fundraising organisation. In only a few days with the help of Prince Constantine of Bavaria, AMREF Germany had its first donation of DM 10,000. Not long afterwards, Mrs. Semler managed to convince Mr. Walter Scheel, the then Minister for Foreign Affairs, to pay the salary for a surgeon and pediatrician in AMREF and to donate an aeroplane. Today’s AMREF Germany is the result of Leonore Semler’s dedication and the German Government has conferred upon her one of Germany’s highest orders for her social work, the Federal Cross of Merit “Das Bundesverdienstkreuz der Bundesrepublik Deutschland”.

Below: Archbishop Macarthy blesses the aircraft donated by MISEREOR, the Association of german Catholic Bishops -1967

press cuttings about donations made to AMREF Flying Doctors, 1965

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Professional Partner Phoenix Aviation Kenya Ltd

A life-Saving partnership

p

Contact: phoenix Aviation ltd. P.O.Box 49493-00100, Nairobi, Kenya phone: +254 (020) 4945 540 +254 (020) 4945 541 Fax:

+254 (020) 600 4049

24hr Mobile: +253 733 632769 Email: flightops@phoenixaviation.co.ke Website: www.phoenixaviation.co.ke

46

hoenix Aviation and AMREF Flying Doctors formed a close working relationship more than a decade ago and together have created an unique and extraordinary service that is used by many of the world’s leading Insurance and Assurance companies. Their combined efforts enables AMREF Flying Doctors to extend the capacity beyond that of their own aircraft, offering a 24- hour air ambulance service response locally, as well as longer-range international transfers. Phoenix brings to the partnership aircraft equipped with FAA approved Lifeport stretcher systems, which combined with the specialised modern aeromedical equipment, including monitors, ventilators and a neonatal incubator of AMREF Flying Doctors, which allows patients to receive intensive care whilst on the ground and in the air. Phoenix Aviation’s highly experienced flight crew of 22 - who between them have flown over 584,000 statute miles and 384 medical evacuations in 2012 alone – carried out many of these medical evacuations under challenging circumstances and in difficult areas, such as Somalia and DRC. AMREF Flying Doctors was the first non-European, non-US air rescue provider to receive full

accreditation “Special Care Status” by EURAMI (European Aeromedical Institute), one of only two organisations in the world that can officially assess standards of service provided by Air Ambulance Organisations. Phoenix Aviation is proud to share this world-class air ambulance partnership and has further demonstrated their commitment to quality by earning the distinction of the independently audited award of ISO 9001-2008, as well as being one of only six air charter companies in Africa to receive the WYVERN Wingman designation. WYVERN provides one of the most rigorous on-site safety auditing packages in the world. Jointly, this partnership brings operational and safety procedures together to ensure the best possible service for patients repatriated to South Africa, Europe, Asia, the Middle East and beyond.


professional partners FrontierMEDEX

Contact: Pascaline Wolfermann FrontierMEDEX Email: operations@frontiermedex.com Tel: +1-410-453-6330

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rontierMEDEX prides itself on helping clients in not only the developed areas of the world, but also in some of the most challenging locations across the globe. Assistance from FrontierMEDEX means quality, consistency and speed. Without partners like AMREF Flying Doctors we would not be able to deliver this level of service to clients. AMREF has been a trusted and respected partner of FrontierMEDEX for nearly 15 years. They are key to us being able to assist clients in East Africa with acute medical emergencies. We respect and admire this organization not only for the fantastic work they do when evacuating one of our members, but also for the incredible charity work they do. It is refreshing and rewarding to work with a partner that values the same things as FrontierMEDEX: integrity, compassion and social responsibility. “If there was one air ambulance company in the world that would shine through their

professionalism, the respect they inspire, their dynamic staff, AMREF Flying Doctors would come on everyone’s minds. Not only are they key in assisting us manage very complex medical evacuations in this area, but they also provide incredibly important charity work. It is a truly essential organization with outstanding staff and leadership. We feel so blessed to be able to work with them.” Susan Torroella, Vice President of Assistance for FrontierMEDEX

professional partners iSOS

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professional partners ADACAmbulanceService

A

Contact: ADAC-AmbulanceService Phone

+49 89 76 76 52 85

Fax

+49 89 76 76 50 70 info-ambulance@adac.de www.adac.de/ambulance

For urgent repatriation requests: Phone

+49 89 76 76 5005

Fax

+49 89 7439012 emergency@adac.de

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s the needs of AMREF Flying Doctors extend beyond the continent of Africa to North America, Australia and the Far East, an increasing number of wingtowing patient transfer services are needed. On a particularly long journey it can be of immense benefit in time and cost to carry a patient part of the way with one air ambulance company and then transfer the patient to another air ambulance company’s aircraft to complete the journey. It does mean, however, that both companies must adhere to a strict code of practice in both medical and operational procedures offering the same commitment to service, quality of patient care and flight safety standards. AMREF Flying Doctors is proud to be associated with ADAC Ambulance Service. World-wide patient transports ADAC Ambulance Service organizes and carries out patient transfers worldwide on ground and by air. The service ranges from the transfer by ground ambulances to the repatriation of intensive care patients in ADAC’s own

ambulance jets. Highly qualified medical staff specialized in emergency medical assistance, intensive care and flight medicine accompany these transfers. The patients and their relatives are looked after personally and more than 40 ADAC physicians check the patient’s medical condition with local attending physicians. ADAC Ambulance Service assists about  53,000 patients and transports more than  14,000 patients per year on ground and by air. Depending on the patient’s diagnosis, air-bound transport may also involve additional transport options such as stretcher, sleeper and PTC. The fleet The ADAC fleet comprises DornierFairchild 328-300 jets, Beechcraft Super King Air A350 and several Lear jets. Equipped with state-of-the-art intensive care facilities, they are very quiet, stable aircraft with the highest hygiene standard specifically designed for patient transport. Thanks to their size and flexibility, particularly the Dornier-Fairchild 328-300 jets, they make it possible to transport not just the patient’s but also their next of kin.


professional partners Healix International

Integrated Travel Risk Management service supports employers’ duty of care

A

Contact: Scott Sunderman healix International Healix House, Esher Green, Esher, Surrey KT10 8AB United Kingdom Phone: +44 (0)20 8481 7720 Email: scott.sunderman@healix.com Website: www.healix-international.com

50

t Healix, we have extensive global experience in the medical treatment, repatriation and evacuation of people taken ill or injured whilst overseas. With a team of doctors and nurses available on the phone 24 hours a day, 365 days a year, we are able to evaluate the gravity of a case from the very first call. To help employers fulfil their duty of care towards staff travelling and working abroad, Healix has partnered with a leading security company to develop an integrated travel risk management solution. By co-ordinating all services needed for travel, health and security risk management through one central point, Healix is able to provide a first class service, ensuring that all employees get the most appropriate support and protection. Communication is improved, employee

compliance with policies and procedures can be monitored and employers have a central record evidencing duty of care for each employee. Furthermore, employees have the benefit of liaising with just one central access point, instead of having to deal with several different departments. A bespoke service is provided according to requirements. For example, we are the international medical healthcare provider for the UK’s Foreign and Commonwealth Office, as well as a number of other government departments. We’re responsible for over 17,000 employees and their families in over 190 foreign destinations including most African countries and provide primary & secondary healthcare management, prescription services and emergency evacuation support with the invaluable support of Amref as local partner to help co-ordinate arrangements on our behalf. We are also involved in the Occupational Health assessment and preparation of FCO employees before they are posted abroad.


professional partner Rega

AMREF Flying Doctors staff displaying the donation from Rega

Contact: Dr. med. Olivier Seiler, M.D. Medical Director Fixed Wing Rega, Swiss Air-Ambulance P.O. Box 1414 CH-8058 Zurich-Airport Meet us in the Web: www.rega.ch

O

ther partners help us out in some many ways. We receive a tremendous amount of support, advice and encouragement from one of the most professions air ambulance companies in the world, Rega Swiss Air Ambulance who recently made a donation to AMREF Flying Doctors of 5 Oxylog 1000 machines. Dr. Olivier Seiler, Rega’s Medical director for fixed wing operations says: “The history of good relations between Rega and Amref has been going on for decades. In difficult to handle cases in the East African region we were always very happy to be able to rely on the services of our partner. Their knowledge and professionalism is essential when dealing with medical emergencies in remote areas of this part of Africa. In most of the cases we ask Amref to bring the patients to the nearest adequate hospital for a first treatment and then organize their trip back to Switzerland by commercial airline together with our own medical escort, if needed. In more time critical cases we have very successfully used the method

of wing-to-wing operations. This helps to save precious time and the patient is being taken care of by a professional medevac-team throughout the journey. When we decided to replace the ventilators Oxylog 1000 we immediately thought of our partner: a phone call and the shipment of five ventilators was organized! We do hope that the devices will continue to be of good service in critical situations for many more years.”

professional partners AIMS

Contact: Bernadette Breton Managing Director Alliance International Medical Services Private Bag X5, Benmore Gardens, 2010 Johannesburg, South Africa Phone: +27 11 783 0135 Fax:

+27 11 783 2950

Email:

operations@aims.org.za

Website: www.aims.org.za

I

n a constantly changing African Continent, Alliance International Medical Services (AIMS) consistently strives to live up to the mission statement “HUMANITY, DIGNITY, RESPECT” in the day-to-day dealings with our clients and their members who become our patients. Based in Johannesburg, AIMS is well positioned not only for assistance within South Africa but also a high percentage of the countries held within the SubSaharan Basin. Naturally, in order to do

this well, one needs reputable professional associations which happily we have with AMREF Flying Doctors. Alliance International Medical Services and AMREF Flying Doctors have enjoyed a working relationship which over a period of 10 years has grown from strength to strength and it is indeed comforting to know that once a patient is in the capable hands of AMREF Flying Doctors, our standard of “HUMANITY, DIGNITY, RESPECT” prevails.

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proud to Support the Work of AMREF Flying Doctors

A HUGE ThANK YOU TO YOU ALL AMREF Flying Doctors would like to say a very special thank you to all our professional partners and supporting organisations. With their help and generosity, we have been able to produce our most comprehensive annual report to date.

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53


AMREF Outreach programme

h

ealth care in East Africa is underdeveloped and under funded. Few patients can afford specialised medical treatment. There are few specialists, particularly surgeons in most rural hospitals. Only 10 -15% of patients referred from District Hospitals to secondary or tertiary hospitals are able to travel for several reasons: poverty, poor transport systems, no relatives to support them during recuperation, no housing, culture shock, ethnic factors and more.

The AMREF Clinical Outreach Programme was established in 1957 to take essential medical and surgical services to remote District level hospitals. The Programme is regional, with 6 inter-related projects in 8 countries in Eastern Africa. The Programme is mainly operated using AMREF Flying Doctors’ Cessna Caravan 208B aircraft on planned, regular flights and hospitals located in adjacent areas are placed on “circuits”. Specialists for each hospital are selected on an annual basis according to the requests from these hospitals. Specialists available for visits cover 25 different specialties e.g General Surgeons, Gynaecologists, Reconstructive, Urologist, Ophthalmologist, Medical Engineers etc. The Specialist Outreach Project in South Sudan, funded by AMREF Spain, began in 2012 and will grow to full capacity in 2013. Over 58% of the patients treated are women or girls with 416 women receiving VVF repairs and restored back to social life after many years – one woman was successfully treated after 46 years of being a social outcast.

Outreach surgery

Outreach Achievements 2010-2012

54

2012

2011

2010

Number of Outreach Flights Made

120

137

146

Number of Hospitals Visited

150

150

150

Consultations Provided

27,033

27,665

26,184

Specialist Outreach

4,839

5,141

4,694

Surgical Outreach

232

388

432

Leprosy/Reconstructive Outreach

1,513

1,554

1,111

VVF & Safe Motherhood

416

823

1,201

Total Operations

7,000

7,906

7,438

Doctors Trained

1,551

1,542

1,519

Nurses & Clinical Officers Trained

6,280

4,893

4,756

Laboratory Staff Trained

1,338

301

303

Support Staff Trained

4,124

1,854

1,944

Joint Ward Rounds

1,358

1,584

1,632

Hours of Formal Training

4,902

1,785

1,437

Hours of Informal Training

-

9,617

9,226

Total Staff Trained

13,293

8,590

8,522


The goals Of Outreach

• Better and improved surgical health care for communities

complicated surgical cases

living in remote rural areas of

presented by the medical

Eastern Africa.

officers.

• To achieve the project goal and objectives, the main activities of the surgical outreach include:• To fly regularly to remote hospitals using light aircraft. • To provide specialized surgical services including Endoscopic, Urological surgery and VesicoVaginal Fistula repair, to remote rural hospitals in East Africa through regular visits. Below right; Early Outreach surgery - 1965

• To operate and give advice on

• To enhance the surgical skills of medical officers based in rural hospitals through training. • To improve the skills of theatre

• To provide emergency surgical care to complicated cases. • To give morale and psychological support to staff in remote hospitals through regular contacts by radio, telephone and e-mail. • To train postgraduate students from the University of Nairobi. • To supply hospitals on the surgical outreach with essential surgical supplies. • To collaborate with University of Nairobi departments of Surgery and Obstetrics/ Gynaecology, Kenyatta

staff and other hospital

National Hospital, KEMRI and

support staff in pre and post-

Nazareth Hospital in training

operative management of

and operational research.

surgical patients.

“I have worked for AMREF for many years but each day is never the same. It’s a joy to assist those in need of medical assistance. AMREF surely makes a difference in Africa.” KIlDA BEgISEN AEROMEDICAL COORDINATOR AND FLIGHT NURSE 55


AMREF Outreach programme

Clockwise from top left: patients wait to see the doctors – 2012; Dr Michael Wood at an early Outreach clinic; An Outreach operating theatre 2012; Outreach surgeons discuss a case 1961.

56


Clockwise from right: A local doctor shows the Outreach team his ward 2012; An early eye treatment clinic, in the back of a vehicle, 1961; patient Consultations held under a tree, 1963; patient consolations held under a tree 1980.

57


Accounts AMREF Flying Doctors – Finance Report: Full Year 2011/2012

Note on Balance sheet: The balance sheet grew by 7% during the year, mainly as a result of growth in profit from operations. With a current ratio of almost 3:1 the working capital of the company is strong and has improved from 2:1 last year.

58

profit & loss Account – for the financial year ended 30 September 2012

N

ote on Profit and Loss Account Turnover: Revenue represents all the receipts that the company receives from normal operations and is recorded net of sales tax. The full year revenue is 11% ahead of budget and 0.2% behind last year. The growth over budget is mainly attributed to strong performance across most lines of business Despite the budgeted reduction in business related to AMISOM flights (actual business reduction is 45% as compared to last year and AMISOM business now accounts for 18% of total revenue) the business has recorded impressive new growth in regional and short distance flights and on the subscription based products. Cost of Sales: Direct cost remained fairly stable during the year under review. Except for inflation related price increases the rest of the direct cost was volume driven. Direct cost as a percentage of revenue was 70%, 1%

off the budget at 69%. The current year ratio is an improvement from last year at 74%, and is mainly due to improved cost control and better asset and labour utilisation. There were no exceptional costs during the period. Overhead cost: Overhead cost as a percentage of revenue was 25%, budgeted for at 26%. However, there was an overspend of $232,000 during the year, mainly related to increased spend on marketing and advertising to drive the new subscription based products. The management has plans to further optimise cost through better asset utilisation, labour efficiency, cost cutting and implementation of key strategic actions to further address cost. profit: Profit from operations grew by 3% over budget and by -30% over last year. The reduction over last year had been anticipated and budgeted for. The budget revenue and profit for the financial year 2012/2013 is Usd 16,014,155 and USD 1,000,383, respectively.


Balance Sheet as at 30 September 2012

Balance Sheet

30-Sept-12 US$

30-Sep-11 US$

Non Current Assets Property & Equipment Investment - WATCO

2,563,169 10,000

2,456,758 -

Current Assets Inventories Receivables Others Trade Receivables Provision for bad debts Trade Deposits VAT Receivable Cash & Cash Equivalents Subtotal -Current Assets

410,853 4,231 1,944,065 (114,277) 108,937 82,520 3,577,844 6,014,173

330,111 7,031 1,477,686 (114,277) 137,851 6,558 3,724,094 5,562,496

Total Assets

8,587,342

8,019,254

FUND & lIABIlITIES Funds Capital Reserves Accumulated reserves Surplus for the year Aircraft replacement reserves Aircraft maintenance reserves Total Funds

3,208,967 1,176,456 675,204 1,091,401 189,079 6,341,107

3,208,967 1,146,515 1,121,365 173,957 5,650,804

Current liabilities Unexpended Grants Trade Payables Payables others VAT Payable Inter-company Payables Sub total Current Liabilities

64,350 1,160,165 112,125 909,595 2,246,235

167,033 1,465,385 95,973 640,055 2,368,450

Total Funds & Liabilities

8,587,342

8,019,254

59


Title (archive photo)


Nationalities Evacuated 2012 Of the 918 patients, the nationalities most frequently evacuated during the period of this report were:


AMREF National Offices

F

undraising for AMREF comes from all sources, but the backbone of donor income is generated by the AMREF National Offices. These fundraising offices raise the profile of AMREF Flying Doctors throughout the world, talking to donors both large and small, organising fundraising events and improving the understanding of the work of AMREF wherever they go. Money donated to AMREF Flying Doctors is spent on aircraft, medical equipment or health services. We acknowledge with grateful thanks the tremendous support received from overseas and especially from the AMREF National Offices.

AMREF in Europe Contact Information ---------------------------------------------------AMREF in Austria Gesellschaft fuer Medizin und Forschung in Afrika, inc Flying Doctors Service; Waagplatz 3; 5020 Salzburg Tel: +43 (0) 662 / 84 01 01 Fax: +43 (0) 662 / 84 01 01-13 Email: office@amref.at www.amref.at AMREF in Denmark Den Afrikanske Lægefond Gorrissen Federspiel Kierkegaard 12 HC Andersens Boulevard DK-1553, Copenhagen V Tel: + 45 33 41 41 41 Fax: + 45 33 41 41 28 Email: tf@gfklaw.dk www.amref.org/denmark.htm AMREF in France 134 Boulevard Haussman, 75008, Paris Tel: + 33 (0) 1 71 19 75 35 E-mail: info@amref.fr www.amref.fr AMREF in germany Mauerkircherstr. 155, D-81925 Muenchen Tel: +49 89 358050490 Fax: +49 89 358050477 Email: info@amrefgermany.de www.amrefgermany.de AMREF in Italy Via Boezio, 17 00193 Roma Tel: +39 06 99704650 Fax: +39 06 3202227 Email: info@amref.it www.amref.it

AMREF in Europe (continued) Contact Information ---------------------------------------------------AMREF Milan Office AMREF Italia Sito della Guastalla 3, 20122 Milano Tel/Fax: +39 02 5410 7566 Email: milano@amref.it AMREF in Monaco Res. Les Saint Andre – 20 Boulevard de Suisse – 98000 Monaco Tel: +377 9777 0808 Email: info@amrefmonaco.com www.amrefmonaco.com AMREF in The Netherlands Haagse Schouwweg 6G, 2332 KG Leiden Tel: +31 71 576 9476 Fax: +31 71 576 3777 Email: info@amref.nl www.amref.nl AMREF in Spain c/ Buganvilla, 5 - 1° C, 298036 Madrid Tel: +34 91 310 27 86 Fax: +34 91 319 68 12 Email: amref@fundacionamref.org www.amref.es AMREF in Sweden Ostermalmsgatan 84, 114 50 Stockholm Tel: +46 08 562 500 90 Fax: +46 08 660 02 43 Email: amref@telia.com www.amref.se AMREF in the UK Clifford’s Inn, Fetter Lane, London, EC4A 1BZ Tel: +44 20 7269 5520 Email: info@amrefuk.org www.amref.org/uk AMREF in North America Contact Information ---------------------------------------------------AMREF in Canada 489 College Street, Suite 407, Toronto, ON M6G 1A5 Tel: +416 961 6981 Fax: +416 961 6984 Email: info@amrefcanada.org canada.amref.org

AMREF in the USA 4 West 43rd Street, 2nd Floor, New York, NY 10036 Tel: +212 768 2440 Fax: +212 768 4230 Email: amrefusa@amrefusa.org www.amrefusa.org AMREF in Africa Contact Information ----------------------------------------------------AMREF in Kenya PO Box 30125-00100 Nairobi Tel: +254 20 699 4000 Fax: +254 20 606 340 Email: info.kenya@amref.org AMREF in Tanzania 11019 Ali Hassan Mwinyi Road, Upanga, PO Box 2773 Dar es Salaam Tel: +255 22 2116 610/2113673 Fax: +255 22 2115 823 Email: info.tanzania@amref.org AMREF in Uganda Plot 29 Nakasero Rd PO Box 10663, Kampala Tel: +256 414 250319 Fax: +256 414 344565 Email: info.uganda@amref.org AMREF in South Africa Hillcrest Forum 731 Duncan Street Hillcrest Pretoria 2000 Tel: +27 12 362 3127/35/36 Fax: +27 12 362 3102 Email: info.southafrica@amref.org AMREF in Ethiopia House Number 629 Kabele, 12, Wewda 16 Megenagna off Gebresellesie Road PO Box 20855, Code 1000 Addis Ababa, Tel: +251 11 6184751/6627851 Fax: +251 11 6627887 Email: amref@telecom.net.et

AMREF Flying Doctors 24 hour Emergency Contacts Emergency Tel: +254 20 6992299 / 6992000 / 315454 / 315455 / 6002492 Fax: +254 20 344170 / 600665 Mobile: +254 (0)733 639088 / 736 0359362 / 722 314239 Radio Frequencies: HF: 9116kHz LSB / 5796 kHz LSB Email: emergency@flydoc.org

AMREF Report 2012  

AMREF Report 2012

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