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Covid-19

Flying doctors in Africa mobilise for Covid-19 medevacs

Airport staff prepare to disinfect a plane after it landed at Juba International Airport in Juba, South Sudan on 3 April 2020.
Airport staff prepare to disinfect a plane after it landed at Juba International Airport in Juba, South Sudan on 3 April 2020. © AFP - Alex McBride

Air ambulance services operating on the African continent are seeing an uptick in medevacs linked to Covid-19 and are adjusting to a number of difficulties in transporting infected patients, both within Africa and outside the continent. 

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"In the air ambulance industry, Covid-19 has had a huge impact,” says Fraser Lamond of Air Rescue Africa, a Johannesburg-based company operating two Hawker aircraft. “The need to safely transport Covid-19 suspected positive cases - it's ever increasing.” 

The continuing spread of the virus in many African countries is driving demand, according to Lamond. The number of enquiries about the possibility of medical evacuation by air has increased too, as clients investigate a potential airlift to the continent’s best medical centres. 

However, there has also been a marked reduction in the flow of normal medical evacuations as lockdowns designed to stop the spread of the coronavirus resulted in many expatriates and business people returning home. 

“We have requests from various sectors,” says Joseph Lelo, medical director of AMREF Flying Doctors in Nairobi, discussing Covid-19 medevacs. “Some are Kenyans returning home and others are expatriates working in Africa being repatriated to home countries or to countries with better care facilities.” 

Preventing further infections 

The highly infectious nature of Covid-19 forced AMREF Flying Doctors to start using special isolation chambers aboard their aircraft, helping prevent the spread of the virus. 

“We could transport Covid patients before getting the units but only over short distances in country and within limited risk management parameters,” says Lelo. “With these units we are now able to do longer intercontinental flights.” 

Lamond acts as regional medical director for International SOS, a medical and travel security services firm, which operates Air Rescue Africa. He says their involvement responding to the Ebola outbreak in West Africa and SARS has prepared them for dealing with Covid-19. 

"We're quite familiar with isolation units, and in fact, our air ambulance system based in Johannesburg has been using isolation units for over 15 years," he says. Closed circuit ventilation systems can reduce the need for isolation chambers, given the reduction in infectious droplets circulating in an airplane’s cabin, nevertheless Covid-19 air transfers are high-risk, he adds. 

Preventing further coronavirus infections during medevacs is not the only concern for air ambulance services. Taking patients from one country to another presents a problem during Covid-19 lockdown measures, says Graham Lambert of Aeroworx

Aeroworx, which aims to provide a one-stop shop for medical evacuations on the African continent, has seen a “flurry of requests” about Covid-19, according to Lambert. But arranging aircraft and flight crews is the easy part. 

Lockdowns restrict air ambulances 

"Where do they go? That's the $64,000 question," says Lambert, describing how some countries are making it particularly difficult to receive Covid-19 patients. 

Aeroworx’s main market is Democratic Republic of Congo and the government is making it difficult for Covid-19 patients to leave, not just Congolese, but foreign nationals too, according to Lambert. His company does not operate its own fleet but tries to match the different medical needs of patients with air ambulance providers. 

“There are a lot of government-imposed restrictions on movement of persons across borders in our region,” says AMREF's Lelo, explaining how Covid-19 restrictions have hit medevac flights. “A lot of our potential clients are unable to travel into the region – mostly tourists and expats.” 

All medevacs flown to Kenya are now treated as Covid-19 positive until tests are carried out in the country, according to a letter sent to diplomatic missions at the end of May by the ministry of foreign affairs. 

“The evacuating company must ensure that the aircraft used is equipped with secure and Covid-19 compliant evacuation equipment and all Covid-19 protocols, including for the protection of air and ground crew as well as ambulance crew, are in place and are deployed,” says the letter seen by RFI. 

Kenya’s foreign affairs ministry must also have a confirmation from the receiving hospital that they are willing to treat a Covid-19 patient, the letter added. 

The situation is similar in South Africa, which Air Rescue Africa uses as a base. The authorities are taking a lot longer to approve medevacs, says Lamond. “It's a lot more complex now". 

Typical clients for air ambulance services in Africa include workers for non-governmental organisations, corporations, tourists and governments, although this has changed with permission to move infectious patients becoming more difficult to obtain. 

Medevacs for government officials 

Some African governments have reportedly employed air ambulances to provide medevacs for officials suffering from Covid-19. Burundi’s First Lady Denise Nkurunziza was reported to have been airlifted to Nairobi after testing positive for the coronavirus. 

South Sudan’s government has been hit by several cases of Covid-19 and President Salva Kiir recently denied rumours that he had been flown to Egypt for medical treatment. 

The other work undertaken by air ambulances has been delivering supplies and collecting blood samples on behalf of African governments, such as AMREF working with the Kenyan government to deliver a ventilator, boxes of hand sanitizer and personal protective equipment to remote areas. 

Nevertheless, air ambulance services are usually beyond reach for cash-strapped African governments who have difficulty providing critical care facilities. 

"Africa is still on that development pathway," says Lamond, referring to the treatment of very sick Covid-19 patients. He points to the continent’s hubs, such as in Nairobi, Dakar, and cities in South Africa and Morocco, where top quality medical care can be obtained. 

Covid-19 changes not only the context for medevacs, but also the destinations where patients want to be treated. Air ambulances are flying longer distances and carrying out more evacuations to Europe. 

A typical Covid-19 medical evacuation by aircraft ranges from between $60,000 to $100,000 for taking a patient from west Africa to South Africa or Europe, depending on the aircraft employed, according to industry estimates. 

"There's a lot of effort going into ensuring that we are responding effectively to the Covid situation,” says Lamond. "There's a huge amount of interest in helping, not just companies that are working in these countries, but also governments that need help from a technical perspective.” 

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