Life and death

 

On a medevac flight you are interacting with people in a time of great personal distress. They, or the family member whom they are accompanying, is critically ill (otherwise they wouldn’t need to be flown out). Medics are doing what medics do – poking, prodding, and speaking in unfamiliar terms. Many of our medevac passengers have never been in an aeroplane before. They must entrust their lives to a malae (foreigner) who can’t speak their language, to fly this noisy, bumpy machine to a bustling city they may never have been to before. Despite the distress, for many of our medevac patients a flight is the only way to save their life – the journey to Dili by road would be too long or gruelling for them to survive.

Over the three weeks I have been flying here, I’ve seen patients of every age: newborn babies, primary school aged children, pregnant mothers, young men, and elderly men and women. Our job as MAF is to provide the air transport; we aren’t expected (nor permitted) to give any medical treatment to the patients. That is the role of the onboard nurse or medic, whom we usually pick up with the patient. Often the patient will arrive hooked up to an oxygen bottle, or with an IV line, or a catheter, or sometimes all three. If they are a baby or require oxygen then we know it’s in their best interest to fly at as low an altitude as is practical. In all cases, when we arrive at the airstrip, we try to do the following as quickly as we can:

1. Wait for the ambulance to arrive, if it isn’t already there.

2. Obtain names and weights for the patient, their accompanying family member(s), the nurse/medic, and all baggage.

3. Assist with loading the stretcher and securing the patient, or seating them if they are able to sit up.

4. Deliver a pre-flight briefing to the passengers. We have a recorded briefing in Tetun on the EFB (electronic flight bag, aka iPad) which is very helpful for this!

5. Calculating take-off weight and centre of gravity position.

6. Closing all the doors and doing a final walk-around prior to engine start.

Usually we aim to get through all of this (steps 2-6) in 15 minutes. Obviously it depends on the condition of the patient, as if they are able to get themselves into the aeroplane it takes less time than loading a stretcher. Sometimes the accompanying family member has to be strapped into the stretcher in the aeroplane, because it’s the only restraint we have left!

My very first medevac flight was to an airstrip called Los Palos. It is at the eastern tip of the island, about 50 minutes’ flight time from Dili. Marcus and I had been doing some training circuits there when we got the call, so we landed and got ready for the ambulance to arrive. 15, 20, 30 minutes passed. We called our contact back at base to ask what was happening; he made some enquiries and found out that the Los Palos ambulance had broken down. After 45 minutes our patient finally arrived in the back of a white delivery truck. By this stage a crowd of about 50 people had formed; most of them arriving on mopeds. We readied ourselves to load the patient – a man sitting up on a stretcher, gasping for air despite the oxygen bottle next to him hissing furiously. The crowd pressed around us as he was transferred to our ‘scoop’ stretcher and loaded on board. I asked the man’s family members (who I presume were his sons) to stand on the scales so I could record their names and weights. Loading the bags in the pod underneath the cabin was a little difficult with so many people standing around. The man was clearly in distress. He also didn’t want to lie down on the stretcher and indicated that he wanted to sit in a seat, which the medic okayed. As I completed the weight calculations I realised that because of length restrictions for taking off at the airstrip, we could only transport one family member, not both. The people were still pressing around us as the two young men decided who would stay behind and who would go.

‘Let’s go, we don’t have much oxygen left.’ Marcus’ voice of reason broke through my observations and the murmuring of the crowd. Fortunately we fly enough medevacs to Los Palos that everyone knows the drill: once the aeroplane’s doors are closed and the pilot starts walking around it, that signals that it’s time to move back to a safe distance outside the airstrip markers. I climbed in, secured my seatbelt, and two minutes later we were airborne.

Throughout the flight both Marcus and I turned around periodically to check on our passengers. About ten minutes prior to landing in Dili I happened to look back and saw the patient slumped in his seat with his head back and eyes and mouth open, not moving. The young man with him, who was seated behind him, had his arms locked around the man’s chest, holding him up. I motioned to the medic: is he all right? The medic just looked at me and indicated with his hand that we should land, then went back to looking out the window.

The man still wasn’t moving after we landed. Marcus asked the medic if he was still alive and received a shrug in response. He gestured that he should try CPR and got another shrug. Thankfully one of our local staff members was able and willing to have a go. When the ambulance arrived about 10 minutes later, they pronounced the man dead.

A couple of weeks before leaving Mareeba to move to Timor I was chatting with the wife of a previous Timor pilot who told me that sometimes patients die during the flight. At the time, I wondered how I would feel if that happened. Now I knew, because it just had.

I felt kind of weird knowing that the man was alive when we took off and dead when we landed.

I felt sad for the man, being taken away from his family in a noisy metal bird, when he probably knew that he didn’t have much time left.

I felt compassion for the young man with him, who would have had to deal with not only the death of a close relative (presumably his father) but also the paperwork, the coroner’s system, and having to get himself and the body back to Los Palos.

I felt sorrowful for the crowd of people we left behind in Los Palos, for whom the moment when we closed the aeroplane doors would have been the last time they saw the man alive. A memory I will carry with me is seeing a young woman holding up a phone, clearly on a video call with an old lady – I presume the man’s wife – so that she could see all that was being done to help him.

I felt angry at the medic for seeming to pay no attention to the man during the flight.

And I felt hungry, because by this stage it was already after 1:30 pm and I hadn’t had anything to eat since breakfast.

 

One day the following week, there were two medevac callouts back to back, with the second flight having three patients. While the first flight was in progress we received an update: there were now only two patients on the second flight. It turned out that the third – a pregnant woman – had died.

This is the reality of MAF’s operations in Timor-Leste as the air ambulance transport provider. The health system here is very basic – both the facilities and the training of medical staff, particularly in the provincial towns. Many people delay going to see a doctor, relying instead on time and natural remedies to heal them. As a result, by the time a person seeks medical attention and a medevac flight is called, sometimes it can be too late. Sometimes the person dies in hospital in Dili, sometimes before the plane can reach them, and sometimes it happens en route.

Now that I’ve had a bit of time to process things, here are some final thoughts:

I know that there was nothing more that Marcus or I could have done for the man who died in our plane that day, and that it was not anything we did that caused his death.

I know that he would not have survived the journey by road; taking him in the aeroplane gave him the best chance he had for survival, even though in the end it was not enough.

I know that there are cultural issues at play that I don’t understand. Whether the medic’s response was part of this or just his personality, is not up to me to judge.

The event has strengthened my resolve to do the best job I can while I am here. While I wasn’t able to make a difference for the man who died, maybe I can make a difference for the next medevac patient I fly. Every person is precious to God; every life matters to Him.

I am even more aware of how ‘Flying for Life’ is more than just a tagline. For people living in remote communities like Los Palos, MAF really can mean the difference between life and death.