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Transfers Around The World

In this article, Dr Maxine Okello, gives an overview of the development of transfer medicine in East Africa with a focus on Kenya
The picture shows a road in Tanzania which is flooded by a fast stream in the rainy season. People cannot cross but a four wheel drive is attempting

Moving away from the high income country setting, there’s also a lot of ongoing change and development in transfer medicine around the world. In this article, Dr Maxine Okello, an anaesthetist from Kenya, gives an overview of the development of transfer medicine in East Africa.

Patient transfers can be very challenging in some rural areas in East Africa despite the immense efforts to improve infrastructure and networks.

Roads like this one in Ethiopia can only be used by skilled four wheel drivers and bear the risk of getting stuck in the deep sand. The conditions only worsen in the rainy season.

Most governments are now investing in a good mobile phone network coverage and plenty of roads have been build in the last years. The improved infrastructure helps greatly to set up reliable transfer services. Healthcare in many East African countries is organised in a tiered system in which the transfer of patients plays a central role. In Kenya, for example, there are six levels of different health care facilities.

Level 1 community facilities

Level 2 health care dispensaries

Level 3 health centres

Level 4 county hospitals

Level 5 county referral hospitals

Level 6 national referral hospitals

Patients frequently require referral to a superior level of healthcare and so medical transfer services are needed. Particularly in rural areas, a majority of the population is left to transfer their loved ones in need of urgent hospital care by public or private transport.

A patient has to be taken by a private taxi to a hospital in Tanzania due to the lack of transfer services.

One difference that is seen in many LMIC settings is that private stakeholders offer ambulance and retrieval services which frequently can only be afforded by only a minority of the population. Financial constraints are one of the major obstacles in the care of critically ill patients in East Africa.

Transfer Service Set-Up

Governments in Kenya, Tanzania and Uganda have recognised the need to establish Emergency Medical Treatment Services and have developed different funds and concepts for this. Institutions such as the Emergency Foundation Kenya have provided training and educational platforms to facilitate referral systems and engaged in mapping out emergency services and centres in the 47 counties of Kenya.

According to a 2004 Service Provision Assessment in Kenya, about 9 out of 10 primary hospitals and 6 out of 10 health centres under government management had on-site transport available for emergencies.
The transfer of a patient from a plane to the ambulance waiting at arrivals, using a regular passenger bus at an airport in Tanzania.
It is a huge effort to develop a safe patient transfer system and many organisations like Non-Governmental Organisations, Civil Society Organisations, Community Based Organisations, Faith Based Organisations and the Private Sector have to be involved.


Training of ICU nurses in non-invasive ventilation techniques during a BASIC course in Tanzania.
There are a number of training facilities in East Africa like the Kenya Council Emergency Medical Technicians (KCEMT) based in Nairobi. This institution was established in 1998 and had been the sole professional body setting national standards, regulating EMS training, and lobbying for formal recognition of EMTs in Kenya.
According to its secretariat, KCEMT has trained and certified approximately 1800 managers of first responders, including ambulance, military, police and interested public members. Similar activities are currently improving the situation in other East African countries.

Ambulance Services On The Ground

Using a motorbike for patient transfers can be the best solution in rural areas with poor infrastructure.
Established in 1928, St. John Ambulance was the only public provider of emergency medical services in Kenya. They responded to patients in need at no cost, but they were based in Nairobi only and couldn’t cater for the greater public.
Meanwhile there are various ambulance service providers that have now been established in Kenya. A well-known established service provider is Emergency Plus Medical Services, regarded as a regional leader for responsive and superior quality emergency, medical and trauma services. It was established in 2006 after a personal tragedy involving a senior staff member of Kenya Red Cross Services due to lack of evacuation services and logistics deficits in emergency evacuation. This resulted in purchase of the state-of-the-art ambulances that began with 5 vehicles and evolved to a fleet of 128 ambulances.
The improvement of roads and infrastructure like this mountainous road in Ethiopia helps to transfer patients more safely.

Ambulance Services In The Air

There are also a few institutions in Kenya that provide air-based medical evacuation. – AMREF Health Africa was established in 1957 with the initial idea to make reconstructive surgery accessible to victims of burn injuries living in remote areas.
Notably AMREF Flying Doctors is now Kenya’s most reputable medical evacuation and transfer service and is the leading provider of fixed-wing air ambulance services in East Africa. They not only have fully equipped dedicated air ambulance fleets but also several advanced life support (ALS) ground ambulances. The 24/7 Operations & Emergency Control Centre at Wilson Airport coordinates medical evacuation services and offers a medical helpline with medical assistance services.
Today AMREF Flying Doctors (AFD) are available to evacuate patients from remote bush airstrips as well as to repatriate patients by jet air ambulance to other continents.
One of the smaller planes in the fleet of AMREF flying over the Serengeti.

Today’s AFD aircraft fleet includes two Pilatus PC12 aircraft and one Beechcraft King Air, together with Citation Bravo, Excel and Sovereign jet aircraft on exclusive lease from long-time aviation partner Phoenix Aviation. This allows AFD to provide a world class regional and international air ambulance service.

If you would like to learn more about AMREF, take a look at this video interview with Dr. Joseph Lelo, the Medical Director of AMREF. He explains the service setup and discusses the challenges of transfers in East Africa.

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A Journey Through Transfer Medicine

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