Transfers Around The World

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.

Training

Training of ICU nurses in non-invasive ventilation techniques during a BASIC course in Tanzania.

Ambulance Services On The Ground

Using a motorbike for patient transfers can be the best solution in rural areas with poor infrastructure.

The improvement of roads and infrastructure like this mountainous road in Ethiopia helps to transfer patients more safely.

Ambulance Services In The Air

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.