Manuela’s Malaria Medevac
“One of our nurses needs a medevac! She has cerebral malaria.” Deputy OPS Manager, Leon Primsloo, received the call Saturday at 2 pm. It was too late to send an aeroplane to Pagil where the nurse was working for Christian Mission of Development (CMD). Everyone was off duty, and before he could gather a team to ready the plane and do flight following it would be late afternoon. The flight itself would be 1 hour and 40 minutes to Pagil, and it would be almost dark when the plane landed. A little delay would mean that it would be too dangerous to land in Pagil, and going back to Juba wouldn’t be an option because the airport would be closed. The patient would have to wait.
Drowsiness, headaches and convulsions
Manuela Yawa is one of 15 staff members of the health service department of CMD in the village of Pagil. Saturday, four days after having left Juba on 30 January, she started feeling drowsy and having severe headaches. Eight days later her condition is critical, and MAF shows up at Pagil with a MAF Caravan to take her to a hospital in Juba.
Gatmai Yak Tutdeal, a CMD clinical officer, and Mary, a Medair Reproductive Health Manager who collaborates with CMD, have escorted Manuela to the airstrip where they stand waiting for the aeroplane. Before Manuela can board the plane Florian Poinstingl, the Caravan pilot, offloads 700 kg of iron sheets and 180 kg of wire mesh, which CMD had required to be brought from Juba for upgrading the roofs of the grass-thatched tukuls (small huts) of the Primary Health Care Centre (PHCC) which CMD runs at Pagil. Meanwhile Manuela sits patiently in the shade of the wing. The temperature is 40° Celsius, so to be sitting outside with a fever isn’t something you want to do for long.
“Thursday Manuela showed signs of malaria, and we started treating her orally with the antimalarial Coaterm,” Gatmai tells us. “But on Saturday she started having seizures and a high temperature; she was convulsing and yelling nonsense from 9 am until 2 pm.”
Running out of options
That was then Gatmai diagnosed Manuela with cerebral malaria. Realising that he didn’t have the means to treat her properly he required a medevac with MAF. No other airline in South Sudan would fly to Pagil on a weekend.
“We continued treating her the best we could,” Gatmai resumes. “At 11 am we treated her intravenously with 20 mg of Quinin mixed with 5 % dextrose and administered intramuscular Diazypham to stop the convulsions. At 4 pm she started yelling again, and at 7 pm we gave her the second dose of 10 mg Quinin and dextrose. We even tried to cool her down with wet towels and gave her paracetamols to keep her temperature down,” Gatmai explains.
Mary, who had been keeping an eye on Manuela the past two days at the Medair Compound, adds to the story by telling us that Manuela had started yelling again Sunday morning at 4 and 6 o’clock, but that she now had become silent; literally she could not speak and only communicated by writing messages.
Flying unconsciously
Finally, Manuela boards the plane; with support from Mary and Gatmai she manages to walk to her seat and slumps into it. James Wieh Thou, a registrar at the PHCC, sits next to Manuela to assist her if something happens during the flight. Next to James is a little boy whose mother sits at the very back with her baby. They are going to Juba to join their husband and father, Thomas Thijin, the Field Officer of CMD operations in Pagil, who was sent to school in Juba last year.
A medevac is quite expensive, and CMD would have used the opportunity to send more people to Juba if only there had been room for them, but all of the middle seats were taken out because of the iron sheets that had been transported to Pagil on the way up. Even with all of the seats installed the plane could not lift off from that particular airstrip if more weight had been added. It was too short.
1:37 pm, an hour and 11 minutes after landing in Pagil, the Caravan takes off. Florian lets the plane climb to 9,000 feet; normally, he would go to 12,000 feet to save fuel and fly faster, but he is concerned with how the altitude will affect Manuela’s condition. Going lower this time of year, with the turbulence of the dry season, would result in a very bumpy ride.
At 2:15 she starts to cry violently, and James holds her firmly. All of a sudden she relaxes completely and either falls fast asleep or becomes unconscious until the aeroplane at 3:19 lands at Juba International Airport. MAF’s dispatch team are ready; David Juma quickly lifts the semi-unconscious Manuela from the plane to a car, and she is immediately taken to Victorious Hospital. Job well done. There is nothing more we can do, but hope and pray.
Epilogue
Richard Duku, one of the dispatch guys, knows Manuela, and confidently said that she would get better, because her church had been praying for her at their Sunday service.
Monday morning Duku and Juma went with me to the hospital to pay Manuela a visit. She was lying in bed, dressed and with a tired smile. She couldn’t speak, but answered all of our questions in writing. Her little sister, Harriet, had slept on the bed next to her and was happy to see her sister recovering so well. Suddenly Manuela answered audibly to one of my questions and Harriet lit up in a big smile.
Nurse Leah Akello came and told us that although they hadn’t been able to detect any malaria – probably because of the treatment she had already been given in Pagil – they had given her further malaria treatment nonetheless. When she arrived at the hospital Manuela’s blood sugar had been very low, because she hadn’t been eating for a couple of days. She was given fluids with glucose and salts together with Diclofenac for a further alleviation of pain and fever. Moreover, she was now on a five day typhoid treatment, but she could continue that at home, as soon as she had the strength to leave the hospital.
Although Manuela had no recollection of how she had come from Pagil to Juba it made everybody happy to see that she was clear-headed and smiling at our jokes.
An hour after we left the hospital Manuela started speaking again. Duku called her the next day, and she sang to him on the phone, praising God for her recovery.
Text & Photos: Thorkild Jørgensen.