From remote repatriations to war-zone evacuations

From Africa to the rest of the world 

In Africa, where vast landscapes, remote regions, and limited healthcare infrastructure pose significant challenges, AMREF Flying Doctors (AFD) continues to support its global customers even in the most challenging situations. From remote medical assistance services to repatriating patients back to their home country – AFD does it all.

It is widely known that Africa’s diverse geography presents unique challenges to those offering aeromedical and assistance services. Remote areas, dense forests, and difficult terrains complicate timely and safe access to patients when needing aeromedical services, which is why AMREF Flying Doctors is operating a diverse fleet of aircraft, including the Pilatus PC-12, Cessna Citations, and the Cessna Sovereign jet.

It is widely known that Africa’s diverse geography presents unique challenges to those offering aeromedical and assistance services

Fleet diversity 

The PC-12 is particularly valuable for challenging missions, capable of taking off and landing on 600-metre dirt strips. However, unmanned airstrips present additional challenges, such as livestock and people crossing the strip, unmaintained or damaged surfaces, and the necessity for daytime operations that can impose critical cutoff times at the expense of patient care. Fortunately, AFD mitigates these challenges through the coordination of a well-oiled operational control centre that maintains constant communication from the mission’s onset to its conclusion.

In contrast, the Citation Sovereign is an exceptional asset for a wide range of aeromedical missions, particularly those requiring long-range capabilities and a higher patient capacity. With its impressive performance, it allows for AFD to repatriate patients back to wherever they call home – from Europe to North America, and the Middle East to Asia. The Sovereign features advanced avionics and a spacious cabin designed for maximum patient comfort, allowing it to accommodate multiple stretcher patients and accompanying medical
personnel simultaneously.

An example of the impressive qualities AFD’s Citation Sovereign demonstrates was seen on a case in early 2024 when AMREF Flying Doctors successfully executed an ultralong transcontinental medevac flight, transporting a critically ill patient from Nairobi, Kenya, to San Diego in the US. The complex 14,000km journey, conducted in the fully equipped Cessna Citation Sovereign 680 air ambulance, was a carefully coordinated effort involving two teams of highly skilled medical personnel and pilots. Advanced in-flight medical equipment and systems ensured that the medical team on board were able to provide continuous round-the-clock care. The patient, requiring urgent repatriation to the US for specialised treatment, arrived safely after the 22-hour flight, showcasing AMREF’s capability in long-haul, critical care transfers across the globe. It is worth noting that AMREF Flying Doctors is Africa’s only air ambulance provider accredited by EURAMI for long-haul intercontinental air ambulance missions and adult critical care.

The year in numbers 

In 2024, AFD faced some exceptional challenges, including extreme weather and political uproar, adding additional layers of complexity and hurdles to the already volatile enviroment. Operating across politically unstable regions has a challenging effect on cross-border operations, including obtaining clearances, ensuring safety and security for passengers, crew, and aircraft, and overcoming flight-path restrictions. Despite these  constraints, AFD completed over 900 missions last year alone, transporting 950 patients and accumulating more than 4,000 flight hours – both nationally and internationally.

With decades of experience, it goes without saying that AFD has accumulated excellent knowledge in transporting the most challenging and critical patients, with around 10% of patients needing critical care in-flight. One of the most significant medical transports recently tackled by AFD was a complex ECMO transfer from Nairobi to Mumbai. The organisation’s operational efficiency is bolstered by strategic planning and collaboration with local authorities and international agencies, allowing AFD to navigate these complexities effectively.

Challenges encountered 

Fuel and technical support represent significant challenges in aeromedical operations, particularly in remote regions like those AFD is operating in. Proper planning and preplanning are essential, as the need for additional en-route stops or longer routes due to a lack of services, can occur. Extreme weather conditions, such as heavy rains, storms, and high temperatures, which are common in areas AFD is operating in, can further complicate flight operations, medical assistance and patient transportation. For example, adverse weather may delay missions and force crews to break duty due to regulations aimed at preventing fatigue or even make certain areas inaccessible for days due to flooding or structural damages in the environment.

Security risks, including political instability, civil unrest, and the presence of armed groups, pose additional safety challenges for aeromedical operations. Ensuring the safety and security of medical personnel, patients, and aircraft is a critical concern, necessitating robust risk assessment and mitigation strategies which are part of AFD’s daily assessments and briefings. Moreover, Africa’s diverse cultural and linguistic landscape can present communication challenges. AFD is committed to overcoming language barriers and understanding cultural sensitivities while providing care beyond traditional services. Effective communication strategies and cultural competency training are vital components of AFD’s operations, leading to cost-efficient and satisfying case management for clients.

Experts in high-risk evacuations

As one of a few providers, AFD also specialises in high-risk and war zone evacuations – a service that many providers shy away from. For example, in recent years AFD has often operated from and to Sudan, with one mission being a highly demanding air evacuation from Sudan, a country engulfed in civil war. The evacuation began at dawn, with a medically equipped AFD PC-12 flown across the Red Sea to Jeddah, Saudi Arabia. A skilled medical team and essential life-support equipment were on board. The precision timing and coordination was critical, as the team faced an unpredictable conflict zone with a narrow window for landing, transferring the patient, and taking off again.

AMREF Flying Doctors is Africa’s only air ambulance provider accredited by EURAMI
for long-haul intercontinental air ambulance missions and adult critical care

Despite the multifaceted security and logistical challenges, the critical operation was launched successfully. The patient, diagnosed with a complex cardiac condition, required immediate specialist care – resources unavailable in the war-torn country. The decision to evacuate him to Nairobi was a matter of survival. Thankfully, the mission went smoothly, and the patient was successfully evacuated in a critical but stable condition, for further treatment in Nairobi, where AFD’s Medical Assistance team took over the case and care. The patient made a full recovery and was eventually repatriated back to his home country on AFD’s Citation Sovereign.

AFD completed over 900 missions last year alone, transporting 950 patients and
accumulating more than 4,000 flight hours – both nationally and internationally

This is just one of many examples of AFD’s aeromedical and assistance departments working hand in hand, providing a one-stop solution for all of the client’s needs.

The latest developments and investments

Over the past 12 months, AFD has introduced several new initiatives aimed at investing in staff skills and enhancing patient care. From implementing air texting, which allows crew and passengers to stay connected during flights, to comprehensive training programmes in defensive driving and first aid, AFD prioritises continuous improvement.

AFD has transitioned from CRM 2016 to Dynamics 365, revolutionising internal processes across various fronts. Complete automation and integration of CRM and MS Dynamics ERP have significantly boosted efficiency, allowing for seamless interdepartmental interaction.

Additionally, the shift to a digital document repository has eliminated reliance on paper files, aligning with sustainable practices and reducing environmental impact.

The implementation of digital platforms has streamlined customer and supplier interactions, optimising the procurement-topayment process. This upgrade has enabled precise tracking of orders, efficient scheduling of appointments, and systematic management of communications.

In addition, AMREF Flying Doctors also managed to continue to enhance its medical assistance services, allowing for better coordination and timely support for its international clientele.

Furthermore, increased measures for data protection ensure full compliance with medical data regulations worldwide, making AFD a stand-out solution for global assistance support.

Lastly, the integration with the finance system completes the circle of efficiency, enabling seamless financial operations alongside enhanced healthcare services.

Enhancing medical quality and training

In 2024, AFD further invested in state-ofthe-art equipment, including patient aircraft loading lifts and portable point-of-care ultrasound devices. These advancements enhance the AMREF Flying Doctors’ capabilities and ensure the delivery of highquality care during transport – whether it is a remote evacuation or a long-range flight back to the patient’s home.

What is widely unknown is that AFD also serves as a centre for Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) training, ensuring staff compliance with medical standards, and enhancing service quality and training local resources to further healthcare development in the region.

The hidden gem – AFD’s one-stop medical assistance

AMREF Flying Doctors’ Assistance Services is dedicated to providing trusted on-theground support tailored to meet the diverse needs of global assistance companies throughout the African continent. With a deep understanding of local conditions and a global outlook, AFD’s Assistance Team serves as a one-stop solution for a variety f cases, ensuring that clients receive the comprehensive support they require. The breadth of services offered by AFD includes coordinating outpatient appointments and arranging house calls, as well as monitoring in-patient care for those admitted to hospitals. Recognising the importance of timely and efficient transport, AFD also provides ground ambulance services and commercial airline medical escort options, ensuring cost containment for clients while maintaining high standards of care.

For those who need an alternative to fixed-wing transports, AFD’s Assistance Division is equipped to arrange worldwide medical escorts. This includes bed-to-bed transports, business class or stretcher flight bookings, medical clearances, and the organisation of ground transportation.

When it comes to transporting non-critical patients on major airlines, AMREF Flying Doctors is committed to delivering impeccable care, focusing on fast, reliable, and cost-effective solutions – always infused with the human touch.

The success of AFD’s Assistance Services is bolstered by a dedicated team of assistance specialists who work tirelessly to coordinate care. With a trusted network of partners in medicine and logistics, AFD ensures that every aspect of patient transport and care is managed seamlessly. Additionally, the organisation boasts a multilingual staff and operates a 24/7 operations centre, providing responsive and reliable communication to clients and their families around the clock.

For those who need an alternative to fixed-wing transports, AFD’s Assistance Division is equipped to arrange worldwide medical escorts

Looking to the future

With another year on the books, AFD continues its mission to support clients from all over the world in the challenging yet beautiful African continent. From investment in technology and equipment to enhancing global branding and content, all the way to training the next generation of medical staff – AFD’s future looks bright.

With a proven track record of operating under the most challenging circumstances and with more than three decades of overcoming various hurdles, AFD’s teams are focused on getting better every day, providing even more pioneering solutions for its clients all around the globe and making sure that every mission and every patient is cared for like family – now and in the future.