Evacuation from Sierra Leone

Evacuation - My 'bubble'

Evacuation – My ‘bubble’

The Ebola epidemic in west Africa is the largest outbreak of the disease since its identification in 1976. The region is also afflicted with other viral hemorrhagic diseases, most of which will lead to death if untreated. One of these is Lassa fever, first ‘discovered’ in the town of Lassa, Nigeria in 1969.

In 2000, while serving with the British Army in Sierra Leone, I succumbed to malaria. During my stay in the Indian Army hospital supporting the United Nations force I developed an unusual fever and throat infection, which the doctor looking after me diagnosed as the early stages of Lassa fever.

This was the second deployment of the Joint Force Headquarters to Sierra Leone. We had mounted a successful operation in May (Operation PALLISER) in response to the attacks by the Revolutionary United Front—the rag bag collection of bush fighters that terrorised the country for over a decade—and had returned in October to bolster the British training presence in order to tackle an upsurge in violence.

In early November 2000 I was within 24 hours of boarding an aircraft to return to the UK at the end of the deployment when I developed a fever and all the symptoms of malaria. I was furious. We were all experienced in this environment and religiously took our prophylactic drugs, covered our skin in the evenings and slept under nets. Our nurse, a young RAF Flight Lieutenant, immediately dispatched me to the United Nations hospital on the other side of Freetown. This was an Indian Army hospital manned by turbaned male Sikh nurses and a few young female nurses. My doctor was experienced and capable and, notwithstanding my adverse reaction to his initial malarial treatment, which made me physically sick and as weak as a kitten, he got my temperature under control and soon pronounced that the malaria was being beaten. I then developed another high fever; this one was constant, not cyclical like a malaria fever. I also had a throat infection and I ached all over. The doctor diagnosed Lassa fever—he had another case in the hospital, a Ugandan soldier—and he moved me into an isolation room.

I was told about the diagnosis by the British doctor of the staff of the JFHQ. He was a peer and a really great bloke. His bedside manner was tough and to the point. He said: “It looks like you have Lassa fever, which is like Ebola and there’s a good chance it will kill you. But the drugs seem effective and we’ll start them this afternoon.” My first thought was, “Why are you waiting until this afternoon?”

The news of my diagnosis and incarceration soon spread and I was visited by a good friend who passed in to my room a television and a video player that he had ‘borrowed’ from one of the officers posted to Sierra Leone on the staff of the training mission. Jacqui, who had ‘donated’ the TV & video player, is an experienced logistician; she is now a civilian and, as I write this, she is back out in Sierra Leone assisting with the operation to combat the Ebola crisis.

It had been decided that I was to be ‘casevaced’. This was to be the first occasion that the Royal Air Force Tactical Medical Wing had deployed with their isolation ‘bubble’ to evacuate a real casualty of this kind. It was quite an experience. I have to say that throughout this I was quite well. The drugs had had an effect and my temperature was under control, I was weak but in reasonable shape physically and fine mentally.

Evacuation - The RAF Tactical Medical Wing Isolation Chamber on the C-130 that evacuated me from Sierra Leone

Evacuation – The RAF Tactical Medical Wing Isolation Chamber on the C-130 that evacuated me from Sierra Leone

Within a day or so the planning for my evacuation had kicked in and the Joint Headquarters at Northwood had dispatched the nursing team in a C-130 to evacuate me. As far as I remember the team comprised a couple of doctors, a nurse (who was quite clearly ‘in charge’ if not in command) and an anaesthetist. The aircraft landed at Lungi airport, about 15 miles from the hospital across the bay where the Sierra Leone River met the Atlantic Ocean. The only way to move me to the aircraft was by helicopter.

In preparation for my trip to the UK the anaesthetist came to my room with the nurse and I was told what was going to happen. I couldn’t quite envision the ‘bubble’ but the procedure to get me to it was simple enough. In case I needed any intravenous treatment during the flight the anaesthetist planned to put a cannula into a vein in my arm. I suppose it might have been natural to be nervous around me. He was masked but shaking like he had palsy. I was not confident that this phase was going to go well. As he turned to me, his syringe, with which he was going to inject anaesthetic at the site of the cannula insertion, flicked out of his hand and, in what appeared to be a slow motion scene from a film, spun in the air and embedded itself in the toe of his boot. It quivered there like a cartoon pirate’s dagger stuck in a table. His first words were, “I don’t think we need to mention this to anyone, eh?” He finally inserted a cannula on the back of my wrist where the wrist bends—I still have the scar it left.

Paramount Airlines MI-8, 9L-LBT, waiting to ferry me from hospital to Lungi Airport

Paramount Airlines MI-8, 9L-LBT, waiting to ferry me from hospital to Lungi Airport

My flight to Lungi was to be in one of the Ukrainian-crewed MI-8 helicopters of Paramount Airlines—it was the same helicopter that crashed in June 2007 killing all but one of the 23 on board. I had asked that I travel in uniform rather than having my bum hang out of the hospital robe that was my only clothing and, having changed into uniform trousers, boots and a T-shirt, I donned my surgical mask and walked to where the helicopter had landed. I was escorted by the RAF nurse from the casevac team and our own nurse from JFHQ, who had been superb throughout my stay in isolation. I was somewhat surprised by the number of people who had come out to watch. The aircrew were in masks also—one had it over his headset microphone, which plagued him throughout the flight—and without any fuss we took off and headed out over the bay to Lungi.

Being aided across the tarmac at Lungi airport prior to my flight to UK

Being aided across the tarmac at Lungi airport prior to my flight to UK. Note the mask on the loadmaster and his attempt to get his gloves on before I get to the aircraft!

As we reached the airport I could see the C-130 on the dispersal. The ramp was down and there were a few people milling about. We landed and I walked over to the aircraft with two of the medical team. At this stage the only thing on my mind was to make sure that all of my kit was there. I knew that some of it had been destroyed but I hoped that the items that I hadn’t been in contact with since falling ill had been packed and would travel to UK with me. The loadmaster showed me what he had been given—everything was there, including the hardwood carving that I had bought a few days before going to hospital.

I walked up the rear ramp of the aircraft to see my ‘bubble’ for the first time. It was a little smaller than a single bed and with enough room inside to sit up. What was not clear was how I was going to get into it. Luckily I was fit enough to just climb in and the flap was sealed behind me. No-one had catered for the heat. It was roasting hot on the concrete outside the aircraft. Inside it was hotter still and in my plastic greenhouse the temperature was extreme. I immediately began to sweat and within minutes my clothes were soaked; I then created my own cloudy eco-system. The temperature differential was such that the bubble steamed up and whenever any of the medical team wanted to talk to me I had to wipe a hole clear to see them.

In the bubble and about to say goodbye to our JFHQ nurse

In the bubble and about to say goodbye to our JFHQ nurse

After a photo with my indefatigable JFHQ nurse and a waved goodbye, the ramp of the C-130 went up and we were off. The team, very thoughtfully, had put some magazines inside the bubble and a packed lunch. They had also put in a set of hospital pyjamas and I was able to change out of my soaking T-shirt. Unfortunately I had to keep it inside the bubble with me so it sat at the foot of the stretcher bed and steamed until everything cooled down as we reached our cruising altitude.

Our destination was Newcastle. There are only three hospital beds in the UK that can provide the level of isolation required, and the single bed in the Royal Victoria Infirmary was to be my new home. We had left Sierra Leone on a hot, tropical afternoon and we landed in Newcastle in driving, horizontal, ice-rain. As the ramp went down we saw the ambulance that would transport me to the hospital. Inside the open back door we could see a smaller version of my bubble on a wheeled stretcher. The four person medical team were in white protective suits and masks and were clearly sheltering from the horrible weather.

When the ramp was down and everyone ready, the hospital medical team were signalled and, like an amateur bobsleigh team, leapt out of the ambulance pushing the wheeled stretcher at a goodly sprint across the tarmac and up into the aircraft.

Now came the awkward bit. It was obvious that the procedure to move me from ‘my’ bubble to the stretcher bubble hadn’t been practised. The new medical team talked about it as if I wasn’t there and were somewhat surprised when I joined the conversation and said that they should join the bubbles together and I’d crawl into the new one. We duly manage that and then, after a hurried goodbye and thank you to my outstanding RAF medical team, it was off at a fast walking pace through the rain to the ambulance.

The worst part of the transfer to the stretcher had nothing to do with the medical team or the transfer itself. It was the photographer who had appeared and who wanted pictures of me in the bubble. He tried to attract my attention by whistling and repeatedly saying, “Oy, mate, look over here.” After a few minutes of this, while I was trying to work out how the transfer to the stretcher bubble would be done, I snapped and told him that if he didn’t ‘get lost’ (or similar words), I’d get out of my bubble and shove his camera where it would need the attentions of the medical staff to remove it.

Isolation Bed

Isolation Bed

I could write much more about the next part of the journey and my stay in Newcastle’s Royal Victoria Infirmary but suffice it to say it was an amazing experience. The nursing staff were superb in every regard, my hospital bubble was spacious, I was well enough to find the whole thing fascinating and, best of all, I was only there for two weeks. There was some dispute over what had caused my fever. It seems certain that it was not Lassa fever, thankfully, but an infection of unknown origin or type, probably picked up in the jungle hospital in Sierra Leone.

I am grateful that I had such a swift diagnosis of my malaria, a capable and experienced tropical medicine team in the Indian hospital, and that the RAF and NHS medical teams demonstrated incomparable professionalism, good humour and kindness at every stage of my treatment. I am also privileged to know people like Jacqui who, after a lifetime of military and civilian service in troubled places, is back in Sierra Leone doing what she does best. I never did find out what happened to her video player.

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