It starts with a voice. A voice chosen for pitch and modulation. Recorded in a booth somewhere over and over until it displays calm efficiency saturated with 42% warmth.
Actually it starts first with electronic chimes and
“The next train on platform one is to Blacktown [stilted pause] first stop, Chatswood… then all stations to North Sydney …”
This is how the trip to Rwanda starts.
Come Fly With Me
Getting a team to the middle of Africa takes quite a bit of work. Actually getting part of the team there. A screening team has been in place for about a week and much of the rest of the team has been draining into the country for the last few days.
From Sydney today there’s just two of us. I have to meet a guy who describes himself as a big Irish Santa. This is not entirely accurate because I’ve always figured Santa would have a flinty streak of mean steel. All those elves and reindeer and deadlines to tear into place. My companion is a far happier soul. There are more joining at Perth and Johannesburg along the way.
So the first part of the travel is just lots of travel.
Airlines would like us to focus on the bit when we step off the plane. Where the slow montage of the happy reunited is on loop.
Travellers know that is just the oasis. Before that there is this. The lines. The waiting. That very particular feeling you have slowly accumulated an outer covering you’d rather not place.
Anyone with medical training of any sort has the additional lingering fear in the back of their mind. Not the slight nagging doubt that everyone lies when they pretend to understand how we’ve harnessed physics to put large cylinders with no business being in the air up above the mountains.
The fear that the PA will sound out and ask if there is someone who can help. The medical assistance call.
Flying Makes People Sick
You can probably understand why it isn’t a prospect that delights. One minute you’re strapped in next to a stranger familiar enough to stretch themselves into your space. Then the call to go and offer assistance. It will probably be to someone dealing with something entirely out of your area of expertise. You imagine that when you ask for the medical kit to deal with this crushing chest pain, the staff will unsheathe an old leather purse, blow the dust off and offer two hard biscuits for the patient to bite on and some Epsom salts.
It’s not actually like that. There are serious kits with machines that tell you to stand clear. I know people who have delivered babies and done other clever things.
How much should we worry about the call?
The calls don’t really come that often. A while back a group in the US published work where they looked at nearly 3 years of domestic and international flights to characterise the sort of medical things that happen.
It’s pretty robust. Even though as an Australian I worry that the definition of “international” in the US might be a little confusing seeing as the locals refer to their domestic baseball finals as the World Series. They looked at 11,920 medical emergencies among an estimated 744 million airline passengers. That’s only 16 emergencies per 1 million passengers It worked out as 1 per 604 flights.
It’s all the common stuff though. Fainting, breathing things or nausea and vomiting topped the list. Only about 7% of cases needed the aircraft to divert.
Of course there was some more serious stuff. People do have strokes and other things up at altitude. They are incredibly rare though. There was a total of 38 who had a cardiac arrest. 31 of those people passed away. But that’s 31 people out of something like 744 million airline passengers.
So actually flying doesn’t make many people sick at all. They’re also pretty unlikely to need the particular subspecialty skill of a medical type who regularly blows bubbles.
The Line of Civilisation
The travel then is just travel. It has the standard stories of adventures in culinary rubber and sad souls laughing at an Adam Sandler movie like a clown on uppers. Standard images like one nurse sitting cross-legged in the transit lounge in Johannesburg counting out large piles of American cash.
It’s a long time until we finally get to our arrivals hall montage. 29 hours to catch a train to Rwanda. And get here.
If you want to read that NEJM paper to enjoy all the stats in an up close and personal fashion, it’s here.