Tailwinds get you thinking four steps ahead

We have two types of windy days in Lesotho. There are the days where you don’t even preflight, because you know that it’s not flyable, and then there are the other days: Windy, and challenging, but not windy enough to call it off. Yesterday was one of those days.

The previous day had been the windiest in the last few months. Bryan had flown and had told me that it was hard work, but doable. This day was a little better, so I knew it was at least worth giving it a shot.

I woke up early, got to work on what was probably the coldest day so far: a winter storm was pushing through, dropping snow on the high mountains and leaving Maseru icy cold in its wake.

With preflight done by 7:30am, I was loaded with my one nurse passenger and a plane full of drugs for the clinic of Semenanyane (SY). I had already told the nurse to not expect to land at SY. It’s an airstrip with a one way landing, and if the tailwind is more than about 8 knots, it’s too dangerous to try landing. We have a hard limit on it: if you see 80kts groundspeed when you are crossing the ridge on final approach, you call it off. I knew by looking at the wind forecst that I would not be able to get in there under 80kts. So, I told her to prepare to land at the closest larger runway and ask the clinic for ground transport. Not ideal, but but an option under the circumstances.

My thinking face

My thinking face

10 minutes after takeoff my optimism for the flight quickly dwindled as I saw a huge build-up of snow carrying clouds on the mountains I needed to get over. No way I was going to get under them or over them right now, so, back to base it was.

I told the nurse we would try later, maybe 12pm ish.

Now to sit and wait, doing the waiting pilot’s ever-hopeful refresh of the weather screen on the computer, expecting a magical answer to appear. Sometimes I wish there was a screen that just said ‘Forget about it, go get some coffee.’

At 11am, I was notified of 2 medevac calls from Lebakeng (LK). 2 women, both in labor, at an airstrip where the road to the hospital had been washed away in the rainy season. I didn’t have more info as to why they needed transfer, but it’s usually due to complications or high-risk pregnancies.

The info didn’t change the weather though. I couldn’t now magically fly through a cloud build-up that was well below freezing. So, all I could say was ‘I’ll do my best to get there when I can.’

I now had 2 more stops added to my flight. If the weather cleared, I would first drop off the nurse and drugs and then go to LK for the medevacs. Then I would have to take the emergency patients to Qachas Nek (QN), then go all the way north to fetch a group of 4 pastors who had been working in the mountains for the last week.

A little snow dropped from the storm that passed through

A little snow dropped from the storm that passed through

At 12:30, I started to get loaded up to try again, hoping the cloud had cleared enough. As I was walking to the plane, I was notified of a third emergency patient, this time a child who had been burned and needed to go with his mother, thankfully also from LK to QN.

I took off at 1pm, knowing that if I couldn’t get through now, I wouldn’t have time to try again later.

Thankfully, the cloud had lifted and moved east, and getting over the mountains was no problem. Now, my concern shifted to wind at my destination. I was now taking the nurse to Thaba Tseka (TA). I had made the call to not even try SY. I knew it wouldn't work with the wind, and we had emergencies pilling-up. I just needed to get her to TA.

TA can be tricky, and while it has a few runway options, the runway into the prevailing wind is the shortest we have in Lesotho, at just 1600 feet long.

If I couldn't land there, I would have to go back to Maseru and be all out of time for any other flights. I had no space on the plane for anyone else.

Thankfully, I landed with no problem. A nice stiff 15 kt wind, but smooth enough to feel comfortable on final approach.

En route (photo taken on another occasion)

En route (photo taken on another occasion)

After offloading the nurse and the plane full of drugs, including COVID PPE, into a tiny car taxi, I quickly set off to LK to get the 3 emergencies.

Here is the thing about tailwinds, they affect you more than you know. If you take off with just 2,5kts of tailwind, your take off distance increases 10%.

I tell you this to explain my thought process as I approached LK. I might be able to land at LK, but would I be able to take off? Excuse the pilot nerd-out, but here are the steps: Where I was going, LK, is a one way takeoff, usually with a tailwind. We take off in around 1200’ normally. LK is 1,804’ long, and as an MAF rule, I need to be assured that I can take off in 90% of that, so 1,624’ was my number. If I had tailwind of 10 kts, that would turn my ground roll into 1,680’ and I would not be able to take off with passengers.

So before landing, I needed to have a game plan. Do I land and then tell the patients I couldn’t take off again? Do I give it up now so they understand that the plane ‘cant sit down?’ Good questions. But, from what I could see, it was less than 10 kts tailwind, so I was happy to try it.

The landing was challenging, as it usually is at LK, but was uneventful. After I shut down and got out, I could immediately see the two pregnant ladies waiting, but wasn’t sure who the other passenger was. Knowing my weight for takeoff was critical, so despite their pain and urgency, I had to ask the ladies to stand on the scale. I noted their weights, and knew I could handle a little more and still be good with the takeoff. I grabbed the wind meter and measured it to be around 8kts tailwind. Acceptable as long as I kept the weight about 70kg under max.

Another lady approached, with 2 children. The nurse indicated they were the other passengers. Oh, and she also told me the nurse who would be accompanying the patients was coming.

Wait, what? We can take 5 people on a good day. Certainly only 4 with today’s conditions. And here I already had 2 ladies weighed, and 4 more people wanting to join? Granted, the children were small and didn't each need a seat, but still.

Decision time. I can’t take the nurse. I can take the mother and her two kids (the toddler was the burn victim and the tiny baby was her other child who she obviously couldn’t leave behind). That would put me at a good weight for takeoff, but I was aware that if I couldn’t land at the district hospital, which can also be tricky on a windy day, I would have to fly them all to Maseru. About a 50 minute flight, with no heath care provider on board. It was a gamble I would have to take. Better than leaving a patient behind in order to take a nurse.

After figuring out seating (baby on the mother’s lap, toddler in his own seat with seatbelt, despite his burns, expectant mothers in the back row), double and triple checking my weight, wind and take-off performance, I was ready to go.

I suddenly remembered and sent a quick voice note to our flight follower: ‘Hey, if you see me on the satellite tracker not able to land at QN, it means I’m bringing them all to Maseru. I’ll need to you arrange the ambulance and then phone the pastors who are still waiting for me and let them know they have to wait until tomorrow for me.’

Take-off, downhill with a tailwind and a sudden drop at the end of the runway that usually creates downdrafts. I could hear my passengers, who were probably scared before all of this, barely holding it together. The wind buffeted us, occasionally giving us a nice upward boost that I took advantage of to gain altitude, but for these passengers this must have felt like the end of it all. I turned and gave them my best ‘isn't this fun’ look, and pushed on for the thankfully quick flight to QN.

Mother with baby and toddler, 2 ladies in the back row (picture taken waiting for ambulance at QN- safe on the ground)

Mother with baby and toddler, 2 ladies in the back row (picture taken waiting for ambulance at QN- safe on the ground)

I turned overhead the airstrip, saw a moderate wind, and readied myself for more buffeting on the tricky turn onto final approach.

Perfect, a strong but stead headwind, this was all going to work out just fine.

Touchdown. Good braking. And a deep sigh of relief from everyone. For me, everything today had been building up to this point: getting these high priority patients here. If I got nothing else done, at least I got them here.

But, of course... No ambulance waiting. With daylight running out, this was creating a new pressure. If they didn’t arrive soon, I would once again have to tell the pastors that they would have to wait another day.

The ambulance did arrive, and I got moving as soon as possible, all the way up north to Mokhotlong to collect the waiting pastors.

Where are your ambulance? Waiting at QN

Where are your ambulance? Waiting at QN

From there things went smoothy, despite a few sick sacks being used by my passengers en route home. I arrived with 10 minutes to spare before sunset.

Not every day is like this, thankfully. But when they are, I am grateful for my training from MAF that gets us thinking about plan A, B, C, D and E... Thinking three or four steps ahead and staying safe in an environment that demands our best.

Nothing else we would rather be doing

“I phoned them this morning, and again before we left, and they assured me the ambulance would be here. Now my patients must wait here for them!”

The nurse said this to me, apologetically more than angrily. His day had already been a long one, and it was only midday.

“I will just have to go and fetch a taxi and pay for it myself, otherwise these patients will never get there.”

 

Wednesday, March 11, was a public holiday in Lesotho. I was on call for any emergency flights. At 8:30 a call came in. A pretty standard request: Go to Lebakeng, pick up a pregnant lady on a stretcher, as well as an old lady with a broken leg, and transport them to Qachas Nek, where the district hospital was.

Within 45 minutes of getting the call, I had left home, preflighted the aircraft and was taking-off. Another 30 or so minutes later, I landed at Lebakeng.

The nurse, Mr Karabo, came running to the plane. “We are very sorry. In the time since we called you, the baby was born and needed to be resuscitated. Would you mind waiting maybe 30 minutes for us to stabilize him before you fly them to Qachas Nek?”

"Of course!” was my answer. As far as I was concerned, they could take all the time they needed. I was there for them, not the other way around.

The maternity ward at the clinic

The maternity ward at the clinic

I made sure the plane was good to go, then I wandered around waiting for a bit. I went to the maternity ward to see how things were going. Karabo saw me and said, laughing ‘You don’t want to go in THAT door!’ Pointing to the one that had the sound of a crying baby behind it. Fair enough. I am confident I don’t need to see that side of health care.

The patient with the broken leg waiting in the plane

The patient with the broken leg waiting in the plane

Karabo briefed me on the second patient. The lady with the broken leg. She was wheeled to the airplane in the meantime, on a wheelchair with a wheel that looked like a bent hula hoop after a few months of playground use. I don’t know how the ‘wheel’ chair was even able to roll. But nevertheless, the lady was loaded, and strapped in, while we waited for the mother and child.

I never learned what the complication was, and have learnt that such information isn’t very important to the everyday person in Lesotho, so I didn’t ask. All I needed to know was that they needed better medical care than the rural clinic could provide.

What was probably 30 minutes later, Karabo came back, full of smiles. “Here are their bags. Sorry for the wait. They will be here soon. Oh, and my apologies, she can sit and wont need the stretcher.”

I reconfigured the seating area of the plane, and a few minutes later the mother, child, and another nurse came to the airplane, everyone walking along smiling like it was a normal occurrence.

Once they were loaded up, with Karabo on board to assist the patient handover at the district hospital, we got going.

Qachas Nek airport

Qachas Nek airport

Lebakeng to Qachas Nek is about an 8 minute flight. Karabo explained to me that the bridge had recently been washed away, and now their only means of transport, besides walking, was airplane. This, combined with a recent lack of funds from the government to provide the regular flight schedule, meant that he had been on duty for 2 months, with no sign of a shift change any time soon. He said he was not willing to leave his patients and go home, so he had no choice but to keep working and wait on regular flights for medical staff to resume.

Even waiting on an ambulance wasn’t a big enough deal to stop this new mom smiling

Even waiting on an ambulance wasn’t a big enough deal to stop this new mom smiling

We landed at Qacha’s Nek, to find no ambulance waiting.

‘These guys!’ Karabo said irritated.

‘Africa!’ He said again, which made me smile. ‘Even time management is a problem.’

After a few calls to try and get the status of the ambulance, he finally told me that the only way would be for him to flag down a 4+1 (the local slang for a taxi car), and pay for them to get to the hospital.

‘Well, I am happy to wait as long as you need,’ I told him.

‘I better go with, because I need to make sure these patients are not neglected.’ He answered.

I was happy to hang out at Qacha’s Nek for 30 minutes more: Drone time! Any excuse I can get to send up the drone and get nice pictures is an opportunity I take!

When Karabo returned in the taxi, the drone was hovering close by. With all stress now relieved, as the patients were safe, he laughed and said to me ‘Ah, this thing! It's technology gone too far! Amazing.’

After loading him up, I flew him the 8 minutes back to Lebakeng.

On final approach, I noticed a blob on the touchdown zone that wasn’t usually there. Sure enough, as I got closer, the baby donkey that was the blob raised its head, annoyed that I should want to land right where he was snoozing.

Landing aborts are not uncommon here. So the procedure comes pretty easily. Maximum power, clean up flaps, open cowl flaps, and climb away, following the airstrip specific abort path.

As I circled overhead, I saw a shepherd running to chase the doneky.

My next approach was donkey-free, and after shut down Karabo said ‘sometimes I wonder why I do this! Everyday is a matter of life and death.’ Of course, he said this with a smile, both of us silently knowing there is nothing we would rather be doing.

Just before the storm

It’s interesting how we perceive things, compared to how they turn out. I was scheduled to take a casket and body, along with a family member of the deceased to one of our most challenging airstrips. After that, I was scheduled for a second stop to take a mother and her special needs child back to their village.

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A Case for MAF

In 2007, when I was new to Lesotho, I was pretty excited to get out into the mountains and visit some of the ‘very rural’ villages. I say ‘very rural,’ because a lot of Lesotho is rural, but there are certainly different levels of rural. Some villages are close to small towns, meaning they have basic clinic facilities, and basic shops for supplies. But then there are those other villages, deep in the mountains, where I was told some of the children had never seen white people before!

Climbing the mountains to reach the far away villages

Climbing the mountains to reach the far away villages

I wanted to go there.

The first time I went out, we went to an area called Ketane. From Semonkong, it took us between 6 and 7 hours on horseback, with pack donkeys following. It was 6 or 7 tough hours, where the horses had to do a lot of technical climbing up and down the many mountain slopes. All in all, it was a fun adventure, and gave me a sense of what life in the rural mountains looks like, where there are no facilities for a day’s walk.

A few years later, a visiting team somehow arranged a Lesotho Defense Force helicopter to take them to the same village. I jumped in the extra seat just to go along for the ride.

The following is no exaggeration:

Defense force helicopter landing at Pulane Children's Centre 

Defense force helicopter landing at Pulane Children's Centre 

The route that took me at least 6 hours on horseback, took us 6 minutes in the helicopter!

Fast forward to 2017. One of our HIV+ children at Pulane Children’s Centre was having a hard time on the medication he had been given. He just kept having bad reactions, and our local clinic, which is pretty far off any main route and not at the leading edge of health care, wasn’t able to help him. They tried to change his medication, but the clinic is staffed by a few government nurses, and no doctor, and they just didn’t know what to do.

One morning the boy came into the room where we were meeting with the staff, and we were shocked. His whole face was swollen, his eyes almost shut. It was clear that we needed to take drastic measures to get him help.

I contacted a doctor at Baylor Clinic, which is a clinic network in Lesotho run by Baylor University in Texas. It is a clinic specifically for HIV+ children in Lesotho. The doctor advised that we get the boy to one of their clinics as soon as possible. The closest one to Pulane Children’s Centre is in Mohale’s Hoek, 3 hour’s drive away. There was no debate, this had to happen.

I'd say the new treatment is working!

I'd say the new treatment is working!

We arrived at Baylor, and what we found was incredible: Professional staff who enjoyed their job, and were on the leading edge of HIV treatments and care. After a quick assessment, the doctor found the problem, and had a simple solution. The child was on an outdated medication that our local clinic didn’t know was no longer in use, and often caused this reaction. The Baylor doctor ran some tests, and prescribed a much better medication. Needless to say, there was immediate improvement, and today that boy is running around, as mischievous as ever.

To me, these two stories link together in explaining just why MAF is so valuable in Lesotho. It’s hard to travel in Lesotho, and there are clinics in the deep mountains, that wouldn’t be reached on a regular basis without aircraft. Secondly, there are solutions to so many of the problems out here, if you can just link up the right people with the recipients who need help. Often the solution is quick and simple, it just takes some kind of practical link to get the right person to the right place.

This is why I think the job MAF is doing is so wonderful, and why I want to be a part of it. Daily, the work they are doing is making very real changes in people’s lives. What’s more, the love and dedication with which the MAF staff do their work goes a long way in reflecting the love of Jesus to everyone they meet. **That’s why we are passionate about being a part of what MAF is doing in Lesotho! This last sentence could be stronger.