Sky News joined me on a flight to show the vaccine rollout challenges in Lesotho. Here it is:
The full circle
Every new South African Commercial Pilot has a right of passage: To visit Lanseria International Airport to hand your resume to as many companies as possible. For me, I made this pilgrimage in 2005, when I had my first job as a flight instructor and was itching to fly bigger, cooler planes.
As I drove around the airport, seeing where else I could leave my suspiciously dense resume (why is it the more experienced you get, the less you feel you need to ‘fill up’ your resume with nonsense), I noticed a sign that said Mission Aviation Fellowship.
My first introduction to MAF.
I was ready to sign-up then and there. Of course they would want me, right? I was a Christian and a Commercial Pilot, surely they would be throwing themselves at me. Little did I know that it would be 13 years until I would actually be ready.
After a few interviews, tests and discussions, MAF South Africa nudged me in a wise and safer direction: Get some life experience, they said, before you go alone to fly a plane in a far away land.
A year or so later, I had resigned from my job and was setting out for a non-aviation volunteer position in the mountains of Lesotho.
'I’ll do this for a year,’ I told myself without irony. ‘Then back to MAF, because I’ll be ready.’
In my first 2 years in Lesotho- (let me pause for you to hear that sentence in light of my previous one)- I worked at Semonkong Children’s Centre, helping to run the place. Buying food, fixing things, doing things, playing with kids, that kind of stuff. Every now and again an MAF plane would land, bringing a doctor, and I would reset my resolve to be that pilot one day.
Me with the kids in 2007, Maggie in the pink hood
A church service. A whole lot of kids, singing, clapping hands, and doing the normal Sunday worship songs I had come to enjoy at the children’s church every week. One child, the youngest girl in the whole Centre, stood shyly at my side, kind of holding my hand. She was the shyest, and so I picked her out to make sure she got some attention, which was so often stolen by the cute, loud, extroverted kids.
My time at Semonkong was filled with these memories, the best of which are firmly attached to specific kids, and the hope that some of their lives were improved by that game of catch we played one afternoon in Semonkong.
An MAF plane arriving in Semonkong 2007
You are reading this, so you know a brief summary of how the following 10 years went: I moved to Pulane Children’s Centre for a few years, then back to South Africa to be a flight instructor, then back to Pulane Children’s Centre with my family and then finally to MAF Lesotho.
Two days ago I received a call from the lady who now runs the Semonkong Children’s Centre. She sounded pretty desperate: “Hi, Jill told me I could contact you. We have a child who needs to get to Maseru as fast as possible for a blood transfusion. We can’t drive as the mountain pass has snow and our car might not make it. Can you help?”
I was on-call, and had just arrived home from getting the plane ready for the day. As soon as she hung up I was getting in the car and heading back to the airport. I didn’t know yet if we could help, but I should at least start moving in that direction.
This was an unusual call. We normally have calls come through the clinics, with an official go ahead from the Department of Health who pays for the flights. Regardless, I knew we could figure out those issues after the child was safe. With permission from our MAF Country Director to do the flight and figure out the rest afterwards, I was soon on my way.
Descending into Semonkong
Semonkong is a short flight, 25 minutes. We very rarely go there, and in fact this was my first time to go alone. We don’t need to go to that clinic anymore because they now have a good road. Today was a special situation.
I landed exactly 1 hour after getting the call. The Children’s Centre director arrived soon afterwards, from the clinic, along with the child and a house mother. The child, a girl of about 15 years old, was anemic, and had some complications with her kidneys.
As I was loading them up, I asked for the girl’s name.
They struggled to remember her English name. Most English names are used just for the sake of white folk who struggle so much with Sesotho. I asked for her Sesotho name, and then it all clicked.
"Her English name is Margaret,” I said. This was the little shy girl who stood by me that church service! She has been at the Centre all this time.
I had a new connection to the importance of this flight. Not that any patient is more important than any other, but my eyes were opened to how valuable and precious each life is. Sometimes we lose that perspective when we see and deal with many patients. This reminded me that each one has history. Each one was once a small child, shy or extroverted, raised in a village or a Children’s home.
Magaret in the pink jacket
Yesterday evening she had been admitted to the hospital and was receiving treatment. We have yet to hear any further updates.
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
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
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)
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)
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
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
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
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
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
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.