'Don't let that happen to us': Doctor's worst fears realised as Covid flight ends in tragedy

A transplant team regarded by colleagues as the best in SA had prayed for years they would not be involved in a helicopter crash.

"We always said, 'God, please don't let that happen to us, because we can't afford it in terms of manpower,'" said Dr Paul Williams, a critical-care specialist who worked with the team at Netcare Milpark Hospital in Johannesburg.

On Thursday, shortly after one of the team had delayed their latest mercy mission to intubate cabinet minister Jackson Mthembu - who died shortly afterwards from Covid-19 - their worst fear was realised.

According to a witness, the helicopter in which the medics were flying to KwaZulu-Natal suddenly disintegrated in mid-air, instantly killing anaesthetist Dr Kgopotso Rudolph Mononyane, cardiothoracic surgeon Dr Curnick Siyabonga (Sia) Mahlangu, and specialist theatre nurse Mpho Xaba.

The three died near Colenso in the KwaZulu-Natal midlands, along with Netcare 911 advanced life-support paramedic Sinjin Joshua Farrance, and Bell 430 pilot Mark Stoxreiter, who worked for the National Airways Corporation.

Heartbroken friends and colleagues told the Sunday Times the accident had left at least nine children without a parent and robbed SA of a world-class medical team.

"Whenever we go and do transplants we go as a team, and we have always been mindful that accidents like this one do happen," said Williams. "And it did not happen with transplant patients, it happened with Covid-19. That just makes it so sad."

Because Covid-19 had dramatically reduced the number of transplants, the team volunteered to help with extracorporeal membrane oxygenation (Ecmo) of critically ill Covid-19 patients. The technique uses a machine to pump and oxygenate a patient's blood outside the body, allowing the heart and lungs to rest.

Last act

"Covid-19 patients are incredibly unstable when they are in ICU, and because at Milpark we have lots of experienced doctors, they have all put their hands up to say they will help us look after these patients," said Williams.

He said Mononyane's last act before he boarded the helicopter was to try to save the life of Mthembu, the 62-year-old minister in the presidency.

"He came from the helipad to help me. It was in his nature that if he knows you need his help, he will come and help you, so within five minutes he came in ready to stabilise the minister," said Williams.

"I could do it myself but it would have been far more dangerous, so I asked for Rudolph and we intubated the patient."

In their last conversation, Mononyane told Williams he would be back from Hillcrest in KwaZulu-Natal in 90 minutes and would call to check on Mthembu.

"I got an SMS that Rudolph had passed away. I could not believe it," said Williams. "I had been with him an hour and a half before - he had been joking and laughing, there was the usual banter between us.

"When I went to ask colleagues I realised that everybody had died in this accident, and I was overcome by grief. Rudolph was a friend who I regarded as a hero.

"The last thing he did with his life was to attempt to help me. He died fetching somebody else to help."

Williams said the atmosphere at the Milpark Hospital had been positive throughout the pandemic. "We knew that we were working together as a team to do what we do best. We are losing patients daily, but then our colleagues die as well.

"They did not get sick and die, they were killed in an accident while trying to help other people. That makes it more painful. They were intelligent, witty individuals who were the pride of their families, everybody liked them. Right now we all need prayers and support."

Netcare group CEO Richard Friedland said this was not just a loss for Netcare, the medics' families and colleagues, but for the whole of SA.

"Ecmo is the most complicated form of resuscitation," Friedland said. "When the ventilators haven't worked and you are out of options, that is what you use. Very few people in the country can do it, they were the A-team."

He said the Netcare management team had split up to visit the families of the team that died in the crash.

"I can tell you everyone is devastated. This week we are taking the families to the crash site to pay our respects.

"We mourn for our medical colleagues and their selfless acts of kindness and compassion. And for our skilled and courageous pilot, he too is our hero and one of us."

Milpark trauma unit director professor Ken Boffard said that just two minutes before a loss of transmission with the helicopter, which was on its way to a patient in Hillcrest who needed Ecmo, the crew radioed in their location.

"They said all was well. Minutes later transmission was lost and the helicopter was seen tumbling out of the sky. There was no warning transmission. No call for help. No Mayday. All contact was lost and there was total silence."

Boffard, a private pilot, said that while mechanical failures occur, "usually there are alerts, which usually give you a reasonable amount of warning. Whatever happened on board was instantly catastrophic."

He described the deaths as a massive blow. "It's like losing a close family member. The team were involved in highly specialised life-saving medical procedures. They were not newbies in their field. They had decades of experience. They were quite easily the best in the country."

KwaZulu-Natal businessman and pilot Richard O'Brien said he was driving towards Johannesburg on the N3 near the Colenso offramp when he saw the helicopter flying towards him.

"I saw the helicopter and then looked down at the road. As I did so I heard this big bang. When I looked up it was like tinsel was coming down. There were pieces of metal flying everywhere. You could see something catastrophic had happened in midair.

"I saw the fuselage falling at an angle towards the ground. When it hit it burst into flames a few seconds later. It was about 300m from me. There were still pieces of steel falling out of the sky, landing all over the place."

Stopping at the off-ramp, O'Brien ran up an embankment and climbed over a farm fence. "As I ran towards the wreckage, two other motorists stopped and ran with me. They suddenly stopped and we ran back. As we did it went 'poof' and the entire thing exploded.

"The wreckage field was more than 600m wide. There was some wreckage in another field across a district road. The tail rotor boom landed 600m from the fuselage in the other field along with other debris."

O'Brien said that when he reached the helicopter after the explosion he found three bodies. "I immediately phoned Netcare and told them what happened. I thought there were only three people in the helicopter, but they said there were five."

O'Brien said the weather was "completely calm and clear, with no wind. There might have been turbulence but the visibility would have been good. There were no power cables and the helicopter was flying about 400ft above the ground. If it was heading to Durban on the flight path it should be flying, that is low - especially for a Bell 430, which is a big helicopter."

South African Medical Association CEO Angelique Coetzee said SA had only a few specialists trained to perform Ecmo. "To be able to transfer Ecmo patients by air requires highly specialised skills. The impact of the loss of such specialists to SA is massive."

To become a specialist in cardiothoracic treatment, be it as an advanced life-support paramedic, doctor, nurse or anaesthetist, required decades of training and experience, Coetzee said.

"Cardiothoracic usually takes five years. This will be over and above their five-year GP medical training and four-year registrar training. SA cannot afford to lose one doctor, never mind a specialist team like this."

Casper Venter, director of the Health Management Network, which represents 3,500 South African medical specialists, described the loss as a calamity.

"We simply cannot absorb the loss of any doctor," Venter said. "Cardiothoracic specialists are scarce commodities and few and far between. Most South African hospitals do not have such specialists. They are mainly centred in a few major cities."

He said such specialists performed highly complex medical procedures such as triple heart bypasses and heart transplants.

Dr Chris Archer, CEO of the South African Private Practitioners Forum, which represents medical specialists, said the loss was "incalculable".

"South Africa only has 113 cardiothoracic specialists and 1,000 anaesthetists in the private and public medical field. Specialist transplant and cardiothoracic nurses, who are responsible for the operating machines used in heart operations, are also very rare.

"How do you describe the loss of this kind of experience? This loss means that while the number of patients requiring specialised heart surgery will not change, there will now be even fewer experienced specialists to perform such medical procedures, with even more pressure placed on those who can."

Helicopter crash victims

Anaesthetist

Dr Rudolph Mononyane

Dr Lance Lasersohn, of the South African Society of Anaesthesiologists (Sasa), said Mononyane gave his life to his work. "As we all do, he struggled to maintain a balance of work and home life in a country with too few specialist anaesthesiologists," he said.

"The most time we spent together was on an annual weekend meeting each year for Sasa work. My fondest memories are of our last pre-Covid weekend where we spoke for a couple of hours about our personal family enjoyment and the happiness they bring to us."

Lasersohn said Mononyane "had a difficult childhood growing up in apartheid SA. He first became a pharmacist and during his intern year was offered a post in medicine after having applied to various institutions." He went on to dedicate 16 years to studying his specialisation.

Small business development minister Khumbudzo Ntshavheni, a friend and former business associate of Mononyane's, said he "would not tire to give both of his time and service unselfishly".

She added: "Despite his many commitments, he found time to give back by lecturing medical students. I was therefore not surprised to learn that on the day he passed away, he delayed his travel to attend to my colleague, the late minister Jackson Mthembu."

Cardiothoracic surgeon

Dr Siyabonga (Sia) Mahlangu

Milpark Hospital critical care specialist Dr Paul Williams said Mahlangu was a South Africa-trained surgeon who "joined the team about three years ago in a very humble capacity, as is his nature".

He described Mahlangu as a confident young surgeon who knew what he was doing and was not scared to take control.

Milpark nursing sister Silindile Ntuli, who last saw Mahlangu on Sunday, said: "He had a humble, playful character, never serious, was full of jokes and loved his patients wholeheartedly." She said Mahlangu, who studied at Medunsa, was married and had children.

Specialist theatre nurse

Mpho Xaba

Williams said Xaba was an "excellent theatre nurse", and Ntuli said she loved her job. "She never talked much. She worked in theatre and I only knew her through meeting in corridors."

The Lesotho-born nurse's Facebook page is full of pictures of herself and her young daughter.

Commenting on her death, the Democratic Nursing Organisation of SA said: "There is a serious shortage of nurses in this country. She was a specialist nurse and we don't have many of those."

Advanced life support paramedic

Sinjin Joshua Farrance

Friends said the Benoni-born medic, who studied at the University of Johannesburg, was based at the National Airways Corporation in Midrand. "He lived for his job. He worked overtime like crazy," said one.

Another friend said: "He definitely made a difference in hundreds of people's lives and was always willing to go the extra mile ... He wanted to be the best paramedic."