Doctors are rarely on board flights, so airlines invest heavily in training the cabin crew to handle fainting, dehydration, breathing difficulties, cardiac events, allergies and any medical emergencies with confidence.
The call no airline ever wants to make is not about turbulence or delays. It is about death. For Dr Eva Njuguna, Senior Manager at KQ Health, Kenya Airways, repatriating a body is one of the most sobering aspects of aviation medicine. It is meticulous, heavily regulated, and emotionally charged.
“It’s very sad because you are dealing with loss,” she explains. “And loss, grief, it comes in different ways. There are very many regulations around it…and the whole process can be quite heavy for the family.”
Yet even in grief, aviation’s overriding principle remains safety. Preparing a body for transport involves layered packaging, certified mortuary handling, and strict documentation to ensure no risk to other passengers or crew. Airlines must also prioritise such cases urgently because, as Dr Njuguna puts it, “you can’t schedule loss.”
From this stark entry point, her world opens into a lesser-known but highly specialised field: aviation medicine. It operates quietly behind the scenes of global travel, ensuring millions of passengers move safely across continents every day.
Aviation is often reduced in the public imagination to pilots and cabin crew. But as Dr Njuguna explains, “there’s so much more that happens in an airline,” including an entire medical ecosystem blending clinical medicine, occupational health, emergency response, and regulatory compliance.
A commercial aircraft cruising at 36,000 feet operates under lower atmospheric pressure and oxygen levels
Her path into the field was not linear. As a high school student, she was already drawn to emergency response, serving as a scout and first aider, attending to everything from minor injuries to her first witnessed convulsion. “I was a scout, so I would be called to respond to emergencies. I think that interest grew.”
After medical school and early work in government and private practice, a chance encounter with a female pilot introduced her to aviation medicine. An MBA in healthcare management later positioned her to oversee health services for passengers and staff at Kenya Airways.
Aviation medicine differs fundamentally from hospital-based care. A commercial aircraft cruising at 36,000 feet operates under significantly lower atmospheric pressure and oxygen levels than at sea level. Although cabins are pressurised, they do not fully replicate ground conditions.
At high altitude, gases expand because air pressure is lower, a basic physics principle known as Boyle’s law. This can worsen certain medical conditions mid-flight. A small fluid buildup around the lungs may cause more breathing problems in the air. Air trapped in dental fillings can expand and cause severe tooth pain. Patients recovering from surgery may develop complications if trapped air inside the body has not fully cleared.
These risks explain why airlines operate under strict guidelines informed by bodies such as the International Civil Aviation Organization (ICAO), the International Air Transport Association (IATA), and the Kenya Civil Aviation Authority (KCAA). Passengers are advised not to fly within a specified period after certain surgeries. Stroke patients, pregnant women, and individuals with chronic conditions may require clearance before boarding. Complications such as hypertension, diabetes, or heart disease may require even earlier restrictions.
Aircraft are stocked with emergency medical kits akin to a mini-ICU designed for qualified professional medics
Dr Njuguna emphasises that disclosure is not about restricting travel but enabling it safely: “Make sure you fly in the safest way possible.”
Contrary to popular belief, most flights do not carry a doctor. It is not operationally feasible. Instead, airlines invest heavily in training cabin crew to manage medical situations. This training goes beyond standard first aid and includes what Dr Njuguna describes as “modified basic life support” adapted to the aviation environment. The crew is equipped to handle fainting, dehydration, breathing difficulties, cardiac events, and allergic reactions.
Aircraft are stocked with emergency medical kits she likens to a “mini-ICU,” though these are designed for use by qualified medical professionals due to legal and clinical considerations. In serious cases, the crew may call for assistance, hence the familiar announcement: “If there is a doctor on board…” Even then, the goal is not definitive treatment but stabilisation until landing.
When emergencies become critical, the crew must decide whether to divert the aircraft, a complex decision involving fuel, weather, distance to the nearest airport, and medical urgency. “If you are over the ocean, you could be three hours from the nearest airport,” Dr Njuguna explains. “What can you do?” The answer is stabilise and coordinate. Pilots communicate with ground-based medical teams while onboard responders manage the patient. At major hubs like Nairobi, Kenya Airways maintains rapid-response systems, including ambulances with airside access. For outbound flights, the airline relies on international partners, hospitals, and doctors at destination stations.
If labour begins mid-flight, crew are trained to assist and aim to reach a medical facility
Standard guidelines allow travel up to 36 weeks for uncomplicated singleton pregnancies and up to 34 weeks for multiple or complicated pregnancies. If labour begins mid-flight, crew are trained to assist, though the aim is always to reach a medical facility. “They don’t treat, they support,” Dr Njuguna notes. “Think of them as first aiders in a very unique environment.”
Passengers with chronic conditions must plan carefully. “For example, you cannot choose to do dialysis after. So, if you are on alternate days, we prefer that you do it today and then fly. You should not wait until it is time for dialysis and then decide to travel first. The repercussions can be severe.”
If a passenger becomes unwell after landing, minor cases may be assessed and cleared to continue travel, while serious cases may require hospital admission. Airlines may offer support for rebooking, depending on documentation and circumstances. Dr Njuguna also strongly recommends travel insurance: “You never know when you might fall ill.”
Kenya is increasingly positioning itself as a regional hub for medical tourism, making robust aviation medicine all the more important. Dr Njuguna categorises medical travellers into two groups: those who are critically ill but stable, fit for commercial flights, and those who are critically ill and unstable, requiring an air ambulance.
Commercial airlines can accommodate the first group using specialised services, including stretchers occupying up to nine seats, oxygen support systems, and portable oxygen concentrators. These are calculated precisely. “Sometimes you tell a doctor your patient cannot travel, they need oxygen, they look at you, because on the ground the patient appears fine. But medical support changes at altitude. Part of our role is to provide awareness and guide accordingly.”
Interestingly, medically prepared passengers often experience fewer in-flight incidents than leisure travellers who neglect pre-travel health checks.
Pilots, cabin crew and air traffic controllers must be medically certified to maintain their licence to fly
Aviation medicine extends beyond passengers to the airmen themselves. Practitioners may become Aviation Medical Examiners, authorised by the KCAA to assess and certify pilots, cabin crew, and air traffic controllers. “In aviation, safety comes first. The airmen, whether pilots, cabin crew, or air traffic controllers, must be medically certified regularly to maintain their licence to fly. The medical assessor heads this process, and because they cannot assess everyone individually, designated doctors are appointed to carry out the evaluations,” said Dr Njuguna.
This also extends to airline staff more broadly, where stigma around medical disclosure can be a barrier. “People think you are standing between them and their destination.” Her goal is to shift that perception and position aviation medicine as an enabler rather than an obstacle.
Despite her managerial role for the past six years, Dr Njuguna was once called mid-flight to assist a sick passenger. The experience highlighted the limitations of onboard equipment, particularly in an environment where noise and pressure affect clinical assessment. “You realise small things matter, like your hearing with a stethoscope,” she recalls. Following that incident, she advocated for upgrading onboard medical equipment to more advanced digital systems within regulatory limits.
At its core, her work is about risk management, not elimination. “There are no two days that start and end the same way,” she says. From routine health clearances to complex international repatriations, the field demands adaptability, precision, and constant vigilance, operating at the intersection of science, logistics, and humanity. For Dr Njuguna, that is precisely what makes the work matter.
