The beacon on top of the tower at Mt Scenery (2,882 ft) isn't working (something happened to power lines leading to top of mountain). And that's been like that a while and wasn't fixed when I was there in Aug. That is probably not the highest dollar (guilder) item in the budget and it's being neglected. There are new officials in government than 6-7 years ago, so not sure what happened to the arrangement w/ the BVI medivac operation.
Everyone on Saba knows each other on a first name basis - so whenever anyone gets sick, you know that patient and their family. The call for airlift is usually made by the attending physician, who is not a local and can provide some sort of objectivity to the situation. Maybe I'm biased because I am from Saba, but I'm trying to think of a 'boy who cried wolf' situation, and burst appendix, cardiac arrest, and emergency C-sections don't seem to factor in to fit into that category. Things happen and the infrastructure needs to be there for when it does. Obviously that does not mean an R-44 operated by a private citizen.