Misadventures in EMS

In Adventures in Asia on April 26, 2008 at 12:13 pm


Misadventures in EMS

American EMT Student in Manila

By Antonio Graceffo



Ma’am Joan taught a lesson on airway devices, plastic appliances we can insert in a patients throat to keep him breathing. She showed us the newest model which was considered safer because it didn’t have to go all the way down the throat. “This one is very expensive, 10,000 Pesos. In America they consider it disposable.”


The students all balked. “Yes,” she agreed. “In the Philippines nothing that costs ten thousand pesos is disposable. You can wash it and use it again.”


“Americans are stupid.” Said Aden at the beginning of our next lecture. “And so is smoking. It is a terrible habit that destroys your health and it will kill you.” He pointed out Arvin, who smokes on all of our breaks while he ogles the caregiver girls. “It will kill you.” After that sank in he added. “Smoking came from America.” He likes ripping on America. Everyone had a laugh at my expense. Then Aidan felt bad and added. “Actually smoking was started by the Indians, and you know what happened to them? The Americans killed them all.”


“With cigarettes?” I asked.

“No with guns.”

“But they would have died of cigarettes?”

“No, they were killed by Americans with guns.”

“So, are you worried that Americans with guns will kill Arvin?”


“You told him not to smoke. Is it because Americans will shoot him?”

“No, cigarettes will kill you.” Insisted Aidan. Then he went after our mutual colonizer, England. “It was Sir Walter Raleigh, an English bastard, that started the modern trend of smoking. Indians only smoked ceremonially, but Europeans started smoking all the time.”


“And that’s why the Americans killed them?” I asked. 



“I saw a movie about World War two and Americans killed a lot of Germans. Was it because of smoking?”


Aidan is so patient, he went on to explain World war Two to me, eating up another thirty minutes of class time. It was funny, but when I started working as an EMT someone could die because of what I missed in class while I was harassing Aidan. When he was finished, he showed us a photo of a smoker’s lung. “Smoking killed this man.”

I was about to raise my hand and ask if he was sure it wasn’t the Americans, but I let it go.


Another habit Aidan hates is spitting.


“Spitting is a filthy habit. Keep your secretions inside of your body.”


I compromise with Aidan’s instructions. I keep my secretions in a bag under my desk.


“There is hydrochloric acid in your stomach that will kill the germs and you will be fine.”


So, keeping my excretions in a bag under my desk would be OK if I bought some hydrochloric acid. I made a point to stop off at Caustic Chemicals ‘R’ Us after school.


“That’s why that system exists. Just swallow your excretions.”


I know that he meant mucus, but I wanted to point out that fecal matter and urine are also secretions, and I am not swallowing either of those.


He showed us a respirator that had been frozen shut because it wasn’t cleaned. “The valve was filled with either dried blood, vomit, or urine.”


I had been playing with this valve during the break. Now, I was thinking, please be urine please be urine.


We get a lot of training of what to do when we are called to a trauma but it is a crime scene. We are told not to touch anything that might be evidence. Still thinking of the vomit soaked valve, I asked.


“What if we are called to a case and it’s a crime scene. And the patient is chocking on vomit, but the police aren’t sure whose vomit it is? If we clear the airway wouldn’t that be tampering with evidence? So, we should really wait till the police have dusted the vomit for prints.”


“Why would someone else’s vomit be in the patients mouth.” Asked Aidan.


“Because, it’s the perfect crime. You vomit in someone’s mouth and let them choke to death. Then the cause of death is obstructed airway. No one even knows it’s a murder.”


You could even eat something chunky first to really make sure the airway will be blocked. But you couldn’t do it to someone on the bus. It would really have to be done to a sleeping victim, but maybe you could cank him on the head with a cinderblock first.


I entered the Philippines on a tourist visa which was about to expire, so I went to Joan for directions to the Immigration Department. There is a famous poster of an incredibly messy desk and the caption says something like, “if your desk looks like this, the inside of your brain must look the same.” If the way she gave directions was an indication of what was going on inside her head, Joan must be under a lot of stress.


She started talking and other than the occasional word I recognized, such as street, road, left, right, luncheon meat, or parachute I really had no idea what she was talking about.


“Do you know the MRT?” she began.

“No, I don’t know anything.”

“OK, take the MRT to Cazero and change to the LRT.”
”I don’t know where the MRT is? What is an LRT?”
”It’s right there.” She said, pointing vaguely in the direction of the restroom.

“It’s in the toilet?”

“No, the LRT.”

“What is an LRT?”
”Yes, then you will walk on Adriatico.”

“Is that near the LRT?”

“No, you have to take a jeep.”

“What jeep, where, who?” Seeing that I was completely lost, Joan took paper and pen.

“I will draw you a map.” She said. She began talking again, at the same rate and with the same level of confusion as before. The only difference was now, she was also drawing. The images on the paper seemed to represent crossings and turns, but none of them were labeled. Worse, they weren’t connected. She didn’t start with the front door of the school, tracing a continuous line to the front door of the Immigration department. Instead, she drew separate, disjointed, pictures, of whatever she happened to be talking about at the moment. 


“Then you turn right on Rodriguez Street.”

“Wait! You mean from san Fernando Road?”

“No, you take the train?”

“What train?”

“Yes, and a bus.”

“Where do I catch the bus?”

“Diego Avenue.”

“I catch the bus at Diego Avenue?”


“Wilfred what?”

“No, that’s where you take a right.”

“Onto Rodriguez?”

“Across the plaza.”

“The Plaza is on Wilfred?”

“NOOOOO that’s for the train, before the bus…inside the immigration there will be many desks, go to the one in the far corner.”

She was already telling me what do when I arrived and I still didn’t know if I should go left or right when I walked out of our door. “Is the Immigration Department on Rodriguez?”

“No, Intramuros.”

She was making this stuff up. She had to be. She already had me standing in line at immigration and hadn’t mentioned Intramuros. Now, she was claiming that’s where it was located. In my life, I had done a lot of bad things, and now they were coming back to haunt me. I had no one to blame but myself.


“Is anything on Rodriguez? That name came up a few times, and you didn’t really go back to it.”

“Go past the big vegetable market.”

“In Intramuros?”

No, on the train.”

“Ah yes.”

I know money is tight in Manila, but no one ever wants to take a taxi. Often when people give directions there are multiple taxis, buses, trains and donkey carts involved in what seems like the most complicated and time consuming way of traveling five kilometers ever conceived. When you ask someone how far away something is, a typical answer is “Very close, just three rides.” They don’t count distance or time. They count the number of transfers it takes to arrive. In the end, even if each of those changes only costs around ten pesos, it would often be cheaper, let alone faster and more convenient, to take a taxi, but no one wants to do it. 

“It should only take twenty minutes.” Said Joan.

“To get there?” This was looking promising. Maybe it was difficult to describe where the place was but it was actually close by and I could get there easily by taxi.

“No, to do your visa.”

“How long to get there?”

“About two hours.”

Two hours! This was one of the other issues with Manila. Traffic was so horrible you had to allow about two hours to go anywhere.

“Does the train stop at Intramuros?”

“No, you walk there from the hospital.”

Hospital? There’s a hospital? This was the first I had heard of a hospital. Next, she was saying something about the monkey king and answering the ancient riddle. This just seemed to complicated for me. The paper was now nearly black, covered from top to bottom in black ink, with images of streets and traffic lights, and the crown of the monkey king. Not a single word was written on the paper.

In the end I took a cab.







My school warned me that because of corruption, getting a student visa would be too difficult. Instead, I was told to tell immigration that I am in the Philippines looking for business opportunities, and ask for a 90 day visa. I was really worried that someone at immigration would try and rope me into selling Amway or Herbalife, or some other some network marketing scam. He would be like “If you are starting a business you need to buy $1,000 worth of merchandise to show you are serious.”


By the time he finished with me I would wind up wishing he had sold me on network marketing.


When I turned in my form asking for 90 days, I thought the immigration guy was kidding when he said. “I can only give you 68 days?”


In my life of living internationally, I had never heard of a 68 day visa. Why 68 days? I don’t know. Maybe because they are Catholic instead of Buddhist. That is the usual answer for why things are strange in the Philippines. The standard Philippine visa is 21 days. So, 68 is not even a function of 21…in other countries it is 30 days and 90 days. But what do other countries know?


Anyway, the fee for the wonderful privilege of remaining in smelly dangerous Manila for an additional 68 days is $200 USD!


In Thailand a sixty day visa is $35 USD and we all complain. Not only was this visa crazy expensive but they told me to come back at 1:00 to pick it up. Having nothing to do, I wandered around Manila for a few hours. Normally, I would be afraid about getting mugged, but luckily the Immigration Department had already cleaned me out. Anyone approaching me with a gun would be wasting his time.


And best of all, to do the entire paramedic program I need to remain here for about six months. That means two more sixty-eight day visas. But I think I read that your second sixty-eight day visa is actually seventy-two days and your third sixty-eight day visa is considered your fourth, is naturally only good for sixty-four days. It was all quite complicated, so I took a copy of the visa schedule with me. It was nearly as thick as a New York City phone book, so I stuffed it into my shirt, hoping it would stop a bullet.


Wandering around Manila’s aromatic riverfront, I thought about the reasons why I came to study here. I am doing this paramedic deal because of the adventure and because I have always wanted to do this. It is a dream. And, believe it or not, one part of the dream is to work, even for six months, as a paramedic in New York City. I think no paramedic can claim to know about medical trauma till he has worked a twenty-four hour shift in the Bronx. And no human being knows real trauma till he has tried to hack out a living in the toughest, biggest, busiest, loneliest, most wonderful city in the world. This is one of the few adventures that I thought of that could be done in America. New York paramedic would be a hell of a ride.


While I was waiting for my visa I wandered around China town, where I spoke Mandarin with a shop owner. He said that his normal dialect was Hokien. He told me “the children forget their language. We have a Chinese school for them, but if they don’t read Mandarin everyday they will lose it.”


This is the curse of many of the world’s Chinese communities, who have given up their language and are now regretting it because of the business opportunities that speak Chinese present. I still haven’t figured out how to make money off of my knowledge of Chinese, but it seems better to know it than to not.


At the internet café the kids were speaking Chinese dialect to each other while they played online role playing games. That was actually pretty cool. It is good that they can speak dialect, but these dialects are often so old or so regional that anywhere outside of their neighborhood the dialect is useless. 


Near the Spanish ruin of Intramuros, I met Jay, another American at Starbucks. “Are you here waiting for a visa?” I asked.

He laughed. “I think all foreigners at this Starbucks are waiting for a visa.”


It was like Rick’s Café with everyone waiting for their visa to get out of Casa Blanca. I told him about my walk about the old part of Manila. “This city would be nice.” I said realizing I had never said that about a city before. Normally cities are either nice or not. But Manila would have so much to offer if they could get a handle on poverty, crime, corruption, and garbage.


“They have a river, old Spanish ruins, ancient churches…they have a potentially romantic promenade along the river, it could be really special…”


“But it isn’t.” concluded Jay reading my mind. We decided this was the unique charm that is the smelly and dangerous city of Manila.


During the long, overpriced taxi ride back to school, a report on the radio said scientists have determined that one in four people suffers from mental dysfunction. Doing the math, I decided if you have three sane friends then the law averages says you are crazy. I only have two friends, so I am like crazy and a half. I had always suspected it. But now I had definitive scientific proof. A voice on the radio never lies.


Back at school, one of my friends is called Arvin, who I often refer to as Joe college; because He always wears walking shorts and golf shirts, with his sunglasses up on his head. Allegedly he only majored in nursing because it was a good way to meet girls. I wonder if he chose this EMT program simply because it is located beside an Asian Caregiver school, where the students are extremely young and mostly female. These are the girls that go abroad to take care of American and foreign old people whose kids are wealthy but don’t care about them anymore. Arvin seems like a smooth operator and could just as easily be using the overseas employment option as a way of avoiding a shotgun marriage. He and Ben always chat up the caregiver girls when they come outside to smoke on their breaks. Their white uniforms are silhouetted against the intense Manila sun, clearly showing the outline of their bodies. It makes you feel jealous for some old guy in Hong Kong who is going to be getting sponge baths from these long haired beauties. It almost made me wish I was wearing adult diapers…I mean, it makes me wish they were taking care of me.


Ben is girl crazy. Unlike Arvin, I think he has less success but infinitely more enthusiasm. Any mention of a girl brings him flying no matter how far away he is. He was three blocks away when I mentioned that the students who live on my floor are female. Ben came tearing into the room, “Can you get their number for me?” This was followed by, “Are the cute.” Perhaps I should respect him for not being so concerned about how the girls look. Just being female is enough for him. I mentioned that my ex-girlfriend, Aymi, is a nurse practitioner and that are younger sisters are Filipina because her dad remarried.


“Are they cute?” Asked Ben. “Can I meet them?”


A huge, front-page story in the news paper today said that president Gloria has declared Black Saturday, the day between Good Friday and Easter Sunday, as a national non-working holiday. The article went on, in great detail, explaining how important it was that people observe the holiday. On page three, there was a small story that said the presidential palace whishes to assure the public that the government is addressing the issue of unemployment. This shows the priorities. Also with such a high percentage of the population unemployed, was it really necessary to declare a non-working holiday? Most people aren’t working anyway. Another story said that crucifixion is unhealthy and anyone planning to be crucified this weekend was urged to get a tetanus shot. Man, this story ran 2,000 years too late. Crucifixion is unhealthy? That’s news to me. If it wasn’t for this story I would have thought crucifixion was a good thing.


Well, I guess now that there is no crime, unemployment or other social problems in the Philippines the government can crack down on important issues, like crucifixion.



To see Antonio Graceffo’s Burma and martial arts videos, click here.


Currently, Antonio is in Manila attending paramedic training. When his course finishes he will return to the conflict in Burma as a medical volunteer. He is self-funded and seeking sponsors. If you wish to contribute to his paramedic training or his “In Shanland” film project, you can donate through paypal, through the Burma page of my website.










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