The Philippines is a tough place to have a medical emergency.
by Antonio Graceffo
After graduating EMT-B (Emergency Medical Technician, Basic) course, I started duty, volunteering on an ambulance crew in Quezon City, Philippines. I have to put in 250 hours of service before I return to school for the next round of advanced training.
The emergency call volume in the whole country is pretty low, with the crew only going on about two and a half calls per day. Since Filipinos are exposed to so many more dangers than people in the west, one would expect to have more calls per capita, not less. Vehicles are not inspected. Buses, completely overloaded with people, often drive, without breaks and slam into motorcycles, carrying a family of five. And, of course no one wears a helmet. Electrical wires are installed with little or no forethought. Outside the houses there are massive tangles of fizzing, sparking wires, pirating electricity, just waiting to shock someone or burst into flames. Poor people don’t have any preventative medical care, only going to the hospital when it is too late to save them. A huge percentage of them smoke and drink alcohol. Vegetables are overcooked or non-existent, and pork fat is a favorite dish, served on a heaping mound of rice.
In poor areas, particularly squatter communities, there are massive open sewage and drainage pits, just waiting to support an epidemic or swallow up a child. But more on that later.
The rescue station was small, dirty and ill equipped. They had three ambulances, 1994 model L-3, which is basically like a family van converted to carry a patient. The only equipment in the ambulance was a trolley cot, a small oxygen tank, tied off with rubber bands, and a homemade equipment locker, which contained no equipment.
Some of the regular EMS guys who manned the station, were, by far, the biggest slackers I had ever seen in my life. They smoked. They were fat. And I just got the impression they didn’t want more than two and a half calls per day. It would just mean more work. And God knows they didn’t like work. The bathroom reeked to Heaven. It had clearly not been cleaned since the station was established fifteen years ago. The sink didn’t work and there was no seat on the toilet.
The team leader, and a couple of the others, however, were motivated and trying to do what they could, but if you leave a good man in a quagmire long enough, he will stop trying to swim. Bobo-Lolo, as I called him, was by far the slackiest of the slackers. He tried to relate to me, because we were both soldiers. He was so unfit, I finally said to him. “how can you save lives. You look like you are going to collapse any moment.”
“I am forty-one.” He said, as an excuse.
“I am forty, and you look like you could be my lolo, my grandfather.”
“I am older than you.” He insisted.
“So, in six months, on my birthday, I am going to wake up reeking of cigarettes, hungover, and eight months pregnant?”
Bobo went on to tell me about why he left the army.
“We had to shoot guns, and it made me tired.”
“Armies shoot guns.” I explained.
“No, but this was hard. We had to crawl.”
“Under barbed wire.” He added.
“With sergeants shooting over your head.” I interjected, before he had a chance. “Those are all normal exercises that soldiers do. You didn’t have it any harder than any other soldier anywhere.”
In the course of this conversation, it turned out that Bobo-lolo hadn’t even been in the army. He was talking about ROTC, when I was in college. So, now I wondered what he had been doing for the last twenty years.
Actually, I didn’t want to know.
In the main room we had a small TV, which played constantly. There was a couch and a sick bed which was missing its upholstery, so you had to sit or lay directly on the smelling, filthy foam rubber.
In defense of how lazy these guys were, their salary was only 6,000 Pesos a month.
A lot of my EMS duty consisted of sitting around the station house, reading. We did practice for about then minutes, doing spinal immobilizations, simulating extracting a victim from an automobile. All the equipment smelled like a thousand sweating bleeding victims had defecated on it,. When it came my turn t play the victim I refused, for fear f becoming infected by having the rescue gear touch my skin. When I played rescuer, I put on rubber gloves for the same reason. We have to buy our own gloves and the regular guys thought I was nuts. My classmates, Ben and Neil, of course knew this whole situation was wrong.
I looked at my watch, then said to Ben. “Two hundred and forty-six hours left.”
In addition to our grueling extraction drill, we had a session of ambulance familiarization. The first thing I noticed when they opened the doors of the ambulance was that the rescue basket had old dried blood on it. I guess two and a half calls a day kept the guys too busy to clean their equipment.
Just before noon, we received word that the Vice Mayor’s birthday was being celebrated at City Hall and we were all invited for lunch. Feeling proud in our new uniforms, my classmates, Ben and Neil, and I followed our EMS team through the crowd at City Hall. Everyone was curious about the EMT from America, so they all came over to talk to me. At one point, I am not sure how it happened, but I wound up leading our procession down a hallway. I stepped through a doorway, expecting to step down a flight of stairs, only to find out that the first step was missing. I fell like a stone, crashing down on my ankle, which of course, had twisted underneath me.
The sudden fall had caused all of the blood to run away from my head and collect in my feet, and I instantly fell into near unconsciousness. The six EMTs all hovered around me, remarking on how white and sweaty I had become. I sat on the floor, with my back propped up against the wall, willing myself to recover. I couldn’t remember the last time I had felt so nauseous or so feint. Sweat ran off my body like a river. While I slowly recovered, an employee of the mayor, a woman in her late forties, brought me an ice pack for my swollen ankle.
I had been working as an EMT for about five hours at that point, and I was my first patient. I really felt like a mook.
Eventually, I made it back to my feet. Limping, unsteadily, I followed my friends into the banquet hall, where we ate an excellent lunch for free.
After lunch, we were back in the station house. I was reading Chuck Berris’s autobiography, wondering if he really had been an assassin for the CIA. We received an emergency call. A woman was nearly collapse at City Hall.
I grabbed my medical bag and jumped in the ambulance, not missing the irony of the fact that I was returning to the scene of my shame. If the injured woman recognized me as the patient from before, it probably wouldn’t instill confidence in her.
We met our patient in an office, where she was being tended by none other, than the woman who had brought me an icepack earlier. Luckily, she was too concerned about her friend to laugh at me. The injured woman was 47 years old. While Ben took her vitals, BP 90/70, we asked some questions. It turned out that she had donated blood a few hours earlier. Since then, she had been outside, in the heat, helping to coordinate the events for the vice mayor’s birthday. She hadn’t eaten anything since breakfast. Making sure that she had no history of diabetes or heart disease, I suggested she rest in front of the fan, eat some lunch and drink come fluids. After a few more questions and niceties in Filipino, the team leader agreed. We returned to base.
To kill boredom, while I read, Ben and Neil took turns splinting my ankle. Neil was better on wrapping. Ben was better at tying. But, it isn’t nice to compare, so I complemented them both equally. You don’t want to squelch the spirit of a new EMT.
We were to be getting off at 5:00. It looked like we weren’t going to get to actually see or do anything interesting, apart from working on each other. At 4:10, we were called to the drowning of a three year old child. Of course our ambulance was stuck in traffic. Even with the sirens blaring, no one made way for us.
In the back of the ambulance, Bobo-Lolo was asking Ben questions about me in Filipino. I have been here long enough that I really understand about 80% of what is being said, if I know the context. One question after another, I simply answered before Ben could translate.
“You speak Filipino?” asked Bobo.
“I understand a lot, but I am just learning.” I answered.
He started teaching me phrases in rapid fire. People do this to me from time to time. They try and make it look like they are helping you, but actually they are taking the piss out of you, telling you a ton of useless language that you can’t possibly remember. At some point they laugh at how stupid you are because you can’t speak THEIR native tongue. The fact that I speak ten other native tongues never seems to make any impression on them. They just feel superior. I didn’t want Bobo to feel superior. So, I shut him down.
“Stop!” I said, holding up my hand like a cop directing traffic. “I don’t need you to throw a bunch of useless phrases at me. Just teach me one or two phrases directly related to our work. That would be helpful.”
“Mahal Kita.” He said, giggling.
“Is that related to or work?”
“What does it mean?”
“I love you.” Answered Bobo and laughed at having baited me. Everyone else laughed too.
“Do you really?”
“Do you really love me?”
Bob began to stammer.
“You don’t love me do you?”
Now everyone was laughing at Bobo-Lolo
“Don’t tell me you love me if you don’t mean it.” I said.
Bobo-lolo left me alone for the rest of the ride.
We arrived on the scene at a squatter village where poor families live in houses made of scrap wood and cardboard. There was a drainage tunnel running off the highway, which had turned into a fast moving river in today’s unseasonable downpour.
In the developed, western countries, it is hard enough to get a straight story, but in the developing world it is impossible. You have to ask, and ask, and ask again. And each time, you will get a different answer or no answer at all. Basically what I was able to piece together was that a little boy was walking along the top of the tunnel. His sandal fell into the tunnel. When he bent over to retrieve it, he fell in and immediately got swept away. The tunnel lead down a steep embankment for about thirty meters, till it hit a valley, which today was completely full of swift water. That is where the story ended. I couldn’t get a straight answer if anyone had seen him swept away or pulled under.
Looking more closely at the current, I saw that the water coming down the embankment was actually flowing in the opposite direction as the river itself. With that, I surmised that the body must not be far away. He would have come down fast, then hit water going in the other direction, which would have stopped his forward progress.
At that point I was certain we were looking for a body, rather than conducting a rescue.
During the course of the conversation, I learned that all of this had happened over an hour before we were called. This tragedy illustrates a number of problems in the Philippines, aside from the fact that they don’t do maintenance or planning and don’t eliminate dangerous situations before or after they kill people. Beyond this, the people simply don’t know to call for emergency response, or they are afraid to. Quezon City, has a population of two million, but only receives an average of 80 EMS calls per month. In the west, we would expect the same population to result in 400 calls per week. Other problems were glaring, such as, we were the first unit on the scene. The police and fire department were nowhere to be seen. When we arrived, we knew we were in the right place because of the huge crowd that had gathered, clearly looking for something in the river. How many police cars must have driven by the crowd on patrol but chosen not to stop?
When I suggested to my team leader that the little boy must be close to the embankment, he said the locals told him that when the river changed directions, it ran back under the highway and went on for miles, eventually coming out at the sea.
The water was moving at least 5 – 10 miles per hour. If he had been swept in the other direction, he would be long gone by now. Obviously I wanted to save the boy, but since that was not possible, I at least hoped to find the body, so his parents could have a Catholic funeral, and get closure.
We went to the other side of the highway and made our way through the squatter’s market. There were large drainage holes, five meters across, covered in metal grates. The obvious thing to do would be to open one of these grates, repel in, and see if maybe the body had been trapped inside. No one seemed to know, or care if there were screens or obstructions under the water. They ignored me when I asked if it was possible that the body was trapped there or had been washed further on.
We are actually EMTs. We are only supposed to deal with medical emergencies, not rescue, but they asked if I was trained to rappel down and look for the body. I said, no problem, as long as you have safety gear for me. Of course they didn’t. So, I refused to go down.
In the Philippines, big cities, like Manila, are divided into smaller cities, Quezon City being the largest of these small cities. Small cities are divided into smaller units, eventually coming to something called a barangay. The barangay is ruled by a barangay captain who is like a ward boss back in old time New York. Anything that goes wrong, any problem is supposed to be reported to the barangay captain, who, like a patron, will help his constituents.
We found out that no one had called the barangay captain. So, my team leader notified him. The team leader said, “We have to be available for medical emergencies. If we stay here looking for a body, someone may die of heart attack on the other side of the city. So, we need to wait till the barangay captain gets here and then leave.”
This was reasonable. But I was still worried about the family. “Does the barangay have equipment to go in and search for the body?”
“No, but they will call the police.”
I couldn’t believe the police still hadn’t been called at this point.
“And do the police have equipment to search for the body?”
“No, but they will call the Coast Guard.”
On the list of things I couldn’t believe was that you needed to call the Coast Guard for a rescue in a drainage ditch, miles from the ocean.
This is the Philippines. It is a sad situation. Poor people live under dangerous conditions everyday. Then, either through ignorance or fear, they don’t call for help when they need it. But in this country, the help is fairly useless, and bureaucratic when it arrives. Most likely someone in that long chain of phone calls was going to refuse to come till tomorrow, if at all.
If this had been a drowning, or if the boy had been alive when we arrived, I would have had no other choice but to go in after him. The EMTs I worked with during my water rescue course and a few of the guys from this team were taking rescue courses with the Coast Guard and Air Force, apparently, although it is not their job, they see that they need the training to save lives. Although some guys are lazy and resign themselves to working for 6,00 Pesos a month, doing the bare minimum, there are clearly other Filipinos who are dedicated. They are struggling to make things better, but life refuses to meet them half way. Everyone has noble ideas about staying behind and helping the country, but I looked at my classmates, Ben and Neil, who had performed heroically, and I just said, “Get out of here as soon as you can.” I felt guilty saying this to them. They are both bright, Ben is a nurse and Neil is a respiratory therapist. They have a chance to go outside the country, work as advanced EMTs and at least make things better for their own families.
“That is our plan.” Answered Ben, sadly.
I didn’t want to turn this child’s death into a soap box. Please say a prayer for his soul and a prayer of comfort for his parents. The death of child must be the hardest tragedy to endure.
Antonio Graceffo is a qualified EMT, Emergency medical technician. When he completes his training in the Philippines, he hopes to return to Burma and Shanland as part of a medical aid mission. He has been embedded with the Shan State Army inside of Burma, documenting human rights abuses, in his video series, “In Shanld.” You can watch all of the Shan videos released to date on youtube.
Antonio is self-funded. If you wish to contribute to the “In Shanland” film project, or his paramedic training, you can do so through paypal, through the Burma page of his website.
contact Antnio Antonio@speakingadventure.com