HOPE CRISIS: An EMS Experience

Left to right: Dr. Becky (blue pants), Nurse Joy (black pants), EMT Joseph, EMT Edwin (at head of stretcher)

My cheap, knock-off boots purchased from the same outdoor market that sells doctorates from Harvard and forged driver’s licenses weren’t made to handle a run as fast as I was going. They started to fall apart on the hot cement. It was three blocks through pockmarked, unevenly paved road through a densely populated neighborhood until I hit the dead-end where the levy blocked the river. That’s where I tripped over rubble and rebar and got entangled in clothes hanging on tree branches. My stethoscope went flying, along with the BP cuff, and the pulse oximeter. No one had time to help me up because I ungracefully rolled back into running. When I finally made it to the tiny shanty, I began to enter through the wrong doorway. There were so many people outside, I didn’t immediately remember which one I was supposed to go into. Neighbors helped me like a marathoner crossing the finish line as others assisted Jerry who was driving the ambulance a few blocks away. He ordered me to get out and sprint to the location while he navigated a way to penetrate the community. A local guide was needed to clear the alleys of motorcycles, pedicabs, and children. The ambulance had to come in through a difficult route that couldn’t accommodate the size of the vehicle as the scratches and dings on the side can now attest.

I finally spilled into the tiny crowded backroom, partitioned off from the entryway by plywood, an altar of the Virgin Mary, and a hanging rosary. Even in the middle of the day, the tin roof and cardboard shutters were enough to darken the place in spite of the single rechargeable fluorescent lightbulb dangling above the bed. Just moments ago, Jerry and I were in that cramped space, replacing the oxygen tank and delivering new medicines prescribed by our teammate. The day before that, we were in there with a whole team of healthcare providers who set the patient up nicely (a luxury for poor and wealthy alike that can only be provided by a team of volunteers from a donation funded charity like ours). So the following day, the two of us only had to check on the nebulizer, retake vital signs, do a bit of cleaning, give more medical directions, and allow the family to continue to care for the young mother of two. I adjusted her flannel blanket, a bright pink Hello Kitty etched in the center smiling at my sweaty face as I struggled to regulate my own temperature and hide my queasiness in the oppressive heat. I forgot my water bottle and had just spent the entire morning digging and hauling buckets of dirt up two levels for a construction project at Hope Center. I was cotton mouth. But what mattered was that the patient still had herself a nice makeshift hospital room set up smack dab in the middle of a poverty-stricken settlement.

We left after feeling satisfied with our work and then went on our way to fill more oxygen tanks. After some kilometers away, we got stuck in standstill traffic at a quarantine checkpoint guarded by military-fatigued police officers with M-16s at the ready. The region is on a strictly enforced lockdown, the most restrictive and longest running operation in the world. Suddenly our phones rang off the hook demanding we race back to the compound. Upon returning is when Jerry ordered me to sprint while he maneuvered the ambulance through an alley system blocks away. We frantically pulled people off to the side trying to make our way to the patient to determine a course of action. One of our teammates called ahead to instruct the family to perform chest compressions over the phone while we were still pushing through traffic with full lights and sirens deafening the streets. Remember, this is the season of chest-only CPR because of the pandemic. They had been pumping the patient for over 5 minutes by the time I was able to lay hands on her.

There is a point during an emergency scene when a responder experiences tunnel vision, not seeing the grief and heaviness of the crowd, nor the cell phones capturing every move, live on Facebook, or even reacting to the anxious panic and wailing of loved ones. We often miss hazards threatening to harm our own lives because of this reaction, like hot wires next to puddles or rabid dogs nearby or unprotected Covid positive people. It’s also hard to keep from belching out orders to whomever is around or to even worry about keeping composure. What we’re fixated on is the haunting stare from eyes so transparent we can see the person’s soul, a beautiful face of a young mother, and then her children nearby. All you can think of is giving every ounce of energy in your body so that those eyes and that face may respond to your words again. She had just thanked us but an hour ago for sustaining her life the day before. She was given the opportunity to wake from unconsciousness and speak to her kids and husband again that morning after recovering from her comatose state in her own home. Her family was just joking about buying her favorite fast food meal for dinner that night. They were all laughing. And Jerry had just prayed over her, a faint "Amen" resonating under the oxygen mask. That’s what overwhelmed my vision, clouding everything peripheral. So I couldn’t stop pushing down on her chest, hard and fast, no matter how ugly it may have looked to those watching, because I knew that her life had been entrusted into our hands and it was our duty to get that loved one to a hospital as fast as possible without stopping treatment. It’s a chaos of emotions for everyone.

The day before that scene, we were doing everything in our power to keep from constructing that makeshift hospital room at her home. But it seems the world’s healthcare system is in crisis and the Philippines has not faired well. Let me plead with you now. Do not get sick. Prevent the virus from spreading. Do not show up to a hospital with breathing problems or any symptoms that are connected with Covid-19. There is a real medical crisis at hand, so if you need to make sacrifices and experience discomfort or take the leap of faith and receive a vaccination or treatment, do whatever it takes to stay away from a hospital.

Nine medical facilities, ten hours of nonstop care, one doctor, one nurse, three EMTs, one medical responder, and the Hope Rescue ambulance filled with supplies and meds. That’s what it took to sustain the life of that very important patient for that day, the day before she coded. Unfortunately, we never set foot into those nine hospitals, save the last one, a missionary clinic that gave IV supplies to our teammate doctor and a nurse friend of hers. How did we restock? We traveled from drug store to drug store and medical wholesaler to supplier trying to gather supplies as we went. The Philippines is in crisis mode and without the charitable volunteerism of the doctor, nurse, and EMTs, the beloved patient’s story would have ended sooner. Just the other day, the president of the hospital association declared that the country had lost the battle against Covid-19. An extreme statement, hyperbole to say the least, but one that our crew would support based on our very true-to-life experience.

Our patient was suffering from late stage tuberculosis. Some of you might be wondering and even Google checking to see if TB still actually exists outside of colonial America during the settlement of the nation. It is rampant in the Philippines, though effective treatment is available and easily prescribed with a monitoring and accountability system already in place. Factors impeding the eradication of TB have mainly to do with poverty culture, the shear number of patients, and education. Trust me, you never want to see what the suffering looks like for someone plagued with this disease. It is terrible. But couple that with the Covid-19 virus, and you have a deadly combination for the patient, their family, and the frontliners helping.

The day before our patient went into cardiac arrest, with lights and sirens blaring we sped to every medical facility we could think of only to be denied at each triage tent. It is common knowledge that finances has everything to do with medical care. No money, no entry to many facilities, and certainly no supplies to use. But listen to me when I say this, the pandemic is no respecter of socio-economic status. Wealthy or not, this quarantine lockdown period has filled all the hospitals up beyond capacity. And we’re not really talking rooms and beds. In fact the other night we were in a hospital with a brand spanking new wing, complete with state of the art hydraulic beds. Still in the plastic wrap. But none of them were in use! We had to wait for hours because the hospital needed to keep the patient on our stretcher due to a lack of beds. What?! Precious time flies by as medics stand still in a hospital simply waiting to be told they are allowed to go. That’s why ambulances have a reputation of never being available. We’re all at the hospital waiting for a signature or to get our equipment back.

Just last week, a rich and famous singer died outside of the hospital in the overflow tents meant for Covid patients awaiting treatment. She had money. But the virus had her in a bad way and even she couldn’t be cared for properly. Another viral story documented a son who drove all of Metro Manila from hospital to hospital to get his father admitted. No luck. He ended up driving to a far-off province for help. They were willing to spend whatever it took, but money has become a weakened bargaining tool in this pandemic. We finally realized through research of our own that what is likely meant when the hospitals say they are full is that they are understaffed and undersupplied. So at this point, I must applaud all of the frontline healthcare workers trying their best with limited resources to work with.

The Filipino people are aggravated with the insufficient and inadequately managed healthcare system, not the healthcare workers themselves. So in an age of sickness and death, rather than spread unhelpful negativity, let us offer up constructive solutions while thinking the best of people. It starts on the grassroots level. And it starts with the treatment of the poor. My team stands up for the poor and weak and sick. Hope Rescue EMS was created to serve the poor with help from the rich. One of our teammates lost her first child while giving birth in the waiting room of a hospital simply because she didn’t have the money to afford immediate treatment. We created Hope Rescue EMS to get emergency pre-hospital aid to the poor to see to it that such situations aren’t repeated. I’m absolutely fed up of watching people die of preventable illnesses or because of substandard action when the tools exist to ensure sufficient healthcare is actually available to all.

Day in and day out, as an EMS worker serving the poor, we experience what I experienced the day we rushed our patient to the hospital. Luxury vehicles unwilling to move out of the way of our ambulance, some getting angry with us, chasing us down and flipping us off. Some actually slowing down or stopping in the middle of the road and going out of their way to become a barrier. Honking and yelling from within the vehicle, nicely maintain SUVs and sports cars. While in the meantime, average motorcycle delivery couriers and poor tricycle drivers, on their own initiative and at risk of their own safety, help us move traffic along by becoming enforcers themselves.

EMTs get treated poorly by many. We are seen as the country’s van drivers hired by the government to also keep the streets clean of any evidence of carnage from accidents. Janitors. And if you’re a public service ambulance medic, you’re probably making less than a janitor anyways. We aren’t seen as highly educated or well-trained. There really isn’t one unified and systematized way to govern EMT or EMS standards so the point is valid. Survey random ambulance units roaming the streets and you’ll be hard pressed to find one manned by certified EMTs. When we brought our patient to the triage tent and waited for the head nurse and doctor to assist me, I was doing CPR non-stop for what felt like an eternity. Jerry had to endure criticisms and an interrogation about why we chose that hospital: did we attempt an advanced call, why did we park so close to the triage tent, why are we doing CPR when the patient looks hopeless? Why this and why that. I heard and saw the dialogue out of the corner of my eye as I was nearing complete exhaustion from performing compressions. We have thick skins, not only because of all the trauma we see, but because of all the derision and degradation we soak in from hospital staff too. That’s not going to be a popular statement, but I’m sure other medics in Manila reading this are secretly nodding their heads in agreement.

But that experience isn’t from everyone. We serve alongside and are close friends with humble doctors and nurses who daily sacrifice their lives and their finances to help people. There are government workers who find ways to get us treats like snacks and soft drinks, or lunch...even extra PPE and medical supplies. There are private clinics who will take our patients with no questions asked besides proper turn-over and a wink and a smile. And of course there are our compadres on the field, the other medics, firefighters, and police officers. We’re constantly checking up on each other by visiting one another’s locations and sending hilarious memes or tips through shared FB Group Chats. We’re not just adrenaline junkies as is our reputation, EMS workers are hard wired to risk our lives so others may live. And the one thing I believe will actually make a systematic difference in the EMS and healthcare world of the Philippines is this - a culture of kindness and unconditional service, especially to the poor. That is what will change the world.

Our patient’s husband and cousin weeped uncontrollably on top of the stretcher. We had continued treatment onto the sidewalk and out of the ambulance as passers-by watched nonchalantly, as if this sort of death were an everyday occurrence in their lives. The doctor declared the time of death. Jerry and I scooted the stretcher to the side to allow pedestrians to pass through without having to step onto the street. I covered the patient’s body with that bright pink Hello Kitty flannel. And after about 15 minutes on the sidewalk, the hospital staff came out with another bed. We placed that Hello Kitty blanket embracing the mother into the black back and zipped it shut. And Jerry and I remained with the family until evening.

Our approach to pre-hospital patient care isn’t conventional. It isn’t efficient either. We spend a lot of time with just one patient. And then we follow-up with them at their home when the time is right. We attend to the needs of the family if they are poor. And we show up to the wakes and funerals. We can’t accommodate that many patients with a commitment like that. But we believe it’s that sort of care and concern that will bring transformation to the world - holistic transformation addressing the needs of the body and the soul. It’s not for everyone, but it’s certainly how we will continue to serve at Hope Rescue EMS.

I am thankful for all of the frontliners who risk their lives every day and night, especially in this pandemic. In turn, they are also risking the lives of their own families. So if you get anything out of this story it is this: serve one another in love. If it means protecting yourself and others from disease, do it. If it means being kind to strangers, do it. If it means holding back that urge to put someone in their place because of your own position, do it. Here is truth from 1 Corinthians 13:7, “Love bears all things, believes all things, hopes all things, endures all things...” even a pandemic crisis.

Jem’s First Blog

Watch this VLog from our very own Operations Manager, Jem Espinar. Though it is his personal contribution to social media, you will discover what our feeding program looks like at the Manila Golden Mosque in Quiapo and what it takes to make it happen on a regular basis. Jem speaks both English and Tagalog in this video, so if you don’t understand, you will still be entertained and follow all that is happening. Enjoy!