I'm not an EMT, I just play one in Liberia

Police SUV flipped over just outside of Robertsport Liberia

This is a little story that illustrates what I love and hate about living here, but first a little about my younger years. Back in the day I had the amazing privilege of serving as a volunteer fire fighter at Station 17 in St. John’s County, Florida. I was underage for most of it, and never went through all the classes that made make you a “real” fire fighter, so while I wasn’t allowed to enter burning buildings, I still saw lots of auto accidents, brush fires, operated the water pumps, and even the Jaws of Life. I used to get so excited when my Dad’s (he was the fire chief at the time) radio would go off, “beep, beep, beep, Station 17, auto accident with injuries on I-95 north bound. Approximately 1 mile south of county road 210…” It was such a rush.  We’d jump in his pick-up, go to the fire station, take the fire truck and pass through the parked cars on the interstate like Moses in the Red Sea. It was awesome. So I can kind of understand why the Liberian Presidential Special Security Service (SSS) drive like idiots, it’s hard not to when you have that kind of power, but I digress…  Anyway, it was a great experience and I learned a lot about first aid. I was never an EMT, but I know a fair bit of what to do, and probably even more importantly, what not to do, when you come across an auto accident.

So I was excited to get to use this knowledge last weekend. I was driving back from a surfing weekend in Robertsport, Liberia with Myles Estey and Katelyn Hendricks. We saw some Liberians try to flag us down for a ride and I was about to pass by then, but then noticed an SUV in the brush with its wheels in the air. I hit the brakes and threw her in reverse.

We all jumped out and started accessing the scene. Myles used to work as a rafting guide, so he also had a lot of first aid experience. I grabbed my first aid kit, Myles and I put on latex gloves, and then started seeing who we could help. There were 5 people in the car, and it turned out to be a Liberian National Police SUV that had flipped. All the people were conscious and breathing. 2 had minor cuts on their head, 2 were just banged up and soar, and one was complaining of sever neck pain and couldn’t walk. He could feel his limbs and move them, but it was too painful for him to move. We first put bandages on the guys with cuts and tried to clean them up a bit. Myles and I decided that we shouldn’t move the guy with the hurt neck, Varnie, since we didn’t have a stretcher. So I was to drive the other 4 to the hospital 10km back in Robertsport, and then have them bring their ambulance to collect Varnie. We knew there was a real chance that there would be no working ambulance, so the back-up was for me to get a neck collar and a stretcher, throw it in the back of my SUV, and then move Varnie.

This is the part I love about living here. I love that just because I learned a few first aid things and have a first aid kit, I can stop at an accident and really help some people. We were the only car that passed by for a long time, and certainly the only car that contained people that had any clue about what they were doing. The usual Liberian thing to do would be to grab him by his arms and legs, and through him in the first taxi to drive by. There’s no 911 here, so the hospital wasn’t going to know about any of this. I love the adventure of not being able to rely on 911, ambulances and life flight.

But this is the part I hate, or at least get really, really frustrated and annoyed with.

We get to the hospital and it’s at the top of a hill with just a muddy dirt road leading up. It’s rainy season and had just rained the night before so there were literally little streams of water running down the road. Who thought that this was a good place to put a hospital without a paved road? So now I have to choose between getting stuck and putting all these people through another rough ride. I decided it wouldn’t do anyone any good to get stuck, so I put it in 4 high and gunned it. My passengers weren’t too happy, but we made it up.

I get to the hospital, hop out, and start telling the people sitting there what happened, what patients I have in my car, and that we need to go back for one more, but then I realize that I’m talking to a bunch of patients. There are no doctors or nurses around. The nurse is over in some other building and she just sorta strolls over without much hurry. So I yell at her, “Why you walking so?” and make a running motion to indicate that I’m not impressed. It’s about this point that I got kinda… bossy, maybe is a good way to describe it. The nurse starts taking the people back to the examination room, and I’m trying to explain that we need a neck brace, stretcher, and ambulance to get another guy. She has no idea what a neck brace is. Stabilizing the neck is the most basic thing you do for someone that’s been in a trauma accident. So I just start going through her closet and find one. Then I ask about the ambulance. “We have an ambulance” the nurse said in a very indignant tone. And they did, a brand new, shinny Nisan patrol with all the stickers from the aid organization that donated it, but the ambulance driver wasn’t there.

They were gonna take the other car into town, find him, drive back, then drive to the accident, but then someone who doesn’t work at the hospital was like, “you can’t just call him?” so they call. Some random guy and the nurse jump in the ambulance, drive into town, get the ambulance driver and then head off. I will admit that I was excited to drive quickly behind the ambulance with my flashers on through town. If you’ve seen traffic in Liberia you’ll know that the flashers are important.

So now we’re driving at unsafe speeds, 70mph, on a dirt road with some lose gravel and bumps to the accident site. We get there and Myles and Katelyn have erected a nice little shade tent for Varnie who is in and out of consciousness and crying out that he’s going to die. He was slightly melodramatic.

When I was a volunteer fire fighter, to move someone like Varnie, we’d collapse the wheels of the stretcher so it’d lay flat, have several people roll the patient on their side, put the stretcher against their back, and then lay them flat. We get the stretch out of the back of the ambulance and realize that the legs of the stretcher are fixed at 2’. Which means the height is only appropriate when in the back of the ambulance, and really, you’re not gonna roll him around in there so why not just have a flat board with no legs? What ambulance company thought this was a good design? In America (yes I know it’s not fair to compare the two countries, I’m just saying someone has thought about this and come up with a solution) the legs of the stretcher collapse flat and then fold down to a normal height for pushing around in the hospital. It’s also at this point that we realize there is nothing else in the ambulance. No IVs, no bandage, no antiseptics, not even a Band-Aid. Completely bare, no one had thought to stock it. This was probably the first time it had been used since it was donated.

Myles and I decide to use a surfboard, roll Varnie on that, carry him on the surfboard to the stretcher, slide the surfboard out from underneath him, and then put the stretcher in the ambulance. Myles goes over to the car and starts getting a surf board off the roof. I hate for things to get too serious, so I look at Myles untying the boards and with a straight face say, “You thinking the short board or the fish for this?” referring to the two different kinds of surf boards we had. Myles just looked me with a face full of confusion, anger, and dumbfoundedness. I could see him thinking, “What? Is he serious, should I use the short board? How can he be joking at a time like this, but does it matter? maybe he’s not joking…” It was hilarious, Myles and I still laugh about that moment. After a second Myles just grabbed the board on top, the fish.

The nurse and ambulance driver were just standing there. They were just letting Myles and I do everything, which was nice since they weren’t arguing with us about what to do. But a little scary since they were the trained professionals and Myles and I had just lived in North America.  Even Katelyn, with no formal training that I know of, had the sense to just talk to Varnie and keep his mind off the pain. At the very lease the nurse should have been getting Varnie’s vitals, and talking to him about his injuries. So we go to move Varnie and they’re still just stand there. This 6 foot tall ambulance driver is standing right next to Katelyn, this gossamer 5’8”, 110lb white girl, as she bends down to help lift 170lbs of Varnie. So I had to tell him to help lift.

Right as we get Varnie situated on the stretcher another car stops behind us. I didn’t really pay attention, but then I hear someone behind me say, “This man has a C-spine injury and needs to go to JFK”. “holy crap someone knows what they’re talking about”, I thought.  The man who had said that turned out to be the chief doctor at the hospital in Robertsport, one of 52 Liberian doctors in the country (this isn’t counting aid worker expat doctors). He was just returning with a bunch of Ministry of Health (MOH) employees packed in the back of a pick-up. I was glad he said that because the ambulance driver then immediately took Varnie to JFK, Liberia’s premier (I use the term loosely) medical facility, two hours away in Monrovia. However, the nurse had taken off Varnie’s shoes. This was her contribution to the moving Varnie into the ambulance. I threw shoes in the back of the ambulance, the chief doctor dude then took them out. Saying, “he doesn’t need shoes in the hospital”. I don’t know if he’s ever been in JFK, but I would never walk in JFK without shoes, so I threw the shoes back in. Varnie still has his shoes.

The ambulance pulled away. The chief doctor guy and the other people in his car where all very nice to us and told us thanks for helping. That was really cool. It was nice to get some positive feedback. Myles and Katelyn both did an awesome job. There’s a good chance had we not insisted on only moving Varnie with a backboard and with a neck collar he could have seriously hurt his neck.

Later that night we checked up on Varnie and he had indeed made it to JFK with his shoes. We talked to him a few days later and he was back in Robertsport. The x-ray machine at JFK was broken so Varnie just left the hospital without knowing for sure that he didn’t have  broken neck, and now he’s not wearing his collar all the time. I just pray he doesn’t look over his shoulder too quickly for the next 6-8 weeks.

And that’s emergency medicine in Liberia. It’s exciting to be in a place where you have to fend for yourself, and you can be an make a big difference at an accident just by taking some simple steps to be prepared, but very sad that the main reason it’s like that, isn’t due to a lack of resources, but apathy and ignorance.

You can read Myles take on this story here.

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4 Responses to I'm not an EMT, I just play one in Liberia

  1. Rob says:

    i’m coming to work at JFK – i’m an american ER doc who volunteers most of the year if i can. i am interested in working at st timothy’s hospital in robertsport. if you have any contacts it would be great. I arrive Jan 6th. Take it easy, rob montana

  2. Lisa says:

    i laughed. a lot. Glad Varnie had his shoes.

  3. Lisa says:

    so, i just started reading Myles take…you had friends who saw the car flip going very fast and kept on driving?