Wednesday, June 18, 2008

Medical Mayhem – East Timor 18th June 2008

At the age of 12 I joined St John’s Ambulance, it was a compromise with my stepmother, if I did something useful, then I could go to the youth club afterwards. So after an hour of dressing fake wounds and creating perfect roller bandages, I would share a coca-cola with my wanna-be skinhead mates at the local Holy Family church youth club.


In my teenage years, however, St John’s proved very useful; you could get to see bands free. Ok, you had to wear a very embarrassing uniform and you were always at the back, but you got guaranteed entrance.


As a diving instructor I teach EFR (Emergency First Response) which is not much different from the St John’s of years ago, simulated situations, plastic dummies and fake pain. Until last Saturday I’d never actually had to use my training in a real emergency, and I hope with all my heart, I never have to again.


In East Timor, crash helmets are supposed to be mandatory, but it’s a complete farce. You often see thin plastic crash helmets rolling down the street where they have come off because the rider has not done the strap up. In a climate such as East Timor, crash helmets are pretty hot but young lads also want to be ‘seen’ on a motorbike because they are still luxury items, most people can’t afford one. That’s why you often see a family of five on one motorbike, and if you are lucky the main rider only has a crash helmet perched on his head. The local Dili motorbike riders also have a habit of removing the mirrors on the motorbike, because it looks ‘cool’ which creates a traffic culture of merge and swerve. As a car driver, the slower the better as you never know what’s going to pull out on you.


On Saturday I was in the Hotel Timor pool teaching a rescue course when we suddenly heard a sickening screech then crunch. It took a couple of seconds to register but then I was out of the pool and in the street as fast as my legs would carry me. One of our Divemaster Trainees was already ahead of me. We emerged to find two young lads only about 16 or 17 lying in the street both with serious head injuries. One apparently was wearing one of these cheap plastic crash helmets that came off immediately upon impact, the other wasn’t wearing one at all.


It does not matter how much training you have had, nothing prepares you for reality. There was absolutely nothing I could do except keep the head still and check for breathing, they were so badly injured that you just were willing the ambulance to arrive, I felt so helpless. There was an Australian army guy there that was amazing, he packed and dressed one of the guys head. It was the second major traffic incident involving a motorbike that he had dealt with in a month. But what really got me was the onlookers, I know it happens in every country, but fellow Timorese taking photographs of a guy that’s lost 2 pints of blood on the street really sickened me.


The first ambulance arrived after 20 minutes but it seemed like hours. They had no neck brace but at least they had a back board, the second ambulance didn’t even have that. Seeing the two young lads off in the ambulance you knew there was nothing you could do for them and their chances of survival were slim to zero. On Monday evening I found out there as a shrine laid out on the road, one the boys had died, just after his sixteenth birthday.


What an absolute crazy waste of life! That lad were someone’s son, brother or nephew. It costs $30 to buy a full face padded helmet here, ok, it may not be up to Australian or UK standards but at least it gives some chance of survival. The attitude here seems to be that crash helmets are worn to avoid a fine, but the education doesn’t extend to the fact that mandatory crash helmet wearing is there to save lives. One of the guys I used to work with cut a star shape in the top of his helmet for ventilation because it was ‘too hot’. If he had come off of his motorbike the sharp plastic edged would have impaled in his skull but that was a risk he was willing to take even though he actually owned a full face padded helmet.


$30 however, out here is a lot of money. On the average wage of $2 per day, that’s half a month’s salary but the loss of a loved one is a hell of a price to pay.


Later in the week I had my own experience of Timorese medical care. While teaching the same rescue course, I got my foot stuck in a hole between rocks. At the time I was carrying a lot of equipment, so when the wave came, my foot stayed where it was and the rest of my body went sideways, spraining the foot badly. After two days of hobbling around I went to see the Portuguese doctor who wanted me to get an x-ray to ensure there wasn’t a fracture.


There are only two places in Dili where non military/UN folk can get an x-ray. One is clinic that’s open from 12 until 2 and the other is Dili National Hospital with its one tired x-ray machine and its single only operator. The hospital itself is under construction, so there are planks over walkways which were hard to navigate with a painful strapped up foot, let alone a wheelchair!


After locating the X-Ray department whose walls are adorned with ‘DANGER RADIATION’ posters, I gave in my doctor’s letter and was told I had to pay, which I expected. What I didn’t expect is payment has to be made in the Laboratory which is two buildings away. So off I hobbled only to find the entrance I had been told to go to was closed for construction, so I hobbled back the way I came and tried a different way. Once I got to the lab a friend of mine who worked there took pity on me and led me through the maze of corridors to the payment section, I’d never had found it on my own.


Back at the x-ray department there were around 60 people in the waiting room. Here you see the poverty of the country, young mums with faded, ill fitting clothes, mosquito scarred legs, carrying their stick thin sick children in sarongs tied around their neck. The whole hospital looks tired, antiquated equipment, grubby walls and posters stuck up with yellowing sticky tape. The renovated blocks look good though and according to the doctor it is so much better than a few weeks ago when the IDP’s were still living there. Then you had tents between every building, with cooking fires and livestock tethered at the entrance of the operating room and Intensive Care Ward, not a hygienic environment for a hospital. I’m glad I don’t get sick very often.


Luckily my foot wasn’t broken, only sprained, so I’m going to be careful where I put my feet in the future, I’d rather not repeat this experience.