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Emergency Care for Peace Corps Volunteers in Thailand--A first hand report
Emergency Care for Peace Corps Volunteers in Thailand--A first hand report
Peter in Thailand
August 1, 2002
Subject: Emergency Care in Thailand --
A first hand report
Subject Emergency Care in Thailand--A first hand report
Date Thu, 1 Aug 2002 19:39:20 -0700 (PDT)
From "Peter O'Brien" <email@example.com>
This Wednesday, following a two-day long English Camp at Tessaban 3 school (the junior high), I set out with four other fellow PCV's (who had come to help with the camp) and six Thai friends to go to the Wax Candle Festival in Ubon Ratchathani. We were divided up between two cars, one of them being a pick-up truck. Since there wasn't enough room for all of us inside, two people had to sit in the back of the truck. Two of the male PCV's on the trip volunteered to take the first shift, with the expectation that we would rotate the seating arrangements throughout the day to keep everyone comfortable and happy.
Around 11 a.m., we pulled into a gas station to take a stretch break, check on the two PCV's in the back of the truck, and figure out where to stop for lunch. We were about three hours into our journey, but still less than a third of the way to Ubon. We decided to drive for about another hour and then pull over for lunch, possibly in the capital city of the Jongwat of Khon Khaen (Basically the central city for the Northeastern region of Thailand). As we got back on the road, the truck was leading the way and everything looked to be quite normal.
In Thailand there really isn't any such thing as a lane divider. Granted the line is there on the pavement, as is the line for the shoulder of the road, but people pass constantly using the shoulder, the opposite lane, anywhere there is room to get past. Also, most cars in Thailand either do not have seat belts, or if they do, nobody wears them. Despite the Thais' seemingly gentle nature and lack of road rage, they certainly drive very aggressively.
I was sitting behind the front passenger's seat in the extended cab of the pick-up. In front of us was a large dump truck of some sort, which everyone had been passing. We began to pull out of our lane and pass the truck, but I was not paying very close attention, as this is a very standard driving procedure in Thailand.
All I remember is looking up when I heard the sound of tires screeching. In front of us, in the oncoming lane of traffic, I remember seeing a dirty burgundy pick-up truck sliding somewhat sideways as it skidded around trying to avoid hitting us. I think there was another car behind this truck already occupying the shoulder area which forced us to go off the road. Our driver was riding the brakes and steered us down this little dirt path which seemed to dead end, but I couldn't really tell. At this point I was certain we were going to hit something, it was just a matter of what. I remember considering our options: Would she try to make it between the two trees ahead of us? Was there room? Could we manage to make the complete turn onto this road and keep going, or would the truck roll in the process of attempting it?
We hit the tree. In retrospect, I think this was probably the best of all the options we had available to us. We were probably going somewhere between 20-30 mph when we hit. The passenger seat flew forward and Mandy, the PCV sitting in front of me, connected with the front windshield. Devin, who was sitting in the back of the pick-up truck, was severely thrown around and ended up on his stomach, with John, the other PCV in the back, on top of him. John ended up sustaining no injuries other than normal soreness. He immediately jumped out of the car and started trying to get Mandy out of the front seat. I did my best to move and help but I was having trouble regaining full use of my body. My left arm didn't want to budge and I felt rather woozy.
We managed to get everyone except Devin out of the car within a few minutes and someone who had stopped to help loaded us into their pick-up truck and headed for the nearest hospital. It was only about a five- to ten-minute ride, but once we got to the hospital it took a long time to get any medical response. There didn't seem to be any doctors on duty and the nurses seemed to be taking their time getting around to cleaning us up and helping us out. Three of the people involved in the accident were in rather extreme pain, which made the wait a little frustrating.
20 minutes after the accident, an ambulance arrived to pick Devin up, but there was no backboard in the van, so they had to return to the hospital to get it. In the past few days we have been witnessing countless examples that have shown us that stabilizing victims does not seem to be a familiar concept to the majority of Thai emergency workers. If the Thai ambulance workers had had it their way, they would have grabbed Devin and tossed him into the back of the ambulance without any concern for broken bones, etc.
My supervisor, Paw Aw Boonrasi, was in almost immediate touch with the Peace Corps, and it was decided within a couple of hours of being at this sub-standard local hospital, that everyone should be moved to the Khon Khaen hospital. This hospital is supposed to be one of the largest and best in all of the Northeast.
A rough one-hour ambulance ride later, we could see for ourselves that our American perceptions of what a hospital of this caliber would be like were not the same. I won't go into all the details, only to say that the sanitary conditions were severely lacking, the place was crowded, and no personnel seemed to have enough time or interest to help us out much with our problem.
A few hours later, it was decided by the Peace Corps medical officer that we should be flown into Bangkok to receive care there. A doctor and nurse from the Bangkok hospital arrived, along with a local escort, to see that Mandy and Devin (the two PCV's most badly hurt) arrived safely in Bangkok. We were expecting a small plane or helicopter, but ended up on a 72-seater turbo-prop plane. The regular passenger seats were folded forward, with the gurneys set on top and lashed to the seats. I gathered this was a little bit of a jimmy-rig job and that this was just a regular airliner jet that happened to be available to transport us. Apparently, just the flight ran the Peace Corps around 400,000 baht (around 10,000 dollars). They definitely spare no expense for our health care.
Two-thirty a.m. Thursday morning, 15 hours after the accident, we reached the hospital in Bangkok. At the front door, Roger Harmon, the Peace Corps Country Director for Thailand, was waiting to greet us. He was relieved to see us arrive in one piece and made sure we were all well attended-to. John and I got a quick check-up for ourselves and it was confirmed that we could go home. We checked in one last time with Mandy and Devin to make sure they were okay for the night, and left for a hotel located just across the street from the hospital. Rebecca also came to Bangkok with us. She had come on the Ubon trip with us, but was riding in the other car at the time of the accident. Throughout the day and night she provided constant care and support for everyone, and wanted to come to Bangkok with us to make sure everything was still taken care of. She went back to the hotel with John and me, also.
The hospital Devin and Mandy are staying in is quite a place. It is like a miniature city, equipped with everything from a McDonald's and Starbucks to Internet access, gift shopping, an outdoor garden, exercise facility, and, I've been told, a movie theater. Some of the patient rooms look more like five-star hotel rooms. They have individualized name placards above them (e.g., Sukta room, Breenwa room, etc.). Still, the quality of the care still seems to be no better than anywhere else. The nurses are very attentive, but they seem to come up a little short when it comes to the technical aspects of the job (e.g., giving PROPER-SIZED dosages of the CORRECT medicine at the RIGHT time intervals). Also, I was surprised that the staff did not speak better English, as this was an International Hospital. Nevertheless, I do feel my friends are in capable hands and I trust they will be fine.
Today is Monday, five days after the accident. I went to work as usual, and I'm using tonight to sort of catch up on e-mail and getting my own head straight. The past four days, I have been surrounded by people, without more than a few moments to myself to think.
Before I get into some internal stuff, let me quickly give a status report on those involved in the accident to put everyone's mind at ease. In all, there were seven people involved in the accident: three Thais and four PCV's. Of these people, only two will have to remain in the hospital for an extended period of time. One is a Thai woman whose leg is in traction. She should be out within a month. The other one is Devin, the PCV I first visited when I was still in volunteer training. He has fractured a bone in his lower back and has broken his leg. He will have to remain in the hospital for at least a month and then will be out on crutches for three months. That is what the doctor is expecting, at least.
This incident has not been without some mystical elements. It has caused me to return more strongly to some long-held metaphysical questions. Just to start with the facts, when Mandy and Devin called their parents to tell them what had happened, both Moms started out by saying either "you're in the hospital," or "you've been in an accident, haven't you." Both moms reported having this sudden feeling of concern for their children around the time the accident occurred. How did they know?!
Intuition on the local front: Two days before we left for the trip, one of the friends of the driver of the pick-up called her, asking that we start the trip early. This friend had this funny feeling and wanted to get on with the trip. She did not tell the driver, but inside she had this really dark feeling like the driver-her friend-was going to die. This feeling persisted up until the accident occurred.
Finally (and I'm sure there's more, I'm just not remembering it all), Paw Aw Boonrasi, my supervisor, who was going on the trip with us, reported not having slept at all the night before we left. Over breakfast, on the morning of our departure, I asked her why she thought she hadn't slept and she could not come up with any good explanation. Was this it? Was everyone having these extra-sensory premonitions of what was to come?
I have been raised to believe that thought, or consciousness, has a tremendous impact on what we see manifested in our outward human experience. There are those who say that actually, thought/consciousness is all that really is; our outward human experience is but a reflection of what is held in thought/consciousness. Through all that I have experienced, thought out for myself, read about, heard about, etc., I am absolutely convinced that consciousness is the primary source of all that is. The problem is: what exactly is "consciousness," and how does it work? Where I choose to use the word "Consciousness," I believe others would choose to substitute "God, Allah, the Divine Mother, the Creator," etc. All these words are just concepts meant to represent or signify something. The words themselves are not important since they are not the THING ITSELF. What is important, however, is understanding that THING which the words are attempting to represent/signify/point to.
This incident has served to bring me back to these questions with a renewed energy and focus. Since the accident first occurred, until now, time has slowed down a lot, allowing a lot of empty space for thoughts like the above to enter. Sitting in a hospital for long hours, unable to do anything other than to stand by and support my friends, provided me a lot of time for turning inward. Mandy, and Devin in particular, seemed to be in a lot of pain. The painkillers they had been given didn't seem to be doing much other than to make them both a little sleepy and disoriented. The pain, however, did not go away.
What could I do to support my friends? The thought that stayed with me pretty continually throughout the day was not to "react" to the situation, but to "respond" to it. What this meant was not seeing this horrible situation, allowing fear to set in, and then reacting to it; rather, it meant observing my surroundings without attaching judgment to them, and then responding as I felt "led" to. At different points in the day, this meant different things: wiping down Devin's brow, interacting with the nurses on Devin's behalf, staying with him to keep him company, singing a hymn to him; comforting the little boy who was involved in the accident (he sustained no major injuries but was shook up); giving mental support to the driver of the vehicle, who felt very guilty and heavy-hearted about the whole affair, etc.
The key element, however, was not letting fear be the cause of my actions, but letting my actions emerge out of a clear and natural inner impulsion. Actually, I was surprised at how many beautiful and wonderful things I saw emerge out of the situation when I stood back and took this approach.
We were fortunate in how quickly and willingly strangers came to help us on our behalf. We were fortunate that we hit the tree, rather than having the car roll or hitting the other car head-on. We were fortunate in how quickly we were able to get in touch with the Peace Corps and have them get us loaded onto an airplane. We were fortunate that most of the people in our group had cell phones, and that the one person who brought the contact numbers for the Peace Corps was the one person involved in the accident who was not hurt at all (he helped my supervisor make the first phone call to the Peace Corps from the accident site). We were fortunate to have Paw Aw Boonrasi, my supervisor, along with us on the trip, because she did a wonderful job of keeping everyone calm from the start and giving very clear orders and directions. She took calm but clear control of the situation and made sure that our needs were met.
Since the accident, I have noticed everyone connected to someone involved in the accident is a little more careful on the road, wears their seat belt more often, and is valuing their daily life a little more. Finally, (but the list still could go on...) I and all the other PCV's have expressed a sort of regretful gratitude for this opportunity to see and experience first-hand, life in the world of Thai health care. I apologize for my critical comments about the Thai medical system. However, I cannot in good conscience ignore reporting what I have seen. I have related the above, and particularly what is to follow, not because I want to entertain or alarm anyone, but because I want all to be aware of the conditions of man on this planet at this time in history. It's really easy to get caught up in the hustle and bustle of our own daily lives and to forget our more distant neighbors who do not cross our line of sight on a daily basis. You would think that at least Peace Corps Volunteers should be more in tune with and aware of life around them, but we are no exceptions either. One PCV, John, commented to me that this trip to the hospital was a real "taste of humanity." It was a side of Thailand and of humanity that had not crossed his path in some time. All the other PCV's, including me, had to agree.
Crowded hospital rooms, bed pans that are not cleaned, relatives sleeping on straw mats underneath the sick person's bed, virtually no fans in the entire room, people with contagious illnesses mixed into the same wards as those who just had physical injuries, the communal water cup. Blood not being cleaned up for hours. Doctors not really talking to their patients but just blindly prescribing drugs to them, giving no time for questions or feedback. Not properly stabilizing patients, just tugging people around like lifeless bodies or dummies. People staying in the hospital for months at a time with little if any improvement and almost no attention paid to them. These are a few of the many images that jump into my mind from our stint in the two Isaan (Northeast region of Thailand) hospitals.
It is now Friday morning (three days later) and I still have not sent this e-mail. There is so much I want to say, and I am so concerned about how what I DO say comes across. I want everyone to get the same glimpse I did into life in the world of health care outside of the United States. Again, that is a comment I want to add a disclaimer to: I am sure there are also facilities this bad or worse in the States also. So, in the end, it really comes down to money. If you don't have money for health care, don't expect to get any kind of quality service, is the message that I'm getting. Still, there are definitely a lot of uniquely Thai things that are going out at these hospitals that could be fixed-e.g., the communal water cup at the water jug (this is a hospital full of sick people, remember), and expecting relatives to stay night and day with their loved ones and do virtually all the work a nurse would ordinarily do-changing bed pans, feeding patients, etc.
For the past three days I have been getting an herbal sponge massage by a woman in Phetchabun. This woman really took to me from the moment I arrived in Phetchabun and loves taking advantage of every opportunity possible to take care of me. I was out jogging the other night and she ran into me in the market and asked how I was after the accident. I told her I was fine but that my arm was still bothering me a little. This woman is a well-known cook/caterer for the whole community, and she knows a ton about herbal medicine. She suggested I come to her house, have a nice vegetarian meal (she had me sold right there) and get this hot herbal sponge massage. The way I reasoned it out, this woman was concerned about me and wanted to do something to help. I couldn't see any harm in learning more about Thai culture and wisdom as it relates to herbs and medicine, so I took her up on the offer. Each night I went over to her house after work, and she would take these fresh picked herbs from her garden, chop them up, put them in a cheesecloth, steam the cheesecloth, and then apply the hot herbal bag/mixture to my arm and shoulder. Wow! Life is really rough in Thailand!
I want everyone to know that I am absolutely fine. I just went for another run this morning. I am, however, going to return to Bangkok today to go visit Mandy and Devin. Mandy is supposed to get out today, at which time she will be put up in a hotel for another week or so until her two fractured ribs completely heal. Devin is not in any danger now, he just needs to stay in the hospital for another month to recover. When I am down there I intend to work on helping him get connected to any kind of alternative treatments I can find. It just depends on what Devin is most receptive to [maybe he'd like a hot herbal sponge bath -- Pete's mom].
Following my last e-mail, I got a couple comments in return that indicated maybe I might be a little overly critical of the Thais and their culture. I want to do a little explaining in response. I feel like my job in these letters/entries is to "call it as I see it." It is virtually impossible to write without a bit of bias or judgment, because we all have our unique perspectives on the world. I do feel, however, that balance in reporting is important. Thailand is not all peaches and ice cream. If it were, they would be sending Peace Corps Volunteers out to other countries instead [of here]. On the flip-side, there are some truly amazing and beautiful things about this land, this people, and their culture, that I think we all can learn from.
When I write my e-mails, so much is dependent on the mood of the moment. My feelings on a particular situation can change so quickly. I hope that there is a good balance in what comes across to all of you. All around, this experience here in Thailand is incredible, and I am grateful every day for the opportunity to live, work, and learn here. I hope this message comes across quite clearly when I write. I like to hear how I am coming across, and knowing what kinds of questions my e-mails raise.
All the best,