The Real South Africa:Job Shadowing SA Paramedics

I have been puzzling over how to begin this post when it hit me: an apology to my mother would probably be a good place to start. 

She (as well as other family and friends) told me not to go ahead with what I am about to tell you. I -- most likely to the surprise of no one -- chose to do it anyway.

Fingers crossed she forgives me and perhaps even embraces my independent-minded spirit :)

------------

At a braai a few months ago, I met a City of Johannesburg paramedic/firefighter named Didier who put an offer on the table that I wasn't quite sure what to do with.  

The proposal was this: ride along in the EMS vehicle for a 12 hour shift. Do what they do. See what they see.

At first, I was super stoked with his proposition. You can't just hop into a EMT vehicle in Canada -- this is a rare opportunity! I would be able to see a side of South Africa that very few people -- let alone tourists -- are privy to. I'd get an intimate view into how paramedic staff operate and experience first-hand what it feels like to help save a life.

How could I say no?

Then the reality of where I am staying hit me smack in the face. This is not Canada. This is Joburg. One of the most dangerous and violent cities in the world.

The majority of calls these paramedics respond to aren't found in clean city buildings or private homes. They are in slums and townships. The areas these guys enter are straight-up the most dangerous, sketchy places in the entire country.

The trauma they handle isn't confined to single gun shot wounds and motor bike accidents. They regularly deal with such atrocities as mob stoning deaths, multiple gang-related homicides, machete attacks, child rape.

A lot of the time, the medics spend their shifts simply driving from motor vehicle accident to motor vehicle accident, drafting up Declaration of Death certificates. This underscores the high level of road trauma this country handles. There are so many fatalities on the roads here that paramedics, in addition to medical doctors, are authorized to make the D.O.D.  

All things considered, signing up for a 12 hour shift with a Joburg paramedic was not to be taken lightly.

Especially when you are the girl  known to wearily peek through fingers slapped over her eyes during fight scenes in movies.

I was very close to turning it down. What if I was faced with seeing bodies half stuck in wind-shields? A child run over by a car? A shooting in a township where I didn't feel safe? Didier has told me stories of being robbed while in uniform, inside the emergency vehicle. Months ago there was a story of two female fire fighters who were attacked and raped whilst responding to a call in a township. Speaking of townships, Didier has also said that equipment attached to the fire truck regularly goes missing after battling fire calls there.

Read the newspaper here in SA for one week and I guarantee you it would also have you second-guessing a free ride with their EMT staff.I flip flopped back and forth for weeks.

What eventually changed my mind was talking with Didier about every detail of the what I would be exposed to. He promised to check out the scene first, relay it back to me in the car, and then let me decide for myself if it was something I wanted to get out and see. This made me feel a whole lot better. He also said that he'd ensure it was safe before permitting me out of the vehicle and that I wouldn't be pushed past my comfort level. 

So, call me crazy but I said yes.

Figuring a night shift may be a little intense for my first time, I anxiously started my 12 hour day at 7am at the fire station. Didier had me all kitted up in proper EMT reflective pants and steel-toed work boots.

I was introduced to Andre, who was the officer accompanying us for the day. He's a big guy with a heart of gold and over 20 years experience so I was feeling pretty confident.

 

Didier in front of the Emergency Medical Services vehicle I spent the day cruising around in. 

 

That was, before a bulletproof vest was hauled out of the back of the truck "just in case I needed it". My oh my... what had I gotten myself into this time??!

As we pulled out of the parking lot Andre handed me a clipboard upon which I was supposed to sign the waiver so the city of Joburg wouldn't be sued if my little Canadian butt got fatally injured during the ride-along. I was told to "read the fine print carefully". It took me all of two seconds to laugh at their joke and see that they had given me a "male" form to fill out instead of "female". Very funny, guys. We all laughed.

They told me to scratch it out and continue reading it carefully. 5 minutes later I was half-way done filling it out when I my eyes scanned the title of the document I was completing: Declaration of Death.

 Needless to say, the boys got a good laugh from my inability to read document titles and I got the feeling that wouldn't be the last rookie prank that would be pulled on me.

Didier and Andre took the front while I watched eagerly from behind. 

The first two hours of the day were deceptively chill. We took the truck through a spin at the car wash, grabbed coffee and snacks from a quaint bakery, and refueled. 

Around 10:30am our first call came in. Motor vehicle accident with an entrapment (as in, a trapped person). 

Andre hit the lights and sirens and the truck lurched forward as we hurtled down the highway. I tried to calm my nerves by conjuring up the most grotesque, graphic shit I had ever seen on T.V or in print. I figured if I could gross myself out before arriving on scene, what I would see in real life wouldn't be as bad. Ha!

As we weaved in and out of traffic, I grabbed an oversized orange raincoat to throw on as it had begun raining. I also stuffed a few extra pairs of surgical gloves into my pockets, not realizing at the time how handy they would be later on.

Driving up to the accident, it was clear that two cars had been involved. Both were decimated.

 

I won't lie -- I was scared as &%$* to approach the vehicles closer. Later on in the day, Didier would tell me how surprised he was with how fast I got out of the car and the fact that I didn't wait for him to check it out first. Funny thing is, I don't remember even giving a second thought to waiting it out in the truck. Adrenaline and a willingness to help in any way I could won out.

Amazingly, 5 out of the 6 passengers involved were able to get up and out of the car without serious injury. By the time we arrived, they were giving statements to the police and getting examined in the ambulances. 

The gentleman driving car #1 wasn't so lucky. As I walked up to the car, I could hear him yelling in pain. The entire front console was jammed into is abdomen and was in the process of being hydraulically pushed off. His was bleeding from the head and his oxygen mask was splattered with blood coming from his mouth.

Didier and Andre grabbed supplies and began helping out. I stood off to the side, just trying to take it all in and not freak out. Before I knew it, clothing shears and bandages were thrust into my hands and I was asked to stand closer to help pass them supplies. Minutes later, an I.V bag was given to me as Didier hurriedly shouted instructions to as to how to uncap the drip.  

Before I knew it, Andre was yelling at me from inside the car to pass him the I.V line. I grabbed the plastic gloves out of my pocket, snapped them onto my hands, and for the rest of the cut-out I held the I.V drip, thankful to have something useful and helpful to do.

Vehicle #1

Vehicle #2

While the firemen continued to work on freeing the man from his driver’s seat, I took a look around and was shocked to see how many bystanders were huddled under umbrellas, trying to get the closest look possible at the unfolding scene. I was appalled. There was literally no reason for them to be there other than to witness the pain and suffering of the trapped driver. A few of them even pulled out cell phones to snap photos of the poor man fighting for his life in the vehicle. It was sick.*

*Yes, I realize this type of rubber-necking happens all over the world. I'm not trying to pin it on SA, I'm just telling you how I felt at the time.

Eventually the steering column was pried off and the man’s lower body was exposed. While there weren’t any protruding bones or visible open wounds, it was very clear that his right thigh was severely broken. The portion of his leg extending from his hip to his knee had fallen into a downward “v”. His femur had been snapped in half. Andre later told me that his pelvis had also sustained fractures, as well as his collarbone and left arm.

The rescue team ended up cutting the man’s shoes off in order to free his feet from the bottom of the car. As they worked together to move his body onto a spine board, his legs and arms flopped around like marionette limbs, limp and broken. Thankfully he had been given morphine at this point so he was pretty much knocked out.

Once they loaded him into the ambulance, Andre shouted that they had to straighten his badly broken right leg. At this point it lay crumpled in awkward angles. As Didier grabbed the foot and Andre began pushing on his thigh, the man let out a desperate, painful groan and I had to walk away. Watching them reset his mangled leg was a little too much for me to take in.

As I walked over to the car I could see multiple pairs of bloody surgical gloves strewn amongst the scrap metal and glass shards on the road. In a country with one of the highest HIV/AIDS rates in the world, it’s not uncommon for rescue workers to go through several pairs of gloves while attending a patient. Once they become bloody or sustain the slightest tear, new ones are exchanged immediately. Long sleeves and pants are a must and safety glasses are routinely worn to protect eyes from wayward blood splatters.

As I was told time and time again, the safety of the medical staff comes first. A dead paramedic is of no use to anyone.

I slid into the truck’s backseat and peeled off my soaked raincoat, thankful to have a few moments to myself to take in everything I just observed.

It wasn’t more than three minutes later that my door was opened by another EMT and I was given a syringe to hold onto for safekeeping. There I was, alone and untrained, holding a medical needle prepped and ready to go with 10mls of Dormicum, a short-acting benzodiazepine that induces sedation. If wasn’t already keenly aware that I wasn’t in Canada anymore, that moment certainly cemented it for me.

From there we took off to the nearest government hospital. Didier rode in the back of the ambulance to monitor and stabilize the patient while Andre and I followed closely behind.

I’ve heard horror stories of government hospitals so I braced myself for the worst. As we pulled into the Tembisa Hospital emergency lane I could see a large line of black people streaming out of the general admission doors. It isn’t unusual for people to wait two, three days to be seen by a doctor.

Our patient was wheeled in through double doors which opened up to a barren lobby encased in drab browny beige walls and tile floors. There was no cheer, no spirit, no sense of hope. The feeling of emptiness continued down a short hallway which opened up to a large room filled with patients (again, only blacks) randomly strewn about in chairs.

There were women with half-shaved heads wrapped in bandages that were quickly soaking through with blood. Men with mangled faces, covered with a smattering of Band-Aids overlapping each other in a feeble attempt to close the wounds. People slumped over their armrests with vacant, glazed-over eyes. It was shocking for me to see such dire conditions with seemingly little order or action being taken.

Our patient ended up in a room adjacent to the one filled with randoms. The room had five hospital beds lined up in a row with no partition or privacy. There was no proper bedding to speak of. Each gurney simply had a sheet thrown over its thin padded surface. The nurse showed us which bed to place the patient, as the first one he was set next to didn’t have a functioning oxygen line.

I stood off to the side while this was taking place. It was at this point I noticed the man two beds over from our patient.

He couldn’t have weighed more than 80 pounds. He took shallow breaths from his oxygen mask as his tiny body lay crumpled up on the bed like a small wounded bird. Each notch of his rib cage was plainly visible and the rest of his bones in his arms and legs protruded vulgarly. His bare chest betrayed large black patches and his skull was swollen and broken in the back. His jaw displayed severe swelling. Most likely root cause of this: AIDS.

It was a sight dire enough to break the hardest of hearts.

As I was trying to come to grips with that, one of the medics picked up the spine board from our patient. As he carried it back over to the stretcher, fresh blood slid down its surface and left a trail of red blots along the floor.

I began feeling nauseous at this point. Just totally overwhelmed by the feeling of death and disease that seemed to cling to the hospital’s insides. I had to step outside the room to refocus myself.

When I re-entered, Andre and the nurse were discussing the sling brace that was keeping the man’s badly broken leg elevated and straight. She said that the hospital didn’t have such equipment and that she’d like to keep it for a few hours.

As a Canadian, I was appalled to hear that the hospital didn’t have access to such basic equipment. I also didn’t understand why Andre and Vincent (another EMT) were humming and hawing over whether or not to leave it with the patient, who was in obvious great need for it. To further underscore the desperation of the situation, Didier made an off-hand joke about tying the guy’s foot to the opposing wall and the nurse actually looked at him and with anticipation said “Really? You can do that?”.

The reason why the medics were hesitant to leave the leg brace is because medical equipment is notorious for going “missing”. City of Joburg paramedics are already working with tight budgets, outdated gear, and lack of uniforms & supplies, so the prospect of leaving a critical piece of their kit alone in a government hospital is approached with trepidation.

It’s actually quite a sad situation. City of Joburg paramedics are desperately needed to handle the millions of patients who live without the luxury of private health insurance, yet they are paid poorly and are offered little to retain their services. Many of the city’s top qualified Advanced Life Support medics end up moving abroad for better working conditions and salaries.

The emergency vehicles themselves aren’t equipped with GPS. This means EMTs waste valuable time finding addresses on paper maps or frantically calling dispatch for directions. Andre even has to show up to work in blue jeans because his uniform pants wore through and he’s been told there is no money in the budget to buy new ones.

For a city with such high demands for excellent public medical services, it sure doesn’t seem to make it much of a priority. As one friend put it: being taken to a government hospital isn’t much better than being left at the side of the road.

But I digress...

On our way out of the Tembisa hospital, Didier had the pleasure of seeing someone urinating black fluid. Not long after announcing this, Andre asked if anyone would like to go eat lunch. Erm... thanks, but no thanks.

From here the boys drove me to Diepsloot. This township is one of – if not the -- most unstable and dangerous in the city. It has two police stations and one fire station solely dedicated to its maintenance.

Back in August I had taken a walking tour through a township, but this one was different. It was decidedly more unsafe and sketchy. I was nervous at the prospect of driving through it as three white people in a service vehicle stuffed with valuable equipment, but the guys assured me that nothing would happen. I had no choice but to trust their judgement.

The township was a heartbreaking sight. Kids walked through the muddy, garbage-filled streets with blankets wrapped around the tiny bodies to help shield off the rain. I saw a girl no more than 8 or 9 years old squat down on the side of the road and pee. Small, cobbled together buildings act as kiosks, cinemas, even surgeries. Flood water cascaded down the hill, threatening the tin shacks that line its banks with total destruction if water levels were to rise even a foot.

It was a place of desperation and poverty. And it stretched nearly as far as the eye could see.

Didier was ballsy enough to run into a small shop and buy a soda. I wasn’t so brave.

Bathrooms

 

Hair Salon

Police tank used in the area

Movie night, anyone??

Local doctor and warehouse

From there, we drove through Dainfern golf estates. This private suburb is the epitome of luxury. We’re talking private golf courses, clean, manicured lakes with weeping willow trees dotting its edges, mansions worth millions of Rands, smoothly paved streets (complete with armed guards who patrol them), stunning flower gardens, thick grassy lawns... all a two minute drive from Diepsloot.

It was a mind numbing experience to say the least. To go from the poorest of the poor to the richest of the rich in a few kilometres... it just doesn’t seem real. But welcome to South Africa.

Once we left the idyllic world of Dainfern estates, a call came in. Another motor vehicle accident.

As we took off in its direction, sirens blaring, lights flashing, cars parting for us like the red sea... I could finally understand why these guys do what they do. It's a total adrenaline rush. Flying through traffic with a screaming siren, the sun on your face, heart pumping and mind spinning as to what you might encounter at the scene... I can see how a feeling like that can quickly become addicting.   

This call one was decidedly more chill than the first. By the time we arrived, multiple private rescue cars had already shown up and were treating the patient. He had managed to roll his car off the corner of the highway, through a ditch and a wall of trees, and flip it over and around so that it faced the road he first spun off of.

I wish I had more sympathy for this guy, but he was drunk. His car came within meters of slamming into someone’s home and had he flown off the other side of the highway... well, at the time it was a field full of young children playing soccer.

From there we attended a call to a private home where a man fell off his roof. Now, this sounds pretty serious but for all intents and purposes it’s sort of a funny story (and he wasn't seriously injured).  

Apparently he got into a fight with his wife and took up to the roof to cool down. Alas, it had been raining and the clay tiles were wet so it didn’t take much for him to topple over. Bet the wife felt extra bad for shooing him up there in the first place!**

When we were waiting around for Andre to administer morphine, Didier showed me a strange white bottle and asked me to try it. “It tastes like bananas and we use it to open the throat for intubation”, he says.

Yeah, right.

Good thing I dodged that rookie prank because it turned out to be a numbing agent that would’ve left me drooling for hours.

**Side note: this (Caucasian) male patient was taken to a private hospital that gleamed with clean white walls, privacy partitions and proper equipment. Needless to say, a huge step up from the Tembisa Hospital.  

It was here where I learned that private hospitals give food vouchers or snacks to paramedics who bring them patients. Some institutions even stagger the quality of incentives according to the number of patients a paramedic drops off at their door.

Am I the only one who sees something very, very wrong with this??

Private hospitals are essentially bribing professional life-savers for no other reason but to further their own profit. I can see this going awry when the decision is made to drive a patient to a farther hospital -- potentially putting them in harm's way -- in order for the EMT workers to receive better food bonuses.

Not to say this happens all the time, but it must happen at least some of the time. And that isn't right. It is my opinion that bribes and "incentives" should have no place in the medical rescue arena. 

  

We left that scene for Hilbrow, yet another uber dangerous slum of Joburg. Think the Bronx of Johannesburg. Hurray! (Mom, are you losing your mind yet??)

I think I was more intimidated in Hilbrow than Diepsloot. Hilbrow is different in that people aren’t living in tin shacks and mud streets. It is decrepit buildings and clogged city streets. People were everywhere. The sidewalks crawled with vendors, stray children, and bystanders. It was tough to escape the aggressive glares and stares.

We were in and out of there in a handful of minutes.

By now it was approaching 5:30pm and the end of the shift.

But the fun wasn’t over yet. Oh no.

The boys had been saying all day that I had to meet the “Jeppe Lady”.

The what?! Their reasons were dubious at best: “every fireman meets her”, “it is tradition”, “she’s been around for years”... hmmm. I could smell their deceit from a mile away but still held out that maybe it wouldn’t be so bad.

Then they demanded I hand over my I.D. and cell phone. That got me more worried. This wouldn’t be any small initiation tactic, from the sounds of it.

We pulled up to a sketchy abandoned warehouse in the middle of nowhere. I was told to get out of the car and knock on a big black metal door to my left.

I refused.

I had a bad feeling about it.

I’ve never been one for pranks and after working as an R.A for four years, I couldn’t have been more over initiation-type crap.

The boys pressured me into doing it and Didier even grabbed my hand and walked me up to the door himself. I braced myself for something to jump out into my face.

And did it ever.

Only it wasn’t something jumping at me as it was blasting all over me.

The second my arm stretched out to knock on the door I was shot in the side by a huge blast of water. In two seconds flat, I was soaked.

Needless to say, I wasn’t a happy camper.

I spent the last hour of the shift seething in the backseat, sitting in cold, soggy underwear, drenched clothing and wet hair dripping down my back. Not exactly my idea of a nice way to end the day.

Shame, the boys felt reeeaaalllyyy bad after they saw how unimpressed I was with their fireman initiation tactic. I was assured that every rookie goes through it and now I’m considered to be 100% part of the team.

I appreciate the sentiment, but still. Soggy undies aren’t fun.

But regardless of the hosing incident, the day out with the boys was incredible and I wouldn’t change anything. It was such an eye opener to the underbelly of SA. Yes, it was a risky choice to go but most things in life worth doing are exactly that.

I now appreciate the commitment, heart, and fearless spirit that all rescue workers, but especially those working in third world countries, must embody every single day they show up to work.

They truly are real-life heroes day in and day out.

To all of them (and especially Didier and Andre), I say thank you and God bless.

Andre, Me, and Didier