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The International Writers Magazine: Asia:

EMS Duty in Tondo
Antonio Graceffo

"How do you shower on a twenty-four hour shift?" I asked, noticing that there was no plumbing in the radio shack, where I was told we would be sleeping.
"We can use the hose from the firetruck," answered the chief.

Suddenly, I wasn't sure if EMS was really the best career for me.On Sunday afternoon I started duty in a rough, Manila neighborhood called Tondo with the Chinese volunteer ambulance company. Its the same story all over Asia, the Chinese pool their money, to pay for the best schools and community resources of any group in the country.

The ambulance and rescue team had three fire trucks, two of which were pumpers. The bigger one had a capacity of 3.5 gazillion liters of water. I may be off on that number, but it was more water than I would care to drink. Water carrying capacity is really important in the Philippines, because of a severe lack of hydrants. The guys told me that the trucks had to be specially designed for the Philippines because the streets are so narrow in the neighborhoods. American trucks wouldn't fit. When I told my classmates I had been assigned to Tondo, they all said, "Oh, good, you can learn a lot about stabbings and gunshot wounds."

Tondo was a pretty frightening place, but I was taking my life in my hands during the commute. I had to take the elevated train (LRT ) to Recto, a den of thieves, prostitutes, and fake diplomas. On my first trip, they were running a special promotion, two STDS and a PHD for 250 Pesos. At Recto I had to take a taxi, but taxis are afraid to stop at Recto.

Standing in the road, in my blue uniform, the only white guy, waving at passing cars, I felt like a target. A couple of taxis slowed down. One or two even stopped, allowing me to shout my destination through a two inch space in a partially rolled down window. When they heard Tondo, they just laughed, and took off. "Take me with you!!!!" I shouted as I watched the taxi disappear. The street people had been casing me. Like the Sand People, they were easily frightened, but they would be back, and in greater numbers. On my first day of duty, I was lucky enough to find a taxi after only twenty minutes. I got in, locked the door, got away from the windows, and slipped a scalpel out of my medical bag in case the driver tried to rob me. From Recto, we turned into a worse neighborhood, then a worse one, then a squatter area, and finally a really, really bad squatter area, where people were roasting dead animals on trash fires in the street.

Eventually we arrived at the EMS base, in a neighborhood which was no worse than where I live in Cubao. By American standards, it was pretty awful, but not too terrible by local standards. My classmate, Sam, was the son of a Chinese family who everyone in our class referred to as "muchos," rich people. They owned a number of businesses as well as the EMS service and the fire tucks.The rescue service volunteers consisted of one trained EMT and several Fist Responders, on the medical side. On the fire side, there were at least eight or more firemen. The Chief took me to visit Sam's house, and of course, they were rich. The house was huge, possessing every amenity known to man.

Back at EMT school, we were all fond of Sam. He was brilliant and had already logged countless hours as an ambulance volunteer, although he was only sixteen years old. We were all impressed when he became the youngest graduate of our program ever.The whole rescue crew also loved Sam, to a point that it bordered on cultish adoration. "That is Sam's bicycle." said the Ambulance Chief, giving me a tour. "He rides it to the station. Those are Sam's dogs, but they are sleeping. That is the table where Sam sometimes eats…" It went on and on. I was waiting for him to say, "This is the air that Sam breaths."

Unlike at City rescue, the people were welcoming and very pro LSTI, the EMT school I had graduated from. Unfortunately they didn’t really have a base. There was a small office where the radio equipment was kept. There was a bathroom, but no running water. Even the toilet had no plumbing. So, you had to pour water down it.The tiny office was only a radio room. This was not where we waited to be called. The actual crew area was on the sidewalk. They had pulled the seats out of an old car and laid them out on the sidewalk, like a display living room at a furniture store. We sat there under an awning, all day…waiting. The men talked mostly of their love of karaoke, prostitutes, and beer. Although they were volunteers who didn't receive a salary, none of them had jobs, except for a young good-looking firefighter, named Bob who sometimes worked as a driver for the TV station and occasionally had parts in TV shows or movies. He was also called for some modeling work. I wondered what was preventing him from following this line as a full time career."Do you want to go with us to fill the tanker?" Asked the chief. "Sure, why not?" I answered. About twenty of us clambered onto the truck. We drove two blocks to a fire hydrant, and while the tanker filled, we stood around talking, the same as we had back at base. The ambulance and trucks were donated by Rotary. The problem is that everyone likes to make a high profile donation of equipment, but no one donates a maintenance plan. Consequently, the crew only had one running ambulance. There were about eight crew members scrambling into the back on every call, leaving little or no room for a patient. After we returned from filling the tanker, we all got in the ambulance, and they drove me over to a municipal parking lot, where I could see the other ambulance. The electric system had blown five years ago, but until today, they didn't have money to repair it. Sam and his dad stopped by the EMS base. They apologized for missing me earlier, but they had been at the mall buying a perversely expensive cell phone for Sam.Sam's father was brilliant, and I hoped that I would get a chance to talk to him more. He was clever, intelligent, and was one of very few Filipino men I had met who actually looked young for his age.

True to Asian culture, every adult I had met that day had some incredibly impressive title, president or director of this or that. They were so proud of themselves. But, when Sam's father arrived,they all bowed. Men talk a good game in Asia, but the bottom line is money. Whoever has it jumps to the front of the line. Seeing people fall all over themselves to worship Sam made me have even more respect for the boy. He was like the big man on campus. Everyone loved him, and they talk about him all the time. In spite of being sixteen he seemed to handle the fame and attention without getting a swelled head and becoming a jerk. I couldn't help feeling he was being groomed to take over his fathers' position as benevolent, man of the people.

After Sam and his dad left, there was talk of turning in for the night."How do you shower on a twenty-four hour shift?" I asked."We can use the hose from the firetruck," answered the Chief. What he really meant was that they could theoretically, and maybe they had even used the hose from the tanker to shower, but it wasn’t like it was the standard procedure. The real answer was, nothing got washed. I had to brush my teeth in the street with my bottle of drinking water like a homeless person."Did you bring mosquito repellent?" they asked me. "No." I answered, annoyed that in the city there was any indication that I should carry repellent with me. "Why not?" they insisted" as if I was really remiss in my planning. "Because I didn’t know we were going camping. "When night came, they put two mattresses on the floor of the radio room for the crew. It was like the expression "going to the mattresses" in "The Godfather." In Mafia parlance that means going to war. Here it just meant trying to sleep. "You can bring your own mattress, pillow, and blanket next time."

They told me. I was already having doubts about how long I would last on this crew. That was all I needed, to strip my bed and take it with me every morning when I come to work. I was really hating EMS at that point. The EMS guys and all the bigwigs with titles went home, and I shared the radio room/bedroom with two firemen who couldn’t speak English. Because I was the oldest, they let me sleep on the trolley cart. It was so unbelievably uncomfortable, I felt bad for the patients. Part of the issue was that the mattress was covered by a wooden spineboard. Back at school, our instructor, Sir Aidan had been a staunch opponent of these injurious boards. All spineboard advocates should try sleeping on one, once before recommending them for use on others.The TV apparently didn’t work, but the computer did, and we watched Rambo IV. The firemen were curious and tried to ask me about the war in Burma. Unfortunately their English and general knowledge were so limited it was impossible to explain it to them. My favorite scene in the movie is, when sly throws the missionary against the wall and screams "Who are you? Who are any of you?"

It was the pain I often felt hearing the suggestions of foreigner visitors who thought they understood the conflict or understood the needs of the people. It was quite presumptuous for outsiders to think they were going to sweep in and save everyone in Burma. My two companions were completely out. A lot of Asian guys are able to sleep in any uncomfortable position and be fine with it. I was mostly awake all night. The radio kept blaring and I wondered if we were missing emergency calls while the guys slept.

One call came in, in Filipino, but I understood they were talking about some kind of emergency in Manila North. So, I woke one of the firemen. "False alarm." He said and went back to sleep. As a pleasant addition to my own private hell, I had contracted diarrhea a few days earlier and needed to go to the toilet about once per hour. The room was so small and my liquid poop so stinky I really felt guilty and considered doing it out in the street. Toilet paper is not so common in public restrooms in the Philippines, so I always carry a roll in my bag.

Unfortunately, because of all the crime in Tondo, the Chief had locked my bag in the ambulance. So, every time I needed the toilet I had to ask someone to open the ambulance for me and wait till I finished in the bathroom and then lock the ambulance again. It was humiliating. Finally, I put about half a roll in my cargo pocket, which I should have done from the start. This worked a lot better. It got me through the night, but there was still nothing I could do about the smell. The hot, humid Manila air and lack of air-conditioning or fans didn't help. During the night I suffered severe cramps and would get up, stepping over the sleeping firemen, and pollute the toilet. There was only a very small quantity of water in a jerry-can to flush with, and I prayed it would last till morning.When I woke up the next morning, or that is to say, when I gave up on sleeping, I went out to get my toothbrush from the ambulance, but the ambulance was gone. At first I thought it possible that it had been stolen.The firemen were as curious as I was. "Where is the ambulance?" they asked me, as if I had misplaced it. I was hoping they wouldn't search my things looking for it. Actually my things were on th ambulance, so we would have to find it first. Anyway I felt guilty. First I had stunk up their sleep, now I had lost the ambulance.Finally, a text came in telling us the ambulance had been taken for maintenance, which was laughable, since we were supposed to be guarding it. I guess we didn’t do that good of job.I found my bags under the trolley cart. I really did appreciate that someone had the forethought to leave them there for me. Now, at least I could brush my teeth. At around ten o'clock the director came in and told me to go home. Without an ambulate it didn’t matter if we got a call or not, we couldn’t respond. We made an agreement that I would go to duty at 4:00 PM every other day and go home at 11:00 AM the next morning. That way I could still do Internet and gym every day, and get 19 hours of OJT. I had 31 hours in the bucket. I needed 219 more for my license.

While I suffered from boredom, fatigue, stinkiness, and stomach cramps at my OJT, on a financial level, I was also suffering from acute broketude.When I started for home that morning, I had less than $5 USD in my wallet. After paying for my commute, I only had $2 left, and decided to skip breakfast. That money would be needed for the Internet to check on the status of any number of checks and or donations I was expecting. I had no idea how I was going to return to work the next day, as I couldn't afford the commute. Magazines that I write for think nothing of paying me months late. The Philippine News Agency (PNA) had owed me money for about year and I was having trouble collecting. At one point, they threatened to have me arrested and deported for working without a permit, so I had to let the money go. I received some donations in the form of checks, denoted in British pounds, which had to be deposited in a bank. I might as well have had Confederate money. It would be months before that money had flown from Britain, to my apartment in Bangkok, to my family in USA where it would be deposited. Then the long wait for clearance would begin. The difference of one or two days was huge to me. Two days without food can seem like ten days or a hundred.I was really at the end of my rope, and knew I couldn't keep living like this. I wanted to get back to Burma border and help out with the war, but with no reliable support or infrastructure I didn't see how I could.An old friend of mine, Pierrre, was now Director of Studies at a school in Taiwan. He offered me a teaching job to help me get back on my feet. The offer sounded tempting.I felt completely exhausted and defeated. Before leaving the EMS station, I had allowed the firefighters to buy me coffee.

They had NO income at all, but I let them spend what few coins they had to buy me coffee. After a 20 hour shift and no breakfast, I NEEDED that coffee, but I should have said "no." Back in Cubao, my "home". The room I had been living in for the last four months was a cement cell, slightly larger than my horribly uncomfortable wooden bunk bed. There were no windows, no TV, and no air-conditioning. To make matters worse, every time I tried to sit up in my bed, I would bang my head on the upper bunk. I was constantly collecting splinters from the unfinished wood of the homemade bed frame. With nothing else to do, I lay on my thin mattress, dripping sweat, and thought about my situation. I was also taking stock of my team mates, who were basically nice guys, but as bad as I had it at the moment, I didn't want to trade places with any of them. My new crew in Tondo consisted of Rescue Nine, who was not married, forty-one, and had a face like a Drakes Coffee cake, with a Manuel Noriega complexion. That is to say, Rescue Nine was hard to look at. He was an EMT, graduate of the same program as me, and had no other job apart from volunteering on the ambulance.Bob was the son of one of the officers, good looking and twenty-two years old. He sometimes worked on TV as talent and sometimes worked as a driver for the TV execs. But, mostly, he was just a volunteer firefighter. He had two kids by one girl, but he wasn't married to her. His older child was five years old. So, he became a father for the first time at age seventeen. "Why don’t you two get married?" I asked ."We have too many plans." explained Bob.This was news to me, because none of these guys seemed to have plans of any kind. They just sat around, and sat, and sat. They had no interests, apart from drinking, karaoke, and whores. They didn’t read. They didn’t exercise. They just sat. I didn't see how this plan would leave your schedule to full to marry the girl who bore your children.

"We are too young to get married." explained Bob. "But you have two kids. Do you see them?" "My wife is a beauty consultant for a department stores. She and the kids live with her parents in the province. On Fridays if I don’t have many things to do, I go to visit them and bring money and food."

Nice, I bet those kids will have a great future. Ivan was also twenty-two and had five kids by different women. He was only doing volunteer firefighting and nothing else. I wasn't sure how any of these guys lived .I also didn’t know what to make of these Tondo boys. They just sat around on their old car seats, on the sidewalk, like rednecks sitting on the porch. They seemed content to do it. There were a lot of them too, at least ten firefighters and a handful of EMTs. I was proud of them for helping the community, but it was strange to me to be so content with doing nothing all day.

A very small amount of money came in through my Paypal account, and I was able to return to duty. This time it took nearly an hour before a taxi was willing to stop in recto and take me to Tondo. After risking my life to get there, once I arrived, we sat, and we sat, and we sat, waiting for a call. There is a major problem of education and communication in the Philippines, so no one knows about the free EMS service. They also didn't know how to call us, was weren't on the government's notoriously unresponsive 117, emergency number. People had to first know of our existence, and then call our direct line to get us. The guys explained to me that sixty percent of the calls we received were from friends and family of the crew, because they were the only people who knew about the service. Luckily, the neighborhood people knew us, so they called us for all sorts of services. Some poor people used us as doctors because they couldn't afford a trip to the hospital. At least someone was using us. But this was a lot of hardware and talent to leave unused while people died. Finally a call came in for a motor-vehicle accident. Ten of us piled into the ambulance and drove two blocks. A sidecar taxi had pulled out in front of a kid on a motorcycle, and he laid it down trying to stop. The kid had banged up his knee and skinned himself, up a bit, but he was fine. Of course he wasn’t wearing a helmet, and the first thing he asked us for was a cigarette. He had five EMTs crawling all over him, rendering first aid. They cleaned his injuries with water from a spray bottle, then put Bedodine on it and bandaged it. I don’t know how bandaging is done elsewhere, but they didn’t use gauze here. In fact when I tried to buy gauze they didn’t even sell it at the medical supply store.

The EMTs took a four by four bandage and just taped it directly to the victim's skin. Ouch!The bystanders were pretty excited to see a foreign EMT. I was naturally much bigger than my co-workers. I outweighed most of them by forty kilos. Also, I wore a nice new uniform, where they all wore shorts and flip-flops. Most people thought I was in charge, and kept waiting for me to do something wonderful. I felt like saying, "I am not an EMT, but I play one on TV."

A murmur went through the crowd, as people wondered about me. A young girl turned to her father and said, "I have seen his photo on" Once again I thought, if I could just sing, I think I could be a huge star in the Philippines. While I had the power and admiration of the crowd, I walked up to the patient, puffed out my chest, and spoke in an authoritative voice, loudly enough that everyone could here. "I am going to be working in this neighborhood now. If I see you riding without a helmet again, I will pull you off the bike and beat you senseless myself."

Basically it was the "I am the new sheriff" speech from an old Gene Hackman movie, but I was hoping that maybe it would make an impression on someone, and they would all start wearing helmets.This may sound completely awful, but on some level, I really wondered if the desperately poor of Manila's slums really wanted to live. Maybe the smoking, drinking, and non-helmet or condom wearing was a form of slow suicide. It made me sad. But then, I had less than five dollars in my wallet again.The next call came at about nine at night. It was a rekindle. There had been a huge fire earlier in the day in a Chinese factory, next to the Chinese school. The school had been evacuated, then the firefighters climbed up on the second story roof of the school and cut holes in the walls of the second story of the factory to pump water in. As always the people of Manila, or the people of Philippines, have luck, fortune and corruption completely against them. In the case of fire, fore example, the Bureau of Fire Protection only has 60 fire trucks in all of metro Manila. From that number only 10 - 15 are working at any given moment. The rest are waiting for maintenance.The volunteers have about 40 tanker trucks and if someone is saved it is normally because of them. Fire hydrants are few and far between so tankers are the most important trucks, brining new water for the hose companies. Complicating matters is that most of the vehicles are donations or picked-up second hand at the lowest price wherever in the world they happened to have been doing duty. Many come from America. Others come from Japan, China, or Korea. A few are European. Some are very old. As a result none of them have compatible or interchangeable parts. So, the pumping procedure is that they find one tanker that can connect to the hoses, and he stays put for the duration of the fire. Then all of the other trucks come and replenish the one that remains stationary. In addition to the tankers there was a single fire hydrant about five blocks away. We arrived on scene just as a stand by. You have to have one company of EMTs standing by when you have firefighters in the field. Some of the men had been there since nine in the morning, and they were exhausted.

The BFP, the government fire service, only showed up once, with a single truck, and left. Rescue-nine lead me into the fire. Always in the Philippines, you have to second guess and think about your own safety because those guys weren’t careful. I was pretty certain I shouldn’t be walking into a smoldering building with no protective gear. Walking down a long dark corridor, I could hear the firefighters walking around on the thin aluminum roof above me. Water trickled down, ice cold. We climbed the stairs and there was a company of firemen standing at the huge smoking holes they had cut in the walls. Their hoses were turned off while they waited for more water.I crawled out on the roof to get a photo. That’s when I learned that the green bits of roof were aluminum, but the white ones were plastic. I almost fell through.
"Some of the firefighter have been there twelve hours." said Rescue Nine.There was thick black smoke billowing out, and I wondered if the men shouldn’t be wearing respirators or air tanks. "We don’t have anything like that." Explained Rescue Nine. Many of the men wore turnout coats, helmets, and boots, but that was it. Out in the street many were shirtless or just in shorts and a t shirt. And the preferred footwear was flip-flops.

Philippines is huge on titles, and every single person I was introduced to was the president of something or other; president of a fire company, of the volunteers, of the unit…. I guess if you are unemployed those titles mean a lot to you, but man I don’t get it and I hate sitting around wasting a life like that all day.The guys asked me again about drinking and sex with prostitutes. It makes me angry. They all smoke. They are already poor. Do they have to make things worse? Can’t they think of something else, like studying and working out or improving themselves? Instead they asked me about drinking and whores. I get email from people all over the world who would give anything to hang out with me and ask about martial arts or linguistics because I have experience most people could never get. But these guys only want to ask me about drinking and whores. While we were standing around watching the Chinese factory burn, one of the many presidents I was introduced to asked me, "have you gone drinking with these guys yet?"
No, and I never will, because I don’t understand this type of behavior. I was one of only three qualified EMTs in the group. No one had asked me, "Have you started giving classes to these guys yet?"
Sam’s dad was a really intelligent guy and I thought we would have some good conversations. He told me that he was coming to Thailand and would call me. I said, please do. "I will show you things you have never seen and never could see without me." I meant I could introduce him to the last Muay Thai monk and ride horses with the warriors on the Burma border, and visit the tribes where I know people by name, and visit the Khmer temple where I study with the monks.
He said, "yes, and we won’t bring Sam, ha ha ha ha."
The implication was more prostitutes and drinking. Is this all they could get out of life? I had trouble liking them. I had trouble not feeling superior. I was down to my last twenty pesos and I still felt like they were weak. I spent another shitty night at the base. When we woke up in the morning, the first thing Ivan asked me was, "have you had breakfast yet?"I looked at him like he was insane. "Are you serious? I just woke up. You saw me just wake up. How could I have had breakfast yet?"
"Oh you don’t eat breakfast."
"That’s not what I said. I said I haven’t had breakfast yet. I just woke up."
"Oh, you walked up and ate breakfast."
"Woke up! I just woke up!"

Part of the problem was probably linguistic, but some of it was just logic. How did he not know that I hadn’t eaten yet? It was weird. Getting back to my place in Cubao, there were no taxis so I would have to take a jeep back to Recto station. "It’s easy to take the jeep." Said Sam’s dad. "Only one ride. You will be there in ten minutes." It turned out it wasn’t one ride. It was two. And it would take more than half an hour to get to the train. Worst of all, I would have to change jeeps in a horrible squatter area which was scary and dirty and dangerous. Bob and his dad agreed to drive me in the ambulance to Recto so I could see how to go. One more issue that I hated was that the people couldn’t give directions to save their lives. "You see that jeep? The one that says, De la Mancha?" Asked Bob Sr ."Yes, do I take that one?" I asked
."No, it goes to the wrong place."
"So, why are you telling me about it?"
"Take the one that says Sra Clara."
"And it takes me to the train?"
"Yes, and you change jeeps."
"Why do I change jeeps if it takes me to the train?"
It went on and on ,as it always does. My brain was filling with extraneous information."Don’t take the jeep that says Borton. That will take you to the wrong place too."
"I wouldn't dream of it."
He began listing off every possible jeep I should not take. "Don’t take the one marked this or that its wrong."
"Ok, I definitely won't do that."
"Do you see the train station there?" he asked slowing down."Yes, do I need to go to this one?"
"It is called Salvador. Don’t take that one."

It went on and on, till I was going nuts. Then the other thing they love to do is give you options."You can also take the jeep to such and such, and then take a train from y… and....."Finally I yelled. "Please stop giving me information. I have enough information. I just want to know how to get to Recto. That's it. I need to get to Recto and take a train to Cubao."

After showing me so much stuff then he said, "If you want to go to Cubao you will have to go another way."
Another way? Where did he think I wanted to go? I was going to Cubao.I understood I was in this vehicle so he could show me how to get to Cubao.The travel just looked impossible. On the way in, it had taken me 45 minutes of standing in Recto, waiting for a taxi, which I am pretty sure is a record. Now I was going to be taking a jeep which didn't seem advisable. When they showed me the place where I would have to change jeeps, it looked like a scene from The Road Warrior, a post-apocalyptic collective of people, teetering on the edge of survival.
"There is no way I would get out of a moving vehicle here." I protested.
Looking around the squatter area, my heart went out to the people, but I was terrified of them.I had reached a point where everything about the Philippines was wearing me out. I hated seeing the poverty. I hated traveling through dangerous or dirty squatter areas. I hated sitting on a car seat on the sidewalk waiting for a response. I didn’t even like talking to my workmates because they depressed me. They were unemployed, they smoked and drank. They had kids by who knew how many women, and appeared to have no desire to do more than what they were doing, which was simply sitting around on the car seats talking and smoking. When a charitable thought came to my mind I realized they were stuck, and there was nothing they could do. And I always had to remind myself that no matter how much I disliked the life, I could leave. They would have to stay forever.That though depressed me even more. So, once again, I hated everything I was exposed to.I finally made the call to Taiwan. "Pierre, my old friend, Ranger needs extraction. Get me out of here."

A few days later, I was on a plane to Taiwan, where I would be teaching English to children.

Antonio Graceffo is an adventure and martial arts author living in Asia. See his website
You can contact him at: or join him on

Get Antonio’s books at
The Monk from Brooklyn
Bikes, Boats, and Boxing Gloves
The Desert of Death on Three Wheels
Adventures in Formosa

© Antonio Graceffo June 20th 2008

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