International Writers Magazine: Philipines
Fighter to Paramedic
A Brooklynmonk in Manila EMS School
Having spent most of my life learning to end life, it is a bit of
a change learning to save it.
Bakers cover their mistakes with frosting. Carpenters cover
their mistakes with paint. Paramedics cover their mistakes with
The course began
with a playing of the Philippine national anthem, followed by a prayer.
Being in a Catholic, rather than Buddhist country, it was so refreshing
not having to take of my shoes. And, unlike Thailand, I was permitted
to point my feet at anyone I wanted and even rub their head. Its
good to be among my own people
sort of my own people.
Sir Aidan is the owner of our school and the primary instructor. He
hates George Bush, which is a good thing. He hates Americans, which
I could understand but could also do without. Being Irish, he also hates
Britain, which I feel ambivalent about. So, when class gets boring I
bring up stories of my family being driven off their land by imperialist
British soldiers who burned our thatched hut.
ing British. Aidan begins. They are worse
than the Americans. Once I get him on this subject, we are guaranteed
at least twenty minutes that we dont have to take notes. Or, just
one note, in case it comes up on the test, I simplified the British/Irish
thing for my classmates. It reads British bad, Irish good.
I enjoy studying with the Irish. They are one of my favorite translucent
people. And as organ sales are common in Philippines, being the owner
of two healthy kidneys, I try to make friendships with rich alcoholics
who may need to buy one. Or is that the liver that alcoholics need?
Probably not. Liver and alcohol upsets your stomach. Anyway, I could
sell them one of my livers if things got really desperate.
You do have two livers dont you? That would be an example of one
of those times when I should have been taking notes instead of winding
As for EMS emergency medical services, Aidan is recognized as one of
the leaders in the world. I was googling his name the other day and
was blown away by how many times he is mentioned in professional journals.
He founded the EMS systems in a number of countries, higher the staff,
trained them, bought the ambulances. He is really amazing. In terms
of his practical knowledge, he was a dive paramedic, and a member of
the faculty at the dive academy in the UK. He was a military paramedic,
and who knows what else. Maybe he was a rescue swimmer like Kevin Kostner
in The Guardian. The man knows his stuff.
Joan, is Aidans wife. She is a Filipina, and is certified
as both an RN and a paramedic. She is our second primary instructor.
Aidan and Joan both said that once you learn EMS you dont
want to do normal nursing anymore because ongoing patient care is
boring in comparison.
My friend and classmate Ben is RN, but he is becoming an EMT because
he didnt want to wash the patients. Sometimes you even
have to clean up their poop. He confessed. I could see why
four years of really difficult university studies, followed by intimate
contact with excrement could be a downer.
on EMS versus medicine was, We see the patient from the time of
the injury, to the time they get through the emergency room. After that,
they become boring. We are lucky to have them at the most interesting
It also seems that in EMS when you rescue someone, they thank you, and
the family thanks you. But once they are in the hospital as long term
patients, they behave like hotel guests and start complaining.
Once again, to have four years of university studies capped off by complaints
It would feel like being a highly specialized waitress.
I am the only RN who ever came back to my country. Said
Ben told me that the normal RN salary in Philippines is 5,000 Pesos
per month (about $120 USD). In most of the world, with the exception
of the USA, paramedics actually earn more than nurses. The reason is
that the US set up their paramedic programs in the 1970s. So, they are
already established and well-manned. In the rest of the world, 911 type
response systems are new, and training programs are either developing
or non-existent. In these countries there is no shortage of doctors
or nurses, but a fully qualified paramedic is a rarity.
Most of the course is taught in English, but the students sometimes
ask questions in Filipino. It is OK, I am trying to learn the language.
Generally, even the instructors dont know the Filipino words for
the specialized medical vocabulary. This country is so America-centric
it is amazing. I think it is one of the few places on Earth where they
still like us. When I walk down the street people always shout, Hey,
Joe. The first time it happened, I looked around for my father,
but then I realized it was me. We all look alike.
There are innumerable dialects and languages spoken throughout the more
than seven thousand islands of the Philippines. Tagalog was chosen as
the national language simply because it was spoken in Luzon, the big
island where Manila is located. Many Filipinos resent being forced to
speak Tagalog when they meet their country men from other parts of the
country. Since they dont speak to each others dialects,
English was seen as a politically neutral lingua franca. So, it is normal
for Filipinos to speak English to each other if they have trouble communicating
in dialect. It is also normal that university and school courses are
taught in English. So, having me in the class only slightly alters the
language usage. Still, I am amazed that the Filipinos are so polite
that the presence of a single Cano (Americano) causes them all to speak
While their accent is American, unlike Hong Kong, their pronunciation
is at times, a bit
creative. At first I thought I was the only
one missing out on one word in seven, then I realized they have trouble
understanding each other.
Maam Joan was saying something about blacking the arteries, we
asked her to explain what that meant and she wrote on the board, Blocking
OH! BLOCKING the arteries. That makes more sense.
Yes, blacking the arteries. She repeated. Try to listen
more closely next time.
I have no idea what it will be like when I start doing my practice on
the streets of manila and people are shouting at me in a language I
dont speak, and then I discover it is English.
first lessons were on human anatomy. Here I had another linguistic
adventure in trying to understand Sir Aidan. Apparently, in nearly
all biological terminology, the people from those islands, UK and
Ireland, put the accent on a different syllable than the Americans.
The spelling is the same, but they move the accent in capillary,
bronchioles, and many other words. They also refer to the gurney
or stretcher as a cot. Which was doubly hard for me because, when
I used to have a British girlfriend, she taught me that in UK, a
cot was what Americans call a crib. But now, in the ghetto, crib
is what Americans used to call an apartment. And in EMS class, a
cot has wheels on it and is used for moving injured patients.
Many of our training
videos are from those islands where leprechauns run free, and everyone
drinks tea instead of coffee, and lives in a castle. Most of the English
ones arent too bad, but Aidan has a slue of videos from Scotland.
Those people should just be fitted with a subtitle generator at birth.
I have no idea what they are blabbering on about. Judging by the glazed
look on my classmates faces, they dont understand Scottish any
better than I do.
This confused me, because in school we were taught that the British
invented our language, but none of them seem to speak it. When I protested,
Aidan mumbled, Bloody American.
Converting my mind from Martial arts to paramedic has been difficult.
I normally refer to the patient as an opponent. I also learned a lot
of new terminology like blood is called hemo, and unlike when I am fighting,
the blood, I mean hemo, is supposed to stay on the inside.
Through years of martial arts training, I knew some of the anatomy,
like carotid artery. This is where I strike with a chop, to knock a
man out. This technique is often referred to as a Jap drop.
Not very PC, I know. Kidneys are something I hit with a knee. Trachea
is with the open hand. The armpit contains the axially artery, which
is one that has to be done with a knife thrust
Aidan told us, As an EMT you will have life and death in your
hands. And what you do will decide if the patient lives or dies.
As a soldier, I was taught almost the same credo, but sort of in reverse.
During this course I am always amazed at what a wide variety of things
we learned in high school. We had basic anatomy, biology, chemistry
didnt think I had learned anything useful in those classes, but
when we see it in EMT class, although I dont know it cold, I know
I have seen it before. What I like abut EMT is learning all of the life
saving techniques without having to struggle through biology, chemistry
and math which would be impossible for me. Thats why doctors have
to be right clever people to get through their years and years of education.
I have huge respect for them now.
Our goal in EMS is very simple, to keep oxygen going to the brain till
the patient gets to hospital. Without oxygen, the brain begins to die
in four minutes. Organs take 50 minutes, skin and muscles take five
The EMT must assess quickly and decide to load and go or
stay and play. You have to make a lot of decisions, in a
short period of time, with the pressure of life or death hanging over
you. Being an EMT is not so different from working on Wall Street or
even boxing. It appeals to me.
When I teach self-defense, I always tell people not to fight especially
if the assailant has a knife. Self-defense is like baseball, the goal
is to run home. If you reach your destination alive, you are a winner.
In EMS, the goal is to help the patient reach the hospital alive. In
most cases, you dont stay and fight, you run away and save a life.
Aidan and Joan are very religious, and they have a nice philosophy which
they live by. People arrive on the scene and see problems. We
see solutions. That was Aidans EMS motto, but his next statement
was like a lifestyle mantra. The only true problem is death, because
once it happens it cant be solved. Everything else has a solution.
He asked my class, Have any of you had a problem in your life?
Yes, but you solved it didnt you? So, you didnt really have
a problem. You had a solution. And you know how I know? Because you
arent dead yet.
We learned about the circulatory system. An adult heart pumps 5 Lt of
blood per minute. An adult body contains 5 6 Lt of blood. That
will cause some dry cleaning issues. I remember my Uncle Sonny telling
me he preferred a .22 to a .45, That way your suits will always
stay nice and fresh, after a job. He never went to school, but
he had a certain homespun wisdom that you could live by.
The rule book said, Safety first: Size up the scene. Make sure it is
safe for you and your patient. Dont go from being a paramedic
to being a patient.
Relating this to going back to Burma as a combat medic, however, you
are in the same danger zone as your patients. And you can be injured,
but have to focus and work. I had that experience when we had an accident
on the Burma border. I was knocked unconscious, but still had to crawl
around and render aid. A friend working for a security contractor said
that they hire both SWAT and ex-military to work as security contractors.
He said that they were both good, but the problem with the SWAT guys
was that when they were rushing into a building to get a sniper out,
they assume that their back is safe. The danger is only coming form
inside the house. But, in real combat the whole area is hot. There is
potential danger on all sides. It is the same for combat paramedic.
You are almost never safe. In fact, since you are traveling with the
troops, then it stands to reason, if they are injured, you are in an
unsafe place, but you still have to go about your work.
My family and friends keep sending me emails that say things like, We
are so glad you are out of Burma and safe in Manila.
I like the people here, so I dont want to insult anyone, but Manila
is a lot more dangerous than Burma. Violent crime is rampant, and people
get shot here all the time. And, unlike the States, you cant trust
the police or emergency services to come help you. We are the best EMS
in the Philippines, but we didnt graduate yet. According to Aidan,
in Manila, of 280 EMS calls per hour, less than 20 get answered.
One of the UK training videos we watched was of a paramedic on a motorcycle.
The idea is motorcycles can arrive at the scene faster and start rendering
aid while waiting for the ambulance to come and evacuate the patient.
Any comments? Aidan asked, when the video had finished.
Cool uniform. I said.
We all wear that flash-green jacket and helmet in the UK.
No, I meant the leather pants. Do we all get to wear leather pants?
No, EMTs dont generally wear leather pants.
Well, is there some other career I can pursue where I do where
leather pants? I dont want to throw away six months of hard work
and study only to continue wearing cloth.
The only career I could think of where I could wear leather pants was
go-go boy, but I had already done that one. My go-go license had lapsed,
and there were no course openings in Manila.
Aidan told us that in the UK all people are assigned a primary care
physician from birth. For the rest of our lives, if we have a
medical problem, we get free medical care. If you are injured and need
to get to your physiotherapy appointments, the ambulance will transport
you for free. That is what a government can do if it sets its priorities
on the people.
Yes, maybe in a perfect world. But, if governments squander their tax
budgets on medical care how will they fund the military?
Saving lives is a calling. Aidan served in the military, but in UK an
army medic is a noncombatant. In the US military he is a soldier first.
He is armed and must engage the enemy if called upon to do so. The same
is true in the war in Burma where no one can afford to specialize. I
want to learn paramedic skills to help save lives, but I favor a military
solution in Burma. I believe there are times that violence is justified
or even called for.
Aidan, on the other hand, finds killing appalling. For this reason he
is better at his job as a paramedic. Only God can take life.
I wondered if he would hate me for my willingness to pick up a gun.
It made me a bit sad and introspective. With the exception of psychopaths
like Hitler and the Junta who run Burma, no one wants to be the bad-guy.
It pained me that someone might point at me and say that I am the villain.
Maam Joan taught our next block of instruction. She talks a lot
about the rights of patients. The Philippines is a very stratified society,
where half of the haves dont have very much, the other half have
everything. The have-nots comprise nearly 80% of the population, and
they have absolutely nothing.
In the Philippines no one is to blame if they are poor. Being
poor is not your fault. She paused to let that sink in. Then she
added, But being rich is. If someone in the Philippines is rich,
we have to ask where the money came from.
Corruption is rampant in the country and is often identified as the
single most crippling force holding back the economic development of
Joan gave a lengthy lecture on discrimination against poor patients
in the hospital. Sometimes these people were abused verbally and even
physically. She said things like Dont try this with white
people. They will stand up for their rights. But we Pinoys let people
push us around.
Organ sales are common, and apparently, some medical staff accept a
commission for brokering the sales when a patient dies. This is
unethical. Joan told us, as if maybe we didnt already know.
Let the families make their own arrangements to sell the organs.
It is illegal and awful, but poverty makes people desperate.
This phrase, poverty makes people desperate, is a recurring
theme in the Philippines. There are a lot of cases in the news of people
jumping off of bridges or committing violent robberies that are so public
and stupid, they seem more like cries for help. Money is really tight
for me during school, and I live in very basic, jail-cell-like conditions,
but I still cant imagine the grind of real poverty. To know that
you cant provide for your family and that there is no hope that
tomorrow will be any better must be absolutely incapacitating.
Doing my anatomy homework, it occurred to me that this stuff is freaking
hard. There is a reason that doctors study for ten years. In Manila,
however, anatomy study is slightly easier, because I can just drop by
the market and pick up a human kidney and practice in my room.
For all of their education and training, the Filipinos approach
to diet and exercise is dated. In fact, everyone smokes. They are all
fat, and no one exercises at all. The course had a unit which said EMTs
should be fit, exercise regularly, and eat right. Joan repeated what
was written on the overhead, basically, You should exercise every
day, eat a healthy diet, and keep fit. But that was the end of
it. We went on to the next slide. No exercise program was laid out,
nothing was planned. It occurred to me, how many times in my life have
I sat in an orientation at a school or a company where they said, You
should do fifteen minutes of aerobic exercise per day, keep fit sleep
and eat right, next slide.
In America, kids are required to attend gym classes but they dont
work out or do any serious exercise. The kids who are fat or have no
fitness or muscle tone in September are fat and have no fitness or muscle
tone in May. I think the kids should be given a fitness test at the
beginning and end of the year. If they fail, the gym teacher should
be fired. Seriously, if we are going to eat up an hour of class time
per day, why dont we demand fitness?
According to a July report, the National Center for Health Statistics
indicate 15 percent of children ages 6 to 18 were overweight in 2000,
up from 6 percent in 1980. Fifteen percent of youngsters ages 6 to 19
and 10 percent of children 2 through 5 were considered seriously overweight.
According to the Weight Control Information Network, which may or may
not be a reliable source, today, more than 65 percent of adults in the
United States are overweight or obese. Obesity puts people at increased
risk for chronic diseases such as heart disease, type 2 diabetes, high
blood pressure, stroke, and some forms of cancer.
In our EMT course we learned that heart disease is the number one cause
of death in the world. WHAT are we waiting for? Get off the freaking
coach already. And as for the kids, kids shouldnt be fat. And
parents shouldnt make the kids fat. If kids get fat later, at
least they had a choice. But as children they rely on their parents
to take care of them. Once again, parents of overweight children should
be fined. I spend less than 45 minutes in the gym per day and I am probably
fitter than 90% of people. Why cant we do this for our kids?
The next slide was a dietary advisement right out of the 1950s when
bacon was thought to be good for you. It had a picture of the food group
pyramid and it said that 60% of our diet should be composed of carbohydrates.
Joan stressed to us, If you want to lose weight please dont
cut carbs. Your brain can only function on glucose.
While it is true that your brain only functions on glucose, carbs are
the first place you should cut when dieting. Otherwise, what are you
going to cut? Fish, meat, vegetables, fruit
Time sense is an issue here. You wait for everything. I waited in line
for an ATM for twenty minutes the other day. You are always waiting,
things take longer and everyone is late. But no one seems to mind. To
travel five kilometers could take one and a half hours, but no one ever
walks. I walk to the mall and my classmate got lost on the public transport.
Its only like 600 metres, Why not walk?
My classmates and I got drunk after class and gave each other tattoos
with IV needles. We were working together on an assignment. Aidan had
asked us to design an ambulance, inside and out. Ours had Playstation,
CD, DVD, and a Borat headbobber. For an engine, I chose a straight twelve
Hemy. I am not exactly sure what that is, but I suspected it was wicked
When we presented our design, Aidan said, That all draws current
and runs down your battery. A serious concern in the ambulance
is running out of electrical power before getting back to the hospital.
Incubators, for example, draw a lot of current. If you get stranded,
you increase the chances of your patient dying.
Filipinos talk about America constantly. America is the standard by
which everything else is measured and still the number one country they
want to go to. But according to the Bureau of Labor Statistics, in USA
paramedics only earn about $2,500 per month. In the Middle East they
can earn $2,500 tax free, and get free accommodations and food. If you
did the Middle East deal you could easily save $2,000 per month. In
US, after paying taxes and apartment there would be nothing left. In
many, many instances my classmates mention that one or the other country
in Europe has a better procedure or equipment than the Americans. But
America remains the standard. I tried to convince Ben he would be better
off as an EMT in Qatar or as an RN in America, but going to America
to be a paramedic was not a good idea. They dont understand that
$2,500 is nothing in USA and $2,500 in the Middle East is a better deal.
Sir Aidan always gets talking and forgets about our breaktimes and lunches.
I wrote the word coffee in huge capital letters on the back of my textbook,
so when it is time for a break I can hold it up. Maam Joan always
says just one more minute and I will let you go, but its
generally another thirty five minutes. I had to fake a seizure to get
us released for lunch. Monday I have to produce a note from my doctor
confirming that I have a medical condition called hypo-cafination and
need coffee every two hours or I will descend into a state of hypo-cafiosis.
That will cost a pretty penny.
After school, before Ben went home, he took his ATM cards out of his
wallet. This is Manila we always have to prepare in case we get
EMTs here have not cross trained most police and therefore dont
have advanced first aid and EMTs dont learn rescue. Sir Erik told
us You are EMTs. That means no Spiderman. No rescue, no rappelling,
no defusing bombs, and no terrorist threat elimination, you only think
about the medical.
Too boring. I want to change courses.
Sir Erik told us how to do triage in Manila. If you have one patient
suffering from a gunshot wound and one with a sprained wrist, who do
you take to the hospital first?
Answer, the rich one.
We are only supposed to have one patient in the ambulance, but it doesnt
always work out that way. Sir Eric told us that once in the Middle East
he had a whole family and a goat, which is strange because in the Philippines,
you dont usually use an ambulance to transport a goat. A pig maybe,
a few chickens, but never a goat.
Sir Eric lectured us about the golden hour. Basically the brain
starts to die after 4 minutes, but if it is still getting oxygen. It
takes ten minutes of no oxygen for the brain to completely die. Then
the next deadline is the internal organs, which start to die after 50
minutes. So, we call it the golden hour, the narrow window of time we
have to respond and take the patient to the hospital. Of course the
hour starts when the patient gets hurt, not when we arrive. We are told
that our goal is to spend only ten minutes on site.
In USA someone sees an injured person, they call 911. The dispatcher
uses GPS to locate them, gets some pertinent information, and sends
out an ambulance. 'But in Manila,' laughs Erik, 'things dont work
the way they do in USA. If they see an accident they call an emergency
number. The dispatcher asks, what kind of emergency do you want: police,
ambulance, or fire. You tell her which one you need. Then she asks,
where are you? Its not always easy in Philippines to know where
someone is, so a long discussion follows. Then the dispatcher looks
up your location and gives you a landline phone number for the closest
command station. You call them and they refer you to the specific station.
You call them and, assuming they answer the phone, they come. A lot
of time is lost in traffic in Manila, where it could take over an hour
to travel 5 KM. Also a lot of time will be lost looking for the place.
When the ambulance arrives, the police are not trained and don't necessarily
take control of the situation. Often the crowd is a huge impediment
to the rescue workers.
When you have an accident in the Philippines the first people
to respond are the onlookers. In a country where many people dont
have a lot of disposable income and arent bogged down by a job
which eats up their time, EMS emergencies can be seen as a cheap source
of entertainment. The second group to arrive is the media. Then
the politicians. Ostensibly this ancient system of ward bosses
still exists where they would show up and shake babies and kiss hands.
Next comes EMS. Once we are sure the situation is safe the police
EMS does their work and transports the patient to the hospital. At present
there are only three trauma centers in Manila. It could take ages to
reach one of these trauma centers only to find out that the hospital
is full and you are being turned away.
The golden hour could easily turn into the golden three hours, especially
if your patient is poor. For rich people, once again nearly everything
is possible with private ambulances and private admission to the best
In primary assessment training, we ask patient What is the quality
of the pain?
Quality? It sucks. Its pain, so, I would say the quality is quite
The book suggests giving the patient a scale so they can measure their
pain. The example given in the book uses a scale of 1 to 10, ten being
the highest. The book stresses that this is just a suggestion, and we
can do it however we wish. Given that creative freedom, I prefer a scale
of 3.9 to 11.7 with 11.7 being the lowest.
We studied ten ways to tell if your patient is unresponsive. Aidan pointed
out it is pretty easy to determine. Just say hello to him, and
see if he answers. Ask him some questions and see if he gibbers nonsense.
All the guys in my class knew that Master Frank is the one who took
me to the school. They all love the UFC and knew that referee Big John
McCarthy is a paramedic. They love martial arts and found my videos
on line. Now, they all want to learn Kuntaw. It was one more sad example
of a piece of local culture that is dying. I have studied the ancient
Filipino martial art of Kuntaw, but they hadnt.
This course is excellent. I am getting to find out interesting stuff
like, what the hell is a spleen? I mean youve heard of the spleen,
but what is it?
I am always amazed at the English spoken here. They do prefer to speak
Tagalog to each other but when they have to talk to me in English they
are all near native speakers. They watch all of our movies and eat at
Taco Bell. So, the cultural differences are not so huge, except for
the time issue.
I wrote in my notebook, Cytoplasm is made up of protoplasm and
occupies the space between the plasma membrane and the nucleus.
How many times have I written that exact sentence in my life? Probably
at least five times between fourth grade and freshman year of college?
Why? And why did it always seem new to me each time? Even now it has
very little meaning for me. I barely understand what it means and how
it reflects to what I need to do to save a life.
I daydream a lot in class and start laying out screen plays for movies
that should never be made. During anatomy lecture I came up with this
one, Thoracic Park, a trip back to a time when the internal organs
ruled the earth.
Sir Eric was excited to tell the guys in our class, Being a paramedic
is one of the only times you get to cut a girl's clothes off.
Of course he meant without buying her dinner first or getting hit with
pepper spray. A training video from USA showed us how to cut the clothes
off of the victim. Teacher Eric laughed, They do it wrong in USA.
They cut straight up the front. Here in the Philippines you need to
cut along the seam, so that the people can have the clothes repaired
if they want to reuse them.
Graceffo May 2008
Currently, Antonio is in Manila attending paramedic training.
When his course finishes he will return to the conflict in Burma as
a medical volunteer. He is self-funded and seeking sponsors. If you
wish to contribute to his paramedic training or his In Shanland
film project, you can donate through paypal, through the Burma page
of my website.
Checkout Antonios website http://speakingadventure.com/
Get Antonios books at amazon.com
The Monk from Brooklyn
Bikes, Boats, and Boxing Gloves
The Desert of Death on Three Wheels
Adventures in Formosa
More Life Styles
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