The boy, 15, had grabbed a power line.
Current had surged through him, burning over 90% of his body. Miraculously, he survived-just barely. But he was
conscious, and he stayed that way through the entire hours-long ambulance ride from his small mountain village
of Copan Ruinas to Honduras' second-largest city, San Pedro Sula. There, clinging to life, in excruciating pain,
he was finally delivered to a hospital…
And the doctor in charge refused to take him. Too far gone, he said. We can't save him. Why waste time and valuable
medications on a child who's going to die anyway?
| That's when Rodger Harrison (pictured here on the right)
lost his cool. He hadn't raced the boy over 140 kilometers of treacherous mountain roads to have him abandoned
to death. "The doctor who was head of the hospital told me, 'Just take this patient back to Copan. He doesn't
stand a chance,' " Harrison recalls. |
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Rodger Harrison
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"And I said, 'No, no, no-you're going to take this patient, and you're going to treat him. We're not gonna
bring him all this way and have you just ignore him.' "
Harrison persisted. Persuasion turned to shouting, then to shoving. An armed security guard ordered Harrison out-he
wouldn't leave. Finally, the doctor relented. He admitted the burned boy to the hospital's ICU.
Three months later, the boy, alive and largely recovered, returned to his village and to work. Today, he's a happy,
healthy, normal Honduran teen. Such success stories aren't unusual for
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The Copan Ruinas Squad
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Paramedics For Children (PFC), a charity Harrison formed
to help the Hondurans in the wake of 1998's catastrophic Hurricane Mitch. |
In a nation of blinding poverty, PFC is not only delivering emergency care to those who would otherwise have none,
it's helping to build an EMS system from the ground up.
Wasted Names
Where infant mortality runs 35 per 1,000 live births. Where more than
a third of all children 2-5 have their growth stunted by malnutrition. Where outside the major cities, there is
no emergency care, often no healthcare at all.
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And then the hurricane really messed things up.
With sustained winds of more than 180 mph, Mitch slammed ashore in late 1998 and killed more than 5,000 people
(maybe as many as 10,000, by some estimates), displaced up to 1.2 million and destroyed |
as much as 70% of the nation's agricultural crops. Roads were washed out and bridges knocked down, making the delivery
of relief difficult to impossible. A generation of children, dubbed "Mitch kids," was left orphaned or
so impoverished that their parents sent them to beg-or even live-in the streets. Diseases Americans have not contended
with for decades-cholera, malaria, typhoid-ran rampant.
Witnessing this grim tableau, Harrison felt compelled to act. Out of the despair was born Paramedics For Children,
a volunteer charity that has spent the last two years helping Hondurans help themselves.
"I originally started going up in the mountains and taking school supplies and books and some medicines when
I could," recalls Harrison, a paramedic from North Carolina who'd first come to Honduras to study Spanish.
"But we never really formed an official charity until Hurricane Mitch, when we started to get donations from
people who wanted to help. They were just devastated down there, and we happened to be one of the few charities
that was there."
Beginning at the end of 1998, Harrison started amassing a corps of volunteers and soliciting any kind of supplies
that would help. He now has more than 120 active volunteers in Honduras, with more working Stateside.
They've established a strong presence in the country, working in remote mountain villages where people live alongside
livestock in homes built from dried mud. The problems they face are huge, the circumstances unlike anything American
EMS providers can imagine.
"They have a tremendous problem with sick children, bad water-now they're getting a big influx of dengue fever
up in the mountains," says Harrison. "You name it; they've got every disease you can have down there.
Some of the villages that we support have child mortality rates of 60%.
| In some of the Chorti (Indian) villages, they don't bother
to name a child until the child's at least a year old. They don't want to waste that name." |
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In Honduras, as the doctor in San Pedro noted, every resource must be used wisely.
A Hand Up
The approach PFC takes is three-pronged:
1. They bring equipment and supplies, ranging from basic medicines to ambulances, to areas that need them.
2. They provide direct medical care to citizens who have none.
3. They teach basic EMT skills to locals who can then assist their neighbors in times of crisis.
The equipment and supplies are all donated, the EMTs and paramedics, all volunteers. But through such shoestring
methods, a growing emergency-care network has been put into place. And the Hondurans have bought in.
"It's kind of like the theory they have with Habitat for Humanity: We'll help you build your own house, but
we're not going to do it for you," Harrison says "And that seems to work. We'll tell a town, 'We've got
what you need, and we'll bring it there and show you how to use it, but you're the ones who will have to keep it
flying.' We'll give them all the tools in the world, but it's up to them to actually do the work. That really instills
a sense of accomplishment and pride as they are doing it themselves."
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That, Harrison agrees, is the key to PFC's success. There's
a conscious lack of Yankee condescension, of cultural and medical imperialism. The Hondurans aren't being given
a fish, they're being taught to fish.
"The rescue squads have to be run by the Honduran people," Harrison emphasizes. |
"That's really important, because that gives the people the pride. If you come in and do it all for them,
it becomes a gringo thing. You don't want to go in and just give people something and then walk away. That's the
problem with a lot of American organizations. They'll bring in all these people, do all this work, but then they
take off and leave the people cold. And then the project will falter and fail."
Realizing this, PFC leaves the Hondurans' fate in the Hondurans' hands."That's one of the main reasons I got
involved with this charity," says Cox. "It's not a handout; it's a hand up."
Crammed Ambulances
The process starts with ambulances. Harrison estimates that there are only two dozen or so in all of Honduras,
eight of which have come through PFC. These are used vehicles donated by American agencies.
"Once I get an ambulance given to me, then I go from rescue squad to rescue squad and ask for medical supplies,"
Harrison explains. "We wait until we get enough medical supplies, then we cram the ambulance completely full.
Then we raise the money to ship the ambulance to Honduras." Once there, the ambulance and its supplies are
dispatched to a village in which locals have been trained to provide basic emergency services. Since any kind of
EMS is nonexistent outside the major cities, and basic medications are hard to come by, it's a system that has
to be built from scratch on a village-by-village basis.
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"We'll take anything from an ALS level on down," Harrison says. "We're
always looking for EKG machines, defibrillators, batteries, chargers, all of your basic trauma fluids. We have
to teach fluid therapy, because a lot of transports are two or three hours long."
To be eligible to receive an ambulance, a village must demonstrate a commitment to helping itself. It has to form
a rescue squad. Trained volunteers must be in place. Hondurans, not Americans, must take the initiative and be
in charge. "We don't give anything for nothing," emphasizes Harrison. "We won't just hand somebody
an ambulance and walk away."
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PFC has outfitted three villages with ambulances to date.
Each village needs multiple vehicles because the unpaved roads, mountainous terrain and lack of available maintenance
take a quick toll on vehicles. |
"Once you set up the service, if an ambulance breaks down-which they do a lot more often in Honduras than
they do here-it takes time to get parts, and the people come to depend on the service," Harrison notes. "So
we like to try to give each town at least three ambulances if we can."
An Incredible Tolerance for Pain
PFC is based in Copan Ruinas, about 140 kilometers from San Pedro Sula. In Copan and neighboring towns, life is
dangerous in its simplicity. Families cook over open fires,that leads to burns. Untrained drivers navigate unmaintained
mountain roads-that leads to wrecks. Disputes are settled with that ubiquitous farmer's friend, the machete-that
leads to obvious trauma.
| Often, when the locals haven't been sufficiently trained
or an illness or injury is too severe for them to handle, PFC offers direct intervention and transport to the big-city
hospital in San Pedro. One of the country's few paved roads connects the towns."When we get an accident, they'll
bring the victims to us from out of the mountains, and then we'll transport from Copan Ruinas into San Pedro Sula,"
Harrison says. |
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"We set up on the far end because we wanted to service everything in between, and we've been slowly building
our services in the direction of the main cities, moving from the outside in."
The 15-year-old burn victim is one example of PFC's success. More recently, the group raised money for chemotherapy
treatments for a 12-year-old cancer victim whose family couldn't afford them. They've even built cocinas, or cafeterias,
for local schools.
On the other hand, limited funds often leave the group in the same awkward position as that doctor in San Pedro:
trying to expend their resources where they'll do the most good and rationing their care, sometimes saying no if
a patient's outlook is especially grim.
"Because gasoline in Honduras costs about $3.50 a gallon, we have to conserve our fuel," Harrison acknowledges.
"With the average wage being $3 a day, nobody can afford to pay for gasoline. We spend about $100 to make
one run to San Pedro Sula. So we really have to look at who we're hauling to the hospital. Sometimes, we have to
make difficult decisions. If we don't think a patient's going to make it, we won't start the trip, because we simply
don't have the resources."
It's a choice no paramedic wants to make.
"It's real tough, because like all paramedics, we think we can save everybody," Harrison admits. "Down
in Honduras, we have to make that call. We don't have medical control; we don't have any of the things paramedics
in the U.S. take for granted. We kind of make the rules up as we go along."
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If a patient dies during transport, the ambulance turns
around and goes home. The body is returned to the family, which buries it promptly, as there are no funeral homes
and no embalming. |
Fortunately, Harrison says, the Hondurans, and specifically the Chorti who populate the mountains, are a resilient
people who can endure a lot of pain and bounce back quickly from illness and injury.
"The Indians of the mountains of Honduras are incredibly tough people," he says. "They're extremely
resistant to infection and problems that would destroy most Americans. They have an incredible tolerance for pain,
and it's amazing just how much damage you can inflict on one of them and still have them walking around and going
to work the next day. It's not unusual to see a guy working with half his face carved off. He'll just wrap his
head up in some dirty old rags and go back to work."
From Town to Town
Perhaps the most important aspect of PFC's work is its training of Honduran volunteers who can then provide help
to their fellow villagers.
"Right after the first couple of ambulances came in, we went down to conduct their first training class,""It
was two weeks, several hours in the evening, and basically, by the end of those two weeks, we had them just below
the first-responder level
Obviously, concessions must be made to the differences between Honduras and the U.S. For instance, with the nearest
hospital hours away, ambulances will often transport to the nearest doctor. Supplies are limited and restocks infrequent,
so the Hondurans often must improvise treatments. And there's never anyone to call for backup.
On the other hand, there's no litigation and bureaucratic regulation to contend with, and protocols are much less
formal.
"Because we don't have the problems with litigation and run reports and everything we have in the States,
we don't worry so much about documentation and that kind of thing," says Harrison. "They do document,
but just very briefly, because they don't bill. There is no insurance, and 90% of the time they get nothing for
their calls."
As the first volunteers taught have become more advanced, they in turn have begun to teach others. Basic knowledge
and skills have thus begun moving from town to town, spread by the Hondurans themselves.
The Ambulance Graveyard
Also, the lack of formal EMS regulation doesn't mean the government never interferes. To bring such things as ambulances
and medical supplies into Honduras, there are procedures that must be followed, and government officials are sticklers
about enforcing them.
This has led to what Harrison calls the "ambulance graveyard"-an impound lot filled with fully stocked
ambulances sent by well-meaning donors who didn't follow proper procedures. The vehicles and everything in them
have thus been seized.
| "There are about 35-40 emergency vehicles, including
fire trucks, that are sitting and rotting because the people who sent 'em didn't understand how to do the paperwork
correctly," Harrison says. "The Honduran government is very strict about bringing vehicles in. |
|
They tax every vehicle that comes into the country-that's one of their main revenue sources. And they don't really
care whether it's for donation or not. If you don't have your dispensia correctly done, they'll tie your ambulance
up, and it can sit there for months. And once it sits there for a month, they're charging you $28 a day.
"What's happened is that all these ambulances brought down by well-meaning groups-fire departments from around
the United States, rescue squads that just blindly send it to somebody who's supposed to go pick it up-just sit
there. You wouldn't believe the beautiful equipment we would just die to have. But once it gets there, it falls
into this black hole, and the only way to get it back is to break down and pay the taxes, which are going to run
$4,000-$5,000."
Given this, anyone who wishes to donate materials is advised to do so through known channels-people who have done
it before and are familiar with the correct procedures.
Additional Needs
Despite the groundwork that's been laid, needs still outstrip resources in Honduras, and PFC is in perpetual need
of many things."Right now the main thing is supplies: bandaging, splinting materials-anything you carry on
an ambulance, we need," says Cox. "We are also in desperate need of funds. We need people Stateside to
raise money. Those are the two biggies, because it doesn't matter how many paramedics we have willing to go if
we don't have the funds to do anything when we get there.
"Also, I'm always searching for any basic-level EMS books in Spanish. They are very difficult to come by."On
the hazardous Honduran roads, Harrison adds, there's also a dire need for extrication equipment.
"We're hoping to find a volunteer organization that will come down and teach our people an extrication course,"
he says. "We have tremendous car wrecks and no tools whatsoever to extricate. We've actually seen 'em use
horses to pull the doors off a car. We're looking for a real top-notch high-rescue team and a rescue squad that
has an old crash truck they want to get rid of. There's not a single crash truck or extrication vehicle in all
of Honduras. But obviously we need them to come down and teach the basic skills as well."
All other donations, of course, are welcome too. Monetary contributions can be sent to PFC's American headquarters
at Paramedics For Children, 311 Eagle's Walk, Gastonia, NC 28056.
For more information on Paramedics For Children, visit their website,
www.paramedicsforchildren.com.
Also visit EMS Magazine at www.emsmagazine.com.
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