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The Philippines

Lumbering like the giant propellers of an ocean liner, the fan blades turn too slowly and too high above us to cool the night. But the loose chugging and whooshing is sending me to sleep. Behind a heavy wooden desk illuminated by a strip of neon screwed into one of the peppermint-green walls is the chief of the Philippine General Hospital’s Emergency Medical Service, Manolo Pe-Yan, a plump man, unusually serious for a Filipino. Seriousness, however, does not always translate to professional appearance and Manolo is wearing the same singlet he’s been wearing for a week, stained by a dark bib of sweat, his head tipping forward then up again as he sleeps.

It’s 1 am on a Saturday morning. Two white uniform shirts are hanging on the posts of a single steel bed beside me. Snoring soundly upon it, curled up together despite the heat, is a crew of emergency medical technicians (EMTs) seemingly content with the status quo – a parked ambulance and no calls on a night when all manner of accidents and murders are occurring in the action-packed metropolis. A stone’s throw from where these medics are sleeping there is a constant stream of jeepneys, taxis and tricycles screeching to a halt outside the hospital emergency department. Onto the doorstep their contents are dumped: an assortment of stabbed and mauled victims; unconscious men with occluded airways, bodies made limp by the fractures of long falls and pedestrians with broken necks. Last week I worked a few shifts in the emergency department and dragged these people in, seeing how nasty and critical injuries and medical cases become without pre-hospital care. And while I did this, across an island of lawn and flowerbeds, under a low tin awning, two beautiful late-model Chevrolet ambulances stood washed and polished – and silent.

‘Okay, tayo marinig ng ibang song!’ Another Filipino hit is announced on a little transistor radio. It’s all we listen to. A World War II ceiling fan and cheesy music, neither of which is ever switched off – the ceiling fan for obvious reasons and the radio because, in its truest definition relating to ambulance work, we are listening out for jobs. There is still no central emergency number in The Philippines, no control room or ambulance dispatch. So we wait, as we do most days and nights, monitoring the half-hour news bulletins on ordinary FM radio and the occasional updates between Pinoy rock classics by Sugar Hiccup and Tropical Depression. Occasionally, maybe once a week, a member of the public will arrive breathless at the ambulance station, pointing in the general direction of some traffic collision nearby. But mostly we wait for a radio announcement – sometimes for weeks on end – about a pile-up on one of the many highways and skyways crossing Manila. Last month, both ambulance crews took it upon themselves to respond to a train derailment after hearing a report on the radio, but have since done little else.

The air is thick with humidity and the smell of green mangoes. I look around the room and see I’m the last one awake. Having no comprehension of Tagalog, the 1 am news means nothing to me. Half of Manila may have gone up in flames and I wouldn’t know. Nor would my colleagues stir from their slumber. There is nothing to do but stretch out on a bench near the door and submit to the urge to close my eyes.

In heat like this my dreams are always bizarre. The emperor of a mighty country, suddenly inspired into a random act of generosity, orders all hungry tramps in the land to be issued a jar of his finest caviar. But one of the tramps is unhappy and says, ‘Just give me a damn sandwich!’ The tramp says this about the same time I wake up and turn over. While I drift off to sleep again I comprehend the dream may well have been about our two ambulances donated by the United States government. They came with the latest, high-tech equipment, with pulse oximetry, twelve-lead ECG machines and pneumatic ventilators. Like caviar to a tramp are these ambulances to The Philippines’ largest public hospital. Only yesterday we took a patient in from another facility hooked up to our automatic ventilator and found there were no ventilators in the intensive care unit of the hospital. How odd it was to see our state-of-the-art device replaced by a simple bag-valve-mask – a bag manually squeezed every four seconds or so by the patient’s beloved without interruption, sometimes for months. No wonder the bag-valve-mask is known here as as a ‘relative ventilator’. And because the chain of health care is only as strong as its weakest link, there was considerable discussion among the EMTs about why they bothered connecting the ventilator in the first place. More interesting to me was to volunteer in a country where ambulances are better equipped than the hospitals they deliver to. It’s May 1998 and I’m only here for six weeks – half my time ambulance-riding, half island-hopping – far too short a period to help create awareness of a paramedical service among twenty million people in the most densely populated city in the world.

Manolo nudges me with a Philippine breakfast plate of champorado – a combination of sticky chocolate rice served with salty fish, a fish which I detest and usually discreetly dispose of so as not to offend my hosts.

‘We have very important meeting in the evening, Joe,’ grunts Manolo, using the rather annoying nickname I share with every other Western male who bears the slightest resemblance to an American GI. Manolo’s face doesn’t give anything away, even when I know he’s being funny. I’m certain it’s his own type of humour, that he’s one of those straight-faced funny men.

I raise my eyebrows and take the bowl.

‘Chinese Fire Brigade again?’ I ask.

‘You’ll see, Joe,’ he answers.

The two EMTs, Juan and Fermin, are awake. Fermin is brushing his teeth in a sink by the door while Juan runs a comb through his hair over and over again, staring ahead with a drowsy gaze. Neither of them bothers getting into their uniform shirts. They only do this if a job comes in or while escorting me across town to the headquarters of the Chinese Fire Brigade where I lecture in first aid. Three nights ago they also turned out nicely for a dinner with the fire chief whose selection of deep-fried insects and marinated grubs revolved on the centre of the table like a carousel of horrors. With this grisly platter still in mind, I hope this evening’s meeting will be nowhere near Chinatown.

Manolo snaps at Fermin to turn off the tap.

‘All quiet! News bulletin!’ he barks.

Roadworks have begun on a new flyover and taxes will go up for a year to pay for it. Joseph Estrada, one of the country’s most popular film stars, is running for the next election and looks likely to win it. The temperature is 36 degrees Celsius with 98 per cent humidity. Heavy showers are predicted for later in the afternoon. And Silvana cookies – according to a radio promotion – now come in the flavours of coconut and purple yam. That’s all. No bus accidents, ongoing hostage situations, no gangland massacres or people threatening to jump off buildings.

With nothing better to do we mop the ambulance for the tenth time in a week. Considerably more mopping goes on here than any treatment of patients. Mopping detergent with detergent, as Juan always says. Oxygen we check too, and not because it is used for patients short of breath, but for the chance that a slow leak may have dropped the levels. This is the life of a public ambulance service medic in Manila – mopping, cleaning, sleeping …

And waiting for news bulletins.

Our meeting after work, as it turns out, is merely a visit by the rest of the station staff, three of them in all, who, out of pure sympathy for the boredom suffered by their colleagues on shift, have come to bring us a hot dinner. Sunny – a young EMT behind The Philippines Emergency Medical Technician’s Association (PEMTA), which presently boasts a total of seven members – lugs in a small television set and box of cables. He connects them up and tests a microphone with a crackly ‘one, two, two!’ Moments later we are sitting round drinking San Miguel beer, singing karaoke.

‘You have choice,’ says Sunny when it is my turn with the microphone. “New York, New York” or “Barbie World”.

Great! Cringing, I tell Sunny these are not the most interesting songs but see few alternatives in the open catalogue. Reluctantly, I ask him to start the Sinatra.

To my great relief, after just one ‘New York’ into the song, Manolo interrupts.

‘All quiet!’ he yells. ‘News bulletin!’