The Struggles of EMS in Other Countries

For many years I have looked for ways to combine my two passions of work as a paramedic and traveling. As anyone who has journeyed off the beaten path through developing nations well knows, these journeys offer thrilling insight into the lives of those we share this planet with. We witness how they raise their children, how they worship, how they work and how they survive.

But these journeys also reveal how blessed we are in the west to have emergency medical services just a phone call away. Few may realize most of the world does not have this luxury.

Opportunities for paramedics in the aid sector have been scarce. In 2002 I was offered an ambulance service development position in Ethiopia with the Red Cross but turned it down for personal reasons. For years I kicked myself for letting that one go, because I never got another call. The other aid agencies operating in emergency health care were only ever interested in doctors and nurses for foreign postings, like Doctors Without Borders (known by the French acronym MSF). The European origin of MSF is no doubt to blame for this institutionalized bias against paramedics, as ‘ambulance attendants’ with advanced training (ie. ‘paramedics’) are only a very recent concept in most European countries, where EMS is based on the Franco-German model of physician and nurse response. 

My frustrations were not just about missing out, but about being undervalued. EMTs and paramedics possess skills that are almost tailor-made for the humanitarian field. Our emergency medical knowledge is broad. We’re expected to manage penetrating trauma one minute and obstetrics the next. We know how to work in the dark, in the rain, in a brawl and under rubble with screaming relatives beating their chests around us. We thrive on working out of our comfort zone and rapidly adapting to constantly changing situations. EMTs and paramedics quickly develop a talent for communicating with people from varied nationalities and range of language ability. We must be physically fit and street smart about our own safety and that of our colleagues. We must think laterally and improvise when we find ourselves in situations that surprise us or where demand outweighs resources.

It is my view that paramedics who have worked the rougher parts of New York, London or any other major Western metropolis for any length of time are, in some respects, better prepared for Sudanese refugee camps and Afghan hospital ERs than many other Western health workers. But no one listened until now.

A week ago I returned from my first assignment in East Africa as Director of Field Programs for Trek Medics International, the first large EMS-specific NGO for the developing world. The organization was started a few years ago by former San Diego paramedic Jason Friesen who shares a passion for travel, EMS and public health. It should be pointed out that Trek Medics has nothing at all to do with mountaineering and has everything to do with delivery of prehospital care in low-middle income settings.

When first asked to be on the board of the NGO I was wary. Many new non-profits have grand plans that often involve unrealistic and unsustainable solutions. But when I took a closer look I realized Trek Medics was different. It was realistic. It took into account all that I had discovered on my adventures on ambulances in thirteen nations, which formed the basis of my book ‘Paramedico’ (HarperCollins). Discoveries such as the hundreds of donated ambulances rusting away in Central Asia; access to EMS in congested cities and across deserts like the Sahara; cost and logistics of 24/7 coverage in under 8 minutes for cities like Mumbai. 

The objective of Trek Medics is not to try and import the high-cost luxury EMS model to developing nations, at least not in the outset. But to work with systems both formal and informal that already exist and coordinate and strengthen them. In the Dominican Republic this has meant building the EMS capability in conjunction with the local fire departments. In East Africa this means an alternative to ambulances where there is no EMS. In Tanzania, for example, I was involved in training and equipping taxi drivers in the place of ambulances and using motorcycle taxi riders as first responders. These resources are then connected and dispatched with a pioneering software developed by Trek Medics known as ‘Beacon’ that can communicate with any phone via text message. While a smart phone version is in the pipe-line, many of the locations Trek Medics works in do not, as yet, have connection to the internet and only low-moderate smart phone ownership. And this is what attracted me to Trek Medics. It does not try and deliver fancy unworkable solutions but seeks out and develops the most suitable fix for a specific location.

Trek Medics is currently looking for fluent Spanish speakers to join our growing program in the Dominican Republic for a minimum of six months.

We're also always looking for other people to help the organization grow, including those who can help launch and shepherd new programs in new locations, telecommunications experts and software developers who can donate their skills and time for small projects and connectors who can help us grow our base of supporters.

But for those interested in field placements, the ideal field volunteer must demonstrate cultural competency, proficient language skills, be long-suffering and have a strong desire to mentor and inspire a new generation of EMS professionals in countries where the challenges are enormous but the hopes of the people are even greater.

Benjamin Gilmour is a paramedic and Director of Field Programs for Trek Medics International. He is also the author of bestselling paramedic memoir Paramedico - Around the World by Ambulance (HarperCollins).