Ambulance Ride

I have never ridden in an ambulance before. Not in the US. I have seen and been in the inside of one for educational and work reasons, but never actually gone in one when transporting a patient or as the patient myself. This week I got to experience what it is like to ride in an ambulance here in WES. No, I was not injured, hurt, or sick. I was the medical personnel going in the ambulance with a patient.

I think a month or two ago I wrote that I am not a maternity nurse. My work here in WES has me working closely with maternity a lot though. I am on a maternity unit at least 2 days a week. Some weeks I am there more often than others. It truly depends on what is going on. This week Yambio PHCC Maternity has been short staffed most of the week. I haven't been around much because I was busy preparing and launching the clinic. 

Later in the week, once things had calmed down, I was in the Yambio's Maternity unit. I am still limited about what I can do but I try to lend a hand doing whatever I am able. Sometimes that means hanging IVs and grabbing equipment for someone. Other times I stock supplies. Sometimes I talk and work with the patients. It all depends on what is going on within the unit when I am there.

However, just as the only midwife on duty was trying to conduct a delivery while I was out in the main ward area. A woman came in with a newborn small baby. She had delivered the baby at home and now the infant was having trouble breathing. There was a student on the unit with me who was able to translate basic information about the situation. I asked the student what the usual procedure was with a case like this, and the answer was that we refer them to the hospital for more advanced care.

I scrambled to find the referral forms, and fill out the paperwork. After I filled that out, I found the midwife in the delivery room doing the delivery and confirmed with her that the infant needed to be transferred. Now the problem was, who was going to go with the mother and infant. Staff has to go. A student could go but that is not ideal. So, it was up to me to go with them.

After several minutes of trying to locate the ambulance driver we got the ambulance over to the unit. There is an ambulance on site most of the time. However, you need to find the driver. We had tried to call his phone but he did not answer. I finally located him and he got everything set up. Unlike in the US when you go in an ambulance there is usually an EMT and Paramedic there is none of that here. There is not even equipment in the ambulance. Any that might have existed in there before had either been used or stolen. All that was there was a stretcher and bench. 

I had no equipment to take with me. The only bulb suction was being used for the delivery and if I took the only ambu-bag from the clinic they would have nothing if an infant was delivered who was not breathing. What do you do in a situation like this? I could take the equipment in case I needed it but what if the clinic had a delivery that needed it. Since the infant was still breathing, though poorly, we opted to leave the equipment behind and I prayed the whole way that this was the right decision.

We loaded the ambulance with the mother, her infant, and 3 other family members. Because it was so crowded in the back I road in the front of the ambulance. The driver was able to communicate with the family as we drove. I could hear the babies breathing most of the time, and while it did not improve it did not stop. This was probably the best-case scenario for this situation.

Now it is a very different experience riding in an ambulance in a country like South Sudan, than I imagine what it is like in America. I've already mentioned a few reasons why, but there are a lot other reasons. First is that this ambulance is much smaller than ones in the Western world. I was lucky enough to be riding in a "hard-top" one which features a regular vehicle cab and a covered truck bed with lights and siren. Other ones are driven by a motor bike with a steel wagon attached to the back and a soft fabric covering, hence being called "soft-tops".

As soon as we left the gate to the PHCC the driver hit the siren for the ambulance. There are no street signs, road markers, traffic lights, stop signs, or any other road signs here. There is not one specific side of the road people drive on, but rather there are tracks people stick to based on where there is more water or potholes or other issues. Most of the time people try to keep to the right side of the road like they do in the US, when there is other traffic, but it does get complicated here. So, as we drove through the main parts of Yambio the siren was going to alert people to get out of the road and out of the way.

I think I have mentioned before that there are no paved roads. The road between Yambio and Nzara, where we are taking the infant so they can go to the higher-level maternity unit at St. Theresa Hospital, is not paved but is considered "nice". This means there are no massive potholes or areas that are so flooded that they are not passable when it rains. They are still relatively smooth compared to most other roads here. Still, you better buckle up and be prepared for a rougher ride if you are used to smooth roads and American potholes because the ones here are much larger.

I am driven to Nzara at least once a week. Sometimes I am there 2 or 3 times a week. This week I have been there almost every day. On a good day, with good weather, no rain and good light, it takes at least 40 minutes to get there. Sometimes it can take an hour or more depending on rain, daylight, and other issues. We were fortunate because the rain that had come earlier in the day was light enough that the road wasn't too muddy or flooded. We made it to Nzara in about 30 minutes.

Nzara isn't really that far but let me try to explain further why it takes a little while to get there. There is usually only one good track to drive on for a 4 wheeled vehicle. Random speed bumps exist along the road, especially near villages or markets, to get people to slow down a little. We have to dodge some of the larger potholes that can have 6 inches of water in them. Your speed fluctuates from 20kmh to 90kmh depending on where you are and what you are avoiding in the road. Even if the road itself is straight, your driving will take you from one side of the road to the other and back again, depending once more, on what you are avoiding.

In the ambulance the same issues apply but this time we are trying to get there faster than when I am simply going for a regular day of work. I am listening and praying the entire time that the baby does not stop breathing. Sometimes I can hear them breathing and other times the road and drive is too loud, especially when the sirens are on. I have planned how to talk the family through mouth-to-mouth if I need to but luckily, we make it without needing to do this.

As soon as the ambulance arrives to the maternity unit I bring the mother, infant, and family inside the maternity unit. I find the charge midwife, explain the situation, and she takes over. They have more equipment since we are at the hospital. Still, they lack so much, but at least here they have a monitor for the baby, oxygen, and more tools to keep the baby alive. I head back to the ambulance once my role is over and we head back to Yambio, this time at a little slower pace.

I am grateful and pray that I never have to find out what it is like to be the patient or be with a loved one in an ambulance here. I am glad they exist and are available for the people here. Getting prompt care is hard but having this tool is very helpful. But the general helplessness of the situation like this one, I don't want to re-experience. But still, this is life here. Midwives, clinical officers, and nurses do this work every day here. Once more I am simply humbled by the way people are able to survive with so little.