Lybya: Fight For Freedom

Hi friends.

Heading to Libya on August 3rd. Just after beginning of Ramadan. I'll will be travelling as a member of Medical Teams International first disaster response team activation to support the "rebels" fight for freedom and help with the ongoing humanitarian disaster. We will be partnering with another NGO called International Medical Corps who have had a presence in country since Febuary. We will be doing primary emergency medical care of those civilians and "volunteer" fighters injured by the troops loyal to Muamar Qudafi, and probably some training and teaching along the way. I'm not sure what ability I will have to regularly post to this blog but will when I get a chance. I'll try to give a little first hand look at history being made by those who long for a taste of freedom. First stop after a 20 plus hour boat ride from Malta, (off the Souther Italy coast line), will be Musrata. It is the 3rd largest city in Libya and has been under siege by government forces.

Vietnam: EMS development project

I was in HaiDong in fall 2007 with MTI teaching an EMT class but had lots of trouble with getting computer logistics figured out so therefore no posts on this project. We , (MTI) partnered with the Vietnamese Red Cross chapter in the province east of Hanoi which covers most of one of the worlds most deadly stretches of highway. It leads from Hanoi to Hai Phong Harbor about 80 miles away. It was a great trip and I loved it. As usual the people I met made the trip fantastic and more memorable than I could hope for.....

Elephants!!

Hikkaduwa Emergency Elephant Service. Some times in the jungle ambulances don't work so well, thats when we use one of our small fleet of rescue elephants. We also have one that specializes in extrication for those really tough jobs! Just kiddding of course.... Here's how you get up on an elephant..... first you must take off your shoes or sandals , (I don't know why), then the "mahout" or handler has the elephant raise his left leg a little off the ground, then you put your LEFT leg on the elephants leg (kinda of like stepping on a ladder), then you jump up grab the highest up part of the elephants ear, and simultaneously, when the elephant feels the added weight on his fore leg he quickly lifts it up as high as he can and then up you go, a little like an elevator.....timing is everything, it took me 3 trys and an extra person helping to get up there! Elephants love bannanas, palm fronds and coconuts. They put the coconut under their foot with their trunk and squish it, but it's slippery so it usually takes them a couple of tries. They mahoot tells me that they sleep standing up because the don't like bugs getting in their ears. The elephants are usually owned by temples, privately if you are really really rich, or they are wild in parks. In some parks in Sri Lanka you can easily see several hundred in a day. The other pictures you see are from the Hikkaduwa Perahera. This is a 4-5 day Buddhist party. Usually consists of a large parade lasting about 5 hours once a day starting either at noon or midnight. Specialized dance troops came from all over Sri Lanka. Each troop has a unique costume and elaborate dance they do.

There are usually about 10 t0 30 dancers in each troop, along with a usually large complement of drummers and horn players. The Kandy Perahera is the biggest in Si Lanka, when Sean and I were there we counted over 60 elephants and about 30 dance troops. This year the Hikkaduwa one was much much bigger. There were only 10 elephants but there were 97 dance troops. On the last day there was an all night ceremony of dancers and singing culminating with fire walkers at 0500 in the morning. We stayed up all night and it was well worth it. No I didn't fire walk but probably over 100 people did. The head priest was first to go then villagers, grand mothers, and even some kids did it.

Class #1 finished!

At the end of Aug. 2006 we finished up the first Emergency Medical Pre-hospital Care Worker class in Sri Lanka. It's the equivalent of the EMT-basic course that you must pass in order to work on an ambulance in the U.S. and most developed countries. I had a lot of fun and really enjoyed being involved with this project.The people in the class were all very talented, extreamly eager to learn and really just SUPER nice people. The two other white faces you see in the picture are Heidi and Travis Gullet. They are a husband wife M.D. team finishing up their respective residencies at Oregon Health Sciences University. They arrived in time for the last half of the class. They were a huge help, and great to work with. They are back off to school now. Sean has gone home early because of the deteriorating security situation here in Sri Lanka i.e., there is a war going on in the North and Eastern areas of the country. This wasn't the case when we left, or when I origonaly signed up for the job but unfortunately it just worked out that way. I obviously haven't included any pictures of the conflict and am not talking about the war in this "blog". I want to focus on the positive parts of the trip, besides it makes my wife, daughter, freinds, and me nervous.


The kids above are our "helpers" They live near the temple were the class was held, and we enlisted their help as pretend patients for a "mock" motorcycle accident, (around here a lot of the motorcycles carry mom, dad, and 2 kids), they even let us pour fake blood on them and strap them to a back bourd. They got cake the next day for their troubles and of course never left from then on. On the last day Heidi and Travis bought them two soccer balls as a going away gift. Thats me and Sean in front of a "dagoba" beside the building were we held the class . They have one at every monastary and Buddhist shrine all over the country. Some are large some small, some very old and some new. This one is over 200 years old. The last picture is of the usual lunch time "cricket" game. The guys are all experts and are teaching Sean and me the finer points of "wicket keeping", "bowling", and what "overs" are.

Kandy Perahera

Kandy is an ancient kingdom in Sri Lanka. It is situated on a lake high up in the Hill Country about a 3 hr. train trip from the bustling city of Colombo. The train trip is really a"Trip" all itself. It's like going back in time to the early 1800's as the train is almost that old. The scenery id fantastic as you climb up out of the flat plains and rice feilds surounding the city and on up into the hills and up to the cool fresh air of Kandy at about 4000 ft. The perahera is a huge week long Buddhist festival that requires reservations for hotels many months in advance. Fortunately a member of the office staff had family up there and we of course were in typical Sri Lankan style, totally set up for the entier stay! We stayed at the Hilltop hotel which was fantastic with pool, great food service and views. The parades go every night from 800-945 pm but you have to be there by 6 pm to get any kind of aa decent seat. We were there on Fri. and Sat. which was not as good as the following Wed. which is the full moon and final best night of the parade. On that night you'd need to bee there in morning to get the best seats fort the night parade. On the night we watched we counted 55 elephants. On Wed there will be over 80 and many more dancers and drummers. It will be televised that night all over the country live. Sunday were requested to go to check on and help with an IDP (Internaly Displaced Person) camp about 3 hours East of Kandy which was rapidly filling with people from a recent conflict problem on the east coast.

Hikkaduwa EMT Class

The Emt class is 1/2 over and whent very well so far. About 15 students not including Sean, 3 student/ translators and two RN's plus me and a powerpoint projector are what we have to work with. Class is held in a spare hall of a local Budddist monastery. It has some windows and a flat concrete roof left over from the Tsunami. At 0800 when class starts its about 90 degrees and 90% humidity and things rapidly get less comfortable as the sun heats things up. We have to be inside for the power point which I use LOTS of pictures for. Then try to get outside for practical stuff when possible. But we have to fight for space with the monks, dogs, trains and cows. The 300 year old monastery is really a neet place to have the class. It is considered even more holy as everything around it including including a large train with 2500 people on bourd were killed or flattened to ground level. Getting the message across from Engish to Singhala and also getting a new medical vocabulary established is a tough, but it's working out because everyone really wants to learn. The pictures above are of water rescue practical labs at the beach, an anatomy and physiology lab which was made a lot easier by a quick trip to the local butcher shop to get some cow "body parts". (Don't wory we checked with the monks first and they said it would be o.k.) The other picture is a local boy very interested in our mock scenarios at the train track near his home..... a future EMT?

Seans' 18th Birthday

Today was a surprise party at the office for Sean. One of the office staff had a cousin who was a cake maker so a special cake was ordered for Sean. Kiru is our interpreter, driver and
NWMT security officer. When we first arrived he invited us to his villlage for a long weekend. We had a great time and his children all called Sean Hawwy Podder, "Harry Potter". The name stuck thus explains his special birthday cake. The office staff also got together and puchased a cricket bat and practice ball. Sat. is a mmeting in AM for me and then we hope to get to a cricket game in the
afternoon.

Sunday we'll head down to Hikkaduwa on SW coast to start the 1st EMT class. We'll teach it for 4 days then break for 4 days. We have planned a trip to Kandy an ancient capital city for their PERAHERA. A big Buddhist celebration with elephants lights, drummers, dancers etc. The pictures from that should be good.
I know Sean missed his Mom, Sister, Granddad, girlfreind Ginnie and freinds from back home, but he'll make up for that later.

A Trip toTrincomallee

The trip trip to the East coast was very interesting. Sean stayed in Colombo for this one due to security concerns. It took all day to get to "Trinco" were we spent the night a a lodging right on the beech. In the a.m. we were off and headed for a rual clinic NWMT opperates in Tyriai. It took a 2 hour drive N of Trincomalee, and a river crossing by " ferry", to get us to a restored building that is on the outer border of the government controlled the area. It is 200 yds. from one the most beautiful beaches in Si Lanka. There was very little else around except a small army checpoint on the side of the red dirt road. Animal life was a usual very cool! We spotted 10-15 peacocks, some big monkeys, (about 4 ft. tall when standing), about 20 of the usual medium size monkeysand some weird type of cranes in rice feilds.
Meeting some Veddah's. The coolest thing was a chance meeting with a indigenous man and his son. Our driver Kiru noticed them as we were driving down a sungle road. So we stopped and backed up to meet with them. They are called "Veddah" none are over 5 ft. and all speak a language no else understands. They live in the jungle just as they have for thousands of years and shy away from the normal Sri Lankans except to occasionally come into a rual village to trade for stuff. After tading some beeds and small carvings they had made the man extends both hands straight out to grab mine, says somthing twice in their language as he bow at the waiste. this apparently seals the deal....to learn mor about these little people you can go to www.vedda.org

The picture below is of a large cobra den that the local Hindu population built a shrine around. They worship the cobra, and will come by, place a raw egg at the shrine and tap the pavement, the King cobra comes out takes the egg and heads back to the den, (Kinda like the toys in the U.S. were you put the dime on the top of teh box and a hand comes out to grab it). I of course had no interest in "tapping" the cement. The trip to Tyriai clinic felt like Christmas time because the country director was handing out permanent contracts to the workers. They are all very happy because this represents secured income for them and everyone in there family for many years.

Geting organized for the EMT class

The Hikkaduwa ambulance service is funded and is run as a pilot project by NWMT International, with the blessing of the Ministry of Health of Sri LAnka. It covers an area of about 16 square miles of coastal and inland area on the SW tip of the Island. It is run 100% by local residents with a very basic level of training, and some ongoing training with a local RN/ public health nurse Their origional training was by an NGO Doctor and RN's from New Zealand and an Lady M.D. from England who were here from the Tsunami.They did a great job starting from nothing, but I don't think any of their training thus far has been done by anyone who has ever been a professional EMS person working from the inside of and ambulance. The ambulance workers do a great job with what they have but have very little and must reuse allmost everything they do have! Almost all the workers have been "on the job" since 26th Dec. 2004 when their homes were all destroyed and they started rescuing whoever they could. Quite an on the job training program! We've secured a large hall at a ruined but partially rebuit Buddhist temple to do the training, we'll supply 14 ceiling fans for a gift to the temple for it's use.

A week of meetings

The picture to the left and below are of the ER entrance to the 3000 bed Nation Hospital in COLOMBO.
The standard of care inside is excellent. Just like a level 1 trauma center in U.S. All hospital care is free in Sri Lanka.
.......... Getting there is the problem...........
This week Carol, (the director of all NWMT operations in Sri Lanka) dragged me around to meet the important physicians, heads of NGO's (Non Government Orgonizations), and various government officials with an interest in the EMS side of medical care in Sri Lanka. Carol has worked in many third world countries and is an pro at networking and otherwise getting things done. She has done a huge amount of foundational work on the EMS project over the last year and a half since the Tsunami. She is hard to keep up with. I'm finding that getting this project off the ground requires meeting with lots of people. Many of whom have been working for, and advocating the development of an EMS system allready. She has a very full plate and is trying to pawn all the EMS stuff off on me. The meeting with the Ministry of Health required a prearranged pass, bomb check, and no cameras. Most of the other meetings required less security. But there is allways lots of security people everywere.


The picture to the Right was taken in the hill
country on the weekend. The mother on the left in the Tuk Tuk,(tri shaw), was holding her limp and in my perception soon to die 10 y/o or so, daughter in her arms, (purple dress). There was also a 3rd person in the back helping. The mother had just run out to the nearest street and walked in a circle trying to block traffic until someone driving a tri shaw stopped and was willing to take them to the nearest hospital. I'm pretty sure the mom took the time to dress her daughter and herself in their best cloths to get them a better chance of a ride/the appearance of money. This, tragically, is typical of how acute medical and traumatic emergencies are delt with at the prehospital level for the vast majority of the 20 million people in this country. After 25 years as a paramedic I found it very difficult to hold tears back after witnessing this sad pathetic scene play out.

A weekend trip to Kiru's Village

Every full moon is a Budhist holiday in Sri Lanka. So this last weekend Kiru invited us to spend the long weekend with his wife and kids at his family's village a few hours drive East of Colombo. On the way there we stopped at the elephant orphanage in Pinnewella. A 1/2 hour from Kandy. There are over 100 elephants there. You can walk right amoungst them as you see in the picture. There are "mahouts" there to keep an eye on everything. There are feeding times for the babies, and a bath time in the river which hopefully we'll see next time we go. Some of the pictures above are of the Royal Kandy gardens, a British enclave in Ceylons Tea hey days. The pictures below are of the Tea plantations . The ladies picking tea make 1 american dollar /day....as long as they don't die of snake bite, (thats what the 6 ft. long stick an the left middle, of the picture is for). Also on the way to various locations we mixed a little a little buisness with pleasure and visited a regional rual hospital with a local polititian. We spoke with 1 of the 2 doctors that work there and discussed his needs and talked about EMS. He also gave us a full tour of his 5 ward 70 bed hospital.

S0me of problems with the rual delivery aspects of EMS in in Sri lanka are access issues. The "bridge" you see below is the only way to get to a village of over 300 people. As you'll note by the picture below the sign leading to the "bridge" states it's rated now for 3 people. It was over 10 but has broke several times so it's load rating was dimnished on each occasion.

This is the same river were Bridge on The River Kwie was filmed. That night the power went 0ut at Kiru's house and what would have been a great sleep under a mosquito net with a fan, turned into an exercise for a reality show on t.v. Never the less the next morning we felt great with the cool mountain air breezing through the front patio and we were off to a national park located at 6,000 ft. elevation. More of the tea district, and monkey troups.

As often is the case the evening trip home to Colombo for the work week had 14 people in the NWMT van so some doubling up was required.

Getting started in Colombo

24 plus hours of flight time had my son Sean and I arriving in Sri Lanka on July 3rd after leaving Seattle on the 1st. We had a 9 hour layover in Hong Kong that was a pleasant break. It allowed us and two other team members that we met at the airport to go sight seeing, walk in a forrest park, visit the zoo, get a good lunch, a Starbucks coffee. Our driver "Kiru" picked us up for the of first experience of Srio Lankan driving. It is harrowing, sweat filled, jaw dropping, and generally just scarry... it also was accented by a torrential monsoon downpour. Prior to leaving I thought it would be a good idea to rent a car while in Sri LAnka. I no longer have any interest at all in this idea. An hour latter at the team building we all rapidly took to our rooms and slept/passed out. Outside it's very hot and humid as Colombo is just a little north of the equator. Our bed rooms are located on the 4th fl. at the NWMT office in Colombo, and are air conditioned thank God. The team offices are located on the 2nd floor of the same modern five story office building that is as nice or nicer than most modern office buildings in any large modern city. The office runs with a staff of about ten people. The NWMT country coordinator "Carol" was nice to me and gave me a few days of easy work. This gave me and Sean time get a little oriented and rested. Sean and I went with Kiru our interpreter/lifesaver, and our driver "Renga" for a day trip to the South West end of the island to a small town called Hikkaduwa. It is a popular tourist area and surf spot. While there we met and talked with the people at the ambulance service/dispatch center which is sponsored and run by NWMT. The Hikkaduwa ambulance/dispatch center is run as a pilot project and hopefully will become a model for the rest of the country . The picture associated with this post shows the building they work out of. Try to immagine a Tsunami wave over the roof of this building. The picture also does not show the train that was about 100 yds. behind this buiding that was flipped over killing more than 2500. (All trains in Sri Lanka are overloaded, as are all buses and all vans). The tsunami waves hit the opposite side of the Island, and then wrapped around the South and North end to cause massive dammage to the West coast as well.


The people at the ambulance quarters were fantasic. Very humble, generous, and wanting to learn more EMS stuff. They, as most people in Sri Lanka, are extremely poor. Which makes thier generosity all the more touching. Many of them suffered through the Tsunami and were then inspired to be a part of this pilot project.

A little history behind my job with Northwest Medical Teams

In Dec. of 2005:
My family and I were on vacation and sitting in a beautiful delux hotel room near Palm Beach Florida watching T.V. I was thinking "How fortunate I was!!" (That is actually a common thought of mine)., A few minutes later on the news there was a live feed of a tsunami hitting the Phillipines and Sri Lanka. In Sri LAnka over 40,000 people were killed, and 2 million people were displaced from their homes. The teenage kids in our and our friends family, like everyone else who heard of this disaster wanted to give money immediately or to just be able to do "something". I cautioned my son and daughter not respond too emotionally but to wait and see what was really needed. I told them that beside the tremendous devastation from the tsunami the people of Sri Lanka were also recovering from another and even larger tragedy, a civil war. This had lasted over 20 years had killed almost two times as many people as the tsunami. There would still be a tremendous need for help in a year or so from now when the rest of the world would cirtainly have forgotten all about what had just happened on T.V., perhaps we would do something then......

Segway to Sept. 2005:
Hurricane Katrina hit the gulf coast of the U.S. This time I tried with some other paramedic friends to go to offer help. Because we were not allready "plugged in" with a organization it just wasn't in the cards despite our best efforts to offer assisatance. At this time I did a little reserch on the "net" and decided the non-profit organization Northwest Medical Teams would be a good group to work with. I mailed in my application, expecting to maybe put in a 2 week stint at some point. After some e-mails, phone calls, and a meeting in Oregon with Paul Bollinger, (Northwest Medical Team's director of International Emergency Medical Services), I was asked if I would be willing to volunteer 3 months to help to set up an EMS system in Sri Lanka, a country of 20 million people. NWMT was to pay my plane fair and all expenses, and I was to offer my expertice... Of course I had to say yes.

Great Blog E! Awsome idea.