(This is not our ambulance but it is very similar. Older, four wheel drive Toyota, but we don’t have fancy shades on the back windows.)

One week ago we had a lady in the Maternity wing who had delivered a baby the night before. When the nurse checked on her in the morning, there was bleeding that was more than normal, and the nurse diagnosed a cervical tear. Because we have no surgeon or operating theater, it was necessary to transport her to the nearest town with a hospital where she could have surgery.

I volunteered to accompany the patient, because hospitals like it if patients show up with a medical professional, not just the driver. Because it was a relatively busy Friday morning, I knew that I could be spared much more easily than one of the nurses. I cannot speak the language here well enough to see patients on my own, and so someone always has to translate. The woman’s mother came in the front seat, holding the newborn baby girl. They sat between the driver and another staff-member who just took advantage of the free transport to Migori.

I knew I was not going to be acting like a medic in the ambulance. For one thing, the ambulance is not set up even to hold a gurney. There is a bar on the right side of the back of the vehicle that at one time may have supported or attached to a gurney, but it is seriously deformed and non-functional . The way the ambulance works now is this: The 20 liter gasoline and water cans (two each) are pushed far forward, up against the backs of the front seats. The forward bench seat is collapsed against the left side, and the spare tire which normally lays on the floor of the ambulance gets tied to the left side with the tire helping hold the seat up. The remaining bench seat is where I sat, and a mattress was placed on the floor for the patient.(Largest rectangle below.)

A wire has been forced between the roof of the vehicle and one of the supports that holds up the roof. This is where the IV bag can hang. (Star shape below.) The wire would be in the perfect position for someone sitting on the forward bench to be able to hold the IV bottle still, but it is out of my reach from the back seat. I have one spare IV bottle and I brought a box of latex gloves and another IV needle and tubing in case the IV fails on the way. These are the only supplies.

Ambulance layout
Front of the ambulance is on top, back doors at the bottom.

 

We set out, and it is a very bad road for at least 30 minutes. We go up multiple hills, and down into their accompanying valleys. At the bottom of the valleys there is often a bridge over whatever water or waterway is there. The valleys seem the worst—the place where the dirt road meets the concrete of the bridge is often extremely rough, and the bridge is likely to be pot-holed especially at the beginning and end. But the hills are challenging , too, and very rocky where the rain has washed the dirt away. Of course, the loose mattress, and the patient,  tends to slide a bit when the ambulance is going up or down.

The driver drives as fast as possible, as the trip takes an hour on a good day, and we want to get to the hospital. I am perched on the back bench, and the IV is swinging wildly. For a while, the staff passenger in the front seat  stabilizes the IV bottle, but eventually she probably gets tired of reaching backwards and she lets go of the bottle. I try to hold onto the IV line, but not pull the line out of the bottle. The patient is bumping along on the bottom of the car, and I have to stretch my legs over her to brace myself and stay on my bench. Then I notice that the tire is wobbling quite a bit, and the rope holding it upright on the left side is beginning to loosen. Since it will fall right on the patient if it falls, I try to hold it still with my elbow. Sometime as all of this is going on, the IV begins to leak, and it is flinging IV solution all over the back of the ambulance and the patient.  I have to ask the passenger to unhook the bottle from the wire and hand it to me, and I am able to force the canula back into the bottle as it was just loose, not all the way out. I decide to hold on to the bottle rather than re-hang it.

I check the patient’s pulse, as I cannot speak her language and she has her eyes closed. The road is way too bumpy to see if she is breathing. It is really the only way I can even slightly monitor her. God alone knows what I would have done if her pulse was weak or something worse. Now, holding the IV bottle and the tire, I notice the tire is even looser. I finally tell the driver to stop, and he comes back and ties the tire much more securely. I change the IV bottle to the fresh one and we are on our way again.

When we finally get to the tarmac we pick up speed and race through the small centers along the road. It is Friday, and there are some protestors out waving greenery in each of the centers. They are supporters of Raila Odinga, the candidate in opposition to the ruling Jubilee Party and President Uhuru Kenyata. They are peaceful, and we also notice more and more vehicles are now sporting greenery on their hoods or grills.

The driver is very familiar with the road, and knows which speed bumps he can go over fast, and which ones will break the axle. As we approach the edge of Migori, we drop our passenger at the main road into town, and we take a back road to the private hospital the driver knows—the closest one.

We arrive and the driver and I go in to see about getting the patient admitted. The registrar agrees to take her, and several staff members come out to get her. They load her onto a gurney and take her in. There is a conversation now between the driver and the mother, and they figure out that the driver forgot to discuss the destination with the patient and her family. They want to go to the Catholic hospital on the other side of Migori. So the patient is transferred back to the ambulance and off we go.

It is about noon as we enter Migori Town, and we are driving in the center approaching the bridge over the river that winds through town. It seems that all the vehicles are now festooned with greenery. There are lots of young men walking cheerfully up the street toward us, loud and happy-looking. Suddenly a loud noise startles me, and people start telling us to turn around. I cannot see what made the noise, but people are running in all directions. The driver starts to turn the ambulance, but someone relents, tells us to turn the siren on, and waves us through. The young men carry a cardboard box in the shape of a coffin, and they pass it over the ambulance. I don’t know until later that they are hoping that one of the members of the IEBC (the Electoral Commission) will step down, and that this represents his coffin, with him in it I am sure.

To be continued in Ambulance, Part Two.

3 thoughts on “Ambulance: A wild ride to the hospital

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