Loose Ends and Good Friends

Hello! Yes, we are home. We had a whirlwind ending to our most recent stint in Vanuatu with ProMedical! We will get to that a little later. In the meantime, we are “catching up” with the blog. This post was supposed to have happened while we were still there, but stuff happens! Better late than never, so here we go!

We wanted to do a blog that featured the two medics that we were partnered with on the same rotation, Phil and Georges. We did a lot of calls with these two, and they are rock stars!

We were able to sit down with each of them individually and find out a little bit more about them.

Georges

Georges is originally from the island of Tanna. Tanna is one of the 83 islands that make up Vanuatu. It’s home to the world’s most accessible volcano, Mount Yasur. Its population is approximately 33,000.

Prior to joining ProMedical, Georges had followed in his Grandfather’s footsteps and was an auto mechanic. On his days off he volunteered at his church’s clinic. Georges had seen first hand in his village that there were great needs for healthcare going unaddressed and people were dying unnecessarily. He was doing what he could to help, but had no formal medical training. It was while volunteering in this clinic where he first crossed paths with the Paramedics from ProMedical. On occasion the clinic had to call ProMedical for a particularly ill patient. Georges caught the attention of Mick, a now retired leader at ProMedical. Mick saw how well Georges managed as an assistant and encouraged him to apply to be a Paramedic. Georges was successful, beating out a number of other candidates, including some with formal medical training like nurses!

Georges career with ProMedical began in 2013 as a Paramedic student and he obtained his Diploma of Paramedic Science in 2021. Georges loves being a Paramedic and takes great satisfaction from serving his community. He cites his faith as a Christian as a strong motivation for his desire to help others.

Georges is married and has a seven year old daughter and his wife is expecting a second child any time now! He enjoys soccer and is a member of the Ifira Football Club. Due to their recent success they are heading to an international tournament in Tahiti! There is never a dull moment when working with Georges! He seems to know ABSOLUTELY EVERYONE! He is continually recognized while driving around town, waving at nearly every car and pedestrian we passed! His positive energy is infectious and his warmth is a comfort to his patients.

Phil

Phil hails from the Vanuatu island of Malekula. Malekula has a population of approximately 25,000, with the majority of people living in coastal areas. The interior is rugged and largely inaccessible by road.

Phil came to Efate in 1997 in order to study Agriculture at Onesua Presbyterian College. He then returned to the family farm on Malekula and applied his new knowledge to further develop it. While enjoying farming life, Phil couldn’t help but notice that his fellow residents of Malekula were struggling to get adequate healthcare. Feeling compelled to do something about this, in 2013 he returned to Efate to embark on an education as a nurse. Upon completion of his nursing degree in 2016, Phil worked in the bustling Emergency Department at Vila Central Hospital. While he was gaining exposure to many patients and a variety of conditions, he felt frustrated in his role. In Vanuatu nurses do not have the autonomy that they do elsewhere. He was also having regular exposure to the Paramedics from ProMedical. He was intrigued by their broad skill set and their independent practice. He inquired about recruitment and was successfully brought on board at ProMedical in 2017! He completed his Diploma of Paramedic Science alongside Georges in 2021. An exciting part of their degree completion included a field placement in Melbourne, Australia!

Transitioning from Nurse to Paramedic has been very rewarding to Phil. He enjoys responding to interesting places and situations to provide care. The variety of the work keeps him invigorated and eager to serve. He takes pride in being a respected person in the community. Grant and Phil share a passion for keeping the ambulances in tip top shape and squarely clean!

Phil is married and has four children. For fun he enjoys all aspects of music. He plays keyboard and guitar and is a great singer! His favourite genre might be country. He definitely enjoyed discovering Dean Brody and The Road Hammers during our shifts together!

Hanging out with Phil and Georges on a day off

Paramedics tend to bond with their coworkers and Vanuatu is no exception. We had the pleasure of spending an entire day touring the island with Georges and Phil. They were excellent guides and they took us to see some incredible sights!

Phil, Miriam & Georges at the Blue Lagoon

Grant, Miriam and Georges in the mud bath at Nasinu Hot Springs! 🥵

Georges helping Grant get the full experience! 😂

“The Cowboy Group” as named by Georges 🤠

A very traditional social event is drinking Kava. Kava is a root which is grown in Vanuatu. The root is smashed fine and mixed with water. It has mild sedative and slightly numbing effects. As interesting as the effects are, the experience of ingesting it is far more monumental to us. It tastes and looks HORRIBLE! It is served by the “shell” in Kava bars called Nakamals. Back in the day Kava was served in actual hollowed out coconut shells and the term “shell” has stuck ever since. Nakamals are like Tim Hortons in Canada. There’s one on every corner!

Downing some Kava with Phil 🤢😵‍💫😂

We had such a great time with Phil and Georges! We were really fortunate to be paired up with them for our rotation! Keep up the great work fellas! 🇻🇺 🚑 ❤️ 😄

ProMedical’s Sibling!

We have told you a lot about ProMedical over the past month. This blog post is all about ProMedical’s younger sibling, ProRescue!

ProRescue began in 2014 here in Port Vila. This all-volunteer organization is lead by Australian Troy Spann. Troy has resided in Port Vila for nearly 20 years and has extensive rescue experience from his homeland. ProRescue is largely based on Australian SES (State Emergency Service).

ProRescue is activated by ProMedical anytime a patient may be inaccessible without additional assistance. This may mean just an extra set of hands. However, these volunteers are much more than that. They train regularly on auto extrication, high angle rescue, water rescue and other technical rescue methods.

ProRescue volunteers performing auto extrication

ProRescue working alongside ProMedical Paramedics at a multi vehicle collision

In addition to their rescue training, ProRescue volunteers have medical first responder training. They assist with patient care and even may drive an ambulance when ProMedical is short staffed, or during a multi patient incident. ProRescue provided medical support to ProMedical at the recent UB40 concert here!

Miriam with our friends from ProRescue at UB40!

ProRescue has very recently taken possession of their new rescue truck which if you ask me, is a real gem! 🚑😍

The new rescue truck’s name is Ronnie, after founder Troy’s father. All of the emergency vehicles operated by ProRescue and ProMedical have names!

Ups and Downs of the Job! 🛫🛬

Part of ProMedical’s service involves medevac responses. If a patient on one of Vanuatu’s many other islands needs more advanced care, they are flown to our island, Efate, where they will be transferred to Port-Vila Central Hospital. Now the level of care in Vila is not first world, but it is a large step up from hospitals and clinics on other islands. The Ministry of Health contracts with two air carriers, Air Taxi and Unity to do the retievals. They then arrange for ProMedical staff to be the medical care for the flights, and for transfer from the airport here to the hospital. Occasionally a Physician may also be part of the medical crew.

Some examples of transfers we might be involved with would be high risk Obstetrics, Trauma, Cardiac or Neurological issues needing further investigation and potentially definitive treatment. Things like neurosurgery and cardiac catheterization are not available anywhere in Vanuatu. The few wealthy Ni-Vans, visitors with insurance or very deep pocket$ would be transferred out of country for definitive care.

Getting back to inter-island transfers, they are usually an adventure! The planes are small, kind of old, and LOUD! Also, we have to bring all the equipment we might possibly need. There is no backup anything or anyone. We are it!

Miriam waiting for our plane at the Domestic Terminal in Port Vila. Yep, all of that is our medical gear!

On the tarmac at Bauerfield International Airport Port Vila.

Taking off in Port Vila en Route the island of Pentecost!

The planes used are all twin engine which is a helpful safety advantage. In Canada this is the minimum standard as well. However, here there is only a single pilot, whereas in Canada there must be two.

Paramedic Phil squeezed into the attendant’s position at the foot of the stretcher

Landing on Pentecost

Upon landing most often the patient has been brought to the airport already. The means of transport varies, from Land Cruiser type ambulance to the bed of a pickup truck! Some less urgent cases are able to sit and walk which makes things easier all around. However, on occasion the team has to be transported to the clinic in order to provide advanced care and stabilization of the patient prior to transporting them to the aircraft.

“Airport” on island of Epi. Note grass airfield.

Once we receive a report from the sending heath care staff, we perform an assessment and determine if any treatment is anticipated during the flight. It is much easier to start an IV or administer medication prior to loading the patient onto the plane.

Not much space to do anything once onboard!

Takeoffs at remote locations come with some complications. Plane tires on a wet grassy airfield like to get bogged down, making acceleration and takeoff exciting! Then there is the issue of obstructions on the airfield. Curious onlookers love to come out and see the plane. Some can be told off more easily than others….

Cows obstructing the airfield while attempting takeoff. They don’t respond to being yelled at!

Last ones being chased off by the pilot driving in a zig zag formation!

Once safely underway with our patient we notify our colleagues on the ground in Port Vila of our estimated time of arrival. That way they can be at the airport with an ambulance when we land for the final leg of the journey.

Miriam in the ambulance back in Port Vila

Another way ProMedical helps with medevac is transporting patients from a local health facility to the airport for repatriation to their home country. An example of this was a case that occurred last weekend. Port Vila gets a steady stream of cruise ships of various sizes. Last weekend’s was a whopper, carrying over 6,000 passengers. An elderly gentleman that we will call Bill had been having difficulty breathing on exertion for a couple of days. Without warning he suddenly collapsed while onboard the ship in the Port Vila Harbour. Bill was in cardiac arrest. Medical staff onboard the ship were able to get Bill’s heart beating again with a defibrillator and some medications. They did a most impressive job of stabilizing him, however he was very critical. The cruise line contacted an air retrieval company in Bill’s home country of Australia and they were airborne in a matter of hours. ProMedical is responsible for getting the Australian medical team to the cruise ship and back to the aircraft waiting at the airport.

Getting the patient safely loaded and settled on the plane prior to takeoff. Critical patients must be carefully and methodically moved between vehicles.

We hope you are enjoying hearing about our adventures! Stay tuned! More to come!

Grant & Miriam

Santo Sojourn

When we came to Vanuatu in 2019, we spent our entire time working on the island of Espiritu Santo. When ProMedical asked us to spend part of our time there this time, we were thrilled! We made some great friends and saw some incredible places there, so a revisit was most welcome news!

Checking in at the domestic terminal for our flight to Santo

After many hours of delay, our flight to Santo was finally boarding! 😄👏

After five hours of delay, our flight took off from Port Vila. Upon arrival at Santo, we were greeted by Bransen, the cousin of one of the Santo Paramedics. Bransen got us to our accommodations which had a very comfortable bed and yes, air conditioning! I’m not sure how we would survive the heat without it!!!

The airport in Santo is pretty small. No carousel for luggage, just a bench that staff place your bags on..directly from the trailer!

A welcome sight for two sweaty, weary travelers!

The way the schedule worked out, we had a couple days off in Santo before our shifts began. We had limited time here, so we made sure to take advantage of every minute! Our first day here, we went back to a familiar spot, Aore. Aore is another small island, just a short boat ride from Luganville harbour. They have a lovely resort there that allow day guests to come and enjoy the amenities.

Not a bad spot to hang out for the afternoon!

The snorkelling here was terrific and so were the Margaritas! 🍸 🥰

The next day we rented a car and tried to hit as many spots as we could!

Our rental, a Kia Morning. I actually fit in this glorified go kart! 😆

The main highway in Santo has seen better days. A few times I thought that the car was going to be swallowed by some of the potholes that we encountered! In spite of this, we got around to some terrific sights!

Million Dollar Point. A beautiful beach and great snorkeling! Many WWII artifacts underwater here!

Matevulu Blue Hole. A spring fed oasis. The water was so clear! And it was a refreshing cool swim after the relatively warmer seawater at Million Dollar Point!

After a couple terrific swimming/snorkelling spots we had lunch at Turtle Bay resort. It’s about halfway between Luganville and the northern tip of Santo, Port Olry. We loved Turtle Bay last time and it did not disappoint! Incredible food and breathtaking views!

Breathtaking views while having a leisurely lunch!

The second day with the rental car we headed to another beach. This one is called Champagne Beach, because of the tiny bubbles made by the water rippling into the sand. The last time we were there it was overrun with tourists. Not this time! 😍

We basically had the place to ourselves!

The snorkelling here was great too! After some time in the water we just sat on the beach and took it all in while reading our books

After Champagne Beach we decided to see another Blue Hole. This one was called Nanda. It was spectacular!

After visiting Nanda, we decided that Turtle Bay was the right choice for lunch, so we headed back! More great food and views!

Unique nature on the opposite side of earth!

After a couple great days of touring about, we did have to report to work! Our reunion with our old friend Minnie was very heartfelt!

After our reunion we got to work. We went through the Santo Station ambulance, Alma and got used to where things are kept on this vehicle.

Getting Alma tidied up. The landscape in Vanuatu makes for dirty vehicles, inside and out! 🫣🚑

Our first partner, Noella, started with ProMedical after we were last here. Noella was also a nurse who had ICU experience from “PNG”. It took me some time to figure out the short form – Papa New Guinea! Noella took us around to see the hospital as it is today.

Definitely more primitive than the hospital in Port Vila

I haven’t seen this brand of defibrillator before!

The call volume in Santo is low so we were able to get some training and review time in with the local medics.

Noella reviewing the traction splint application

Our second partner of the week was Dominic. He’s relatively new so we spent all our downtime going over an assortment of treatment modalities, from basic first aid to airway and oxygen therapy.

Dominic applying an arm sling after splinting Miriam’s forearm.

Bandaging heads can be tricky but I think Dominic nailed it! 😆

Practicing bag-valve-mask resuscitator technique

At the end of our time on Santo our friend Minnie invited us to her home for a wonderful traditional meal!

Wonderful food with wonderful people! ❤️

We had such a great time in Santo that we didn’t want to leave…and it became apparent at the airport that we might have to stay longer than planned! The morning flight had been cancelled and now there was quite the crowd at the airport trying to get a spot on our flight. Meanwhile, the plane we were taking to Port Vila did not depart Vila on time. We were starting to get nervous. Rumours of the plane being repaired and possibly not coming today swirled around us. The airline staff was nowhere to be seen. Some locals reported that they don’t check in departing flights until the plane has physically left Port Vila. This is to prevent having to give everyone back their luggage if the flight is cancelled! It would appear that this is a regular occurrence…🙀

We were getting anxious with all the people crammed into a small check-in area, and no staff to be found. If the flight was cancelled, we wanted to know ASAP so that we could make arrangements to stay another night. We also did not want to lose our seats on this flight if it was actually coming. There is no “online check-in” option, so it’s every person for themselves in the hot, chaotic check in area. And without any flight status board or PA announcements, everyone just huddled around the check-in counter eagerly awaiting an airline official to open check-in.

Thankfully around the time our flight was supposed to depart, a couple staff members appeared and began checking in all the passengers. The lines for the desks were chaotic and poorly defined. We weren’t sure if we were in a line, but we stayed with it anyways. We later discovered that we were behind a massive group of people with countless cardboard boxes to check in as luggage. We had taken the worst possible queue! 😫 Other lines didn’t look much better. Two young Australian women were in tears pleading with the agent over some issue that dragged on for 45+ minutes.

After being at the airport for over two hours, we finally were checked in. We were the VERY LAST TWO! Talk about anxiety!

Feeling all the emotions after a crazy few hours navigating the Santo Airport fiasco!

We managed to get back to Port Vila and to our apartment with enough time to grab a nice drink and a snack at the adjacent Stone Grill Lounge. That felt great!

A super Margarita! It tasted extra good after our zany afternoon and evening!

We have three more weeks to go here in Port Vila, Vanuatu! We will bring you more stories soon! 🇻🇺 🚑 ❤️

Anatomy of an Ambulance Call 📞 🚑 🇻🇺

Hi! We have had many people ask, “How does it all work?” So we thought we would take you through it step by step! Warning! This will be a longer blog post as we get into some details that may only be of interest to Ambu-geeks like us! 🚑 🤓

As in all emergency services, the first step starts with a caller requesting ambulance service. On Vanuatu’s two most populated islands, Efate (Port Vila) and Santo (Luganville), ProMedical is reached by calling 115.

Ok, so say someone calls 115. The call is immediately routed to a local Paramedic that is on duty. There is no call taker, no dispatcher. If that Paramedic is unable to answer, for example they are already on a call, the call is routed to a second phone carried by another Paramedic. Once the location is confirmed the Paramedic advises their partner that a call has been received. Between 8am and 5pm, Paramedics are physically together in the station. After hours, they are allowed to either remain at the station or go home “on call”. Each on call crew member has a response vehicle, be it an ambulance or a non-transport response unit.

ProMedical’s Ford Transit Ambulances stationed on Efate in the city of Port Vila

Miriam with “Katrina”, one of two Ford Everest Paramedic Response Units operated in Port Vila. When we are on call we generally have one of these sharp units at our apartment.

In busier Port Vila, there are three Paramedics on call at night. This may include Paramedics like ourselves, the overseas volunteer. Miriam and I decided that we would both go on any calls when one of us is rostered “on call”. For these after hours responses, the primary Paramedic receiving the call will then phone a second Paramedic and make a plan to meet up and they respond together in the ambulance.

Ok, back to daytime response. We will run through a call that happened this past week.

Pascal answered a call for a woman who fell down a well and had a fractured leg. That was it, no further details. Miriam and I hopped in the ambulance and we zoomed across town.

People are pretty good at pulling over here! 👏

About 10 minutes later we arrive at a village rather close to the airport. We gathered our equipment and followed a bystander down a narrow dirt path into a village. The sun was in full force and it was about 33c plus humidex! 🥵

A crowd of concerned neighbours and relatives surround and support our patient who we will call Marie. Marie had been distracted while walking and fell into a well. The opening was very narrow which kept her vertical for her harrowing drop! Thankfully she had been removed by the villagers before we arrived! Miriam was the lead Paramedic on this call and with Pascal’s assistance, she assessed Marie. Miriam removed the cloth that had been tied over Marie’s injury. This exposed an open fracture of the right lower leg. Her Tibia was protruding through the skin right where her ankle would normally have that familiar lump, the Malleolus. We irrigated the wound with some saline and then Miriam inserted an intravenous into Marie’s hand. Pascal and I drew up some powerful analgesia medication, Fentanyl from the drug kit. Pascal administered the medication and within a couple of minutes Marie seemed very calm and content despite her situation. We monitored her vital signs with our “Lifepak 12” and began to dress the wound. Then we splinted the fracture with some locally sourced cardboard! ProMedical does carry splints but sometimes improvised solution is best!

Miriam and Pascal administering Fentanyl to the patient via an intravenous. This allows the pain to be minimized before splinting the leg.

Once the leg was splinted we moved Marie to a portable stretcher. The bystanders were more than happy to assist with carrying her to our ambulance!

Pascal directing our great helpers on scene!

Once in the ambulance Miriam reassessed the patient. The pain was all but gone, Marie was relaxed, and there was no change to her injury. Pascal then did his best to drive avoiding bumps on the road. (The main roads here are decent, but side streets can have some big potholes. Once you leave town, secondary roads can get VERY INTERESTING!)

The Ford Transit ambulances are very spacious in the back compared to the older Toyota Land Cruisers which are used as back up units

Once at the hospital, Miriam gives a report to the ER staff and we move the patient onto a hospital stretcher. The offload process here is much smoother than in our normal work area in Canada! We haven’t had a delay once!

Miriam checking on the patient prior to handover to hospital staff

Resuscitation room in the ER where we placed Marie for initial assessment

Once the patient handover is complete, Pascal cleans up the stretcher and equipment and Miriam fills out a paper chart and leaves a copy for the hospital. It is similar to an old Ontario ambulance call report, but without a lot of the codes etc. it takes only 5-10 minutes to complete. We then return to the station where Pascal and I restock the ambulance and Miriam completes a digital copy of the paper chart. Again, this is quicker than our charting at home.

Miriam finishing her patient chart back at the station

Well, there you have it! Some aspects are amazingly similar and others are vastly different to our experience in Canada. Stay tuned for more in our adventures! Stay warm! WE ARE! 😂 ✌️

First Few Days

Yep, we made it! The office staff at ProMedical got our visa situation ironed out and we were able to leave Fiji only two days late. Two extra days of time by the pool, cold drinks and warm sunshine. Did we mention the most epic sunsets??? 🌞 😯 🤩

When we landed at Port Vila we were greeted by yet more warm air and sunshine. We travelled west and slightly north/closer to the Equator. The climate is essentially the same, HOT, and prone to thunderstorms as it is rainy season. It’s also tropical cyclone season so that’s fun…😯🫣

Feeling gleeful relief at arriving after a stressful couple of days!

The first order of business was to pass through customs employing that ever so important visa! Then we retrieved our bags, got some Vanuatu cash from an ATM and then obtained local SIM cards and phone plans. We will rely heavily on our own phones for both emergency and administrative communication while here.

Digicel, the same company that I utilized in Haiti 🇭🇹

After taking care of these items we were greeted by Alex, an Australian medic from Canberra area. Alex has been a Paramedic for five years and is in his first month of a year long stint at ProMedical. Australian Aid assists willing Aussies to come here and they cover some funding while they are on leave from their employers in Australia.

Alex got us to our rental apartment and we immediately cranked the air conditioning as low as it would go!!! We are fortunate enough to have cold A/C, hot water and a small kitchen. A balcony with a western view was another highlight of this place!

After a terrific sleep we were picked up by Alex and brought us to the station. We put some faces to the names of some of the people that helped get us there. Alex facilitated our day of orientation and before we could get done we had to head out on a call! Jules, another Australian medic was heading back to Port Vila on an air evac with three patients from another one of Vanuatu’s 83 islands. ProMedical staff is typically the air escort for the Ministry of Health chartered air transfers. The MOH charters through two air providers, alternating weeks with each provider. In this case none of the patients were critical, but they did require ambulance transport from the airport to the hospital.

Air Taxi, one of the two companies that provide air ambulance service.

Once we made it to the airport, we drove right onto the tarmac and began getting those patients into the two ambulances that ProMedical staffs during the day in Port Vila. Once we arrived at “VCH” – Vanuatu Central Hospital we offloaded the patients and got a brief tour of the ER by Celine, one of the local ProMedical staff.

ER admin clerks inside the ambulance entrance doors

Acute on right, followed by Fast Track! 👏

Fast Track area for minor cases, usually walking into the ER.

After our hospital ER tour we returned to the station for further orientation.

Getting familiar with the local bag configuration.

ProMedical has done an incredible job of developing an advanced life support Paramedic Ambulance service in this country! It was started by an Australian Paramedic in 2004 and has been going ever since. Local staff receive their didactic education online through Australian Paramedic curriculum. The other piece of their education comes from volunteers Paramedics coming from the first world, primarily Australia. Their medical directives parallel Australian standards.

ProMedical’s funding comes from private and corporate donations, and from a subscriber payment system. Residents and businesses pay an annual fee for ambulance service coverage, similar to CAA roadside assistance. Subscribers still have to pay extra for certain procedures like medication administration, but the response and transport are covered in the subscription fees. Tourists can claim the fees through their private travel insurance. It is unfortunate that fees must be applied, but given that the government provides no funding for the service, it is necessary. The alternative is what most developing countries face, no Paramedic service whatsoever.

Stay tuned for more stories as we get our feet wet!

South Pacific Speedbump

Today is our departure day from Fiji into Vanuatu! Guess what? We aren’t leaving! 🙃We discovered yesterday that there is an administrative issue with our work visas. We have people actively trying to resolve this, but in the meantime we cannot enter Vanuatu. So, we have two more days of R&R in Fiji! Not all that bad! Our first two days in Vanuatu were supposed to be Orientation, followed by three work days on the ambulances. So if plan B pans out we will really hit the ground running!

Fiji really is gorgeous! Greenery everywhere you look. Surprisingly there are many coniferous trees as you gain a little elevation. The people are some of the nicest and happiest you will find anywhere! ❤️ 🇫🇯

We had an epic day Friday! We went on a full day river rafting adventure on the Navua River. Action photos and video to come! We don’t have adequate wifi right now to upload from the GoPro! Here are a few pics from the ride in on the bus. The road was narrow and gravel. Our bus driver was driving it like he stole it! 😳😆

Halfway there!

At our halfway point to our start location we got off the bus and stretched. We also got to have some great banana bread and Tang. Breakfast of champions! 😆

Miriam with the bus. This thing must have had a bulletproof engine and transmission…some of those hills were pure insanity! 😮

The weather has been largely sunny and warm (30-31C 😎). A couple short bouts of daytime rain have not hampered our fun. What’s a little rain if you’re in the pool or ocean? We did a little snorkelling off the beach at the resort and it was great! Again, water pics stuck on the GoPro for now. Shout out to Vanessa for lending it to us! ❤️

Stay tuned as we await official approval to move on!

Grant & Miriam

VANUATU:PART DEUX!

Well hello! It’s been a while since we wrote a blog! Five LONG years! It actually took me a bit of time to find the page!

Just a quick note to let our followers know that we are FINALLY returning to Vanuatu! If you followed us in 2019, you will recall that we served as Paramedic mentors for six weeks in this tropical island nation in the beautiful South Pacific. Back then we served at the station on the island of Espiritu Santo. This time we will be splitting our time between Santo and the busier station on Efate, where the capital city of Port Vila is located. We will be part of the ambulance crew and also providing some support to the student Paramedics working on completing their certifications.

Espiritu Santo’s population is approximately 40,000 with approximately 11,000 living in the largest town, Luganville. Santo’s geographic size is fairly large at approximately 4,000 sq Km. That’s just a little smaller than Halton, Peel, York, and Toronto combined. Yep, ONE AMBULANCE! Much of Santo is inaccessible by roads, and has villages that are practicing traditional living that keeps them isolated from modern civilization. Still, there are some wild response distances! The call volume on Santo is roughly 4-5 calls per week. If you are a fan of musicals, Rodgers & Hammerstein’s “South Pacific” was written based on experiences of American Soldiers stationed on Santo during WWII.

Efate’s population is approximately 66,000 with the majority living in or near Port Vila (51,000). Two units are based in Port Vila. The call volume on Efate is approximately 10-12 calls per week. Efate is roughly the size of Halton Region at 900sq Km. It also has a road that circles the entire periphery of the island making it somewhat more accessible by vehicle than Santo. Port Vila also has a volunteer Rescue Squad known as ProRescue. More on them later!

We leave Canada on New Year’s Day. We fly from Toronto to Los Angeles (5.5hrs), then after a 3.5hr layover fly to Nadi, Fiji. That’s the biggie at 11hrs. We scheduled a four day stopover in Fiji which will allow us to get used to the time and climate change…and SEE FIJI! That’s it for now. Lots more to come! In the meantime, feel free to go back and read our old blog posts!

Grant & Miriam

Dress Rehearsals with Lucas

The largest contribution we are making in Santo is in regards to education. The call volume is not high compared to the original station in the capital, Port Vila. People on Santo are still getting accustomed to the concept of prehospital emergency care. Our station came online in 2014 and ProMedical Vila was founded in 2004.

We spend most of our on duty time covering many topics with Nathaniel and Yvong. Yvong works opposite of Nathaniel and us, but has been coming into the station most of his days off to participate in training and scenarios. The students also have the benefit of internet access while at the station which is necessary for their online didactic education and research. We recently handed over some ECG workbooks written and donated by our gifted colleague Rob Theriault.

Yvong gratefully receiving Rob’s ECG workbook

Subjects we have covered while here include basic airway management, Bag-valve-mask resuscitator technique, hemmorage control of multiple kinds, cardiac arrest causes & management, neurological assessment and differential diagnoses, abdominal assessment and differential diagnoses, ST elevation Myocardial Infarction assessment and management, complications in obstetrics and more. Hopefully much will be retained as this has been an intense month. Both students are eager, taking good notes and photos of our white board work.

Miriam covering obstretical post partum complications with Yvong and Nathaniel

My favourite part of teaching is when we break out the equipment. The staff are fortunate to have relatively up to date equipment like Lifepak 12 defibrillators and Lucas mechanical CPR devices. We ran through many many cardiac arrest scenarios, with a combination of two or three providers and with/without Lucas. The consensus is that Lucas is our best friend! Air conditioning is scarce so manually doing compressions is gruelling in the heat. Also, with no more than two or three medics on scene and no backup, using the Lucas is essential in order to provide additional care like intravenous fluid and medications.

Station Manager Jerome starting an IV and Yvong on airway during a cardica arrest exercise in the training room

Recently Joe (the long term Aussie medic here) arranged for us all to conduct a joint exercise with Medical Santo. Medical Santo is a non profit charity from Australia that has provided an urgent care like service here for many years. They accept emergency cases and often can offer a higher level of initial care than the public hospital. ProMedical and Medical Santo are currently working on clinical guidelines for transporting to their facility and establishing a regular schedule for exercises. Our first exercise was a scenario involving an middle aged male who develops chest pain after two deep dives. The patient showed an ST elevation MI on the 12 lead ECG and then the patient collapsed. Miriam and I participated as Advanced Life Support providers as the students do not perform at that level as of yet. See some pics of the exercise below.

Yvong and Jerome initiating Basic Life Support

Backup has arrived…providing ongoing ALS care while preparing to move our “patient” with a scoop stretcher

Nathaniel, Jerome and Yvong working on egress to the ambulance

Getting ready to hand off to Medical Santo in their Acute Care Room

Much was learned by putting our scenario into motion

We really enjoyed participating in this joint exercise. Everyone was pleased with the results and both organizations are eager to conduct more in the future.

Both ProMedical and Medical Santo are pleased with this first exercise. There is already planning ongoing for the next one. We were happy to participate and see relationships being strengthened in this small healthcare community.

R&R in the South Pacific

We are fortunate to have some days off where we can explore this truly remarkable island. Here’s a few highlights of what is nothing short of paradise! Enjoy the photos.

Let’s start at our motel. Natapoa has been great. It’s a pretty basic unit, but there’s plenty to be thankful for. Consistent power, air conditioning, hot water, lots of water pressure and a comfortable bed are huge blessings! I (Grant) had none of the above in Haiti! It really helps get your energy back coming back to this after a long day working in the heat. I know, nobody reading this has any sympathy for us! We are glad to be missing a cold and snowy January.

Cooking here is a bit of a challenge. We have a single gas burner. No oven, toaster or microwave, but we have adapted and make it work. The kitchen also has an apartment sized fridge. We started out with simple meals like pasta and sauce, and then took on more complex ones like stir fry’s and chicken peanut curry.

The grounds of Natapoa are beautiful.

We have so many places to spend time off. Below is a collection of photos highlighting our adventures:

Aore Island Resort. A 15 minute boat ride from Luganville

Flowers from the “Fish Poison” tree on Aore. The pulp from these trees can be ground up and placed in water to stun fish

Hammocks are Miriam’s favourite way to lounge!

Getting ready to take a traditional canoe ride up the Riri River to the Riri Blue Hole. Our student Nathaniel was kind enough to offer to be our tour guide on this day.

Incredibly clear waters on the Riri River

When we arrived at the blue hole we were yet again amazed at the beauty. If you ever have a chance to travel to the South Pacific, do it and come here to Santo!

Nathaniel waiting for us at the Riri Blue Hole

Time for a swim in the crystal clear fresh water at Riri

Heading north on the east coastal road towards Port Olry

Port Olry Beach. Nothing short of breathtaking. We made the acquaintance of a friendly sea turtle who kept swimming by. I couldn’t get a good photo of him.

We actually walked to that island on the right along a sand bar and got roasted in the process!

Freshly caught and boiled lobster prepared for us on the spot at Champagne Beach

We took an excursion to a place called Mount Hope Waterfall. It’s an hour long jarring drive north of Luganville. Apparently the area is owned by none other than Cate Blanchett. The story we heard is that when she visited Santo she bought 3000 acres including the waterfall and adjacent river. This spot is the most amazing one we have seen so far! Our guides kitted us out with life jackets and gloves and encouraged us to take a 4m jump into the river to start our experience. We chickened out and opted for the smaller jump….Once in the river we floated for 40 minutes along the most gorgeous river. Again, crystal blue water, but this time we were in a channel lined with limestone, stalactites and beautiful foliage. It was surreal. It was better than any elaborate amusement ride anywhere! A friendly Aussie tourist took a few pics of us with his GoPro:

It was difficult to capture the beauty of this place, and the lighting didn’t help. Those are rock out croppings lining the channel!

At the end of our floating ride down the river we traversed up the waterfall. It wasn’t overly difficult.

The expedition group. The trip’s highlight to date!

Trips the the market in Luganville can yield some epic produce!

There’s nothing like a South Pacific sunset to relax you. This is from the Deco Stop Lodge resort which is a half kilometre walk from Natapoa. They have a great pool and restaurant to go along with a million dollar view.

Yep, we are having fun! The weather for the first two weeks was much better than expected. It is rainy season and January typically gets over 300mm of rain. The last week it has returned to the norm with daily deluges. Usually there is a break in the rain and we can get out for at least an hour or two and explore. Thanks for following with us on this incredible journey. There’s much more to share. Stay tuned!