So what’s it like? How does it all work? We will try to answer some of your many questions through this post, and compare and contrast this system with our Ontario experience.

We are normally working four days on, four off. We meet up with the staff we are relieving typically by being picked up at our motel in the ambulance. Yes, my (Grant’s) three minute commute in Milton has been outdone! We take a brief report from the previous medic and then drop him or her off at their home or place they’re staying and then head into the station. The station is only about a four minute walk from the motel. The reason we meet up at the motel is that the person we are relieving was on call the night before and took the ambulance home with them. We typically will relieve the visiting Paramedic. The Ni-Van Paramedic students have the other ambulance and spell each other off in the same manner.

After heading to the station we meet up with Nathaniel and we start off by performing vehicle checks on both vehicles. The frontline unit is the Toyota Land Cruiser. It definitely lacks the work space of the Isuzu, however the Land Crusier can go places that the Isuzu cannot. Most treatments have to be initiated on scene as there’s just not that much room in the Land Cruiser. There’s also only room for one medic in with the patient. Prior to departing scene we need to be sure that we have the supplies and equipment that we will need for the trip, because once we are en route we cannot access the bags!

The Land Cruiser is known as “QAS” because it was donated by Australia’s Queensland Ambulance Service.

The Isuzu is known as “Survivor”. Nobody seems to know why it’s called that. I don’t mind, it was a great 80’s band! 🎸

Vehicle checks are pretty much the same as home. Check the defibrillator, change the batteries, charge the suction units and LUCAS 2…..yes, we have a LUCAS 2! For those not in the know, the LUCAS 2 is an electric CPR device. It is carried by a handful of services in Ontario, but not where we work. It’s really a need given that CPR is not as widely taught here and we have no backup on calls. Another nice device carried here is the Seldinger Surgical Airway. Most superior to the 14g IV catheter used at home! I’m glad that I have been previously trained in it’s use.

We count our drugs and sign our narcotic check sheets just like at home. We have nearly all the drugs that we have at home. Drugs we don not have here: Dopamine, Calcium Gluconate, Gravol, Benadryl, Toradol, D50W. Some drugs that we carry here that we do not carry at home: Ceftriaxone, Dexamethasone, D10W, Furosemide, Ipratropium Bromide, Lignocaine 1%, Misoprostol, Ondansetron, Prochlorperazine. The supply chain is weak, and at times we will not have a given drug. Sometimes the staff will get some sent over from Port Vila if they have any surplus, otherwise it is purchased from the least expensive supplier. Some of our meds are Spanish. As long as it is labelled in a recognized manner, it can be used. “Adrenaline” is used as an inotropic infusion in lieu of Dopamine or other pressors. It is mixed on the fly so your math better be up to snuff! Other equipment that is carried both her and at home: CPAP, 12 Lead ECG with NIBP, end tidal CO2 and SpO2 (Lifepak 12), KED, Scoop stretcher, SAM splints, Laerdal portable suctions, rigid collars, Bag Valve Mask resuscitatiors, OB Kit, Intraosseous Needles (no gun), CAT Tourniquets. In addition to the LP12, we have a Laerdal Heartstart AED as a backup defibrillator. For stretchers we have two different Ferno models, both are roll in cots, and both are old. Alas, no power cots for a month! There is a wheeled folding chair in Survivor that’s good for tight spaces but it is not a “stair” chair.

The trauma supplies are superior to home. We have an array of bandages including “Coban” style self adherent bandage, elastic bandage and non adherent dressings. Current burn care practice here (and in Victoria) is to cool them and wrap them in Saran Wrap, so that’s pretty much the extent of our burn kits.

Dispatching is pretty simple. Pro Medical is contacted by dialling 115. Calls are sent directly to our primary cellphone, which is typically carried by our Ni-Van student. They obtain the patient’s location and complaint and we are on our way! No middleman! No “Positive for FREI with the shakes”, no “Shortness of Breath” tacked on to a simple back pain call! Unfortunately in Ontario, calls are over prioritized constantly which places legitimately critical patients at risk of not getting an ambulance when they really need it. My dispatcher friends know this, but are stuck working with antiquated algorithms. If our student doesn’t answer the phone within 5 rings, the call is then forwarded to the backup phone, which is normally carried by the visiting Paramedics. This comes into play during on call hours. If we cannot understand a caller, we have two options. The first is to have them call back and try for our student again. The second option is to track down someone who speaks Bislama to translate, and possibly also navigate us to the call!

Getting back to the daily routine, after vehicle checks are done we have been doing training with Nathaniel. We have been using our calls as teaching points to leap off from. So far we have covered a variety of topics including neurological assessments, basic airway management, chest assessments/auscultation and IV starts. We also have been asked by Joe, the long term Australian Clinical Paramedic here to emphasize a consistent approach to patient assessment. They use similar mnemonics to us for this – ABC, AVPU, SAMPLE, OPQRST, numeric pain scale etc. Nathaniel is a strong student and it’s a lot of funnhelping him grow. I may or may not have been an IV training manikin last week! 🤫

Responding to calls here can be a little complicated. Many times we are faced with extensive distances and unpredictable road conditions. A few months ago Nathaniel and his Aussie partner were responding at night to a call on a dirt road that had been washed out by flooding after heavy rain. They had limited visibility and nearly went over a newly formed cliff while traversing this road 😬. Sometimes we have to rely on the student’s local knowledge to decide whether we make a long response at night on unpredictable roads.

Traffic on Santo is light and getting around cars isn’t tricky. They yield exceptionally well for the flashing ambulance lights and the siren is rarely required. Our students have been well trained in emergency driving and fully understand the principles of being prompt but safe, and that care cannot be provided effectively en route hospital if the vehicle is bouncing around too much.

Below are a couple of photos of a call that we did last week. We were called for a 21 year old female who was experiencing acute abdominal pain. She was on the northern half of the island so the caller was driving her southbound on the coastal highway with his four way flashers on to rendez-vous with us. About 20 minutes north of town we spotted them and we turned around. We used their pickup as a blocker vehicle to protect the ambulance while we unloaded the stretcher and packaged the patient. There isn’t really any shoulder on the coastal highway or any other roads for that matter. After loading the patient onto the stretcher Miriam performed an abdominal assessment of the patient and then we loaded her into QAS.

While Nathaniel and Miriam worked on the IV, I drew up some Fentanyl to help make our patient more comfortable. After the IV was in place I handed Miriam the meds and we started our trip to Northern Provincial Hospital. En route I gave them a call and updated them on our patient. Did I mention that the air conditioning doesn’t work in either vehicle? 🥵

On arrival at NPH we bring our patient right into the ER and offload immediately! That is not like our Halton hospitals! A breath of fresh air in a stiflingly hot place! Miriam then gives a brief report and completes the Patient Care Record.

Pro Medical is a non profit organization, however it must charge a fee for service to exist. Patients understand this and generally pay willingly. The cost for a Vanuatu citizen for a basic response and transport begins at 20,000 Vatu. 80 Vatu is equivalent to a Canadian Dollar. However an annual subscription is only 3000vt for residents, so most people opt for the subscription after their first call. Some companies pay for their employees’ subscriptions. There are additional charges for various procedures as demonstrated below, but subscribers get a 50% discount off of procedures. Typically a family member will attend the station after the call to pay.

Quality assurance is overseen by the Australian Clinical Instructor Paramedic. Joe is currently in his third of an eighteen month placement here as part of an Australian governmental volunteer assistance plan. Joe audits 100% of the Patient Care Records to ensure care is being provided as per the Ambulance Victoria standards. There is no medical control or base hospital patching. All treatments are covered off by the AV Directives, even termination of resuscitation.

End of the day comes at 5pm. Leading up to that we ensure that we have restocked anything we have used, that is if we have it in stock. Then we clean the vehicle and head home with QAS. The on call student takes Survivor home. Usually after a shift we are pretty sticky so it’s straight to the shower and then some cooler comfortable clothes in the motel room while we prepare dinner. We can go out to dinner or to a resort while on call, however we must have our phone and uniforms with us at all times. So far we haven’t been that brave!

How did this all start? Well, we are still learning about that, but basically it was started in Port Vila on the island of Efate by an Australian Paramedic in 2004. Everything at that time was procured from whatever sources were able to donate the supplies and equipment, mostly Australian State Ambulance Services. The station in Santo wasn’t opened until 2014. Now revenues are received through corporate sponsors and individual Ni-Van subscribers. We hope that we have answered may of your questions with this post, and we sincerely hope that we have peaked the interest of our Paramedic colleagues in Canada enough to make you consider coming here to serve! You won’t regret it. Please send us a message via Facebook or at our emails: grant.rumford@gmail.com or miriam.rumford@gmail.com for more information!

Stay tuned for more blog posts, including what a day off looks like!

We were picked up by Joe in the ambulance Monday morning at 8. We headed over to the station and met Nathaniel. We will be paired up with Nathaniel for the entire time that we are here. Nathaniel was born and raised on Santo. He has a wife and two sons, aged 8 and 18 months. Nathaniel spent three years in Fiji taking a Radiology program and then returned to Santo to work as a Radiology Tech at the Northern Provincial Hospital. He enjoyed his work, albeit routine most of the time. A year and a half ago Nathaniel’s mother had a debilitating stroke. He decided to take a leave of absence from work to take care of her. That included escorting her to the capital, Port Vila on the island of Efate where she was partially rehabilitated. Nathaniel eventually had to quit his job because the hospital would not extend his leave of absence. He returned to Santo with his mother and considered his future career options. Unbeknownst to him, his wife had heard of a job as a Paramedic Student with Promedical. She filled out an application for him and submitted it without telling Nathaniel! He was shocked when he was called for an interview! Upon going to the interview and asking some questions, he quickly realized that this was a perfect fit for him. He got the job, and his first day was exactly one year prior to our first day working in Vanuatu!

There are three Paramedic Students in Santo and four in Port Vila. Each one is completing an online Australian College Paramedic program which takes approximately two years. They recently learned that they will all be sponsored to go to Australia for field preceptorship where they will get road experience with Australian medics! In the meantime, they are mentored by visiting international Paramedics like us. While not on calls, we will be covering many topics, from primary & secondary assessments to basic first aid, airway management, IV insertion and beyond.

Nathaniel took us to see the two facilities that we will be transporting to. Northern Provincial Hospital is the only public hospital on Santo. They have approximately 300 beds, including a Paediatrics ward, Tuberculosis ward, Emergency department, operating rooms, outpatient clinics, lab, X-Ray and Ultrasound. There is no CT scanner or MRI anywhere in Vanuatu. Nor is there any cardiac surgery like angioplasty or pacemaker insertion. Typically when a patient is brought into the ER there is only a nurse present. Doctors are called into the ER from the wards as required.

The other facility that we transport patients to is a clinic called Medical Santo. It is a private not for profit clinic run by The Churches of Christ from Australia. Medical Santo has some Ni Van staff, but are largely staffed by volunteer international healthcare professionals. They do not admit patients, but they do receive emergency cases and manage them at a higher level of care than NPH. Normally Ni Van patients request to go to NPH whereas visitors with insurance are taken to Medical Santo. There they can be stabilized and held until air medical evacuation can be arranged. While visiting there we were told of a patient who was recently brought in having a STEMI (heart attack). The clinic had thrombolytics on hand and treated the patient immediately. He is doing well and was discharged home with minimal heart damage! Unfortunately most Ni Van cannot afford this level of care. Medical Santo also does remote mobile medical clinics which see patients that cannot get to Luganville for treatment and have no local medical care.

We ended our first orientation day with some wheel time in the Land Cruiser ambulance. This is the part Miriam and I have been dreading! A right hand drive, manual transmission vehicle operated on the right side of the road! 😬 Thankfully it went better than expected, mostly due to our great driving coach and coworker Rachel! She sacrificed her clutch for the cause last month as we got used to the manual transmission.

Next time….the trucks, the equipment and how we get calls!

Hello from Vanuatu loyal followers! Lots has happened in a week! This was supposed to be already posted but wifi is not great here….anyhow, Sam and Maddy delivered us efficiently to the airport New Year’s Eve and we had a smooth flight to San Francisco. Once there we enjoyed the KLM airport lounge for a couple hours, then saddled up for the big jump.

Our 15 hour flight went on and on, but without a hitch. We were impressed by United, the staff seem exceptionally friendly and attentive. I suspect that they are trying hard to rescue their reputation after a couple of bad stories in the media. We had next to no sleep on that flight, so by the time we got to Sydney we were zombies. Thankfully our hotel was able to accommodate an early check in so we crashed for a few hours. Then it was time to explore Sydney! We had four great days there!

On Sunday morning we got up at the crack of stupid (04:00) to start the trek to Santo. Santo is the island that we are serving on. It is the largest land mass, roughly the size of Halton, Peel and Hamilton combined. It is the second most populated island at approximately 40,000 people. Our first flight was to Brisbane, then on to our point of entry into Vanuatu, Port Vila. It was really great to finally arrive in this country! My first impressions were that it was similar to arriving in Haiti, without the craziness of the Port-au-Prince airport. The land looks very similar, and the people very friendly.

It took a little wandering around to find the domestic terminal. It’s a separate building from where we landed. It’s really quite small and old school.

Once we landed in Santo we were amazed that the airport could be smaller than the domestic terminal in Vila. We entered, looking for signs for the luggage pick up area. We wandered around for a minute only to realize that we were already there…..no luggage belt, just some guys throwing all the bags into the arrivals room!

The luggage was distributed in record time and then we headed out the front door, approximately 60 feet from the luggage area/arrivals gate. We were met by Joe, who is an Australian Paramedic who is here for an 18 month rotation. He is working alongside Jerome, the Ni Van station manager in Santo. He’s also overseeing the education of the three Ni Van Paramedic students in Santo. Joe picked us up in th ambulance as he was on call!

We got settled at the Natapoa Motel and grabbed dinner at the local Chinese restaurant. Now I make a habit of not eating at Chinese establishments outside of the GTA, but was I ever hungry! It was quite good! And no GI aftermath, so I think we will return! Stay tuned for another post soon outlining our first couple of days at work!

We have finally run out of things to do! We have packed and repacked, purged the fridge, given instructions to the great fam & friends taking care of the house, painted toenails…..NO, not Grant!

The last supper was the yummy leftovers from Mom’s Christmas dinner! A special thanks to my old friend Shawn for collecting some greatly needed supplies! We are at the weight limit for most of our flights and unfortunately quite a bit over for the last one. The Air Vanuatu flight was booked after the fact as our assignment changed. The downside besides the cost is that the last flight is a domestic flight, and there are much lower limits to baggage weights. We have a letter from Promedical explaining that we are carrying lifesaving donated supplies, but no guarantees that it will keep us from those nasty overage fees……

We opted for a duffel over a second rolling suitcase to maximize the weight we are carrying. Who needs wheeled luggage eh? 😬

We hope that we have everything we need….We do have four days in Australia which is great! We can adjust to the different time zone and have a little fun before hitting the ground in Vanuatu! Lots of photos and stories to come!

We have been getting asked loads of questions, so we decided to give you a little more information on what we know about Santo, and how we are getting there. I’ll start with the latter. First off, it really helps when you have a friend that is a travel agent. Debbie at Noecker Travel in Elora is excellent and highly recommended for your travel needs, especially if they are complex like ours are. You can find her here: 

http://www.noeckertravel.com/ 

So we start at good old Pearson International at 4:20pm New Year’s Eve. We hope to sleep in that day to stagger our sleep pattern a little. I’m kind of skeptical that will work given our anticipation! The first leg we get warmed up with a 5h 50min flight to San Francisco. There we have a three hour layover where we hope to relax and enjoy their airport lounge until the big jump across the Pacific. At 11:05pm Pacific (2:05am Miriam & Grant time) we head to Sydney. Fifteen hours later we arrive in Sydney, where it will be 09:05am, January 2nd! To say that we hope for a long sleep on the flight is an understatement of global proportions! 

So yeah, SYDNEY! 🇦🇺 🌞 If you have to travel through Australia, you HAVE to at least see a little bit of it right??? We are stoked about having four nights there to see some sights and tick a few boxes off of our bucket list! Our friends Tom and Jane have given us a few pointers, but if you have suggestions, please pass them on! We are definitely going to check out the Taronga Zoo, the Blue Mountains and some local beaches. There’s also an old amusement park alongside the harbour that is tempting me! 

Once we get our taste of life down under, we start the next leg of the journey. On January 6th we make our way to the island of Santo in Vanuatu. We start at 8am with a 90 minute flight to Brisbane, followed by a 2h 45min flight to the Vanuatu capital, Port Vila on the island of Efate. After a short layover we have our fifth and final flight! Thankfully this last one is only 50 minutes long. We arrive there at 6pm. If you’re doing the math, yes, the total flight time heading down is 24h 55min plus layovers! 🤯 Thankfully we are doing this in two pieces both directions.

Once in Santo, we will be picked up by the local staff and taken to our accommodations. The visiting Paramedics used to stay at the station, however the station had to relocate and it isn’t set up to house people the same way. We will be staying in a local motel in Luganville for the month. By all accounts it is a good place, and we look forward to having a space of our own to enjoy during our time off. 

A neat fact….we will be on call at the motel after 5pm, so we take the ambulance home with us! Another neat (and terrifying) fact….we are the responders and the call takers! Yes, the “115” emergency line is routed directly to the crew on duty or on call. We will see how that goes! 😬 English is commonly spoken, but there are many people who don’t speak it. The other main languages are French and Bislama. Advice from another medic who has gone before us is to grab a local to translate the call details, and to take them with you to the call if there’s confusion on where you are going!

There isn’t any backup from what we know. There is no rescue service offered. I’ve been told, “It’s you and the police department”. Stay tuned…

Here’s some photos of the local vehicles. As this is an Australian initiative, the in service vehicles and equipment are Australian surplus. That means right hand drive and manual transmission! Thanks to our friend Rachel for our stick shift refresher course!

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Our medic friends have asked about what directives we will be working under. We will be using the Ambulance Victoria Medical Directives. There are many similarities, however there are some differences. A lexicon is required to translate much of the terminology. The short forms are particularly foreign. If you’re a geeky medic like us and curious, click on the link and see for yourself….426 pages of light reading: https://www.ambulance.vic.gov.au/wp-content/uploads/2018/07/Clinical-Practice-Guidelines-2018-Edition-1.4.pdf 

The hospital. There is one government operated hospital on Santo, Northern Provincial Hospital which is  located in Luganville. We have learned that they have an emergency room, obstetrics, paediatrics, a Tuberculosis ward and general medicine and surgical wards. Overall there are 100 beds. Diagnostics include a laboratory, X-Ray and limited Ultrasound services. There is also a hyperbaric chamber due to frequent diving related injuries. See photos below.

There are some other clinics located in other areas of Santo. We don’t know much about these yet, but from what we gather we are more likely to pick up patients there versus taking patients to them. We know that some of these are Maternity birthing clinics. Here is an example:

We will finish off this post with a few photos of Santo. Truly breathtaking!