After a brief introduction we had our first call, and made our way some distance out of Queenstown to a remote location for a patient experiencing shortness of breath. En route we discussed the similarities and differences between South Africa and UK ambulance services. The density of population in London, the small geographical area, the resources, training of staff, levels of equipment and speed of response were all of interest. To me, it was not the differences between our services, but rather the similarities that became apparent. As we had sat in the crew room before our first call, the TV on with no-one really watching it, laughing, joking and complaining, it could have been any ambulance station in the world. So too en route to the call, we discussed the inappropriate calls we had attended, how ambulances are treated like taxis and I think we realised our own problems were far from unique to our own countries.
Once we arrived at our destination we were met by our escort party who took us down to the small ramshackle hut where our patient was waiting. We looked for an entrance, but found only a small gap in the fencing, through which we had to climb. Our attendant remarked that it had best not be a stretcher case, for there was no easy way to carry someone out to the ambulance. How often much the same remark has been made in small blocks of flats in cities across the UK.
I followed the crew into the hut and watched as they set about taking a history and assessing the patient's condition. He had experienced some sort of allergic reaction from an unknown cause and once the crew had determined that he was stable, he (thankfully) declared himself fit to walk to the ambulance.
Once on board, I was handed the keys and told I could drive for the rest of the shift. Opportunities to drive an ambulance in the Eastern Cape do not present themselves often, so I gladly accepted and did my best to provide a smooth journey to the Frontier Hospital in Queenstown, where we handed over our patient in Casualty. We then were allocated some local transfers from a clinic in the township and while en route were asked to attend a small boy who had a suspected fractured arm. We arrived at the clinic to find our original patient had left, but were given another instead since we were there (could never happen in the UK...honest) and then made our way to the little boy who had been playing a little too rough. It was close to the shabeen the GSE team had visited the previous day and we were again met at the end of the road and directed to the patient, a small lad nursing an arm that was not quite the right shape. Amid the very impoverished and run-down setting, the crew chatted away in the back of the ambulance, laughing with the child and his mother and made me feel that if we had transported the ambulance and its contents to anywhere in the UK it would not have been out of place. There is something unique about pre-hospital care in that irrespective of the location or the patient, the focus is solely on helping someone in distress, making best use of the resources available and it was a real pleasure to watch the crew work. It would seem patronising to say I was impressed, for they are doing what we are all trained to do, to a greater or lesser degree, but I felt there was a common thread between us which it is perhaps easy to take for granted when going about my day-to-day work in the UK and it was so easy to fit into their way of working. No fancy vacuum splints here, but an excellent job was made of assessing and immobilising the limb using a frac-pac and a bandage. With a full ambulance, we made our way back to Frontier.
Once we had disposed of our patients to the appropriate departments and exchanged banter with the Casualty staff (something along the lines of "he's from London...no, not East London: London, England"), it was decided we were in need of a "shop stop" and it was necessary for me to have a 'fat cake' - the staple of the hard-working ambulance professional. I then proceeded under careful direction to the centre of town where we stopped and made our way to a nearby food shop to place our order. As is the tradition of any emergency services personnel worldwide, as soon you order any kind of hot food, a call will come in. Already prepared for this eventuality, my highly experienced crew had paid in advance and arranged to collect the order after this priority 1 call. And so we set off with lights and sirens to the post office for a collapsed male. Only speaking English I cannot say exactly what remarks were made about my emergency driving, but there was a very animated conversation and several bouts of laughter, usually co-inciding with my cornering late and at considerable speed, en route. A request was made subsequently to see my driving licence, under the pretext of comparing it with a South African version, but I am inclined to think some sort of wager had been placed as to whether I had one. Fortunately our patient was in a fit state to walk to the ambulance and after assessment was taken back to Frontier and we then resumed our food run, this time with success. After another emergency call which proved to be a no trace (am I actually back in the UK with better weather?) we then returned to station to enjoy our lunch (it seems not, because we made it back and ate it undisturbed - Waterloo kindly take note).
It was not long before we were sent out to the Zwartwater clinic in a remote area some 40 - 50km from Queenstown to transfer a boy to the Frontier. This rather routine-sounding job took a more complicated turn when the road up into the mountain disintegrated to the extent it became impassable, despite my best attempts to take the bumpy track at some speed. With a smaller vehicle stranded up ahead we had to wait for a local farmer to arrive with his Massey Ferguson and tow us up the hill. After two abortive attempts involving a steel cable that would not stay tied, we finally made it through, although from the smell of the clutch I should think the workshops will be giving the ambulance a once-over before too long. Hopefully I will be back in the UK by then and I shall deny all knowledge.
The heroic farmer refused any offer of compensation other than wanting some paper he could use to roll cigarettes and after much shaking of hands and smiles we continued on our way. After we collected our patient and took an alternative route back to Queenstown it was time to clean the ambulance inside and out in preparation for the night crew, which, in the best traditions of ambulance comradeship, I supervised closely from a safe distance.
My sincere thanks to all the staff at Eastern Cape Queenstown, in particular those who had to put up with me for the day. You are all very welcome in London to see what real traffic is like (sheep crossing don't really count). It has been a real privilege spending the day with you and while it may be true that the UK public health services have more resources, the staff in Queenstown were a pleasure to work alongside and I wish them all the very best doing a difficult job in difficult circumstances.
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