Administration and Leadership, Training

Waves of Health Helps Establish EMS System in Dominican Republic

Issue 12 and Volume 40.

Paramedic Neel Mehta, NRP, NJMICP, can be thousands of miles away from the Dominican Republic, but he still sees the faces of some of the lives he’s touched while working there on medical missions.

“On our first trip in April 2012, we had a very sick baby—less than a month old—who almost died,” Mehta says. “She presented with advanced malaise and was febrile. The hospital had told her mother, ‘You don’t have the money, we aren’t treating you here.’ After some of our board members were able to arrange a car rental, one of our doctors took her to the capital. The baby ended up living. But, I can tell you, I can close my eyes and picture two or three people, I’m sure, they’re gone because of whichever medical condition they had.”

Mehta doesn’t dwell on the lives lost, nor does fellow paramedic Keith Shipley, NREMT-P. Instead, they focus on the lives they’ve helped and how they can help more. Mehta and Shipley are two of dozens of volunteers at Waves of Health who’ve been making the trip to the Dajabon region of the Dominican Republic to provide healthcare. Waves of Health was created in 2007 by Clayton Everline, MD, and organized by Suraj Saggar, MD; Kate Hanify, MD; Humberto Jimenez, PharmD, BCPS, AAHIVP; and Chris Boni, MD. Everline, then in his last year of residency at Saint Michael’s Medical Center in Newark, N.J., wanted to help those less fortunate.

EMS headquarters for the Red Cross

EMS headquarters for the Red Cross needs additional funding to complete the construction and establish connections for electrical services and running water. This project has been in the planning process for the past four years.

The organization has two goals: help provide care during two weeklong missions each year and educate folks in the region about the medical challenges they face. Upward of 40 doctors, nurses, EMTs, paramedics, translators, pharmacists, instructors and others make each trip, all using their own vacation time and money to participate.

For Mehta, a state planner with the New Jersey EMS Task Force and based at Robert Wood Johnson University Hospital, his first trip to the Dajabon region was life changing. He got involved with the project after a cadet member of the Edison (N.J.) First Aid Squad 2 returned from a trip. Asked where he got his tan, the cadet told Mehta and others he was volunteering for a healthcare mission. That led Mehta, also a paramedic at University Hospital in Newark, and Shipley, a paramedic at JFK Hospital in Edison, to join the organization.

“It’s just so humbling to go down there,” Shipley says. “It was definitely an eye opener. I didn’t know exactly what I was getting into.”

“You get off the plane and it’s like you’re on vacation,” Mehta says. “You’re in the Dominican Republic. You see people in vacation mode. And you see our team and a row of 50–60 suitcases, all beat up and filled with medications. We started heading toward the border and that’s when it hit me. We were passing the resorts. This wasn’t going to be a vacation.”

EMS training for the Red Cross.

After intense days of training, volunteers from the Red Cross take part in a full-scale exercise. The team here used their own belts to secure a mock patient to an improvised lifting/moving device (a piece of wooden fencing). The brims of two baseball caps were formed around the patient’s neck to make a C-collar.

Although it hasn’t been a beach vacation for those who participate, it’s no less rewarding. During each trip, the team treats around 1,500 patients, many of whom would have no medical attention whatsoever. They see a variety of illnesses—some of them rare, some routine— and provide patients with 3–6 months’ worth of medication that’s donated through various programs here in the U.S.

CREATING AN EMS SYSTEM

EMS team members of the Red Cross practice spinal immobilization and rapid trauma assessments.

Team members of the Red Cross practice spinal immobilization and rapid trauma assessments.

Most recently, the Waves of Health team has been instrumental in the creation of the area’s first full-fledged EMS team. The idea was to make a long-term impact on the region that was more than just dropping in, fixing people and moving on, says Co-Founder and President Jimenez. “We ended up going and not knowing what we were getting ourselves into. It was a lot of work.”

Primary care and basic health issues were obvious shortfalls, but over time the healthcare professionals also found trauma was a big cause of death there, largely because the EMS system in parts of the region was rudimentary at best. If there was a trauma case, someone would call the local radio station, which would then send out a message to anyone with a vehicle to pick the person up and drive them to the hospital. There were private ambulances in the region, but most folks couldn’t afford the fees. A majority of the trauma patients bled out before getting real help.

“There was absolutely no clinical capability,” John Koerner, MPH, CIH, Waves of Health’s senior public health advisor, says.

These health issues led to a Waves of Health project to create a true EMS system. In 2012, Mehta and Koerner created a game plan and worked with Ildefonso Cruz George, the head of the Red Cross in the region, which oversaw EMS efforts. Koerner says the way to approach it was to teach the volunteers in the Dominican Republic basic EMS skills such as CPR, splinting and rescue skills, before simply handing them an ambulance and top-notch gear.

“We needed to build clinical skills over time, add complexity to their training and ultimately build out a 9-1-1 response system,” Koerner says. As a member of the Army Reserve with experience in Afghanistan, he has a background in getting local buy-in to a new idea and building new teams.

From my professional practice, if you want an intervention to be sustainable, it’s going to take time to build it out,” Koerner says. “We can provide all of the devices and the training, but in the end, if we don’t have the buy-in from our partners, or from the community, it’s not going to be sustainable.”

In this case, Waves of Health already had a good relationship with George. “I said, ‘Bring me 20 volunteers who all have the same hat and same shirt, with CPR and basic lifesaving skills,’” Koerner says. “‘Once you show me that, we’re going to start to lift the bar.’”

Within a year, the emergency squad jumped from nine members to 124.

With each successive mission, Waves of Health’s EMS unit has taught the volunteers basic skills and anatomy classes. Their third mission, which included a team of 11 volunteers from the U.S., focused on building the EMS system, was strictly focused on trauma care. Volunteers focused on teaching tourniquet application, bleeding control, splinting and bandaging, chest seals and CPR.

The emergency squad originally received an ambulance and enough equipment to provide care, but it was quickly looted and stripped of all significant tools such as a siren and emergency lights. The Waves of Health team has helped restock it and is now trying to locate the donation of a new apparatus.

EMS volunteers monitor a patient with chest pain and dehydration.

Volunteers utilize a LifePak 15 monitor lent to the team by Physio-Control to care for a villager with chest pain and dehydration.

The new EMS system was tested during a mission earlier this year when an elderly male patient presented at one of the Waves of Health treatment centers with chest pain and congestive heart failure. The squad made the 45-minute trip to the nearest hospital with the ambulance’s backdoor open, because there’s no air conditioning in the unit. It was the EMS team’s first real emergency transport.

“We were able to start an IV and take him to a local hospital,” says Shipley. “That was awesome. We were pushing it. And we realized we could actually treat these people.”

Today, the team responds to a variety of emergencies.

“They definitely provide 24-hour EMS coverage now, which they couldn’t before,” Mehta says. “They also have the motivation to do more stuff.”

Shipley says part of the satisfaction with the program is watching the responders in the Dominican Republic learn new procedures and then teach others

“We kind of give them homework,” Shipley says. “They then become pros at it and pass it along. We tell them, if people want to learn, teach them. Education is power.”

Koerner estimates most of the Dajabon volunteers working with the Waves of Health efforts are trained to be the equivalent of first responders in the U.S. with a couple of leaders at the EMT-B level.

“I think we’re successful because we’ve gotten through the first hurdle of starting something and getting people to believe in something,” Mehta says, noting there’s still room to grow. Future plans are underway to develop some form of a text-based dispatch system.

“The impact Waves of Health has made in the community is big,” says George. “They’re meeting many needs in a poor population, which is admirable effort and sacrifice by all the volunteers. Waves has been providing medical care and medications that may not be readily available to the poor. The EMS team has supported the Red Cross as well. They have helped us by providing new knowledge to improve our abilities as volunteers to this community.”

PERSONAL IMPACT

An EMT and paramedic transport their first patient for the Red Cross Dominican Republic.

After four years in the making, EMT Noel Saharig (left) and paramedic Neel Mehta (right) transport, in partnership with the Red Cross, their first patient after establishing the Waves of Health EMS program.

For Mehta, building the EMS system there is just the beginning. “I know the team and I are committed to returning ever year,” he says, “To train, triage, treat and lend a helping hand in any way we can.”

He can’t help but think of how much impact the team could have on EMS care in that region if they were there for a month at a time, rather than a week.

“I never want to leave,” Mehta says. “A week is too short. A week or two weeks is an awesome deployment. But you’re always thinking about that one person, that one kid who gave you a big hug, or that one geriatric person who invited you in to give you some food.”

Koerner knows the feeling. “When we’re there, we’re on the ground, we’re executing something we planned for six months,” he says. “It’s very intense. It’s hot. The running water is usually cold. It’s a fairly intense physical and emotional experience. I’ve run a lot of missions with various teams. There’s an emotional vacuum when you first come back. You’re trying to focus on work, but your brain is still stuck on trying the fix that one person you left behind.”

It does take time to acclimate himself back at home after a medical mission, Mehta admits, especially when working a shift on an EMS unit where someone is complaining about having to go to the hospital. That kind of attitude stands in contrast to those in the Dajabon area of the Dominican Republic, where quality healthcare is a challenge.

“You don’t take stuff for granted,” Mehta says of the impact the trips have had on him.

But the trips to the Dominican Republic with Waves of Health have had a positive impact on his work. In the Dajabon area, he’s triaged or treated patients with malaria and dengue fever, necrotized ankles from untreated burns and even treated a young girl who had loiasis, caused by a parasitic worm. These are all skills he can use back home in New Jersey.

The trips also helped refine his people skills, he says, because he’s needed to use a translator to speak to locals.

Fact is, after every trip he starts planning his next and how he might help boost the EMS efforts there.

“I’ve always been involved with community healthcare, but this was totally out of the norm,” Mehta says. “This was true medicine. Twice a year, this group provides the only healthcare in the region.”

“It’s kind of like going to summer camp,” he says. “You don’t know anyone when you get to the airport and by the end of the week you’re like family. You get to practice true medicine. You really feel like you’re making a difference. You get the satisfaction of saying you worked really hard that week and can’t wait to get back to work the next day.”

For more information about Waves of Health, including information on how to join an upcoming mission, visit www.thewavesofhealth.org.

More on Education & Training from JEMS.com.