The class was a real challenge. Most of our students had no more than a ninth grade education; some none at all. Several could not speak or understand any English. None of them had any prior medical training, even those with 10 or more years of ambulance service.
At the end of the first day they were unusually quiet when we asked them questions. It was not clear to either of us whether they understood what we were asking or were just being polite. Either way, we realized that we needed to make some adjustments. The following morning and for the rest of the day things went much better. Most everyone seemed to have a satisfactory grasp on what we were trying to do as evidenced by their performances in patient assessment drills and practical sessions. A class like this one raises the question of how do you teach and then evalaute people speaking a different language and/or living in a totally different culture.
The students in the class truly were ambulance drivers. Except when transfering patients requiring a higher level of medical care, they generally travel alone or with one other person who has even less experience. On transfers, a nurse (“sister”) travels with them. At the scene of an accident, unless they can get help from bystanders, they must access, extricate, and carry their patients to the ambulance and then transport them to hospital singlehandedly. They have spine boards but no collars or straps. Sometimes they carry oxygen. They only have medications when traveling with sister. Cardiac monitors don’t seem to be used much. With no airmedical assets in Bhutan and given the underdeveloped road system, transport times outside of the larger communities to anything more than basic care regularly exceed 8 hours. This certainly qualifies as wilderness. I think we have something to offer them.
India has provided them with some new ambulances and has offered some EMS-type training but nothing has materialized on the latter front. EMT-basic training or above is not likely in Bhutan in the near future and I don’t believe that those standard curricula would meet their needs right now anyway. There were at least 6 students in the class who really understood where we were going as evidenced by insightful questions and solid performances. I would love to see two of them take one of our month-long EMT/WEMT or Canadian Wilderness Emergency Medical Responder (WEMR) courses in either the US or Canada and then attend an IT, followed by some apprentice teaching and EMS work in N America. Then based on the experience and knowledge gained, they could return to Bhutan and teach a curriculum that would really make sense for their marathon transports. A WAFA-level program would make sense. Certainly considerably less time could be spent on some of the thermoregulation information and more on pregnancy and delivery; a more practical approach to spine management and less emphasis on N American problems like MIs (apparently unusual here). In fact, labor and delivery was the one topic they wanted to hear about that we had not planned on discussing. Somewhere between a third and a half had attended out-of-hospital deliveries. We did our best to oblige them.
After a travel day on Monday, we have 2 days for some medical recon and course preparation for a WAFA.