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I mentioned in a previous post that we had to do conversion work on the house in order for Neu to do his dialysis at home, we sought help from the municipal government with the cost of this work and for a road to be constructed to the house which would facilitate the delivery of the dialysis material and benefit all of our neighbours as well. We also asked for transport to the clinic in Fortaleza three times a week for training.
Claudia (social assistance at the clinic) wrote a fantastic letter but warned us that it is very much a lottery, some municipal governments help with everything, others nothing at all. Unfortunately we have the nothing at all type and were told that as there is a forth coming election, the Prefeitor would not wish to be accused of buying votes, therefore the only help available was with the transport to Fortaleza, which is a right available to everyone. It’s wasn’t much but I was grateful for it, we wouldn’t have been able to pay for a taxi and taking the bus is complicated.
The small vans which are commonly used as ambulances here have a partition between the passengers and diver, with a small hatch that can be opened to allow communication between the two. In the back there is a trolley bed on one side and a bench seat on the other, a window runs down the side of the van beside the bed. Also a ventilator fan, light and a small oxygen tank, at least there should be.
The first day we travelled in the ambulance was just after Neu’s surgery, he was feeling very weak and as he had stitches in his belly, walking was painful and pretty much everything was uncomfortable. The ambulance was due to arrive at 6.30 in the morning to get us to the clinic in Fortaleza for 8.30.
At 5.30 I heard someone outside the house calling me, it was Maria one of the cleaners at the school, she said the ambulance had already arrived (the school is as close as they can get to our house) and the driver wanted to leave as we weren’t there, Maria told him to hold on while she came to tell us. If it hadn’t been for her, the ambulance would have gone and we wouldn’t have made it to the clinic.
At the ambulance, the driver asked if Neu needed to lie down or could he sit, Neu said it would be more comfortable if he could lie down. The driver opened the back doors and where the trolley bed should be, was just a mattress on the floor. The head end of the mattress was propped up, we assumed with some kind of fixed support, so Neu went to lie down. As he did so the head end of the mattress doubled over backwards under him at about shoulder height. Neu struggled to get up again and we lifted the mattress to see what had happened, under it we found a metal T shaped post about 6 inches high and 4 inches across at the top, sticking out of the floor, it should act as a stop for the trolley bed that was missing. By shuffling down and lying with his knees bent, Neu was just about able to lie on the mattress with his head resting on the post, not exactly comfortable but better for him than trying to perch on the very narrow bench seat. We were grateful for the ventilator as the van got incredibly hot during the trip into Fortaleza and on the journey home later in the day was worse.
Two days later a different ambulance driver arrived; on time. He said he would have arrived earlier but he had gone to another community to pick up the other two passengers who would be coming with us, they hadn’t been there so he had come to us and would go back for them on the way into Fortaleza. This ambulance had a trolley bed but it was missing one leg and was propped up with a rock, the window glass was missing and the back doors were kept shut by a simple latch lock (the sort of sliding latch that you would use on a cupboard door) crudely fixed in place. As the glass was missing from the window, everything in the back was covered in a film of dust. There was no ventilator and no oxygen bottle. The bench seat was narrower than normal, in fact it looked to me like the back rest and bench seat had been swapped over at some point, the seat was so narrow it was almost impossible to sit on and was very uncomfortable.
We picked up the other two passengers, Natalia and her mother. Natalia is 16 years old and suffers from cerebral palsy, the driver said she should sit in the front with him but this was clearly not an acceptable idea so Neu went to sit in the front and Natalia, who isn’t strong enough to hold herself upright without support, lay on the bed in the back. As the widow couldn’t close and the sun was rising, Natalia had to have towel laid over her face for the best part of the journey to keep the sun off her. Every time we took a left hand curve, the bed would tip sideways putting Natalia at risk of being dumped on the floor. Natalia’s mother and I spent the journey trying to remain perched on the bench, keep the towel over Natalia’s face and the bed upright. Natalia kept asking me if I had accepted Jesus into my life, perhaps she felt we needed added protection.
At the clinic, the driver opened the doors for me to get out. Neu was still sitting in the passenger seat; I asked him if he intended to stay there, why wasn’t he getting out? He couldn’t open the door, no handle! There was also no seat belt and the seat of the chair had collapsed so that Neu sank down in it until he felt like he was sitting on the floor; the journey hadn’t been comfortable for him either.
The journey home was incredibly hot and the bench was torturing my backside. When Natalia and her mother got out, I lay on the bed, thinking it had to be more comfortable than the bench seat. As we drove home I tried to imagine the vibrations that were thundering through my body where some kind of massage, no doubt there are people who would pay for treatment like that; I just had to remember to keep my jaws clamped shut to stop my teeth from shattering. I can’t imagine how Natalia must have felt after 2 hours of non-stop rattling about on that bed. As her mother said, for a seriously ill patient, being in that ambulance would be enough to make them give up the will to live.
That night I put up on face book that Neu and I were taking bets on what the condition of the next ambulance would be, one of my sons who lives in England said it would have no bed, no seatbelts and holes in the tires.
Two days later my alarm went off at 5.30 and as I switched it off, I thought I could hear someone calling my name. Opening the door I was greeted by another ambulance driver who said he had been sent from a neighbouring community to pick us up, the ambulance that should have picked us up had broken down (now there’s a surprise). He didn’t seem best pleased that we weren’t ready until I explained to him that he wasn’t meant to arrive for another hour. He said the driver of the other ambulance had told him 5.30 so he just asked that we got ready as quickly as we could and he went back to wait for us.
Neu walked slowly to the ambulance while I took our son over to his Grandparents.
At the school the driver was standing to the side of the van talking on his phone, Neu was standing by the open back doors, a big smile on his face, signalling for me to look inside. There was no bed, not even a mattress on the floor. I burst out laughing; for all but the tires which thankfully were ok, my son had won the bet!
The driver got off his phone when he saw me coming but looked somewhat bemused by me and Neu laughing, he saw the funny side when I explained to him about the bet my son had laid. The driver said that he had taken a seriously ill patient into a hospital in Fortaleza; the hospital had said they were short of beds and would not accept the patient unless the driver left the trolley bed for the patient to lie on. He’s repeatedly asked for a new trolley bed but has never been given one; he said most of the ambulances are the same. Inside the ambulance was a sign which should have said USE O SINTO (use the seatbelt) some of the letters were missing and so were the seatbelts. There was a fan which Neu switched on, only to nearly leap out of his skin with the noise it made, we felt it safer to switch it off again.
One of the services the clinic provides is a Psychologist. We, including our eight year old son, were due to see her on the Friday. I went into Beberibe on the Tuesday and spoke to the lady from Social Assistance to ask if they could send a car for us that day, I wasn’t prepared to risk my son in one of the ambulances, we had yet to be in one that had working seatbelts. I was told they would definitely send a car.
On Friday morning despite the promises, an ambulance arrived. The driver said he was sorry and understood why I was unhappy, he showed me the paper with our names on and the time he should pick us up, there was nothing on it about needing a car. He had a working seat belt in the front so our son had to sit there, not ideal but as there were no seatbelts in the back and no time to wait for another car to be sent, we had no choice. This ambulance also had no bed or mattress but it did have a light that worked.
Another trip to the clinic and yet again we were woken up by someone calling for us at the gate at 5.30, this time two men who treated me like I was a complete idiot. Telling me they had had to leave at 4 in the morning to reach us as they’d had a very long way to come, all the way from Beberibe (maybe they were pushing the ambulance, it normally only takes 40 minutes maximum) and that I had to understand Neu wasn’t the only patient they had to pick up. I told them that obviously I understand they have other patients to transport but I had spoken to their supervisor only last week who had assured me that they should not be arriving until 6.30, that was the time marked on their sheet. The men said the equivalent of “No love you’ve got it all wrong, they send us out to arrive at 5.30 love, you don’t understand” (because you’re a foreigner / woman), condescending sods they were. I told them Neu was still asleep, I would get him up and be there as soon as possible but I wasn’t prepared to rush him, they stomped off looking anything but happy.
This ambulance was probably the worst to date. Once again the glass was missing in the window; the fibre glass shell of the van was split in places with pieces missing under the window frame where it was badly rusted. The rear shock absorber was visible through a hole in the top of the wheel arch; its cover that should have been screwed in place was missing. The door handles where improvised and there were wires tied in a knot, protruding through two holes to one side of the door that were holding something in place, possibly the tail light.
The driver, now with a friendlier tone, said he had tried to make it more comfortable by putting two mattresses, one on top of the other and that Neu should lie on those. We just had to wait a few moments for the other passenger who had gone to change her baby. A few moments later Maria arrived with her 6 month old baby.
Maria perched on the bench seat alongside me, her baby girl in her arms. Maria said she was taking her baby in to see a Neurologist, at six months her daughter was not doing the things she should have been doing at 3, the baby had suffered from convulsions when she was smaller and they were now trying to assess the damage done. Maria was very unhappy at having to travel into Fortaleza in the ambulance, it was filthy and amongst the problems her baby has, one is a risk of Pneumonia caused by her having a permanently open throat, Maria was concerned that the heat and dust in the ambulance would be detrimental to her baby. Normally transport sends a car for her, she has a baby seat which she can strap in but she couldn’t use it in the ambulance because none of the seat belts worked. Maria lives closer to Bebribe than we do, why the driver had picked her up first was a mystery to us all. Our appointment was for 8.30, Maria’s for 9 o’clock, so absolutely no need to pick her up at 5. No she was not happy.
I was glad to help when she asked me to hold her daughter for a while, the effort of holding and protecting the baby as the van lurched about in the traffic was nerve racking to say the least but thankfully we arrived at the clinic, if not relaxed at least without incident. Maria told us that is she could, she would find an alternative way to get back home, and she must have managed as we didn’t see her again.
Maria had said she intended to complain and I said that I would complain on her behalf, I was not happy that they had not sent a car for us on the day we had to take our son in, adults having to travel like that is one thing, children quite another and a baby, well it goes without saying.
As I was out walking the dogs, I got a call from the lady from Social Assistance wanting to check if we really needed transport for Wednesday, it’s a holiday in Fortaleza and surely the clinic would be shut. It might be a holiday for office workers but a dialysis clinic has to remain open, so having confirmed the transport I made my complaints : Why do the drivers keep turning up at an hour early, Why did we get an ambulance when we had been promised a car and How could they send an ambulance for Maria and her baby? I know it’s not her fault and I told her that, she is not responsible for the dreadful state of the ambulances but if people don’t complain then nothing will change and my biggest complaint was for Maria, not for us.
Social Assistance lady told me that the drivers ARE told the time of pick up and should not be arriving so early, she will speak to someone about that; unfortunately on the day we had to go in with our son they had two patients who’d undergone surgery and had to travel by car (funny Neu got sent in a crappy ambulance when he’d just had surgery but Oh well) and she hadn’t known that the baby had respiratory problems. I did point out that it’s simply not safe to be transporting a baby in those conditions, regardless of its state of health and also against the law.
So far none of the ambulances we have used would pass a British MOT (Ministry of Transport) test and am sure they are not to a standard considered legal in Brazil either. I suggest that rather than spending the money on election campaigns, the Prefeitor of Beberibe should invest in a new ambulance and renovate the rest.
I have been talking about the municipal ambulance service, which is not the same as the Accident and Emergency service, known as SAMU which operates nationwide in well equipped, modern ambulances with well trained staff.
Between writing this and posting it, I have been told that the ambulances of Beberibe have all gone in for renovation.

©Claire Pattison Valente 2012

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