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On the streets of Vientiane with the teenage first responders saving lives

The man is unconscious in the whooping ambulance as it races towards the hospital. A rectangle of surgical gauze now covers the gash in his cheek as we nag and bully our way through the Saturday evening traffic. Gobs of dark blood ooze from his right ear, suggesting cranial trauma, possibly a fractured skull. A boyish paramedic presses at the man’s abdomen, searching for signs of internal bleeding.

A second youngster has clipped a pulse oximeter to the man’s finger, the cheap-looking plastic device signalling that the oxygenated haemoglobin level in his blood is falling, and Sébastien Perret clambers from the front to administer emergency oxygen.

Just minutes earlier, the unconscious passenger had crashed his motorcycle into a parked people carrier in the Laotian capital of Vientiane. A quick-thinking bystander phoned Vientiane Rescue, and Frenchman Perret and his youth­­ful first-responder team sprang into action. The motor­cyclist, perhaps in his early 30s, at least today has a chance of survival. If the crash had taken place a few years ago, he would probably still be crumpled in the gutter, dying slowly in the rain.

Laos is one of the poorest countries in Asia. Its capital city, however, is thriving, and Vientiane’s newfound prosperity has resulted in streets teeming with shiny sedans and muscular SUVs, even the occasional luxury Bentley, as well as tens, possibly hundreds, of thousands of motorbikes and scooters. The gore-spilling, bone-crunching downside to the city’s success is a perfect storm of drink driving, endemic speeding, aversion to crash helmets, poor vehicle and road maintenance, and virtually no traffic-safety education or enforcement of road-traffic law.

Making matters worse is the country’s tragically inade­quate health-care system, with no public ambulance service affordable for most pockets. Fighting back against the carnage, the 200 or so unpaid volunteers of Vientiane Rescue are praised as the city’s miracle-working “saviours of the streets”.

A few years ago, the independent emergency service – which is free of charge and operates 24/7 – comprised just a handful of dedicated individuals who slept by road­sides, praying that, when emergency calls came, they would have enough cash to put petrol into their sorry excuse for an ambulance. Today, on a budget of just US$6,000 a month, Vientiane Rescue operates eight ambu­lances, a fire truck, a scuba-rescue team and hydraulic “jaws of life” equip­ment for cutting trapped passengers from mangled vehicles.

Last year, Vientiane Rescue responded to 5,760 emer­gencies, saving thousands of lives. Perret expects that number to rise to 10,000 this year. Most astonishingly of all, the majority of Vientiane Rescue volunteers are aged 16 to 25, many of them students. The youngest is just 12 years old.

“Some are on standby 24 hours a day for weeks, with just one day off a month to see their families,” says Perret, 38. “That’s 700 hours on standby a month!”

According to the Laos Ministry of Public Security’s Traffic Police Department, from January to October this year, there were 1,275 road accidents in the capital – a city with a popu­lation of just 760,000 – with 215 people killed. Perret knows of 272 road fatalities in Vientiane in 2015. By comparison, official figures for Hong Kong (a city of 7.2 million people) show that 122 people died in such accidents last year, suggesting that residents of Laos’ capital are at least 20 times more likely to be killed on roads than Hongkongers.

SATURDAY IS ALWAYS busy for Vientiane Rescue, and its four emergency response stations are on alert. The evening starts calmly at the Nong Hai Village station, a re­purposed 14-metre-long shipping container positioned beside Boulevard Khamphenmeuang, a major road that’s notorious for speed­ing, and now slippery following an afternoon of angry thunder­storms. The station is 12km from Vientiane’s centre and halfway to the landmark Friendship Bridge, which spans the Mekong River to connect Laos with neighbouring Thailand.

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Dozens of cheap flip-flops are already jumbled at the entrance to the ramshackle station when Perret arrives at 6pm for the evening shift, a floor-to-ceiling curtain hanging halfway down the sea-green container’s length to conceal a musty dormitory of bunks catering for up to 10 volunteers on standby. A large white banner hanging above announces the Vientiane Rescue hotline number, 1623, in red, flapping noisily with every truck that bundles by. Outside, plastic spine-board stretchers are stored against the perimeter wall of the adjacent Nong Hai Yai Buddhist temple, its grounds a dark and forbidding tangle of gnarled trees, jungle creepers and graves.

Three young men – minus crash helmets – speed back and forth in front of the station, provocatively pulling wheelies on their bikes. “Future customers,” groans Perret, who speaks English and Lao with an unmistakable French accent. Previously a primary-school teacher and part-time fire­fighter in Paris, Perret arrived in Vientiane in 2008. Slight in build and with thinning hair razored into a severe military-style crop, he has the placid and composed demeanour of an ascetic, though a word he uses frequently is “passion”.

Motorbikes and scooters are involved in 95 per cent of all road accidents in Laos, according to the Traffic Police Department, with nine out of 10 of the dead being male. It is also estimated that only one in five road users in Vientiane has a licence.

“People don’t wear helmets, so most motorbike accidents are very serious,” Perret says over the din. “They end up dead, in a wheelchair or with severe head-trauma complica­tions. It is illegal to ride without a helmet, but there are few police about, especially at night. The problem is huge.”

The evening’s dramas begin when the motorcyclist cannons into the people carrier at about 7.40pm, and the ambulance carrying him arrives at Setthathirath Hospital (4km north of the Nong Hai station) within minutes.

With the four stations and 40 volunteers active at any time during the day, and 70 on most nights, Vientiane Rescue has the entire city covered.

“Vientiane is small, so we can get to any accident in three to six minutes,” Perret says. “That’s good. The international standard is around 10 minutes.”

The advantages of such efficiency, however, fade away at the hospital. In the 10 years to 2015, the World Bank reports, Laos’ gross domestic product grew by 257 per cent, reaching US$12.33 billion last year. But the country has one of the world’s most woeful health-care spends, averaging just 0.5 per cent of GDP in recent years. Laotians who can afford to, tend to cross the Friendship Bridge to be treated in Thailand.

Those who cannot, however, must stay closer to home, where treatment is cheaper. The communist Lao People’s Revolutionary Party, which has ruled the one-party state since 1975, gave up on free health care in the 1990s, but Vientiane’s hospitals are notoriously poorly equipped and manned by insufficiently trained staff. Setthathirath has just two doctors on duty for emergencies. The city’s Mittaphab Hospital has the only dedicated trauma centre in the entire country.

Surprisingly, Vientiane hospitals do have their own ambu­lances, but there are charges for their use and so they largely sit idle. Before Vientiane Rescue, bystanders might have heaved a road-accident casualty into a tuk-tuk (an extremely dangerous move in the case of spine or neck injuries). And without suffi­cient cash for treatment, it is not uncommon for a seriously hurt person to be left bleeding or screaming in a hospital corridor until necessary funds are found.

Perret sympathises with doctors and nurses working under such grim conditions. Ensuring Vientiane Rescue’s survival has, after all, been a constant struggle, the team often having to make do with second-hand and out-of-date equipment, even having to wash bloodied bandages to be used multiple times.

“When we take an accident victim to the hospital, once there we must remove our cervical collar, because we can’t leave it behind and waste money,” Perret says. “Sometimes they have no collars of their own at the hospital as a replacement.”

Ultimately, Vientiane Rescue’s success depends upon its volunteers.

 

“They are very special,” the Frenchman says. “The most amazing people I have ever met, with a real passion for helping others. They give everything. Many are students, but we also have people working for NGOs, policemen, shop assistants, soldiers, sailors, workers, whatever.”

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Vientiane Rescue took on the team’s youngest member at the request of the boy’s mother. The 12-year-old was a tear­away, and she was at the end of her tether.

“The mother was alone – the father had gone – and the kid was out every day, missing school and meeting bad people,” Perret says. “One day, she brought him to one of our offices and asked us, desperate, to take care of him. Our volunteers have never learned to say no, so they took him in, for a week at first. He was kind of tough, but after the week, running on-board the ambulance, he started to understand the meaning of our work, and maybe to find himself meaningful. He changed. He started to respect his mother and to listen to her. He’s now polite, respectful and he’s still coming to our office every day.”

Thirteen-year-old Ton, son of the volunteer who heads up Vientiane Rescue’s firefighting team, also joined at 12.

“He always wanted to come along in the ambulance,” Perret says, “but I always refused. Then, one time we got in the ambulance, and he was right behind me. I told him, ‘Get out! You’re too young.’ He said, ‘You forgot your first-aid bag. I brought it to you.’ That was a special moment – I realised that the most important thing was his will, nothing else. He was full of passion already, a passion that can move people, a passion that we all need to have and feel. Since that day, he’s welcome on-board our ambulances. He’s 100 per cent part of our team. He even has his own uniform.”

WITH THE UNCONSCIOUS motorcyclist stretchered into the hospital, Leeming Manivong scrubs blood from the rear of the ambulance. The 17-year-old high-school student, whose braces glint on his teeth and pristine-white moccasin shoes poke incongruously out from his navy blue Vientiane Rescue uniform, lives with his parents, but is on standby after classes most days, sleeping at the station and seeing his family only on weekends, usually Sundays.

“My brother used to drink and drive, spending all his free time with friends in discos and partying all night,” the softly spoken teen confides later. “But then, two years ago, he joined Vientiane Rescue as a volunteer, and I saw him change. He stopped drinking and hanging out with his old friends, and spent more and more time with the team. I started to visit him while on duty, and the team welcomed me like I was one of them.”

The crew is about to return to base when another call comes in, and burly paramedic Anoukhong Keoounheuan, the Nong Hai station chief and its main ambulance driver, flicks the siren on again and his vehicle back into gear. Keoounheuan has the unshockable, seen-it-all mien of an old emergency hand. He is 28.

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Most of Vientiane’s roads lack adequate street lighting, but Keoounheuan knows when to put his foot down and when to drive cautiously, especially when manoeuvring a right-hand-drive vehicle in a left-hand-drive country (the ambulance is a decommissioned van Vientiane Rescue picked up for free from emergency services in Tokyo, paying only for its ship­ping). Keoounheuan also knows how to avoid the city’s worst potholes, which the afternoon’s rain has filled, making them difficult to see. A middle-aged man on a scooter has collided with a deep one.

Keoounheuan positions the ambulance to shine its head­lights on the man, who squirms semi-conscious in the street, and a gathered crowd backs off deferentially when the volun­teers approach. Perret leans in close to check the man’s breathing, also shining a torch into his eyes.

“Look at me, look at me,” he demands, to no avail.

As he did with the earlier accident, the Frenchman suspects alcohol has played a role in the crash.

Vientiane enjoys a wholesome reputation as an easy-going city of quaint French colonial-era villas on frangipani-lined boulevards, with ethereal monks gliding from Buddhist temples – a gentle place where the perils of modern life have been kept at bay. The truth is somewhat different. According to the World Health Organisation, cheap booze makes Laos the second biggest consumer of alcohol in Southeast Asia, after Thailand, and the rate of intoxication in freewheeling Vientiane is likely to exceed the national average. Commercial versions of Lao-Lao, the popular Laotian rice whisky, sell for less than HK$8 a bottle and are typically 45 per cent proof. Home-made hooch can be stronger.

“Alcohol is a real issue here,” says teetotal Perret, who estimates that drink is a factor in 80 per cent of road accidents attended by Vientiane Rescue. “It doesn’t fit in with the usual image of Laos, but people drink a lot. Stay at the hospital for just one hour, watch the people coming in, and you will see.”

Perret has described Vientiane Rescue’s story as “the story of a miracle”, and its origins can be traced to 2007, when a grassroots initiative called the Foundation for Assisting Poor People of Lao People’s Democratic Republic (FAPL) used a donated ambulance to provide a rudimentary first-aid service, but only on weekends. Perret’s crusade to bring a fully func­tioning ambulance service to the poor Asian country began three years later, when he witnessed a serious road accident and was horrified that no emergency service came to assist. He offered his services to FAPL, and Vientiane Rescue was soon estab­lished by the Frenchman and six Laotian volunteers, five of them just 15 years old at the time (all seven founders are still active).

Perret says more-established charities sneered at their “insane idea”, but progress was gradually made. Then, in January 2012, the group’s ambulance was taken out of action and volunteers began deserting. A defining characteristic of Vientiane Rescue, however, is its never-say-die attitude and, with a one-off financial gift from an angel sponsor, in January 2013, a near-wreck of a Toyota Hilux pickup was purchased and converted into an ambulance. The service’s unlikely resurrection was complete by April.

Today, 150 of its frontline volunteers are trained as first responders and 14 have qualified as emergency medical tech­nicians from the National Institute for Emergency Medicine, in the Thai city of Khon Kaen, with experts coached in rescue diving, firefighting and hydraulic rescue.

Financial sponsors include the Australia, Luxembourg and United Kingdom embassies in Laos, companies such as Toyota and Bosch, as well as the state-run Lao Lottery. Most funding, however, comes from individuals, with many donations amounting to just a few dollars each. Perret momentarily loses his cool when discussing how some large corporations he has approached for support insist on “benefits and visibility” in return.

“That’s such a disgusting lack of respect,” he complains. “Really, it’s amazing that they make demands when our young volunteers give so much for nothing.”

Respect is coming, however, from many quarters. In August, Vientiane Rescue landed a Ramon Magsaysay Award, which has been called Asia’s equivalent of the Nobel Prize. The Ramon Magsaysay Foundation praised the service’s “heroic work in saving Laotian lives in a time and place of great need, under the most deprived of circumstances, inspiring by their passionate humanitarianism a similar generosity in many others”. Last month, French President François Hollande handed Perret and Vientiane Rescue a prestigious La France s’engage award at a ceremony in Paris.

HAVING RETURNED TO the Nong Hai station, Keoounheuan has just wrenched on the ambulance’s handbrake when there’s another emergency, and we tear southward to a major crossroads, where two unconscious men are sprawled in the road on their backs. They appear to have fallen from the same scooter with no other vehicle involved (though hit-and-run incidents are on the rise in Vientiane. By August 26, there had been 23 reported cases in the city since the start of the year, with police citing intoxication as a primary cause).

A second Vientiane Rescue ambulance arrives within seconds and the two teams act without speaking, mimicking Perret’s trait of measured haste. The youngsters make on-the-spot assessments of injuries, stabilise victims, employ cervical collars to immobilise heads and necks, and check for breath­ing difficulties. Perret inserts an oropharyngeal airway (a tube designed to stop a patient’s tongue hampering the ability to breathe) into one man’s throat. Soon, both casualties have been carefully scooped up, and within minutes we are back at Setthathirath.

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There, the rider who hit the rain-hidden pothole is now awake and shambling around the car park. His right cheek is swollen and a crooked cigarette dangles from spittle-flecked lips. The man who smashed into the people carrier remains unconscious in the emergency ward. His mangled face has been haphazardly stitched back together but his prospect of a full recovery, Perret believes, is slim.

The frantic 90 minutes has been typical for a weekend evening, Perret says, though the incident-free hour to come offers welcome respite. When the team finally returns to Nong Hai station, one young volunteer lazily strums a guitar by the roadside while others sit cross-legged inside, playing cards. A polystyrene box of Cantonese-style barbecued pork is passed around and Manivong stretches out on a wheeled gurney, his face illuminated by the blue-white glow of his smartphone.

One of the more outgoing volunteers is Nid Niravanh, a 22-year-old accountant who chooses to be on standby more or less full time, taking small paying jobs to survive. Ostensibly she lives with her mother, who she now sees once a week.

“I was just an average girl who liked to ride her scooter without caring about others,” Niravanh says. “I was selfish. But four years ago, I was in a car that was hit by another car, and I wasn’t wearing a seatbelt. One of my friends was severely injured and I had a head trauma myself. Vientiane Rescue had shut down at that time because of lack of funding, so nobody came to help. “Then, two years ago, I saw an accident and Vientiane Rescue arrived on the scene very quickly. They were so caring and organised. I wanted to be part of it.”

And part of it she is. The final emergency of the shift occurs almost directly outside Setthathirath Hospital, at about 11pm. Again, the injured man is a motorcyclist – seemingly in his mid-20s – and he has collided head-on with a minivan. The violence of the collision has broken his left femur and he bleeds profusely, a glossy puddle of crimson spreading on the damp tarmac.

This time, the young women in the rescue crew, including Niravanh, take control, bandaging his leg while reassuring the man, who remains awake, his eyes wide and his breathing fast from shock and panic. Perret says his wound is such that the motorcyclist might, without professional help, have bled out and died, even with a hospital emergency room less than 200 metres away. Now, Perret believes, he will survive.

What’s more, the young man’s leg will likely be saved. Until recent years, the main cause of losing a limb in Laos was explosives left over from the Vietnam war. From 1964 to 1973, half a million US bombing missions dropped more than two million tonnes of ordinance on Laos, making it the most heavily bombed nation in history. One-third failed to detonate. Today, road accidents are more likely to blame.

Later, with 2am approaching and the shift winding down, fresh volunteers arrive and others shuffle from the station’s dormitory, rubbing sleep from puffy eyes. Those who have been working for hours appear loath to pass the baton, and Perret believes that, while scraping smashed bodies off streets day after day, week after week, can be heartbreaking, it also bonds the youngsters together.

“I feel sad that often we arrive at an accident, resuscitate a victim, take him to the hospital and then two hours later learn that he died,” Manivong admits. “Sometimes I feel helpless, but I place my hope in the team. I’m proud to work with the others and to be part of this beautiful story.

“We don’t perform miracles every day, but at least we try.”