Child died at childbirth due to no emergency air transportation on Ambergris Caye

A woman who experienced complication at childbirth lost her child after there was no available air transportation for her. Jorge Aldana has the story in the following report.

Jorge Aldana – San Pedro Correspondent
A young family on Ambergris Caye is devastated after their unborn child died because of the lack of proper health facilities. The pregnant mother was rushed to the San Pedro Poli Clinic sometime before midnight on Wednesday after she began experiencing complications. A doctor was located who examined the mother and recommended that an urgent C-section be performed in an attempt to save the unborn child.

Because the government operated Poli-Clinic and the island do not have an approved surgical and child birth facility to handle such emergencies, the only other option was to air lift the distressed mother to Belize City. During the night, finding medical assistance can be very stressful and in a case of emergency, a minute can save a life and that is what apparently occurred last night.

A member of the family, who chooses to remain anonymous, explained that there was no available air ambulance to transport their family member to Belize City. It took almost three hours before the family chartered a plane from one of the local airlines in the wee hours of Thursday and carried the mother to the International Airport and then to Belize City. By the time the mother arrived at the KHMH, the child was stillborn.

In the past, the only quick emergency option to airlift patients from San Pedro Ambergris Caye was via BATSUB; those services were discontinued last year in July of 2010. But in an interview with Love News on the 18th of August 2010, Area Representative Hon Manuel Heredia said that “as the matter is of extreme importance, I will be following up with the relative authorities to come up with a plan.” Heredia told Love News in the said interview that the matter would be taken to Cabinet on Tuesday August 24th 2010, but until now, islanders are yet to be informed what the emergency plan is.

San Pedro being a municipality that generates much revenue in taxes and a population of 22,000 people on the island at any given time, the recent incident highlights the urgent and desperate need of having a proper health facility on the island, something islanders have been clamoring for years from both administrations.

This news reported is sponsored by Grand Belizeans Estate Limited.

Reporting for Love News from San Pedro Town, I am Jorge Aldana.

Lack of proper medical facilities on AC causes loss of baby’s life

The death of an unborn child early Thursday morning (April 28, 2011) has left a young Ambergris Caye family devastated. It is believed that this most unfortunate incident is as the direct result of the lack of proper health facilities on Ambergris Caye.

The pregnant mother was rushed to the San Pedro PolyClinic II (SPPC) sometime before midnight on Wednesday (April 27th) after she began experiencing complications with her pregnancy. After initial examination by the doctor on call, it was recommended that the mother needed to undergo an urgent C-Section in an attempt to save the unborn child.

The SPPC currently does not house a proper operating facility. As a result it was necessary for the mother to be airlifted to the Karl Heusner Memorial Hospital (KHMH). Presently, the only available emergency air transportation service available to the SPPC is BERT- Belize Emergency Response Team; however this service is only offered during the daytime hours, with the cut-off time at 5pm.

A family member who chose to remain anonymous explained that it took almost three hours before the family was able to obtain the chartered service of an airplane from one of the local airlines, which transported the mother to the International Airport and then to Belize City.

By the time the mother got to KHMH, there was not much that could be done to save the unborn child. The mother lost her child shortly after arriving at the KHMH. The question remains, for a community of over 20,000 permanent residents, why is it that we are not equipped with the facilities needed to deal with such emergencies like this one?

Access to airstrip via Tropic Air Hangar is closed

A correspondence containing the following message was received by representatives from the San Pedro Poly Clinic II (SPPC) a couple of weeks ago: "Due to theft and vehicular damage to our aircraft we are forced to close and lock the gate by the Tropic hangar to the airport in San Pedro. Effective immediately no one will be allowed access through our gate to the airport."

In the past, that access - a gate immediately across from the SPPC that led to the airstrip - has been used for emergency access to a waiting aircraft. SPPC Administrator Owen Vellos tells The Sun, "It was very convenient. We would take the patients on stretchers or on the mobile beds and wheel them from our emergency exit directly over to the airplane, which would be situated on the runway immediately in front of the hangar". He further explained, "More than just a convenience, this access was essential as it saved time and in grave emergencies a couple of minutes could be the difference between life and death for the patient."

The San Pedro Sun contacted Mr. John Grief III of Tropic Air to get Tropic's side of the story. "There never was a privilege for the Poly Clinic to use that gate. They never asked and we never granted them permission. They just did it and being San Pedranos, we were willing to help. The problem is that we've had young people who have no reason driving vehicles, driving through there at all hours of the night or day and one of them hit one of our aircrafts. So, we had a vehicle running into a $4 million aircraft and damaging it. That's private property, it's not government property. So, we closed off our property, it's as simple as that," Mr. Grief informed The Sun.

Mr. Grief went on to explain that there are other options for emergency access to the runway, including the entrance at the northern end of the airstrip between the Tropic Air and Maya Island Air terminals. He reiterated that it was unfortunate that they had to take this action in an effort to protect their assets.

San Pedro Sun

It would seem that Tropic would be doing the community a big service by coming up with a solution that would allow for emergency medical evacuations. Tropic is one of many businesses that owes its existence to the patronage of the people of San Pedro.
I am appalled that this long after after the BATSUB pull out the GOB has done nothing. I would think it a good idea if private sector worked out a plan whereby aircraft could be activated in a reasonable time for missions of mercy. I thought such a plan was in place.
The news story says there was a three hour wait for an aircraft, I would appreciate more information as to whether or not it is true and if true what broke down in our system. My son may have possibly died at birth if we were not able to get to the hospital quickly. Our airline companies play a vital role in our communities.
Unfortunately health care has never been regarded as a priority issue here, except by the people.

"Tropic is one of many businesses that owes its existence to the patronage of the people of San Pedro." Political blather and grandstanding. Replace "people" with "tourists". And even if it were 50% true, what do they "owe" the community? They are a business not a philanthropy.
And then describe how you would expect Tropic to help? Because this statement:
"It would seem that Tropic would be doing the community a big service by coming up with a solution that would allow for emergency medical evacuations." is so ludicrous.
If you want to lead yet know nothing of the issue, find someone with the knowledge to propose solutions. Tropics makes schedules and flies planes. What gives them the background to understand all of the issues associated with medical evacuations? It is absolutely not Tropic's responsibility!
Should they retrofit one (or more) of their airplanes to handle stretchers? Should they hire extra pilots to be on standby 24/7? What is an acceptable response time? 5 minutes? 15 minutes? What about ground crew/engineers? Should they also provide the accompanying paramedic, nurse, or doctor too? And just to close (because there are far more questions): Who is going to pay?
Now, if you want to be a leader why don't you engage a few interested citizens to form a committee to investigate the issue and develop some proposals for the pubic and private sector to consider. That's smart politics.

This is yet another very sad reminder of the limited access to medical care on the Island. Can we look at best practices from other Islands with similar population? Is it feasible to provide more complex care on AC verses transport?

I have to agree with C2C relative to Tropic's responsibilities. Why isn't Maya part of the equation? Both airlines should both be considered stakeholders, however, and should be at the discussions table.

What ever happend to Wings of Hope didn't they offer medical evacutation within Belize?

This is a tragic and sad, but:

There is a plan in place, and it has been used many times.

Tropic Air does night medivacs. In this case, the acft was dispatched as soon as Tropic was contacted.

The contact numbers have been published many times, all medical persons in SPR have these contact numbers.

Mentioning anything about the gate is nonsense! In case of a medivac/emergency, Tropic personnel will be there to assist.

The reporter also fails to mention that there was no attending Dr. at KRMH till the morning.

Emergency/trama medical care is not just a SPR issue, it is a nation wide issue.

We had been 'spoiled' by the British Forces presence here for years and they kindly offered helicopter services for medical airlifts, day and night, usually free of charge or for a nominal fee of about US$600.00 when I needed an airlift, say 15 or so yrs ago. This service no longer exits and was stopped months ago. San Pedro, Intl and Placencia have lights for landing at night, but Placencia's lights have not been installed. Otherwise, everyone has to depend on commercial airline or helicopter, all privately owned and will require payment. Wings of Hope is here and also available for emergency airlifts. Should you require a helicopter airlift at night in an area without lights, best to create an HLS (helicopter landing site) with vehicle (or golf cart) headlights in a circle or other to illuminate the HLS. And most important, make sure there is a doc ready with the patients stats at the medical facility by calling ahead.

Sorry if you thought I was blaming Tropic in any way. I would like to know what happened. All the issues with stretchers etc are very valid. I am hoping a plan can be worked out. I thought we had one. So far no one wants to address any of this. What did happen? I thought we were just talking about giving access.

C2C.
"What does tropic air owe the
comunity?"

We live on a small island we help our neighbors. Thats how it allways been done.

You cannot be a responcible business, making money off the comunity and ignore the comunity when it needs you.

you my friend,..... are full of shit

Tsk, tsk. Sticks and stones...

As reported, Tropic did respond when called. That is laudatory community service and they should be recognized for it. Apparently that's not enough for you and Mike. So how much more do you think they "owe" the community, Dick?

My argument was with Mike Campbell putting the problem in their lap to come up with a solution. People running for public office should pay better heed to what they write. It is not Tropic's problem to solve. It is a community (indeed national) problem.

Again, without mandate Tropic responded when called. Kudos to them.

I think mike was comitting on there total refusal to help out. This is not the first time.

So how much more do you think they "owe" the community, Dick?

really...

I apologies if I step on anyone toes, typical bunch a talkers and no doers, but you guys argue over a stupid thing. Here is a family that is devastated because of the lost of their child because of two things
1 There is no certified/approve child birth facility
2 No emergency air ambulance available for island residents.
Whoever provides that transportation service in a time of emergency do it to assist the community. No commercial nor private airline is force to provide such service. As for wings of hope, they are based at municipal airstrip which has no lights. BDF defender is not working due to a none functional propeller, Astrum is not certified to fly at night.
No one is to blame but the GOB who has neglected this community period. We need people to stop talk a bunch of shit and elect people that will fight and give this island what is deserve.

I am not sure how you thought I was putting the problem in Tropics lap. My comments were aimed at the emergency access to the air field being blocked to emergency traffic, necessitating a taxi to get to the plane as opposed to taking them through the gate which has all been explained and was I had imagined. Of course Tropic will allow emergency traffic.
I asked what happened and i never said or implied that Tropic did or had ever done anything that was reproachable. They have always contributed to our community in many ways and I do business with them regularly. If I offended them it was unintentional.
My question still stands which was what went wrong with our system. I personally could not imagine Tropic not responding to such a situation. They have always responded in the past to the best of my knowledge.
Why did it all take so long and why was no doctor waiting in Belize?
We all owe our businesses to this community 100%.

Stop covering your ass Mike

Still dont know why it took so long, at least they backed off the total shut down of the emergency access, thats a win right?

MINISTER MANUEL HEREDIA RESPONDS TO ISLANDERS’ CONCERNS

April 29, 2011

A mother lost her child on Ambergris Caye on Thursday due to the lack of proper and adequate health facility and transportation off the island. The issue has caused uproar amongst the island’s population and today the Area Representative met with media on the island.

Jorge Aldana reporting....

“In a knitted community like San Pedro Town, where everyone practically knows everyone, what affects one family affects the community. Such was the case when a mother lost her unborn child due to the lack of a proper and adequate health facility on Ambergris Caye. It’s another wake-up call for the elected officials and today, that was the sentiment that dominated the local airwaves. It’s a situation that needs urgent attention. In an early morning press conference Area Representative Manuel Heredia lamented the incident and said that he is prepared to take the matter once more to Cabinet to avoid such occurrences to ever happen again.

Manuel Heredia – Area Representative, Belize Rural South

“It is my duty to really look into the matter because I can recall that when BATSUB had announced that it would be leaving Belize we knew that there will be problems if we did not have their assistance and I can recall that it was mentioned in Cabinet and that we were going to look into the possibilities at what other arrangements can be made not only for San Pedro and Caye Caulker but also down south which is remote areas of the south. I feel that steps are being taken. I do not know, but I will speak to the Minister responsible for Health and Defence and see what is the latest on that because if that is the case then something urgent needs to be done so this type of incident not to occur again. Any life that is lost is something serious. San Pedro is a very united community and when an incident of this nature happens it is the talk of the island and it truly hurts everybody including myself. Whoever loses a child particularly in this manner, probably if it is for transportation or inadequate equipment then I have to make sure that I look seriously into both areas, better facility which I am sure by July we can have extended hours. I think it will be more doctors, more nurses. If we have difficulty trying to get air lift services then our duty is to make sure that we do everything we can to equip our local poly clinic to the extent, probably upgrade it to a hospital because we are isolated from any other area, it is a big town, and we are becoming one of the biggest. We should be given the priority and the assistance that we deserve."

Again Minister Heredia assured the island residents that he will take the matter to the next Cabinet meeting for urgent attention.

LOVEFM

There is no "system" in place for emergencies on the island.

This has been discussed at great lenghts in other threads. The island is in serious need of an Emergency Medical System.

This is a post from last year. This is not a new problem.


It's nice... and a bit frustrating I suppose... to see this thread start again. As part of Bandage International, my colleagues (emergency room docs, advanced paramedics, and nurses) and I have been to AC 8 times, runing training sessions with ACER, hotel staff, and whoever could and would come.

Our goal from the start was to set up a chain of survival system where an injured/sick person could be met by a first responder and transferred to more appropriate care with increasing knowledge and ability to act. We have trained over 500 people in country but the goal of keeping this "system" in place is elusive because the players change and it only seems to get "popular" when something happens.

We have gone so far as to offer (to mayor and area rep) coordination of setting up a non-profit ER on the caye to to help bring in volunteer physician and medic staff from Canada/US in high season. Any and all donations would back to the clinic and all followups to the local docs to help smooth the political waters. Also expressed pleasure to work with the locals docs. In the end, No interest.

We tried to have an emergency health summit last year. The phrase "herding cats" comes to mind.

The bottom line is that having a real chain of care is by no means impossible but requires citizens (expat and local), government, and business to make this a priority and sit down and sort it out. Until that happens, good will and good effort by many bringing equipment and instruction will help a bit but never really attain the syste that is optimal.

As always, we are happy to participate in this process in any way we can with planning, ideas, time, and money, but it really needs to be taken more seriously by more people at the same time.

As always, I love the place and the people but feel a little frankness is required in this conversation. Hope to see you all soon.

Dr. John

btw Costa Maya has an AED and have staff trained in its use and there was one at the South Neighborhood watch station.

Possibly now the area rep will do what is right. Politics controls all our health care, just a few months ago our area rep could not even get funds to fix the roof on the PolyClinic, now he says we will expand the hours and get more doctors. That still will not fix our situation. WE MUST HAVE A HOSPITAL. Obviously there are many who wish to help us but have been prevented from helping as much as they could by politics.

I may be jumping in here and get in over my head, but is there a reason that the doctor that looked at the pregnant woman and declared that she needed an emergency C-section didn't do it? I mean if it is an EMERGENCY, seems like most any trained doctor could do it. I am talking an absolute emergency, where a life will be lost if it isn't done. I believe that all doctors are trained to do basic surgery, which might do in a situation like this.
I mean, if my vet can do an emergency C-section on a goat in a barn, surely a C-section could be performed on a human in a relatively clean environment somewhere.

Unfortunatly, it is not quite that simple. Among other things there is no way to provide anethesia on the island.

And we need an anesthesiologist to go with the anesthesia.

AND a blood bank, and 24 hour medical and nursing services to care for the post op patient.

So right Natalie - the list just goes on and on.

But it is time to make this happen. I want to see the politician that will guarantee to make this a number one top priority. San Pedro needs a hospital and it needs it now.

Not to mention a good lab complex. None of it is cheap but what price do we put on our lives and the lives of our children?
On the financial side, the lack of medical facilities keeps San Pedro from becoming a retirement haven. Many want to be here but because of the health care issues just will not take that chance.

There are many factors that go into a proper EMS system. We have a doctor that posts here from the states that is VERY interested in helping the island at his own expense. All he would need is governmental approval to practice medicine in Belize. He is willing to open his own operating room and facility. There are a lot of people that post here that think that is a bad thing, because he would take a job away from a Belizean doctor.
Most of you knew Dr. Tina and her dealings with the government.
There has to be changes made in the local thought process.
There are many doctors, paramedics and EMT's on here with great ideas on how to come up with a viable medical response system.

Until the GOB cares and takes some type of action, nothing will change. It takes $$$.

A minor heart attack on the island could easily kill you. Getting hit by a taxi or golf cart could prove fatal.

Imagine a town of 20,000+ spread over 20 miles, with 2,000 of them SCUBA diving and partying like a rock star most of the time, and another 3,000 of them kids...without an ambulance service or ER.

The medical board will approve non-Belizean doctors license to practice in Belize but these doctors are required to first serve at a government hospital facility for a certain period of time as well as satisfy other licensing requirements.

Unfortunately we don't have to imagine the town you are describing -we are living it everyday and playing with fate 24/7.

Absolutely the GOB needs to get some priorities straight - and as a community the islanders must identify its priorities and then begin lobbying.

There are always a few crusaders for each of the urgent issues facing the town but it is tough to get the full backing of the voting community until issues hit crisis point and actually affect the residents lives directly. So from time to time a family here and there may realize the problems of health care and make these problems known to the majority - but once the crisis has passed they just go back to their regular lives.

The best way to get the GOB to stand up and take notice is to have strong, incorruptible, dedicated, educated and passionate representation. And one man alone cannot take up this plight - it will take a concerted and organized effort.

What ever happened to the Ambulance? I can remember raising money for it years ago when we had a restaurant.

Let me know if I can assist in any way Amanda. I have a feeling you are going to lead the charge on this one, eventually.

Hey Reaper don't curse me like that. I have tried to work on the health system in a small way for the past few years and trust me, it has improved immensely recently which is testament to the hard work and efforts of some wonderful folks within the ministry of health and the Lions Club.

NOt that it should be done, but it can be done without anesthetic:
http://www.nlm.nih.gov/exhibition/cesarean/index.html

Of course there are two lives to consider in this situation. More often than not, when an emergency cesarean section is needed, the baby is in distress and often needs treatment in a neonatal intensive care unit---obviously the trained professionals and equipment for treating such a poorly baby is not available here on the island.

Even after we have our hospital we will still need to have emergency medical evacuations available as it is not reasonable to think we could have a hospital that could handle all situations.
The emergency transportation issue must be addressed. Ideally we would have aircraft on the island at all times that could immediately be dispatched for such purposes. As the real need is infrequent in aviation terms it is not practical to have an aircraft dedicated to that purpose stationed here all the time. Even if we purchased an aircraft the maintenance necessary for an infrequently flown aircraft would lessen its reliability and would be cost prohibitive.
One obvious remedy is to put lights on the Municipal air strip. Being as BART (Wings of Hope) is stationed there they are grounded as soon as it gets dark. This could be done on an emergency basis very quickly and would offer some relief. Ultimately we need to be able to fly into Municipal at night on Missions of Mercy. That would speed up the process by a lot.
Possibly Jr. (Minister of Tourism and Civil Aviation) could mention this immediately available remedy to the Cabinet as they probably have no clue. Last time he mentioned the problem it was left to just faded away. Actually as Minister of Civil Aviation he probably has the power to pick up the phone and tell them to go install the lights at Municipal, one time.
It would be good if there was established an emergency loan fund to assist those who need emergency evacuation that do not immediately have the resources or just have no way to pay. It would be horrifying for someone to die because they did not have the money to pay for the emergency evac. I dont know that that has happened but payment is always an issue as aircraft are expensive to operate.

Could we not work out a sensible deal with say 'Astrum Helicopters'. The last time I spoke with them they had to sell one of the choppers due to lack of business. I think some monthly government support to them to have a helicopter and pilot available at all times would help in establishing a procedure to follow in instances like the one being discussed. A lighted helipad, a team trained to accompany the patient, and a communication system would be a lot cheaper (and faster) than building a hospital wouldn't it. Hospital's are very complex and expensive to establish and operate but doing something like the above wouldn't prevent that happening it would just, hopefully, go a long way toward solving the immediate problem. Just my two penneyworth.

Check the acquisition and operating costs for a bell 206L.
It would be cheaper to establish emergency medical care in spr than to rely on airlife.

I don't think you read my post correctly. I am well aware of the cost(s) operating and otherwise of a helicopters. My point was to pay Astrum, which already has the helicopter(s) and pilots a stipend each month from the government to be available for emergencies like this one. It would be absolute peanuts compared to building and operating a hospital. These are both subjects that I know something about and I am just trying to be helpful.

Agree with the Capt for what it's worth. However, as opined elsewhere, even with transportation in place a pre-hospital EMS would make sense (for starters) given the population.

For sure, what is an immediate priority, even before thinking of a hospital,is a 24 hour emergency room with staff trained in emergency care in there---perhaps a nurse trained in this field with the doctor on call.The other immediate necessity would be an aircraft to evacuate immediately---Tropic Air does this service for a fee, I myself have been taken as an emergency by night to Municipal Airport. It took about 1/2 an hour for the flight to be arranged.There are many residing here who would not be able to afford this fee, so a system to aid them would be vital.
So Priority # 1---an ER with 24 hour trained staff in situ
Priority # 2--- funding for persons of need for a plane charter in an emergency.

Depending on the services you expect the ER to provide, that seems reasonable but an ER (in the sense understood in 1st world) could be overkill. Bear with me.
If reliable, speedy transportation to the mainland is available, properly trained paramedics/nurses/doctors can (generally) stabilize patients for transport to a better equipped medical facility.
In the long term, yes, ER for sure. There are many life-threatening emergencies where time is of the essence - no argument there. But it seems this project is starting pretty much at square one so from a financial (and health care) standpoint, taking full advantage of resources that already exist seems to be the correct "baby step".

Yes, and a helicopter is the much preferred type of aircraft in my view as they, in most cases, eliminate the need for a ground ambulance and can deliver the patient directly to the hospital facility. Further, establishing one or more helipads on the island could help in the event that someone is far from San Pedro and the air strip. I know there is at least one helipad up North here as I have used it and there are probably more.

I am against virtually any kind of tax and government involvement but this may be one time that a permanent fund could be set up and funded with donations and that fund tapped to pay for transport for those that cannot afford it. Donations could be made all through the year and not just when someone needed to be transported. This could also possibly serve other medically indigent persons.

Using Astrum will not work. They are based in Belize City. It would take too long to get into operation in the event of an emergency.
It makes more sense to have a small fixed wing aircraft based on the island to fly a patient to Belize City.
The bigger problem is the initial emergency response personnel for the island. Island Ferry had a team of responders for a while when they were in business. I donated a lot of medical supplies to them.
I think a group of the local doctors, nurses and visiting medical pros (there are many winter residents that are in the business) should assemble in the case of an emergency.
That would just take some supplies, a few cell phones and a transportation system. A local doctor should oversee it also to develop a few protocols.
The group should also help train island residents in first aid.
It's a pretty simple fix with a few complex issues to overcome. IMHO

Full-heartedly agree with the Helo. A helipad (LZ) is easy to create - trained EMS/FD do this all the time and in a place like Ambergris Caye is would be easy to define accessible areas - pre-defined LZs if you will - in an EMS plan.
However, there is still the necessity to stabilize the patient, transport same from the scene to the LZ, and ensure they are ready for the flight. Please do not discount the value added added to EM services. In my view, they are a priori service to any medical system.
As for the budgeting...tough call. A tax on visitors? A tax through businesses? Voluntary donations? I have lived in places where one or more of these have been in effect.

In my humble opinion the flight time to the island by helicopter is not a such a big deal. It would probably take that long to get the patient and crew ready and as I said it will do no good to get them to the international airport and then take another 25 or 30 minutes getting them to the hospital. There is always a delay when you change transportation methods which also adds to the time.
Plus perhaps there are light on the runway here but I haven't seen them and landing at municipal in the dark would in my view be pretty dangerous. All of this really doesn't matter though if we don't have things organized on the island first.
We started a similar thread over a year ago and although there was a lot of talk and we even had at least one meeting it never went anywhere.
The Astrum approach is pretty easy to get started and most helicopters can be outfitted pretty quickly to carry a patient.

I would form a small committee, identify your needs, make an appointment with Dr Peter Allen, CEO in the Ministry of Health and get direction from an expert in health care in Belize on how to move forward and provide solutions for people on the caye. And talk to Belize Medical Associates and Belize Health Care Partners and let them know its time to expand on the caye. Put a bug in their ears.

In essence (albeit with more detail) what I recommended to Mike Campbell. He's running for office? Geesch...

Municipal is supposed to be getting a make over. I think it includes runway lighting. "Cracked up" would know.

By the time Gustavo (Astrum's CEO/pilot) got a call, left his house and drove to the hangar, rolled the helo out and fired up to fly out would be a while.

Tropic and Maya Island have Airvans and Islanders with pilots close by.

So sad, but true.

I have worked for many years in San Pedro as an RN/midwife. The biggest problem we have is not having a central location for emergencies to be taken to and treated where trained staff are in attendance. Much time is wasted looking around trying to find a doctor or nurse or waiting for someone to arrive at a clinic to give treatment. If everyone knew where to take an emergency, it would save much time.If a nurse or paramedic where there 24 hours able to provide emergency treatment while getting a doctor on call it would save time and lives. There are many first aiders on the island, all tour guides have to have first aid certificates. The island is very small,it just takes a few minutes to get anywhere on the island, the problem is NOT how to transport the patient to a location on the island, the problem is not having a location open to take them to. Not all emergencies would have to be evacuated in the middle of the night at great cost, only the more serious life threatening ones. Having anything other than a 24 hour unit (which I call an ER)to take them to and to keep them in for observation if not evacuating immediately seems useless and not providing a necessary service.I was not involved in the recent tragic situation,I don't know why it took three hours to arrange a flight for the lady needing an evacuation but I suspect much time was lost finding a doctor to evaluate her condition.
A helicopter on call or stationed on the island would be ideal, but not financially practical. People cannot afford the charter of a small plane and a helicopter is much more expensive.We have the planes here. They do land at Municpal at night, it just takes a 15 minute flight.It doesn't take long to arrange it. However, it does cost money.

I'm a small town doctor who still practices OB including c/s deliveries. I came to my home town 12 years ago and restarted the OB program here. I practiced by myself for 10 years before other OB providers came here.

I said all that to say this, including operative OB services is not that dificult. Spinal anesthesia is prefered and easily done by any doctor or trained NP. A blood bank is not needed. I can count on one hand the number of times I've needed blood for an OB patient and I've delivered over 2,500 babies. It's much easier to bring blood to the patient rather than bring the patient to the blood on the rare occasions the blood will be needed.

I volunteer my time to come train providers that are on the island who want to be trained in surgical OB. Message board locals may offer my assistance to Mr. Heredia(sp?) or anyone with the authority to get the ball rolling with surgical OB on the island.

As already stated this is not a new topic and has been discussed at length here before with lots of providers volunteering to come assist with emergency training. If a local could take charge and organize this effort I feel that there are reasonable options the island could put into effect immediately. Medical evacuation is far too time consuming and will result in loss of lives. An emergency surgical room to me is a must for the island and shouldn't be very difficult to establish.

I'm available immediately to come help set up and train the local providers in surgical OB care if needed.

I'm sure your services would be very useful,and I wish you luck in getting approval for working here, however I think it should be pointed out that we do have a practicing OB/GYN surgeon resident on the island. We can always use more! However, as a real priority, we still need an ER and evacuation system for all emergencies, not just obstetrical ones.

American Heart Assoc calls its a "Chain of Survival" You must have all the links together to form a chain.

I have collected medical supplies, transported tehm to the island, built websites, taught many classes, mostly out of my own pocket and a few donations from some very kind folk.

Island ferry is no longer, and Ambergris Caye Emergency Response (ACER) is all but dead.

Why did I start? Even before my first trip to AC, I evaluated the EMS side of care (or lack of) on Ambergris Caye.

I decided that if I planned to spend any time on the island, from vacations to even retiring on Ambergris Caye I need an EMS service in place.

Many will not visit or live, if given a choice where there is no health care.

So sorry to hear about the loss of life.

Does not KH have helo capability? If not, there are ample local (to KH) areas better than Municipal that could be set up for a helo on short notice. Again, coordination...as DDD wrote... it's part of a system.

C2C, a medical helicopter 45 mile trip costs $12,000 US here.

Helicopter medical evacuation would be the most expensive and most time consuming option.

The island needs improved local emergency care and surgical care. Not a stand by extremely expensive medical helicopter. The island could build a surgery / ER facility far cheaper than they could buy, maintain a helicopter.

Hmm, I don't believe the math supports your position. It would take (ball-park) 10 trips with the helo to pay for one ER-qualified MD on call 24/7. Half to 2/3rds that again for one nurse or paramedic and 20 times that or more for the equipment. Two people on call 24/7 would burn out fast as I'm sure you'd recognize.
The numbers for an adequately equipped ER (equipment, personnel, and drugs) are high no matter where you are.
I encourage the existence of an ER but understand that depending on their capability they are not an end-all solution. The typical ER is a gateway to in-patient care. So, a full-fledged hospital makes sense. I'm all for it especially with a population of 20K+. Until then, what have you got? Nada. Sometimes small is more expensive but it serves two purposes: 1) immediate care to the needy and 2) incentive to reduce costs through increased capabilities/economies of scale.

As Nurse Natalie has pointed out, this is not just a lack of persons trained to provide EMS type services or a transport issue. There is a need for a equipped location in which to treat in an emergency 24/hrs a day.

The Polyclinic is centrally located close to the airport and could easily be outfitted to be able to provide a broader range of support services to those trained to provide rescue care / stabilize patients. At this point, the Polyclinic provides little more than Public Health - vaccines, etc. If you toured the facility, it is obvious that the design resembles more of an Emergency Room set up.

However, I believe the issue is that the Polyclinic does not provide on-call services and has very little Physician coverage (if at all). And since the Belize Government "owns" the clinic, they do not currently authorize "on call" private physicians who are not employed by them to use the facilities.

Too bad they can't just credential the Physicians and have their support staff on call to provide access / assist with the Emergency.

There is no paramedic program in Belize that I know of. Starting one would take a huge amount of effort.

The math supports Dr. Tommy's position. Locals and many visitors aren't going to be able to pay for a helicopter trip to the city. Outfitting an EMS equiped helicopter is about $3,000,000+usd for a basic set up in a Long Ranger. Now add in pilots, nurse and maintenance costs. And lets not forget an operating certificate from civil aviation. The GOB is not going to pay towards a helicopter program.

Unfortunately the GOB didn't support the BATSUB issue. Goodbye equiped helicopter. But that's an entire new thread.

A samll set up in the Lions Poly Clinic would work. Dr. Danny at Ambergris Hope Clinic has a set up for operating.

The big issue is getting the first responders all on the same page, packaging the patient for transport to a recieving facility of some type and stabilizing, evaluating and then transporting to the city if needed.

Yes of course a 24/7 ER type facility is the first step to having a hospital which we need. Yes we have been offered the help to establish and maintain an ER facility repeatedly and the government has never acted on it, political reasons I guess. Maybe this time they will listen. We will also need an emergency medical evacuation system, not one or the other. If Municipal had emergency runway lights Wings of Hope could provide service. They are trained and equipped. Possibly each of the towns should have emergency runway lights. It solves a lot of problems. Our ones in San Pedro were donated by Wings of Hope.
And no I dont need a committee to tell me what to do to take care of this right now. We have more meetings and committees than any place and nothing gets done. Put lights at Municipal emergency lights now, not after we study the situation some more. Let Wings of Hope roll. Tropic and Maya can help but of course are not obligated to but that is what Wings of Hope does. Runway lights would allow any of the three to operate in an emergency at night.
To be any kind of plan it must have redundancy which is not possible with rotary wing. Rich man can still call Astrum if he wants.

I repeat I am not talking about buying a helicopter and I agree with Mike this place has so many committees, groups, meetings that accomplish nothing that it is truly amazing. Do what Mike says and do it now!

I am in good, if obese, health and 64 years old and I would never consider living here full time if I were not able to afford to call Astrum or whomever.

What will you do if you have a heart attack and Gustavo is flying tourists down in Placencia or Cayo?

Using the local fixed wing operators is a much better solution.
But first we need a system to get medical attention to you and then you to a receiving facility or the airport. (Not wishing anything bad on you Martin:) just using you as an example)

Seems like the first priority is to get the emergency transportation off the island regularized followed by getting the GOB to allow all you good people to help us. Get our 24/7 EMS going while we put together the hospital project. That includes all the things mentioned, health care professionals with practical experience in less than first world conditions certainly have a lot to offer. Jr has implied that he will work on getting the hours extended and more doctors. That would be a great start.

In addition to a good local EMS system and a central place to use as a base for emergent care it would seem to me that locating a helicopter and crew at the main hospital in Belize would be a good option. Presumably they would serve the whole country as we must not be the only place isolated and in need of emergency medical transport.

I admit my lack of local knowledge on all this but I assume there is a procedure in place to take people their from all over the country and hopefully a procedure to get them to tertiary hospitals outside of Belize if necessary (Mexico, US, etc).

And of course if a fixed wing transport was ready to go I would use that. My point was having the ability to pay and not having to depend on the government or some other entity to guarantee the cost. I assume you can't just call up Tropic and say I have a sick person that needs to get to the mainland without them asking you to pay?

Letter to Hon John Briceno

May 4th, 2011
Hon. John Briceno
Party Leader
People's United Party

Dear Hon. Briceno
The residents of Ambergris Caye are still in shock following the death of a child due to the lack of an adequate medical facility, and the unavailability of an emergency transportation off Ambergris Caye. I am humbly asking you to raise the issue in the next sitting of the House of Representative scheduled for Friday May 13th, 2011 for and on behalf of the people of San Pedro Ambergris Caye.

It is my humble option that one of the basic needs of any human is to have access to adequate health care. In this time and age, there is absolutely no excuse for a mother to lose her child due to the lack of an appropriate health facility. In the past, BATSUB would transport patients from San Pedro and Caye Caulker at night to Belize City. In August of 2010, those services were discontinued and since then the residents of both islands have been left in the cold and are forced to find other alternatives to get their loved ones off the island in an emergency. The Area Representative of Belize Rural South Hon. Manuel Heredia has indicated in two separate instances that the matter would be raised in Cabinet; there has been absolutely no solution or indication that Cabinet is treating this matter with urgency.

This matter needs URGENT attention because the life of over 12 thousand residents of Ambergris Caye is being gambled with. It is unfair that at this point, San Pedro Ambergris Caye has made no substantial progress to its only public health facility since the inauguration of the Poly-Clinic. The residents of this island do not have a certified and equipped child birth and emergency facility on this island. San Pedro is the number one tourism destination, one of the communities that generates the most in revenues but yet is neglected with a basic necessity such as an adequate health facility on the island.

The only available transportation off the island during a night emergency is via a chartered plane from one of the commercial airlines, which cost over $3000.00. The marginalized, working class and the poor people of this community, which is the majority, cannot afford such an option. The death of the baby belong to the Narvaez family could have been prevented if there was the adequate facility or a quick and practical emergency air transportation off the island.

While the death of the baby is irreversible, it emphasizes the urgent need and should serve as wake-up call for our elected officials to put our country and people first. However, it seems no-one has awoken. Hence, I am writing you to kindly raise the issue and lobby to the government for us the residents of Ambergris Caye.

Looking forward for a response in regards to such important and urgent issue.

Yours truly,

Jorge Aldana
San Pedro Town
Ambergris Caye, Belize

Resident of San Pedro Ambergris Caye

The solutions are very simple:
#1. I have spoken to Wings Of Hope and if emergency lights were installed at Municipal they could and would be able to serve San Pedro at night. It would take less than a week to do that. It does not require committees or cabinet meetings. If emergency lights were installed at Caye Caulker they could receive the same service, also Placencia. This very simple. Our lights here were donated by Wings of Hope. The lack of runway lights at Municipal is the ONLY thing that keeps them from supplying the service at night.
#2 There are several doctors and international medical groups that would be very very happy to set up a 24/7 EMS facility on the Island. This has been proposed to the Town Council and Area rep and they have refused to take any action.
#3 Given the fact that Johnny Briceno sold out all the land on North Ambergris Caye I find it extremely unlikely he would do anything that he did not profit from. Johnny's help is the last thing we need, what a joke.
Some of our politicians are too greedy for words while others just dont care at all.
Hope everyone is following the deal with Guat money going into the PUP. I have heard no denials. After Narda Garcia's involvement in the Social Security scandal she was rewarded with a large piece of Free Zone land. This is the kind of government we do not want nor can afford to have. We must fight corruption not reinforce it. Johnny only became party leader by the favors he passed out in San Pedro but I doubt that many knew he had sold us out so badly. If they did and still supported him it speaks tons about their characters as well.

Lights would be nice at TZA, CKR and PLJ except that it would be extremely hazardous to have night ops into these airstrips.

Not really, I have about 600hrs of night time and I would not hesitate. After speaking to Wings of Hope they said they would for sure do it. There are some times when it would not be feasible. Not much difference in landing with runway lights and landing in day time a little difference in perception in the last few seconds but you get used to that quickly. Besides that no problems except weather. The GOB has refused to allow the lights to be installed at Placencia, they think the drug traffickers would take it over or something like that. Wings of Hope actually donated the lights on request of the Village Council but they were never installed for the reason mentioned.

Yes really,
the nature of these 3 strips, departing over water, no horizon, loss of reference at night is an invitation for something bad.
And, the WOH Cherokee 6 is not a very well IFR equipped acft, which is a necessity if contemplating this service.

When TZA is expanded, night operations into the city will be feasible and safe.

Drug trafficking had nothing to do with not installing lights at PLJ.

@ Mike CAmpbell - The issue of the land is not here nor there. This is not a political issue, its something affecting all of us. If you had any knowledge of our political system, issues such at what the letter state should be raised by a member of the opposition. But again what can be expected about Mike. Just prove to me that if i had any slightest intention of voting for you, you just turn your opportunities off. Best to just close your mouth and you may benefit plenty.

My two cents worth - we need the following:

1. In San Pedro - 24/7 emergency room capable of minor surgeries

2. Runway lights on all government runways in the country - for health and safety for everybody all the time - don't turn the lights on unless they are needed

3. Air-ambulance(s)

4. Improved pre-natal care with high-risk mothers being advised to be close to an appropriate care facility in anticipation of issues at delivery

Diane's point #4-I have had pregnant women from both Placencia and San Pedro move into my house in Belize City up to 3 weeks before delivery date. Have had people with illnesses further from better medical care also park themselves at my place, till they were out of a danger zone.

I stand by my suggestion a committee meets with Dr Peter Allen, who studies health modules, for reasonable suggestions on how to move forward, what you will need and how to procure. Talking to each other on this board doesn't make anyone safer in case of..

3. Air-ambulance(s)

How the hell are you going to keep Air-Ambulance(s) in the AIR when you can not keep one Ambulance on the ground?

The ambulance had something to do with St. Matthews medical school. I don't know if it was ever up and running.

I saw a great rural ambulance in Scotland that was a land rover.

It really is unacceptable, considering how current communication and corresponding information and education have improved man's lot, that people continue to suffer needlessly in numbers that have changed little per capita over many years on Ambergris Caye. Sure, urgent medical attention is only one serious problem.

Also, we don't pretend to understand politics, let alone Belizean politics, but it is at least astounding to learn here that persons who consistantly demonstrate incoherence have political aspirations!

What we wish to understand, is why emergencies on the island must be evacuated to Belize City. Are there yet more political obstacles when evacuating to Mexico? Wouldn't it be better to evac to Chetumal General than to KHMH? Ugh!

Always interested in this topic, but as noted, we have seen it before. Interest goes up when something happens, and fades after a few weeks. As some of you know, our group, Bandage International, composed of emergency room docs and paramedics, has been to San Pedro 8 times. We have at our own expense helped train hundreds of people in first aid and rescue and for a while had a a decent rescue team build around Island Ferry. The company is gone and the team not far behind I'm told. We have also offered to:

1)Coordinate bringing in Canadian/US trained volunteer ER physicians/paramedics (and equipment) on a rotating basis for 1-2 week stints during the high season if they could simply be found a place to live.
2)coordinate an emergency health summit
3)continue to train rescue volunteers in the community and at hotels/businesses.

The first two ideas simply fell on deaf ears and the third has suffered from a general lack of interest and coordination. The simple fact as I see it is that politicians or business, or ideally both, need to be behind making something happen and so far that hasn't been the case. Good emergency health care is good for all people and it's good for business. Change needs it's champions and eventually this will become a big enough priority either through foresight (hopefully)or after enough bad things have happened.

As always, happy to help, but there's only so much you can do if the "buy-in" is not there. Would rather be treating folks there than on a cool foggy night in Halifax....

Doc John