Cities Get Out There

The Bomberos of Guatemala City

The author with the Bomberos Voluntarios in the bottom of the ravine.

“Slowly, when I count to three!” shouts a young, bald man in a white t-shirt, perched upon a precipice, his face glistening with sweat as he holds tension on a rope stretching far below.

“One, two, three!” A long line of firefighters, police officers and soldiers in army green, heave together. Slowly, a metal basket, containing a white, lumpy sack, secured with rope, slides up from the nearly vertical, one hundred foot drop to the ravine below. Six firefighters gather around and lug the heavy basket up the steep steps remaining before reaching the street. They place it reverently down beside its twin.

“It’s common,” explains firefighter and paramedic, Cesar Garcia. “Especially in this zone. One day, we pulled five bodies out of this ravine.” The bodies belong to unidentified women, each with four visible bullet wounds. Two days earlier the firefighters from this station were dispatched to a female corpse nearby, that was completely dismembered.

Cemetery in Guatemala

If you’ve heard of it, what you heard probably wasn’t good. Guatemala City, or Guate, as the locals call it, has a bad rap. It’s been high in The Citizen Council for Public Security and Criminal Justice’s list of fifty most dangerous cities in the world since 2011. A story in the New Yorker by David Grann pointed out that more civilians were killed in Guatemala in 2009, than in the active war zone of Iraq in the same period. According to the United Nations Office on Drugs and Crime, Guatemala has the sixth highest murder rate in the world. In 2012 the Guatemalan government proudly announced it had reduced impunity for crimes, such as murder, from ninety-seven percent in 2010 down to seventy percent. There is now, at least according to a government with a questionable record of honesty, a thirty percent chance someone will be caught and punished for each murder.

View of the streets of Guate from the central station.

View of the streets of Guate from the central station.

Violence is nothing new in Guatemala, a country devastated by the atrocities committed by its own government throughout a thirty-six year civil war, which started in 1954 with a military coup backed by the United States’ CIA. This developing country still struggles to provide basic services and protection to its citizens.

In the United States, citizens take for granted that when they call 911, a well-equipped ambulance will arrive with credentialed, highly trained staff to care for them. In Guatemala City, calling 122 will bring the caller a tiny Toyota Hiace, small enough to fit between cars on two lane roads, as it careens at high speeds through unbelievable traffic congestion. It might have a backboard, but might not have straps or head blocks to secure a patient to that board. Any bandaging or IV supplies are provided by the volunteer paramedics themselves and may have run out earlier in the day. Even tape is a luxury. One young paramedic spritzes Pure Seduction by Victoria’s Secret to remove caked, dried blood from wounds to examine them.

Toyota Hiace ambulance, typical for all stations in the country.

Toyota Hiace ambulance, typical for all stations in the country.

Patents are only guaranteed high quality equipment, if the unit M-1 responds. This black, battered SUV, driven by Dr. Jorge Chiu, a cardiovascular surgeon who splits his time between the United States and Guatemala, can do much more for patients than ambulances in the United States. He starts central lines, inserts chest tubes, can sedate, paralyze and intubate a patient, he has a cardiac monitor with a defibrillator, he places sutures, and writes prescriptions on scene, and, most astounding of all, he can perform a thoracotomy if needed, before the patient ever makes it to the hospital.

Dr. Chiu is a tall, lanky, athletic man, with short cropped, spiky, graying hair and a merry smile. In an interview from a year ago with reporter Abbey Martin, she mentions his description of himself as a “mechanic, doctor, paramedic and firefighter”.

“And a male stripper,” he says, grinning, “They always forget that one.” He has been a firefighter in Guate since 1990, long before he became a physician.

FireBomberos

The Bomberos Voluntarios extinguishing a small brush fire.

On the ambulances and within the crumbling stations of the bomberos voluntarios (volunteer firefighters), there is always laughter, singing, endless joking and teasing. But working in Guate, as a firefighter and a paramedic, is not easy, and can be lethal. Dr. Chiu himself has been shot in the left leg on his way to help the victims of another shooting. A grenade was thrown into an ambulance while transporting a patient. Frequent instances of being chased by gunmen to the hospital occur. One night, a member of a crew was left alone at a station, while the others bought food. When the bomberos returned, their friend and fellow volunteer’s body was bound and shot in the head inside the station.

Says Dr. Chiu,“By saving people, the aggressors become your enemies. I have had life threats on a regular basis.”

Why do these men and women still show up to do their work? Some of the bomberos are “permanentes” and receive some payment for their services, but the majority are volunteers, risking their lives, with no remuneration. In fact, the reasons are probably as numerous as the volunteers.

“My job is a blessing,” states Orantes, a ten-year veteran of the force. He works at station 69, where the firefighter was found killed. “Because I do what I love, every day.”

Currently weekly protests occur throughout the country, people are standing up against a scandalous case of corruption reaching the highest levels of the Guatemalan government. Corruption in the police force also gives more power to the many active and brutal gangs (called maras) in Guatemala. In 2013 the International Assessment and Strategy Center released a study showing that United States’ deportation policies have been a root cause of the increase in gang activity and violence in Central America. Young people were deported back to a country many of them had never known, where, in many cases, they did not even speak the language. They created their own social structures and communities.

The actual homicide rate in Guate varies depending upon the source. However, in 2014, The Institute of Forensic Sciences in Guatemala, registered 2,306 bodies with injuries consistent with intentional homicide in the city. For a city with a formal population of 1,075,000, this is an unbelievably high number. However, currently the actual population, including those living in slum areas, is believed to be approximately 4.5 million, making this city the most populous in Central America. Even with this adjustment, the murder rate is still 51.4 for every 100,000 people, compared to 45 per 100,000 in Detroit, Michigan. Guatemala registered 101 homicides each week in 2013. It is what Dr Chiu describes as a “lawless society.” What would be a national news type tragedy in the United States, here is just another day. Femicides, like the incidents described above, have become normalized. Death, danger, being chased by the maras, is nothing out of the ordinary for these men and women.

While resources are currently desperately scarce, Dr. Chiu has a vision for the emergency medical system here. “A system that treats certain medical emergencies on the scene without needing to transport. And a system that can deal with advanced techniques in a war scenario (high velocity projectiles, not simple gun wounds).”

His ability to respond and perform very invasive surgical procedures on scene, is part of his dream, but something he wants extended so that other technicians can also perform such procedures. “Transporting [people for] minor things to the hospital means leaving a huge area of the city uncovered. Plus the majority of the people are poor. The public health system is super crippled so by [treating some problems on scene], we help the patient and we help an overcrowded ER. And we have units in their areas ready for major events like shootings, which happen daily.”

Xela

Sunset in the center of “Guate”

It is 1 AM, the ambulance is returning from the hospital toward their station in the dangerous Zona 18 of Guate. They just left a teenage male, severely beaten, in the public emergency room. It is dark and the streets are almost empty. A few vehicles and motorcycles glide slowly down the deserted roads and the ambulance dodges around them easily. During the day, navigating the famously congested streets of Guate is a slow, agonizing process, but at night, the bomberos are free to play. The only pedestrians are prostitutes, lanky legs stretching from tiny skirts, leaning against tall buildings along the main road. The bomberos hear another unit on the radio responding to a shooting close by, and the ambulance pulls up, leaving the lights flashing, waiting for the call for help. Sure enough, the call comes and Garcia slams the gas pedal to the floor, sending every technician inside flying.

They laugh as the ambulance tears through the streets, six paramedics crowded together, jovially shouting directions at the driver. Lights flashing, siren whooping and brakes screaming at every cross street. The rush of joy and excitement at this next challenge, at the glorious unknown danger that lies ahead. Some would say the criminals hold dominion after dark, but they know better. It is the bomberos, not the maras, who own the night in Guate.

MemorialBomberos A memorial to the Bomberos Voluntarios in Quetzaltenango, Guatemala.

Emily Batdorff
Emily is a full time paramedic in Michigan and a full time student finishing her undergrad at Eastern Michigan University and currently applying to Physician Assistant schools. She is passionate about healthcare and justice and learned years ago that volunteering abroad can be detrimental without speaking the language and without a set of skills you can bring to the table. As a paramedic she has been able to volunteer on ambulances in Mexico and now Guatemala, working alongside other emergency medical services professionals in some of the most dangerous cities in the world.

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