A busload of more than 40 University of Kentucky faculty and students were on their way to work at a medical clinic in the Andes Mountains of Ecuador on Monday afternoon when the cars ahead came to a halt on the winding rural highway.
Two of the UK medical residents participating in the Shoulder to Shoulder Ecuador mission program hopped out to see what the holdup was. Around the bend, they saw that a bus and a tanker truck had collided, sending the bus skidding down a steep hillside.
Passengers were lying in the ravine. Others were sitting dazed and bleeding on the roadside. Only one Ecuadorean ambulance had reached the scene.
The two UK doctors, John Ragsdale and Jamie Bamford, quickly waved to their group for backup before rushing down the hill.
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"We ran down, and people were screaming, 'Help me, help me, help me,'" Bamford said in a telephone interview from Ecuador. "And you know the people who really need your help the most aren't the ones screaming."
As doctors, they have been trained to treat the type of broken bones, abdominal injuries and head gashes they were seeing at the bottom of the Ecuadorean mountain.
But it's one thing to patch someone up in a hospital emergency room surrounded by medical technology.
It's something else to rush into a ravine filled with injured people — who speak a different language — and few available medical supplies, even basics such as bandages and backboards.
Ragsdale, an internal medicine specialist who has one year left in his residency at UK, said he'd never handled so many injured at one time and never outside of the hospital. Instinct, he said, carried him through.
"One part of it is that we're well-trained, and we know what it is we have to do to prioritize," he said. "You have to deal with the airway before you deal with breathing before you deal with circulation."
Ragsdale and Bamford, joined by their medical colleagues from UK and the Ecuadorean emergency responders, began seeking out the most severely injured.
"The bus was on its side with the front smashed in. Some people had climbed out, but there were about 15 people around the site laying on rocks and in the mud," Ragsdale said.
The UK students not trained in medicine pitched in, collecting water from a mountain stream.
"It was a real group of young-people heroes," said Dr. Thomas Young, a UK professor of pediatrics and one of the leaders of the team in Ecuador. "I don't think any of them thought about themselves."
Shoulder to Shoulder
Since 2002, Young and a team of UK professors and students have traveled to Ecuador to volunteer at medical clinics in the capital city of Quito and in the city of Santo Domingo de los Colorados deep in the Andes.
The group gives checkups and treatments to children of poor families in Santo Domingo, as well as children of the indigenous Tsáchila people who live outside the city.
This year, 26 students, 11 faculty and six staff members from UK's colleges of medicine, nursing, public health, health sciences, dentistry, design, education, and arts and sciences made the trek.
They arrived in Ecuador late Friday and held a clinic in the northern city of Cayambe, the first stop in their week-long trip.
Along with their Ecuadorean partners, Peace Corps workers and University of San Francisco medical students, the UK squad was en route from Quito to Santo Domingo on Monday afternoon when they came across the bus accident.
"I went on the trip two years ago, and you do great work in the clinics," Bamford said. "I don't think any of us expected to come across such a tragedy."
Lindsay Burns, who is finishing her residency next month in pediatrics, said at least 20 passengers were with the bus at the bottom of the hill, with 10 more at the top.
The Ecuadorean newspaper El Migrante reported that the bus driver was killed and 27 people were hurt.
For the first 15 to 20 minutes after the UK group arrived, Americans outnumbered the Ecuadorean responders.
"Some of us knew Spanish, and some of us didn't, so we were communicating in charades trying to direct the other EMTs," Burns said. "Nobody was technically in charge. But we all got the work done."
Fate on a mountain
Bamford, who is in her last month of residency with specialties in pediatrics, adult psychiatry and child psychiatry, speaks some Spanish. One of the first of the injured people she came to was a woman in her late teens or early 20s lying with her hand under her head.
"She said she couldn't move her arms," Bamford said. "She could move her legs, and she was breathing. She was definitely in shock."
The man next to her kept telling her that her baby was OK. But Bamford couldn't see a baby nearby.
Finally, the girl said she was pregnant. She needed to be taken up the hill on a backboard. But even as the Ecuadorean National Guard and other emergency workers arrived, there weren't enough straps or neck braces to hold the victims to the backboards for the steep climb up the hill.
So several students and staff made straps by ripping up the 25 Shoulder to Shoulder T-shirts they were bringing to give staff at the Santo Domingo clinic. Bamford wrapped two shirts around the pregnant woman's neck to support her.
"It was quite overwhelming," Bamford said. "But I don't think we realized until after it was over."
The young doctors said they felt fortunate to have helped out.
"If this had happened 10 minutes later, we would have been past it and wouldn't have known about it," Ragsdale said. "Or if it had been much earlier we would have been too far back."
Bamford called it more than luck.
"A bus rolls down a hill and there are 40 medical professionals behind it," she said. "Here's a great example of fate."