Healing in War
An Oregon Tech Student’s Journey in Emergency Medicine during Egypt’s Revolution
It was when the authorities thought he was a spy that Esmail Raslan realized that his arrival in Egypt to help provide emergency medical care might not be as easy as he assumed. It was 2014 and Egypt was in the throes of a revolution after the overthrow of President Morsi. All Esmail wanted to do was to help alleviate some of the suffering that he was seeing on television and social media from his home in SE Portland. This was his country and his people who were in pain. He now had a skillset in emergency medicine, and he knew he could help if only they would let him.
Originally from Egypt, Esmail came to Oregon when he was nineteen to live with some family, and with plans to eventually study emergency medicine. With his father and other family members having been in the medical field, it was somehow in Esmail’s DNA to want to practice medicine, but to do it in a way that held the excitement and fulfillment of providing daily life-saving care to those in a medical emergency.
Esmail started at Portland Community College when he was 22 and obtained his Emergency Medical Technician, or EMT, certification. His next step would be to enroll in Oregon Tech’s joint Paramedic degree program with Oregon Health & Science University (OHSU). But before this, and with his EMT in hand, he arrived in Egypt in the summer of 2014, having arranged with an ambulance company over Skype to train their staff in basic emergency care as a volunteer. Esmail traveled there with another EMT, Keenan Leismeister, who had previously served in the U.S. Marine Corps in the Middle East and was also interested in helping bring some relief through medicine.
Esmail and Keenan met in PCC’s EMT program and bonded over their shared experience in the Middle East, and both had also applied to enroll in the Oregon Tech/OHSU Paramedic program. They saw themselves as a team and approached the planning, travel, training materials, and plans for helping the people of Egypt always together. They used their own money to get to Egypt, and Keenan even tapped his Marine pension funds to cover his costs. Esmail noted, “We want to contribute, we’re not following the money.”
But after arriving in Egypt their plans were soon squelched when a top administrator with the ambulance company told them that their presence was a national security problem and they were suspected to be spies.
Both Esmail and Keenan were heart sick that their idea to volunteer to help save lives had hit a brick wall before they even could get started. After unsuccessfully going to every hospital in the area and the Red Crescent (the Middle East’s version of the Red Cross) for the next three weeks and offering their help, they had little hope left. Finally, through some family connections, Esmail and Keenan met with top administrators at Ain Shams University hospital, which was one of the three major medical centers in Egypt. After hearing about their willingness to help and all the doors that had been shut on them, they were given a chance to prove themselves with the opportunity to train nurses at the hospital in basic emergency medicine.
There was a joint understanding that this was merely a “test” of their skills and ability to actually help. They were on trial and not allowed to actually practice yet in the hospital but were limited to training nurses in basic CPR and life support skills. After a few weeks when mutual trust had developed, Esmail and Keenan were able to help in the ER, and provide on-the-job training to nurses at the same time.
Esmail recalled, “On that first day when we arrived in the ER, the head nurse just looked at us and said, ‘Welcome to the jungle.’ Within a few hours we knew exactly why she had said that. We both wanted to accelerate our learning and practice in para-medicine, and we got just what we asked for.”
Suddenly their pre-hospital ER experience was put into practice as they mainly treated horrific bullet, knife and machete wounds, and injuries related to car accidents. The trust between them and the hospital nurses and doctors grew very quickly as they all saw what Esmail and Keenan had to offer in both immediate care as well as in providing training to other medical personnel. They could resuscitate, suture, or jump into the operating room assisting the doctors at a moment’s notice. The days in the ER were long ones, lasting 18-24 hours some days, with Esmail staying and doing this for a total of almost 6 months, and Keenan staying to help for almost three of those months.
During their treatment of one patient, Esmail and Keenan were working as a team to keep the man alive, inserting an IV for fluids, getting oxygen going and beginning to treat wounds when the manager of the surgical hospital walked by and observed what they were doing and how well the emergency care seemed to be set up, which was new since Esmail and Keenan had applied their experience to the ER. Unlike in the U.S., medics are not well trained and do not know how to use basic life-saving equipment and procedures. With very few ambulances, injured patients arrive in the backs of trucks and in taxis, and with no trauma care once at the hospital, they often get much worse or die waiting to be treated by regular surgeons or in whatever transport was used to take them from one location to another for surgery.
After being called into the office of the hospital’s surgical manager, Esmail was not quite sure what to expect. But this time their skills were being recognized and the manager asked them to make recommendations on how they would set up trauma care at the hospital. Their recommendations included setting up new ER patient protocols, having the trauma ER in the same location as the medical ER so fewer lives would be lost in transit; and increasing security in the ER, where guns would sometimes be drawn by family members using force to get their loved one to the front of the line for treatment, or where doctors were physically harmed by families who blamed them if a patient died.
Just when they were leaving for Egypt the second time in 2015, both Esmail and Keenan learned that they had been accepted into the Oregon Tech/OHSU 2-year Paramedic program. “This was the only program that I wanted to be a part of,” explained Esmail. “I knew it would give me the best experience available, including being trained by emergency department physicians and various specialists in their fields. All of Oregon Tech’s faculty have high levels of knowledge and that makes a big difference in the skills we gain in the program. For example, this is one of the only para-medicine programs that enables students to work on cadavers. It’s a lot harder to learn to intubate a human if you’re only trained on a manikin.”
“Students really help each other in Oregon Tech’s paramedic program,” Esmail added. “Some were more familiar with trauma care and others were stronger on the medical side, so we were able to support each other throughout the program. Trauma care keeps the patient alive, after which the medical side of care kicks in and that’s not as straightforward as it’s generally dealing with organ functions, proper meds and really being a medical detective in trying to figure out what’s going on with the patient.”
On the second trip to Egypt, Esmail and Keenan went to the same hospital to again offer their services as volunteers in the trauma center. To their surprise and delight, all of the recommendations they had made had been implemented! The nurses that they had trained in 2014 were applying their training and were more effective overall. It was incredibly fulfilling for Esmail and Keenan to see this.
After completing his paramedic externship with American Medical Response, a 911 ambulance company with services in the Portland area, and then graduating from the paramedic program, Esmail decided to take the next step in trauma care and he enrolled in the Oregon Tech/OHSU bachelor’s degree program in Emergency Medical Services Management in the fall of 2016, with a focus on Critical Care.
Esmail said, “I felt both proud and relieved when I graduated from the paramedic program. It blew my mind that I was actually taking 19 credits a term and loving it. The program made me a better person and a better medic. The Egypt experience definitely accelerated my skills in some areas, but I also learned how to adapt to pretty much any situation. I got a lot of experience in patient communications because there weren’t social workers or resource people in the hospitals there so we ended doing some of that along with our medical care.” Esmail’s mother flew in from Egypt to join him at the graduation ceremony last summer, making the whole experience even more special for him.
Once Esmail completes the Oregon Tech/OHSU bachelor’s program, he plans to start his own company doing much the same as he did in Egypt, to train and set up EMS systems at hospitals internationally that do not currently have the life-saving infrastructure that is enjoyed in the U.S. His first step will be a visit to Saudi Arabia in the summer of 2017 where he will use previous family connections to make important contacts in the medical field that will help guide his entrepreneurial ambitions.
Jamie Kennel, director for the Oregon Tech/OHSU EMS programs said, “It is selfless people like Esmail and Keenan who we are privileged to help educate in our programs. It is fulfilling to know that our graduates dedicate their career working to make a meaningful difference in people’s lives not just locally, but across the world, sometimes in war torn countries that need assistance with basic care.”
Oregon Tech’s Paramedic program and its EMS bachelor’s degree are offered at its Portland-Metro campus in Wilsonville.