The ready set: Dr Ted Esguerra

MANILA, Philippines - He was a Bagobo orphan left on the banks of a river when he was adopted by a Davao del Sur family. He wanted to be a pilot, but his adoptive mother’s cancer made him decide to take up medicine. He passed the board, and was on his residency when he was invited to work at an air base in Saudi Arabia. It was easy for him to leave.

"I was more of an artist at the time. I sculpt, I paint, I performed in a band. I was known as an artist more than as a doctor."

It was at the Middle East base that he discovered operational medicine; a field that he says isn't as ripe in the Philippines as it is in other countries. He describes it as the umbrella for emergency medicine, combat medicine, wilderness medicine, expedition medicine, travel medicine and disaster medicine. 

"I like it more in the field," he says. "I see people fresh in the field. I see how people react when they are being pinned down, or under a collapsed structure, or inside a bus that has turned turtle. I've seen how a man looks like he is the most unfortunate creature on earth. And when he sees you, whoever you are, whatever your color is, he sees an angel in you."

That look is what brought a boy from Davao to the front lines of disaster. The man field operators call Doc Ted has headed some of the most dangerous rescue operations in the country, including the Leyte landslide and the aftermath of typhoon Sendong. He is a certified flight surgeon, and was the expedition doctor for the 2007 team that climbed Mt. Everest.

"It makes it hard for you to go out with all the ugly things happening around when you are trained to work in a neat, soft environment. And then you are in the midst of so many people wailing and yelling and destruction all around."

He stops and smiles. "I think it's not very good for a doctor's psyche."

The car

When he was a boy in elementary school, Ted Esguerra broke the rules and went swimming with his classmates in the middle of the day. The river was fast, and he almost drowned. It is why his goal has always been to intervene. He was saved, and he hoped he could too. He says being a rescuer is a way of life, that rescue works its way into how he thinks and acts. There are two knives just in the cockpit of his car, and another two in his person. He keeps what he considers the basics of communication here: glow lights, a satellite phone, a spot tracker that can triangulate his coordinates in case he is taken, and an am-fm radio with a built-in GPS. He carries IDs from the international disaster response network and accreditation for cardiac and trauma emergency rescue in case he is asked on the field.

He has a helmet on the dashboard with a headlight that will burn safely even in methane-heavy environments. He has a flashlight with a blood-tracking light, in case he is hunting for an injured bleeder, a tactical light, to signal anyone with night vision, and a non-glowing map-reading light. His other flashlight doubles as a blade. He also carries what he calls the loudest whistle on earth.

He saves packets of sugar from coffee shops to add to his emergency rations. He has medication for itchy eyes, hand sanitizers, anti-fungal creams, anti-bacterial creams, creams with steroids, as well as ear plugs for rescues with choppers. He also has a windshield smasher and a seatbelt cutter.

“If there is an accident and I am slumped in my car, I can just cut and run, smash the windshield, or cut out another victim.”

And because he believes anything is possible, he also has backup.

“This is a seatbelt cutter-windshield smasher-flashlight combo. Redundancy, always redundancy.

Rescue 1 has a built-in searchlight. Behind the driver’s seat is a water purification system, an oxygen pressure gauge, and another gadget to check on surface heat.

The bag

Esguerra has 16 hours of airtime as a helicopter pilot, and was once a professional scuba diver. He drives a ’99 Explorer Pajero he calls Rescue 1. Rescue 1 is responsible for saving a total of eleven lives, including two infants he tossed into his backseat during waist-deep floods at the height of typhoon Falcon. He says he gets bored outside the field. He trains in his spare time, while driving he drills himself through possible emergency scenarios. Every chance he has he unpacks and repacks one of his four backpacks, loaded with what he suspects is millions worth of emergency supplies he financed for years using income as a trainer.

"When I open the bag, I know where I'm going to find my trauma kit."

His standard backpack, the 40-pound monster he carries everywhere, has a built-in c-collar and pelvic sling for trauma victims. The bag has a section for hydration and other basics like trauma scissors, power scissors, a pen light, a thermoscan for body temperature and a capnometer to measure carbon-dioxide. Outside he has gauges for blood pressure and pulse rates. He has an airway kit that includes all that is necessary for everything from needle decompression to suctioning infants. He has a trauma kit, with bandages, hot and cold packs, a hypothermia blanket, bandages and antiseptics. He has a laceration kit, an OB kit—although he has only delivered two babies in the field—a burn kit,  and a kit for blood borne pathogens. He has emergency rations, and the treatment necessary for everything from malaria to open chest wounds. A small black box holds invasive medication: cordarone, epinephrine, dopamine, sodium bicarbonate, adenosine, morphine.

He carries condoms in his hydration kit, along with Betadine antiseptic. Eight drops can be used to purify water. The condoms are for storage.

He flips over another panel. Ted Esguerra carries an oxygen tank. Daily.

His other backpack has a stretcher.

The doctor

Every rescue team, says Esguerra, needs a doctor.

"If I see my superior working with me in the front lines of disaster, I am more comfortable. And believe me, I would render my salute. Not only to the rank, but to the person."

Esguerra is the Officer in Charge of the Philippine Coast Guard's elite rescue team, and is sent with his crew to disaster zones, often rappelling down from helicopters to rescue sites. Their mandate by law is to save lives.

He takes his team through repeated training. The situations change, and include earthquake, hazardous materials, flood, bombing, combat and trauma. He admits he has gotten into trouble for hiring prostitutes for demonstration work.

"I used a prostitute--sorry for the word--and she earned money in the right way, not hanky-panky things on the bed."

In Esguerra’s program, the prostitutes are paid to act as casualties all the way to the second assessment on the field. Esguerra's students work as if the ambulance is still on the way. They are required to strip the prostitute and make a full patient assessment of injuries set up by Esguerra. It is training especially for situations with multiple trauma victims. He says students are more confident on the field after handling real people on training instead of dummies and diagrams.

"In EMS, we have a rule. You cannot treat what you cannot see. How can you treat me if I split my testes and am wearing dark pants? If I'm bleeding, will you see the blood? You have to open up the pants, look at the testes and look at the anus if there are injuries there as well."

Esguerra's technique became an issue. He stopped hiring prostitutes, and paid ex-cons instead. They volunteered for the work when they found out Esguerra was looking. He was responsible for training many of them into volunteer firefighters.

The man

The worst, he says, is when there are children on the field that he cannot save. 

“I can’t stand by and watch when children are hurt. It’s like I don’t see the justice. I deserve being hurt, being injured, with all the ugly things in my head, all the evil intentions and all the ways of waging war against somebody. But not these young, innocent children.”

He smile is almost apologetic. “Sometimes the tears just come.” 

He admits his work takes him away from his family. Esguerra has three children—all of whom are trained to react quickly in case of disaster, although his smallest one still cries at the thought of their house burning. His wife, whom he met during his residency, is also a member of the Coast Guard. She has a ready smile for his random guests, and jogs with her husband in the morning. He says she hates that he is always at risk, and sometimes he agrees. He has tried to quit emergency work, tried often, but then a text message would come, a thank you for a brother’s life saved or word of a storm in Cagayan de Oro. Then he goes back, because it’s what he does.

It is difficult to classify Esguerra, although McGyver and Rambo are possible references. Then he picks up a guitar and begins singing. His songs have won national awards and presidential recognition. He is doctor and soldier and maybe poet, maybe saint.

He solves the dilemma quickly, as he does on most field emergencies. Three things, he says. Humanitarian worker. Husband. Father. He grins, then unpacks his bag again.

(Video by Patricia Evangelista, Adrian Portugal and John Javellana. Scoring “Diulan” by Moon Fear Moon.)