Sanity amidst chaos: The story of Aragalaya street medics

by Dr Lahiru Kodituwakku

MBBS, MSc (Community Medicine), MSc (Disaster Risk Reduction & Development), MBA, PgD in Health Sector Disaster Management

Healthcare institutions are often considered to be sanctuaries amidst crises and wars. Not only do they provide lifesaving health services but also give refuge to the most vulnerable, when there is nowhere else to go. This is most evident in the ongoing crisis in Palestine. Heart-wrenching images of scores of wounded, including innocent children, being rushed to hospitals and subsequent chaos within the hospitals are portrayed and aired through the media daily. Marred by resource constraints, amidst the most difficult circumstances one can ever imagine, they are in a constant and desperate struggle to keep basic lifesaving services running. Furthermore, despite the so-called ‘Immunity’ under international law from being battered in a warzone, hospitals and ambulances have become a target for indiscriminate bombings and even being caught in the crossfire.

In a dire situation where hospitals are no longer safe, inaccessible, or unable to cope with the influx of patients, what would be the solution? When people are dying in the streets, ambulances are targeted and wounded are left to find their way to safety on their own, who will take care of the most in need of urgent care? These questions have been raised repeatedly not only in warzones but also during mass protests, civil strife and all types of disasters where conventional modalities of providing healthcare are severely challenged. It calls for a certain degree of sanity amidst the chaos.

‘Street Medics’; a concept that first originated during the Civil Rights Movement of the United States in the early sixties, has been highlighted by many scholars and activists alike, as an alternative mechanism to provide urgent first aid, treatment, and basic life support during emergencies. Street medics usually comprise volunteers of diverse backgrounds, united by the common goal of providing essential care and treatment for the most vulnerable during crises. These medics could be well-trained physicians in trauma and injury management, first aid providers, activists or just good Samaritans who just respond to the call for help! During the anti-capitalist and counter-globalization movements in the US in the early 1990s and 2000s, numerous groups of street medics operated within the crowds of protesters, when hospitals were inaccessible, overwhelmed and some injured protesters refused hospital care due to the fear of being arrested by law enforcement. They often provided care for trauma victims, injuries sustained due to crowd control weapons and elements, as well as general conditions such as dehydration, heat exhaustion and heat stroke.

Global experience in Street Medics is numerous. However, do we have our own brand to go in line with the rest of the world? YES, WE CERAINLY DO.

In early 2022, Sri Lanka plunged into turmoil amidst an unprecedented rise in civic activism and sustained peoples’ protests in response to the economic meltdown, corruption, and poor governance by successive governments. People took to the streets in numbers, demanding that their rights be reinstated, culminating in a mass protest movment, popularly known as ‘Aragalaya’ (The Struggle). Sporadic street agitations gradually moved to the iconic Galle Face Green, where thousands of protesters occupied the premises and organized daily agitations, vigils and protests, attended by thousands from all over Sri Lanka. In reminiscence of the ‘Occupy Wall Street’ movement in the USA…, protesters, activists, and civil rights groups, camped at the premises, which is in the heart of Colombo, closer to the seats of power, causing daily confrontations with the Police and Armed Forces.

Socially conscious doctors along with humanitarian organisations anticipated casualties among the agitating public. A few amongst them, armed with backpacks containing essential medical supplies for trauma care took to the streets voluntarily, mingled with the protesters and provided urgent medical care at the site. However, as the agitations grew in numbers, it was evident that a much larger scale organized attempt was required to meet the demand. This paved the way to form a voluntary street medic group connected through social media platforms, calling the doctors, nurses, medical and nursing students, and volunteers for urgent medical action in the streets. They were backed by the able support of the Sarvodaya Shramadana Movement, Sri Lanka Red Cross, St. John’s Ambulance Service and 1990 Suwasariya Ambulance Service, for casualty extraction and transfer for further specialized care.

As the street agitations moved to the Galle Face Green, a field medical unit was established in partnership with Sarvodaya, the Red Cross, and St. John’s. A core coordination group was formed to liaise with diverse stakeholders. This included patient care planning, coordination of donations, mass casualty planning and prompt evacuations to hospitals. Over 400 doctors including specialists in the fields of trauma care and emergency medicine, nurses and First Aid providers came on board, making it a 24×7 operation. Medical students joined on a roster basis to scale up operations whenever necessary.

Subsequently, the basic unit was converted to a fully-fledged field medical unit with emergency facilities and four ambulances placed in the camp. Psychological First Aid, medical clinics, dental and physiotherapy services were provided to resident activists, in addition to the care provided at the site of protests. Within three months, Street Medics had served over 20,000 patients both at the camp and on the streets, with over 1000 ambulance runs and critical transfers. Guided by the principles of humanitarianism and medical ethics, they provided the necessary care, not only for the protesters but also for injured law enforcement officers alike. These care providers mostly worked backstage, sans any fanfare and publicity.

In the final analysis, this voluntary humanitarian effort could be identified as a great example of providing urgent medical assistance during a crisis when conventional medical services are restricted and or inaccessible. Furthermore, it also demonstrated how the concept of Street Medics could be scaled up to expand urgent medical services in a challenging environment.

The concept of Street Medics is not an alternative method to provide urgent help anymore! It is a lifeline that could preserve the ‘Right to Health’ for the masses under duress and pandemonium. Therefore, it is also high time for the medical fraternity to recognise and acknowledge the importance of Street Medics and explore the best possible ways to integrate it into mainstream medicine for the betterment of the most vulnerable and oppressed, during times of incontrovertible need.

(This article was extracted from the December 2023 Newsletter of The Sri Lanka Medical Association and presented to The Island by Dr B. J. C. Perera)