Lindah, Bernard and I had just returned from the Cultural Heritage Center in Arusha. While both a gallery and exhibit hall, every piece for sale, it offers an incredibly rich collection of antique treasures, historical pieces, and modern painting, sculptures, and photographs from throughout Tanzania and neighboring lands.

From the ELCA Guest House we walked over slippery, red mud roads lined with houses, shops, and dense green to a small shop along the main, paved road to purchase a container of yogurt. While waiting in line, we noted a number of people running to the scene of what we assumed to be a fight or an accident.

When the crowd did not disperse, we also walked this direction. A shuttle bus (matatu in Kenya, dala-dala in Tanzania) sat idle in the middle of the road, its windshield cracked and broken glass on the ground. I noted a single flip-flop on the pavement behind the bus.

Bernard and Lindah were soon at my side, the pressure of the growing crowd making it difficult to determine what happened. Someone said they thought a man riding a piki-piki (motorbike) had been hit, and so I turned to see if one was around, lying on the road.

In looking back I realized we had walked past a circle of tightly clustered people, all facing in. We pressed through the wall to find a man lying on the ground, his right temple and cheek covered in blood. Once inside the circle, I asked if anyone had called for a doctor. A man to my side said he did. Then I recalled that in our lodge was an American M.D. I told Bernard to run back to the Guest House and bring him immediately.

I yelled to the crowd to step back, motioning with my hands and body as best as I could. I turned to Lindah and asked her to translate to Kiswahili, loud and clear. By the man’s side, I could see he was unconscious but breathing. I asked if anyone would loan me their sweater. No one responded so I removed my shirt, rolled it, and placed it below the back of his head, careful not to move his head side to side nor lift too much.

Calling to the crowd again, I asked for pen and paper. Immediately, someone handed me a 4×5 card and pen. I pulled my cellphone from my pocket, launched the timer application, and asked Lindah to alert me when it reached 15 seconds. I took the man’s pulse at just 18 beats or 72 per minute. Steady. Strong.

The crowd pressed in. I asked them to step back again, this time in a stronger tone. The man who had called the hospital was now assisting me. He wanted to move the man but I insisted on checking him for additional bleeding, broken bones, or spinal injury.

The man was starting to come-round, his eyes fluttering. I carefully, slowly repositioned his body so that he was completely flat, rather than one leg on, one leg off the pavement. I positioned his legs in parallel, arms at his side.

We took his heart rate again. 20 beats per 15 seconds. He was waking up. Better to be climbing slowly than dropping or rising too quickly, which could point to internal bleeding. We learned his name is “William” before he passed-out again.

I gave Lindah some cash to purchase paper towels and a water bottle. When she returned we took another reading. 22 beats per 15 seconds, steady and strong. William was more alert now. I could smell alcohol on his breath. He tried to rise, but I asked him to remain lying on his back. Lindah and the volunteer assistance both translated. I gently pressed him back down.

Kneeling at his left side, I crossed his right leg over his left, tucked my arm under his arm and supported his head. My WFR training came back to me. Although I surely missed a few items or did them in the wrong order, I believe I was not making things worse.

He did not complain of any acute pain at any vertebrae, but said his left hip hurt a great deal. No blood, and from what I could see without removing his jeans, no abrasion. As the right side of his face was hit by the bus, it is likely he landed on his left hip.

The crowd has pressed in again to the point of near suffocation. I was yet without my shirt, the light rain cooling my back. I stood up and physically pushed a half dozen people away from the center.

Lindah later told me later that she heard people asking how I knew his back was not broken without an X-ray. She thought on her feet and responded, “He is a doctor. He just knows. Do what he says.” It worked, and people gave us more room for the few minutes we required.

Bernard had arrived to the Guest House and found Dr. Rob who in turn called Dr. Kawisi whom I had met a half hour earlier at the Guest House.

With William fully awake now, we sat him up, slowly, taking the weight of his upper body. He could not stand, due to the impact or alcohol or both, it didn’t matter. We carried him, one arm behind his back, the other beneath his leg, a comfortable, safe chair for the short transport.

In the back of the Toyota there was a flip-down bench which was too small, and so we placed him on the floor. But clearly, this was not an option for he could not extend his legs and as lying on a hard, metal surface, his neck now crooked against the back of the last row of seats. I was frustrated for things were happening so quickly, the truck already pulling away. The rough road forced William into tears, crying out and grabbing at my shoulder and neck trying to lift himself.

I asked for the truck to stop. It did not. I yelled instead, this time it did. I asked that the back seat be cleared of the boxes and William be moved there. We opened the back of the truck and with less elegance than our original transition, I literally carried him from back to front and onto the cushioned seat.

Lindah recorded his full name, telephone number, and continued to ask him basic questions to make certain he remained cognitive. The doctor, from the front passenger seat had also engaged him in a conversation. I poured water onto a stack of napkins and washed his forehead four times. He calmed down and seemed more relaxed, but tried to sit up repeatedly, always complaining of the pain in his left hip.

At the hospital the doctor and driver returned to the truck with a stretcher. We moved William in four successive, small efforts, grabbing folds of clothing then arms and finally supporting head to keep his back straight and stable, just in case.

Once in the first room to the right of the entrance, the nurses arrived. They laughed, uncomfortably, when they entered the room. I handed one the note card with the heart beat data, his name and number.

She did not make eye contact with me or William, and asked, “What is the matter?”

I offered, “He was hit by a bus.”

“A what?” Still no eye contact was made, with anyone. This is a cultural difference, I know, but it remains difficult for me, especially at times when I want to know if someone is paying attention.

The nurse looked at William and then me, “He is drunk.” She frowned again.

“It doesn’t matter. He needs his back checked. An X-ray.”

“I am sorry. But you see, the technician is gone home. We can’t do it now.”

“You have his number, right? Can you call him?”

She rolled her eyes and reached into her pocket for her phone. William was lifting and lowering his legs, trying again to sit up. I placed my hand on his head so he would lie still again. The lights wavered and the power went out. A few seconds later, it returned, but continued to fluctuate most of the night.

The doctor entered and asked the nurse to start an IV. He left the room to prep the X-ray machine. Clearly, they had the required staff. When he returned, he and the nurse conducted a more thorough examination while talking to me and Lindah.

We waited for a half hour. I followed William on his stretcher into a recovery room and helped move him to a bed where they continued the IV. The X-rays showed no damage. The doctor called his driver and ten minutes later, Lindah and I were on our way back to the Guest House.

As I do not encounter this kind of direct life/death situation every day, I was reserved and reflective for the remainder of the evening. I reviewed my effort in the street, recalling additional facets of my Wilderness First Responder training. I also worked to not judge the nurse for her initial reaction for I know that in the U.S. too it is difficult to find compassion for someone who is drunk or high who hurts himself or someone else. Here, that challenge is compounded by the poverty and challenging conditions in which everyone lives and works.

I am thankful for my training, Lindah’s help, the proximity of the doctor and his good timing.

The next morning we were informed through Dr. Rob that William was released and is ok.