Mardi Gras season in Sydney

Happy Ho & Karyn O’Reilly

Sydney Gay and Lesbian Mardi Gras, 24 Laura Street, Newtown 2042, Australia. Phone no: +61 –2 9516 5694. Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Mardi Gras attracts between 600,000-700,000 people to the streets. For one night in the year gay and lesbian people own the city; for the community it is bigger than Christmas. It is still the biggest demonstration of gay and lesbian rights. The sense of celebration is huge. Mardi Gras also has a huge impact on tourism in New South Wales. Last year it drew something like Australian$90million from tourists. There is a wonderful sense of celebration around this time. By the time the dance party begins on the Saturday night after the parade, the gay and lesbian community has been celebrating for something like three or four days.

In the briefing room, I always tell our doctors: "You are here to look after this community, you are not here to judge. You are here to care with respect and compassion". About 22,000 people come to the Mardi Gras dance parties and out of this about 540 people present at the Medical Unit, that is about 1.5% of people get into some sort of trouble. The large majority of the community party well and party safely with drugs. Recently at a community drug forum, following the national drug summit, the gay and lesbian community decided to follow the national path of looking at the issue of drug use. It decided not to follow the national line of prohibition because it felt that is the wrong way to go. The aspect of criminalisation of drug use in the community creates more harm than the perceived benefits. We have found that the community uses drugs safely. There is a great deal of folkloric knowledge within the community, and they have a great deal of fun. The 1.5% who do get into trouble are very valuable, and that is why we have created this Medical Unit at our dance party.

The Medical Unit

The Medical Unit is very much like an army mess unit. There is a tent in the middle of the dance area which is about a kilometre long and there are about five dance halls for different themes. The medical tent has to be set up in a place quiet enough to use our stethoscopes to hear the respiratory problems that present. It also has to be close enough to get radio control to the main dance areas; there is a seamless line of communication between the security and the medics so that we can get out there and help someone if necessary.

There are about six beds laid out like a casualty unit and an area dedicated to resuscitation. Like any emergency unit we are prepared for all contingencies. We have IV fluids, heart monitors, dextrose solutions and nebulisers. We also have free water for all those who come in dehydrated, a full resuscitation trolley, everything from adrenaline to xylocaine to band aids to panadol to IV valium. We have used all of these over the years.

Behind the triage area is the chill out area where people can sit down relax and we have personnel, nursing staff, site nurses who are there to hold your hand and look after you until you feel much better. The tent is set in a very muddy area. Unfortunately our showground area is undergoing a lot of renovations which has served as a problem within itself because we have a lot of falls. We wear medical vests and our triage stop is florescent so when you first present the triage person then triages you to the chill out area or to the acute care area at the back. We screen the resuscitation area away from the main area to give the person some sense of dignity and care.

The whole area comprises over a kilometre. You have to run five hundred yards through the crowds to try to retrieve people. The different halls of different dance themes are scattered throughout the whole area. We have a golf buggy and we have made the back of it into a table so we can put someone who has collapsed on it and race all the way back to the medical tent - taking care not to create more accidents on the way by knocking people over! We pack all our beds and all the medical equipment into the trolley at the end of the day, and unpack it at the start of the day. Apart from the medical parties we also look after a lot of the community parties which are fundraising events as well. The trolley was a wonderful donation from the AIDS Council to us; we can cart everything in one stop and it makes such a lot of difference being able to put everything together quickly at the end of the day because after a sixteen hour shift the last thing you want to do is pack up.

The team

There are two doctors per shift (each shift lasts about two hours) in around five shifts. The whole dance party lasts from around ten o’clock at night to about ten o’clock in the morning. We have one nurse dedicated to resuscitation, one psychiatric nurse, one person at triage, one team leader (often a person with a very high level of acute care responsibility), a high level paramedic, or a high level nurse who has worked in accident and emergency, who also has a lot of experience with organising a team, as well as radio experience in order to be able to coordinate our away teams which we send out to the dance party areas to bring back community members safely. The ‘away team’ often goes out to retrieve patients from the floor, and another team goes out to the stage areas because often the shows in the dance parties are quite spectacular, with fireworks and other things. This team looks after the performers as well as the community. We also have one person dedicated to a chill out area. We also have people outside. We separate the teams: one person resuscitates the person and we make sure there is someone out there to look after loved ones and significant people, as you can imagine how frightening it must be to see the screen come up and hear beeps.

The casualties

There are a whole host of presentations: people who come in agitated, people who come in psychotic, people who come in with distonic reactions from ecstasy. We see the whole realm of drugs. By far the majority are ecstasy based, but there is also a lot of poly-drug use, with mixtures of speed and LSD, not so much heroin. Ketamine also appears, although less frequently now. We see mixtures with GHB. We treat collapses, hypertension, dehydration, falls from great heights, broken bones, rashes, headaches, asthma, respiratory depression and respiratory arrest.

Visually, we provide first aid care but in reality, like a casualty unit, we get onto people very, very quickly. We maintain vital signs and a seamless control radio unit attaches us to our ambulance control in town which is dispatched immediately. Pathways are carved out for ambulances so we can ship patients out to the hospitals very, very quickly. It has worked very well over the years. Very few people have actually come into a life-threatening situation.

There are instances of ‘costume control’ where people come in and ask for band aids for their feet, to protect blisters caused by silly shoes. They will say, "My shoes are clear plastic don’t you have any clear plastic band aids?" Young people who do get into trouble are people who fall outside of the gay and lesbian community, and who decide for some reason to party for that weekend. They will then take a lot of drugs with little experience and mix it with alcohol. Often they are in their late teens, young girls who think it is very ‘cool’ to come to Mardi Gras. They come into the Medical Unit and say ‘Oh, I feel disgusting, I feel so bad I am going to vomit’.

Sometimes people come in absolutely panic-stricken saying "I do not want to be in a hospital!" There is a perceived and very real homophobia within the medical system, and an additional prejudice against people who take drugs. One young man was absolutely petrified, confused and agitated. He said " I do not want to be in a hospital. Get me out of here!" We talked him down, explaining he was not in a hospital, that he was fine. However, he did not believe us: being Mardi Gras, a lot of doctors also go out to party after their shift. Here was this doctor in very skimpy, leather shorts with laces up the sides and big silver buttons trying to convince him not to be frightened! Finally his friend said "Listen, look at that lady’s shorts. You aren’t in no hospital seeing shorts like that!"

There have been some terrible situations. Once we were called to pick up a person who had had a respiratory arrest in the toilets. It is impossible to imagine what it is like to run out in a crowd of 22,000 people who are too busy partying to notice you trying to get past them with a stretcher. One person who was so heavy (at least a hundred an twenty kilograms) had stopped breathing and we had to bag him and carry him five hundred metres back to the medical tent. All I could do was to put my knuckles onto his chest and keep pressing on him to make sure he was breathing. In the corner, there was a man of about six foot four who had an acute psychotic attack and he started to smash the place up with a broom. There was glass flying everywhere; there was a nurse with his head cut. Then we had another person with a cardiac disrhythemia and his heart was going so fast he had lost his sight. He refused to believe he was ill and he would not let us get to him, but he was dropping his blood pressure with his sweats. I shall never forget that day but luckily that is rare, and everyone survived out of that situation.

Since then we have had to revise a lot of our operations. We now have our buggy which enables us to drive out into the crowd, pick up the personnel and bring them back in it, because it is literally exhausting running through the crowd on foot. The danger is now to drive the buggies out safely without knocking into people, but some have little horns and we have also created jackets with luminous stripes so that people can spot us in the dark.

We have a great relationship with the party production people and security, so at all times there is a flow in communication, so we can get out and get to people really quickly. So far this has been a very manageable system. We have one interesting problem. There are a lot of police who visit us in our tent. We cannot stop them coming in but we share an understanding that they have no rights to our medical notes. The Police have to subpoena us because we have to protect the community so people feel it is safe to come to us rather than collapsing out on the floor. As a result, over the years we have had to code our records over drug use. We need to get more statistics so we know what we are dealing with in hard steps as opposed to anecdotal evidence.

There is always a sense that we have an uneasy relationship with the police and there is always the sense that they are trying to close the gay and lesbian Mardi Gras down. One of the greatest fears we have is of someone dying at one of our parties. Apart from the great personal tragedy, our dance parties are major fundraising events, and once the fundraiser goes, the whole of Mardi Gras, all the rights that we have fought for in the twenty-one years, will go down.

‘Sleaze’

In the last year or so GHB hit our shores and it is a different ball game altogether. GHB comes under different names, including liquid ecstasy (although of course, it is not ecstasy). It comes in many, many chemical forms, and we were getting a substance called ‘nitro blue’ which is lethal. Not only was this a new drug but we also found that the dealers kept changing the names and the dosage was very variable

The issue of drug use was discussed at a huge community forum where every community group was represented. I beseeched everyone about the dangers of GHB. Up until then we would see 500 people, six or seven of whom might need to go to a hospital, the drug use peaking at about two thirty to four o’clock in the morning, when the whole medical tent might be full with collapses or dehydration and things like that. With GHB we had our first comatose patient at eleven o’clock. It did not stop there. 25 people were so close to death, we had to cart them to hospital. It was an awful night. I remember running into the crowd pulling up bodies and going back and resuscitating them and it was all due to GHB.

We did not want to call a crisis, or patronise people nor did we want to demonise the drug, so we formed a ‘sleaze drug’ action group. Sleaze was the name of the next major party. The biggest dance party ever was coming up, and all the community groups got together and took on the expertise of the AIDS Council of New South Wales. A great deal of experience of community education was shared, and together we got out there and did the job. We created a package of information about GHB: about not mixing it with alcohol, how the doses are variable, how you should test drive your drugs like people do with ecstasy, to take it slowly and not mix it with your HIV medication, plus a whole host of other information.

There was another element we found distressing. For years there was a community that looked after each other but people were now on the floor collapsed on their own and people were dancing around them. So we created a project based on ‘Party safe, Party together’. The gay and lesbian media were engaged to help gain publicity

"Buddy up, look after your friends, make sure no one goes home alone. Maybe one of you needs to stay a little bit more straight so someone can call for help"

At the same time we increased our personnel and security so we could look out for people who collapsed and created a group of ‘drug rovers’. Traditionally those working with gay and lesbian injecting drug users had to go to the toilets to check up on the emptying of needle exchanges. Since they roam around our party area, it was felt they could also keep an eye out for people who are in distress and radio us immediately. In the first project, my partner and I walked the whole night from about nine thirty to about six thirty until the start of my medical shift. It worked brilliantly. The community took it up and it was the quietest Mardi Gras night in six years, yet everyone had a fabulous time. The only respiratory arrest occurred six-thirty in the morning, and was spotted by a drug rover on the dance floor. He reached us, and we resuscitated the man and got him into the ambulance within seventeen and a half minutes flat. That was a great example of community action.