A month ago, the Delhi high court asked city hospitals to check the misuse of ambulances after a public interest litigation was filed on the basis of reports about how accident victims had bled to death waiting for an ambulance, while the vehicles were ferrying doctors and laundry across town.
It seems Agra, the home of the Taj Mahal, is no better. This city of some 24 lakh has only one government ambulance available for the public. The reasons given for this paucity are interesting. The health department officials told the correspondent of my paper that in January 2007 alone, no less than six of its officials had suffered heart attacks, 10 others underwent surgeries, and four met with accidents. This necessitated that nearly all the available departmental ambulances that were in working condition be made available to them for commuting to and from work.
The department of health in Agra has a total of 54 vehicles at its disposal. Twenty-three of these were awaiting repairs, 15 ambulances earmarked for rural areas are standing idle, leaving only 16 in working condition. And all these had been pressed into service for ferrying the above-mentioned health officials with health problems, a chief medical officer and two deputy CMOs. Only one ambulance is thus free for meeting medical emergencies in a city of 24 lakh.
This, too, is more often than not reported to be in the garage for repairs. Officials use ambulances to supervise the local health camps where vasectomy, tubectomy and cataract surgeries are carried out. Since such camps are held periodically, it is not entirely clear what sort of supervisory work keeps them away from the hospitals for the rest of the year.
Agra is not the only city in northern India where the public health-care system suffers from a shortage of vital life-saving equipment. Vinaya Pendse, head (department of gynaecology and obstetrics) at the Udaipur Medical College for some 17 years, was mystified by the high rate of maternal mortality in the local hospital.
In 1995, she began to conduct “verbal autopsy” on each death that had occurred in the zenana wing of the hospital during 1994-95. She found that despite minor improvements, the average number of maternal deaths had not gone down in the hospital since 1959, the year it was built. The hospital, initially equipped to handle 2,000 deliveries per year, was handling 4,000 births by 1980, but there was no corresponding budgetary increase.
From beds, medicines, attendants, vital blood supplies and ambulances to oxygen cylinders, everything was in short supply. Almost 40% of the mothers had no hospital beds available to them. They had to sleep on the filthy floor with their newborn babies, often next to women suffering from life-threatening communicable diseases.
Still, women in Udaipur, Dr Pendse says, have a better chance of survival than their rural counterparts, because when medical emergency arises, they have easier access to the hospital. In the villages, most deliveries take place at home and are handled by traditional birthing attendants. Most mothers are at risk, being very young, anaemic and hence, more prone to fatal bleeding. Women are only rushed to hospital when there is a crisis. Since state-provided ambulance services in Rajasthan are as unreliable as in Uttar Pradesh, often, heavily bleeding women are transported to the city hospital in a tractor trolley or a tempo over potholed roads.
Of the women thus transported that Dr Pendse surveyed, only eight out of a hundred had arrived in an ambulance, the rest had been brought in tempo, cart or tractor trolley. One-fifth of such patients died giving birth as they were severely depleted by the time they arrived at the hospital.
Some 29% of India’s poorest, some 300 million, depend on India’s public health-care system, presently groaning under the pressure of a vast population.The government spends close to 0.9% of its budget on this sector against the global average of 5%. Even here, the poorest quintile, expected to benefit the most from the state’s largesse, are able to use only one-10th of the resources on offer. The richest access 34%.
And it is not just subsidized ambulances that are unavailable to the average citizen. According to a 2001 World Bank report, the poorest in India are incurring 87% out-of-pocket expenditure on medicare, the highest in the world, because as a later (2004) report explains, 93% of all hospitals, 64% of all hospital beds, 85% of all doctors, 80% of all out-patients and 57% of all in-patients in India are by now in the private sector that provides services for a fee.
In 2001, when I was working as an anchor with national broadcaster Doordarshan, a major earthquake hit Gujarat on 26 January, India’s Republic Day. Our correspondent was frantic that the news be telecast as soon as possible so help and life-saving equipment could be rushed. But Doordarshan was unable to oblige as this alarming bit of information had first to be okayed by the officials who controlled all decision-making at headquarters. At that point in time, they were all at Rajpath, watching the Republic Day parade. The news room waited for them to return, as schoolchildren lay dying under collapsed buildings. By the time we aired the news, and Mumbai and Ahmedabad swung into action, it was too late.
Afterwards, I watched the children’s parents on television. The fathers said, “Yes, yes, the children were brave, they died while parading for their country and singing patriotic songs.” The mothers only wept inconsolably. They knew that their children had died because of faulty buildings, because of unworkable ambulances and unavailability of rescue machines, because of human apathy and official bungling. But like the citizens in most small towns, they must play the Shakespearean Fool, teetering on the verge of madness and chaos as they are handed compensation cheques in front of TV cameras.
This came back to haunt me when I read that the medical superintendent of Delhi’s Safdarjung Hospital had imposed a fine of Rs100 on four of its staff for misuse of an ambulance. Each of them will pay Rs25. The price of a kilo of onions.
Mrinal Pande likes to take readers behind the reported news in her fortnightly column. She is chief editor of Hindustan. Your comments are welcome at firstname.lastname@example.org