What is wrong with our ambulances?

In the absence of an effective healthcare system, it is only the bigger hospitals that people go to in an emergency. The failure of our state to provide emergency services in rural areas is exemplary, but even in urban areas the situation is pathetic.

If you live in cities such as Karachi, Lahore, or even Islamabad, you are at the mercy of private clinics and hospitals, most of them notorious for fleecing people with impunity. The horror stories of private doctors are too many and too frequent and almost everyone has encountered them.

Here this writer would like to share his experiences in Karachi with three ambulance services that are no doubt doing invaluable work, but are in need of a critical appraisal. My mother, who is over 80, broke her femur and knee in an unfortunate accidental slip at home. I was in Islamabad; my brother had to take her to hospital. He called me and I advised him to contact the Aman Foundation ambulance service, since it has a reputation of having better vehicles and some first aid facilities that could be life-saving in an emergency.

The accident had happened at around 3pm and the Aman ambulance service was contacted within 10 minutes. The guy on the other end informed my brother that no ambulance was available at that time and it would take around 30 minutes for the ambulance to reach the given address. The Edhi and Chhipa services were called; they gave almost the same response. It was decided to better wait for an Aman ambulance then. After half an hour, Aman was called again and the response was that still no ambulance was available and it would take another 10 to 15 minutes.

In short, repeated calls were made for the next two hours but no ambulance turned up and every time a roundabout answer was given such as ‘it is on its way’, ‘just wait for a while’, ‘the driver has gone to fill the fuel tank’ etc. Finally, at around 6pm the ambulance came and the driver said that their first priority is the victim of an accident who is bleeding, and since in my mother’s case it was just a broken bone, and no life was in danger, he had to take care of other pressing demands.

Now the question is: if that is the case why can the ambulance service not inform the caller that it may take two to three hours for the ambulance to pick the patient? Why is a different answer given each time, and promises made that the ambulance is about to arrive? This is not a free service so at least some training must be given to the person sitting at the reception and handling such matters. Why can’t they simply be honest that ‘since your mother’s life is in no immediate danger and she is not bleeding’, you are not on our priority list?

After fifteen days when I was with my mother, we needed to take her again to the surgeon who had operated upon her. This time I was in for a rude shock myself. We decided not to call Aman ambulance but go for Chhipa or Edhi; both first enquired about the situation of the patient and after realising that it was a repeat visit to a surgeon, both informed me that no ambulance was available and I could avail some other means. My mother lives in Saudabad, Malir, with my brother, around five kilometres away from the main Shahrah-e-Faisal.

We know that near Malir Kala Board, both Edhi and Chhipa have their units set up where a couple of ambulances are almost always there. I decided to personally try and fetch an ambulance. When I reached Kala Board, as expected, both Edhi and Chhipa units had ambulances parked on the roadside. When we asked them why ambulances were not sent when we called, both expressed ignorance about any such call. Anyway, a Chhipa ambulance was sent with us to take the patient to hospital. Sitting in the ambulance was an experience in itself.

The ‘Suzuki Carry’ van that was called an ambulance was in a ramshackle condition, dirty from the inside with a rickety stretcher. The engine made horrible noises as if the whole machinery needed an overhaul. The overweight driver was wearing a Chhipa uniform that was bursting at the seams. He visibly lacked any training in handling delicate patients or victims of accidents. I sat with my mother in the ambulance and realised that the air-conditioner wasn’t working in the ambulance, and that day the temperature in Karachi was over 40 degrees Celsius.

Moreover, there was no blind or shade to prevent sunshine directly falling on my mother’s face. When I protested, the good driver took out a dirty piece of cloth and tied it with the window glass so that it could stop the sun rays. The lack of air-conditioning and extremely hot temperature within the ambulance forced us to keep the window open so that some air could enter inside. The dirty piece of cloth was fluttering right in the face of my mother, and you can picture me trying to hold that tatter.

The ride was so bumpy that while the ambulance negotiated countless potholes and speed breakers, tears flowed down my mother’s eyes as she spoke out in pain. Finally we reached the hospital and the driver gave us a bill for Rs1, 000. The hospital was hardly 15km from our home, but since we had been informed about the rate beforehand, we could not argue. We just wondered how a poor family can ever afford to pay that much just to transport a patient to hospital. The journey was a nightmare in itself.

On our way back we used an Edhi ambulance which was almost the same. Now, with the PPP government in its third term in Sindh can we humbly expect somebody to look into the matter and launch a government-run ambulance service in Sindh? I mean a proper ambulance service with trained medical staff and drivers. After 70 years of independence and Sindh being the hub of economic activity, is it too much to ask this of a government that is not short of resources. Health is one of the primary needs of the common people and it has been neglected for far too long.

Can we also expect the Aman, Chhipa and Edhi ambulance services to be honest with their patients? No doubt the Aman ambulances are better, but if they take three hours to reach the patient and in the meantime keep promising an early arrival, this is highly unethical. Chhipa and Edhi have been doing some good work but rather than having too many vehicles that don’t deserve to be called ambulances, it is better to have more focused service delivery with proper ambulances and trained staff.

There are hundreds of ‘foundations’ in the country that claim to work in the health sector, but are in fact run like commercial organisations. There are ‘foundation’ or ‘trust’ hospitals that charge exorbitant fees and then claim to work for the poor. It is about time the government took action and put a brake to such unethical practices. In Pakistan, perhaps only two models are ideal, and both are in Karachi: Indus Hospital and SIUT.

One can only wish that more such models are established, or at least Aman, Chhipa, and Edhi – rather than trying to do everything under the sun – can focus on better service delivery, even if it means reducing the areas of work they claim they try to serve.

The writer holds a PhD from theUniversity of Birmingham, UK and works in Islamabad.

Email: mnazir1964@yahoo.co.uk