Ambulance chasing in Mumbai

MUMBAI, India — Dr. Saeed Ahmed gets a call – a patient at Noor Hospital in South Mumbai needs to be transferred to another hospital with better medical equipment. The doctor, his assistant and driver load up into the ambulance, turn on the siren and head downtown. A similar scene could have taken place in New York.

But there is one glaring difference: During the approximately 30-minute ride not a single car, taxi, bus or person moves out of the way for Dr. Ahmed's ambulance.

Not one even pauses.

The ambulance, despite its bright yellow color and blaring siren, becomes just one more vehicle on Mumbai’s famously congested streets.

“We can’t do anything,” says Dr. Ahmed, as he points out the window to the bumper-to-bumper traffic. Most people take public transportation like taxis or rickshaws to the hospital, he says, because they know an ambulance cannot get them there quickly.

Some of India’s private hospitals provide such top quality, and relatively inexpensive, healthcare that the nation has become a hub for medical tourism. And yet a combination of infrastructure challenges, rigid behavioral norms and lack of political will has created a situation in which the country’s pre-hospital care and emergency services for its own residents are lamentable, say public health specialists.

“It is the golden hour [the first hour after being stricken] that is most important especially for cardiac patients or even stroke patients,” says Dr. Ahmad Mecklai, the chief of operations and projects-in-charge at Mumbai’s Prince Aly Khan Hospital. But India, he says, does not have a system in place to serve people during this critical time.

In countries like the United States emergency services are centralized, and everyone knows exactly what to do: Dial 911. In India, Dr. Mecklai says, there are multiple services that all operate on their own with no coordination.

“Forget a national plan, there’s not even a local plan,” he says.

Enter a market opportunity. A company called Ziqitza Healthcare Limited is trying to improve India’s pre-hospital care with an ambulance service that aims to provide quality service that is sustainable and available to the country’s poor, according to marketing manager Amit Antony Alex.

The company, which goes by the logo Dial 1298 and bills itself as a "social enterprise," launched four years ago. It has 51 ambulances serving Mumbai, another 30 in the southern state of Kerala and 10 in India’s northern state of Bihar.

Dial 1298 aims to provide services to Mumbai’s poor while being sustainable by using a cross-subsidy business model. The company’s fee structure is simple: A patient pays depending on what hospital he or she is using.

India has some top-notch private hospitals that offer excellent medical care to the country’s wealthy. Anyone who can afford them, uses them. However, the vast majority of India’s population must rely on government-run hospitals that tend to be in poor condition.

A simple walk around a state-run hospital in Mumbai and one quickly understands why only the poor use it. It feels old and dirty. In one hallway, stains from old pigeon droppings mark the floor. Rooms are filled with patients sleeping on flimsy mattresses on top of peeling old metal beds. Bloody patients and visitors share a waiting room with a stray dog sleeping on the floor.

India’s state-run hospitals are mostly in “deplorable conditions,” says Dr. Mecklai. “Half the time the machines aren’t working, half the time the doctors aren’t available.”

If Dial 1298 picks up a patient who is going to a private hospital, the patient must pay 1,500 rupees ($33) for an advanced life-support ambulance that comes with a doctor and medical equipment, and about half that for a basic life-support ambulance, says Alex.

If a patient chooses to go to a state-run hospital, Dial 1298 assumes he or she is poor and gives the patient a subsidy of up to 50 percent. If a hospital contacts Dial 1298 and says the patient is so poor he or she cannot pay anything, the ride is usually free. About 20 percent of all the calls are subsidized or free, he says.

But there's a problem: People aren’t calling.

Dial 1298 has the capacity to handle about 300 calls a day, but only 50 to 60 call. Alex blames the bad reputations of government ambulance services, or patients who worry about bad traffic.

“The biggest challenge for us is to bring about a behavioral and cultural change among Indians to call an ambulance when they need it,” Alex says.

During a different shift, a 1298 ambulance responded to a call to transfer a patient between hospitals and then sat around at Bombay Hospital for hours, waiting for another call.

Waiting, the driver read the newspaper. The doctor listened to a cricket match on the radio. This reporter managed to lie down in the back of the ambulance and get in a long nap.