By Nabamita Mitra
Case 1: A 32-year-old woman from Bhoirymbong recently gave birth inside a 108 Ambulance while she was being shifted to a city hospital from a community health centre. The emergency medical technician in the vehicle, Dolly Tohtih, conducted the delivery.
Case 2: Earlier this month, the alacrity of 108 Ambulance saved a teenager who attempted to hang herself.
Case 3: A few days before this, the 108 Emergency Response Centre got a call in the middle of the night from a 27-year-old man who was on the verge of killing himself. The response officer on duty and the supervisor started counselling. After a long conversation, the response team, which coordinated with police, could finally convince the man to change his mind. The man in distress had told the team that he called on 108 “because it gave him hope”.
For many, 108 is indeed ‘hope’ because the emergency ambulance service has saved hundreds of lives since its launch in Meghalaya in February 2009.
Started as Emergency Management and Research Institute by Ramalingam Raju of Satyam group in Hyderabad in 2005, the ambulance service was taken over by GVK group in 2009 after Raju was arrested in an accounting scandal in his company. It was rechristened as GVK-EMRI. Run as a corporate social responsibility programme of GVK, the emergency service is now spread across 15 states and union territories, including three in the North East (Assam, Meghalaya and Arunachal Pradesh where only emergency service runs).
In Meghalaya where healthcare is in a shambles and remote areas hardly have access to medical facilities, the only hope is the 108 Emergency Ambulance.
The service initially started in two districts, East and West Khasi Hills, in partnership with the state government. Then it had only 15 ambulances and an emergency response centre. Now, it covers all the 11 districts with 43 base locations and a fleet of 48 ambulances, two of which are engaged in referral transport from Shillong and Tura to Guwahati. All the vehicles have advance life support and other state-of-the-art facilities.
“We have around 300 staff and over 100 emergency medical technicians, or EMTs, here,” says Deepankar Choudhury, the chief operating officer of GVK-EMRI in Meghalaya, who is associated with the service since its inception here in 2009.
The National Health Mission in collaboration with GVK-EMRI started the Mother and Child Tracking Centre in Meghalaya on July 3, 2014, that continued till March 2016. The programme was suspended with a proposal for an integrated health helpline.
Choudhury says in all these years, the emergency service has saved over 20,000 lives and its employees have handled over 1,800 pregnancy cases. “The statistics is impressive. But one should know that a lot of dedication and hard work, besides expertise, are involved in this job,” he adds while listing the achievements of GVK-EMRI in the state.
Evangelica Blah, a former EMT who is now promoted to the quality control section, says one needs to be strong when working on the field. “Before joining the service I was a teacher for over six years. But the two and a half years as EMT changed my life. This is a job where you connect to people and realize how precious life is,” says 38-year-old Blah.
Talking about her experience, Blah says she had handled many critical cases, some of which would make her nervous initially. Once when on duty, she got a pregnancy case in a rural area. “The woman was in a taxi and had already delivered. I was new in the job and was baffled by the sight. The pilot (drivers of ambulances are referred to as pilots and they too are trained) and I tried to bring out the woman. The baby was still attached to the placenta. But we could not. So I called up a doctor and kept the phone on speaker. We followed the doctor’s instructions and completed the procedures and sent the mother and the baby home in the same taxi,” she smiles.
That was one of the many critical cases that Blah, who had to undergo a 45-day training in medical emergency service in Dehra Dun, handled. “It feels good when you save lives and people show their gratitude in various ways. For instance, the parents of a baby girl who was born in a 108 ambulance in Sohra named the child Emrishisha,” she says.
But challenges are aplenty for EMTs and pilots who are on the field. Susan Erica Lyngdoh Nongbri, who is associated with GVK-EMRI for the last four years, says there is lack of awareness among people, especially those in the rural pockets of the state, on how the emergency service work.
Often, the ground staff have to face the wrath of the public or family members when they reach late for “unavoidable circumstances”.
“They expect us to reach immediately, which is not possible because we follow a certain procedure,” says the 28-year-old EMT. She explains that emergency calls first reach the response centre from where cases are distributed according to the location of ambulances, which are fitted with GPS and can be monitored.
“Also, traffic is a major problem and we are often held up because of the narrow congested roads here. Since we have life-saving equipment in the ambulance, the vehicle does not and cannot cross a particular speed limit. These things should be taken into consideration when one is expecting us. If the case is critical and from a remote area, we sometimes request the patient’s family to move forward so that no time is wasted,” says Nongbri.
An important parameter of emergency services is the concept of the “golden hour”, which states that the mortality and morbidity of a patient greatly reduces when he or she is admitted to an appropriate health facility within the first hour of the occurrence of the emergency. Even with the most chaotic traffic snarls in Shillong, GVK-EMRI has managed a base-to-scene time of 17:21 minutes across all urban areas (district headquarters).
“For rural areas, because of dependence on higher health facilities and poor road conditions, the base-to-scene reach time is 27:03 minutes and total case handling time of well over one hour (86 minutes),” says Choudhury.
He informs that there are five back-up ambulances in case of a glitch in any vehicle. “Most of the ambulances are over seven years old and we have to take into account the chances of breakdown,” he adds.
Alicia Phanwar, a resident of Nongrah, narrates the haarrowing time that she and her family had to face when her brother fell sick. “My brother needed oxygen and we called 108. The ambulance, though came near our house, could not climb up the slope because it was an old vehicle. The employees apologised but we had to arrange for a car to take him to the hospital,” she says.
Tough road ahead
Nongbri’s colleague Sumarbhalin Basaiawmoit, who is working with GVK-EMRI for the past 10 years, says sometimes they have to travel to even the remotest corner of districts at odd hours. “There was an emergency delivery case in a Mylliem village. I was on night and received the case around 3am. It was winter and you can imagine the cold. So we went there and realised that there was no proper road and so me and the pilot walked through a field in the dark with a stretcher,” she narrates.
But by the time Basaiawmoit and her colleague reached the house, the woman had half delivered the baby that was stuck inside. “It was a clear case of delivery at home. The woman’s family must have opted for the services of a midwife who could not handle the critical case. Ignorance about institutional delivery and superstitions among rural folks are also some of the challenges which we face,” she says and adds that in several cases EMTs have to provide awareness on the spot.
Many people do not know that 108 service is free and some are even confused about the number. “Once I had to explain to a relative that 108 is the phone number and not just a mere name of the service,” laughs Nongbri.
There is also no booking system and cases are dispersed depending on the availability of ambulances. Shillong city has four ambulances which are available even at night.
Moments of joy & despair
Basaiawmoit says the work of an EMT involves both satisfaction and dejection. “There have been days when we fail to save a life and that can make you feel really helpless. We are not gods, neither doctors, but we try our best.”
Both Nongbri and Basaiawmoit agree that road traffic accidents, or RTA cases, are the worst.
“One of the worst cases that I remember was an RTA in 2011. One was spot dead and the body was beyond recognition. One of the survivors was critical as the collision with a truck had smashed the lower part of his body. He kept on asking me why he could not feel his legs and I had to keep him calm saying it was nothing. It was traumatic. The man did not survive,” says Basaiawmoit with a somber expression.
“But miracles too happen,” she quickly adds as her eyes get back the sparkle.
She narrates the story of a newborn during her training days in Dehra Dun. The mother had delivered on a river bank while washing clothes and the baby was still. “There was no semblance of life and I kept on praying so that the innocent life is saved. I was only a trainee then. Our senior trainer was with us and all of us were trying hard to make the baby breathe. Finally, the little one cried and we cried too of joy,” the senior EMT says.
The EMTs admit that the most important criterion to be on the field is a strong mind. “You cannot show weakness when someone else is in distress. You have to keep calm even if you see a gruesome accident,” says Nongbri, a former cadet of the NCC.
One should also be ready for erratic timings and should not complain about skipping meals, points out Nongbri.
Besides saving lives, EMTs also go for awareness and other training programmes.
Misusing 108
Hoax calls are rampant on 108. Of the 24 lakh calls that 108 had received in the past years, a little over 2 lakh were emergency calls. This not only inconveniences the employees but also delays service to a genuine patient. “There should be enough awareness and sensitivity among citizens so that they do not misuse the service. Someone might die for such calls,” says Nongbri.
Other services
The GVK-EMRI is planning to launch a mobile application in Meghalaya that will help people track the movement of ambulance. “It is similar to an app cab service and can function even with 2G internet connection. We are ready with the app and are waiting for the green signal from the state government,” says Choudhury.
Besides 108, GVK-EMRI also has women’s helpline, boat ambulance, veterinary ambulance (in three states), bike ambulances in remote and areas and conflict zones like in Chhattisgarh and mortuary van service, among other things. However, these are yet to be launched in Meghalaya.
GVK-EMRI also runs a two-year programme, affiliated under Osmania University in Hyderabad, for paramedics.
Better remuneration
Despite the hard work, the EMTs are not well-paid. A former pilot of 108 Ambulance told Sunday Shillong on condition of anonymity that the salary is “really less compared to the work pressure”.
“EMTs and pilots are always on the ground and have to face the public. There are challenges and no fixed timing in this job. So the salary should match the hard work. Also, it will encourage the staff to work better,” says the former employee who quit for a better option.
Choudhury informs there are two sections of employees — basic and integrated, the latter being the most trained and experienced ones. “The salary depends on the expertise. We have annual appraisals and based on the grading system we give remunerations. Also, they get all benefits like PF, gratuity, medical insurance and ESI, among others,” he adds.
But for some, money is not a deterrence because “our only priority is to save lives”.
“This is one of the best jobs that one can have. When I go to bed after day’s or night’s work, I feel good about the fact that my services are of some value, that I have the capability to save someone’s life and that we can bring hope amid despair,” says Nongbri.