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Thursday 8
May 2008-The Kathmandu Post
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The Kathmandu Post
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BY MOHEINDU
CHEMJONG
Picture a very recent real-life scenario. You're stuck in a horrible,
typical Kathmandu traffic jam when suddenly a wailing ambulance siren draws
your attention. You feel a chill in your spine and turn to look at the
emergency vehicle rushing past. And what do you see inside the ambulance? A
bunch of people laughing and talking their heads off. They seem to be
thoroughly enjoying their good fortune to be traveling in an ambulance tearing
through the traffic-choked chaos of Kathmandu. Very interestingly, there's no
sign of a medical emergency, let alone a patient. What is one supposed to think
after seeing such a sight? A few minutes of reflective pause.
Honestly, doesn't that unnerving sound of an ambulance create a sense of
urgency that human lives are involved? Or should you disregard the wailing siren and tell
yourself that an ambulance is just another vehicle that's trying to get ahead
through the choking traffic? You read in the papers that ambulances have been
seen being used for all kinds of purposes instead of carrying sick people to
hospital. You also read in the papers that lives that could otherwise have been
saved have been lost for lack of an ambulance. And how may of us know the
number to call if you needed an ambulance?
Even in the
capital Kathmandu, health services are primitive. As there is no emergency
telephone number (like 911), if you needed help in a hurry, you would have to
look up and dial one of 30 plus ambulance services. And as there is no
coordination between the assorted service providers, nobody knows what would be
the quickest way to get an injured or sick person to a hospital. Considering
the long turnaround time, people find it more expedient to just call a taxi.
Early treatment
and proper transport are key issues in improving the outcome of a medical
emergency. An ambulance that is well-equipped and well-designed prevents the
aggravation of the patient's condition. In Nepal, ambulances are operated by a
driver with no medical training and there is no paramedic riding with him.
Family members of the sick or injured are forced to provide emergency care and
end up worsening the patient's condition.
According to
Mahesh Nakarmi, director of Health Care Foundation-Nepal, many easily
preventable deaths occur in ambulances in Nepal. Therefore, people prefer to
use taxis or buses or even motorcycles instead of ambulances. As a result, most
ambulances remain idle during the day and don't earn enough to sustain
themselves.
It may be
fruitful to consider the following points as a first step in reeducating
ourselves and redefining ambulance services in Nepal:
Definition: The
term ambulance service needs to be defined more specifically by the ambulance
service providers so that everyone can easily understand what it entails.
Coordination: As
mentioned earlier, ambulance services lack a coordinating mechanism. A
harmonized network with a free three-digit telephone number and a 24-hour
dispatch center would make medical transport assistance more efficient. The
recent spread of means of mass communication (cheaper frequency modulation
radio and mobiles) can be utilized to coordinate activities to produce better
ambulance coverage.
Ambulances: It
is important to set standards for the type of vehicles to be used as
ambulances. Considering the perennial traffic congestion in Kathmandu,
ambulances need to be very visible and have a distinct livery. They need to be
equipped with medicines and equipment like ventilator, oxygen, first aid kit
and stethoscope. Similarly, the service charge also needs to be fixed and
standardized so that even low-income groups can afford to use ambulance
services. There should be a rule to provide free service in case of accidents and
other specific cases. The Nepal Red Cross Society provides free ambulance
service during emergencies such as road accidents, violent conflicts and
natural disasters. Since petrol shortages have become part of life in Nepal,
appropriate arrangements should be made to ensure uninterrupted fuel supply for
ambulances so that people don't have to die because they are out of gas.
Public
awareness: It is also important that the public is educated about ambulances
and ambulance services. The public awareness program should include instruction
on how ambulance services can be accessed and information about obtaining
assistance during medical emergencies. The dos and don'ts inside an ambulance
should be clearly outlined.
Manpower: Here,
manpower refers to emergency medical personnel and ambulance drivers. The
drivers and paramedics should be trained in first aid and emergency care. They
should have valid IDs and licenses. The emergency medical personnel should have
adequate experience to deal with emergencies. They should also be able to use
the medical equipment in the ambulances and also know how to report and keep
records about their patients and ambulance usage.
With regard to
emergency medical services in Nepal, the number of tasks that need to be done
are many, and the paths that need to be traveled are chaotic. But we need to
work extra hard to improve ambulance services and save more lives. World Red
Cross Day (May 8) is celebrated around the world in the name of humanitarian
service. It is the most appropriate occasion to pledge to get serious about
humanitarianism and emergency medical care. It is also time we put an end to
the misuse of ambulances and inculcated some sense into people to show the
proper respect to this life-saving profession
(With input from Mahesh Nakarmi,
Health Care Foundation-Nepal.)
