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Life at risk

Updated July 21, 2013
Ready to respond - city government ambulance parked in the Civic Centre, Karachi.
Ready to respond - city government ambulance parked in the Civic Centre, Karachi.

Pakistan’s 9/11 happened in 1948, when an ambulance carrying the founder of the newborn nation ran out of fuel near Keamari. It took the authorities several hours to send a replacement, making little effort to help Mohammad Ali Jinnah live longer. No improvement was made even with the passage of time.

“Pakistan has always needed a state-owned fleet of ambulances in its cities and towns since its inception, but unfortunately the authorities have never allowed it to materialise,” says a senior medic who serves in Lady Reading Hospital in Peshawar, a city which is facing the Taliban-led militancy.

Accounts are quite few and vague about the country’s ambulance service 66 years ago. Investigations show that there was no coordinated ambulance service in any of the large cities, including Karachi, the first capital of Pakistan until Islamabad replaced it in 1960.

Civil Hospital Karachi (CHK) was the largest health facility of a small city. “There were three or four vehicles which worked as ambulances, being operated by the civil hospital as many ambulances were owned and operated by the Karachi Municipal Corporation,” said octogenarian Mohammad Ramzan, who at that time worked in the CHK’s morgue.

He reminisces about the operation of the country’s first private ambulance service operated by St John. “They had a few ambulances, which we often see on the streets,” says Ramzan. St John still operates in the country with its main service in Karachi. According to its official figures, it has 547 active adult volunteers and 182 youth members and its 24-hour ambulance service has made 236,937 visits in Karachi and 882 in other parts of the country between 1991 and 2006.

It is generally believed that Pakistan has a vibrant private ambulance service because of the government’s unending failure to offer such a proficient facility.

Although there are irregularities in Punjab, it has established a huge emergency service, which is getting efficient especially in emergency services. Titled as the Punjab Emergency Service and famous as Rescue 1122, it has infrastructure in all 36 districts of Punjab. Officials say Rescue 1122 has rescued around two million victims of emergencies through its emergency ambulance, fire services and community emergency response teams since 2006.

“Rescue 1122 is not just providing the emergency victims with the basic right to timely emergency care but believes in saving lives and changing minds,” said a senior official of the ruling PML-N.

In an earlier United Nations Development Programme (UNDP) report about emergency response capability in Pakistan, the situation in Lahore was quite dismal, although there were a large number of ambulances available in the government hospitals and other welfare organisations. There were around 50 ambulances in Lahore (Red Crescent (13), Edhi (19), Government Hospitals: Mayo (15), Lahore General Hospital (8), Jinnah (10), Services (5), Municipal Corporation Lahore, Fauji Foundation, Police and other hospitals) but “none of them seem to be available on time”, in case of an emergency.

“The ambulances that do exist are mostly patient transport vehicles with only a stretcher and an untrained driver, and thus do not merit to be called ambulances. These ambulances do not even have a basic first aid box and lack even the very basic minimum equipment for an ambulance.”

International organisations say the picture is the same in most of the hospitals in the country. An obvious reason is the ambulance service being a lower priority. Another reason cited is the lack of resources but more so it seemed to be a lack of understanding and awareness in this vital area. The UNDP report warned that as a result of an organised ambulance service in the government sector a number of private ambulance mafias also flourish around the major hospitals of the country.

Seeing the success of the Punjab programme, Sindh tried to emulate it and planned its own Rescue 1122 starting from Karachi in 2008. The defunct City District Government Karachi (now KMC) had been tasked to start the programme with a fleet of 100 ambulances. However, it initially started with nine ambulances but, as happened to every such scheme in the past in Sindh, five of them were soon declared ‘out of order’ and are lying in the KMC’s headquarters at the Civic Centre. The remaining four are used whenever needed during public processions like Ashura etc. It is anybody’s guess if the Rs100 million project will be reinstated or not.

Though, recently Chief Minister Syed Qaim Ali Shah has announced to restore the same scheme with ‘renewed zeal’, critics however show no hope in that.

In a recent study, the most common mode of transport of the casualty in Pakistan was found to be taxicab (58pc) followed by private car (23pc). Specific reasons for not using ambulances included a perception that the patient was not sick enough (45pc), slow response of the ambulance services (23pc), not knowing how to find one (11pc) and the high cost (8pc). So, the reasons for this low usage include not only poor accessibility, but also cultural barriers and lack of education to recognise danger signs. The study said, in Karachi, ambulances, where they exist, barely have a comfortable gurney and arrangements for oxygen supply. The public does not perceive ambulances as medical care providers but view it only as transportation with sirens.

“Such vehicles do not reach the hospital earlier due to multiple reasons such as distance, traffic jams and poor public cooperation. Therefore many victims die a preventable death at the scene or during the first few hours following injury,” the study said.

The study lauds the Punjab system. “Rescue 1122 has managed to set up a low cost, effective system of pre-hospital care in Punjab, which can be replicated in other developing countries with little or no modification. Almost all the recommendations of the World Health Organisation guidelines for pre-hospital trauma care systems have been fulfilled by them.”

In Karachi, eight ambulances had been handed over to the CHK — each costing Rs6 million — in 2011, one of which had been handed over to the police to be used during “VIP rides” and that too had been thrown into the CHK’s parking space when it developed a fault in less than 10 months.

Balochistan has the largest area among the four provinces with sparse population. Its dilapidated infrastructure and rugged terrain coupled with the insurgency make it too difficult to provide a state-owned effective ambulance service. The government had planned a disaster risk management plan in 2006 which promised ideal emergency services to its people. However, the situation has aggravated more and the programme has been dormant since. Last year, Khyber Pakhtunkhwa passed the Emergency Rescue Service Act 2012 to establish its own Rescue 1122 with the objective to maintain a state of preparedness to deal with emergencies. Among other things, the act promises to “arrange transport where necessary for carrying persons requiring emergency medical treatment from the emergency area to the nearest hospital”.

With the change of government in the province, it is unclear to what extent this programme will take priority, though the country’s north-west is marred by terrorism and militancy. —Hasan Mansoor