“She could’ve succumbed anytime,” Shakya said of the situation where a well-equipped ambulance with a skilled staff could have prevented the medical conditions from worsening.
Shakya is only a number when it comes to people in desperate need of emergency medical services and an ambulance.
The scenario could improve with the new ambulance service scheduled to start in upcoming months.
Call 102 and you can have a full-fledged ambulance service with trained emergency medical staff onboard.
The current situation of ambulance services in the Nepali republic, even in Kathmandu, the center point of progress, is inefficient and does not meet government standards. According to the Ambulance Service Regulation Act 2003, ambulances are categorized under A, B and C grades. The A grade ambulances are required to have a doctor and emergency medical system, B grade ambulances must be equipped with a health worker, oxygen supply and saline, and ambulances under C grade must have a driver trained in first aid along with an oxygen cylinder and saline.
Though the government has set aside mandates for the ambulance services, compliance has been minimal. In the congested Kathmandu traffic, it is the patients who bear the brunt. While the siren blares and the emergency signal flashes in the erratic stretch of traffic, not much can be done inside the ambulance that resembles any other public or private transportation: usually small and mid-sized vans.
“The government has policies [for ambulance services] but lacks monitoring,” said Professor Dr Rajesh N Gongal, Dean of the Patan Academy of Health Sciences. “Ambulances today are just being used as transportation vehicles with no trained personnel.”
Amid the poor management and services of ambulances, people in need of an emergency vehicle service do not get to use them.
A 2009 study in the Journal of Nepal Medical Association by Gongal, B Dhungana, M Nakarmi and B Yadav from Patan Hospital and Health Care Foundation, shows that Nepal lacks emergency medical services. According to the study, a total of 9.9% patients came to the hospital in ambulance whereas 53.6% came in taxis, 11.4% used private vehicles, 13.5% came by bus, 5.4% came by bikes and the remaining 6.2% came by other modes of transportation. The study was conducted in Patan Hospital in Sept, 2006.
The report further reads: “Only 13.5% of Triage Category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attended the Emergency Department in the surveyed area.”
In a situation like this, Nepal Ambulance Service (NAS) is trying to “develop a new system” so that health institutions maintain a standard and also the government can take some interest, said Gongal, also the president of NAS.
With the motto of “Saving Lives along the Way” and the toll-free number at 102, NAS is looking forward to giving an integrated service. When someone calls 102, the dispatcher assesses the situation and communicates with the ambulance in close proximity to the caller’s area. Currently, the five ambulances of NAS will be stationed at Sita Paila, Satdobato, Koteshwor, Narayan Gopal Chowk, and Kamal Pokhari. NAS will charge Rs 500 for transportation apart from other medicine charges incurred.
NAS’s emergency services have been deemed basic life support ambulance equipped to save lives. It consists of a stretcher trolley, folding wheelchair, spine board with head mobilizer, scoop stretcher, cervical collar, suction pump, and oxygen cylinder, among other standby necessities.
Since every injury is different, the medical personnel should have the knowledge and skills to tackle the problems and assist the patient in the right way, or it will only worsen the condition, Gongal said. So NAS’s ambulances are facilitated with a Emergency Medical Technician (EMT) with the required skills. Currently, NAS, under Stanford University School of Medicine’s supervision staff, has trained 50 EMT personnels.
Keshab Prasad Risal, Chief Executive Officer of NAS, said the ambulance is a “non-profit service rendered by Nepalis for Nepalis” since the entire initiative is being done on a voluntary basis from individuals and corporate houses.
The five NAS ambulances have been donated by organizations like Brihat Investment, Golcha Organization, KIST Bank along with Dr Suraj Shakya, and Pawan Agrawal. Although NAS will initially only cater to Kathmandu and Lalitpur, there are plans to expand its fleet to 10 ambulances in the coming months and 20 by next year before expanding outside the capital.
There are also many patron members who donate Rs 1,000 for five years, corporate members who donate Rs 5,000 monthly and one-time donors who have been donating for a social cause, which would help in covering the operational costs of the ambulance, Risal said.
And Shakya, an entrepreneur, has been donating Rs 1,000 for this cause. He said though he was skeptical initially, he realized that it was a noble idea and now hopes people will benefit from the service.
“I needed ambulance service in the past when my parents were constantly getting sick, so anyone can need an ambulance,” he said. “So if my small gesture can save lives directly or indirectly, my objective [investment] will be fulfilled.”
Gongal said that ambulances like this are a societal need and people can thus “gain trust in the ambulance service” since the toll-free number and paramedic staff can make the journey from their home to the hospital a stress-free one.
As for people like Shakya and many others, the start of NAS could only ease their frantic search for an emergency medical vehicle to transport sick patients to the hospital. Even the journey to the hospital will be taken care of by the EMT.
“Every initiative in Nepal is good,” Shakya said, “But my concern is that they maintain their services and with the same standards. When people call this service, they should get that help and that will be a key determinant to rate NAS’s services.”
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