Questionable rides

Sadiqur Rahman explores the reasons behind the shabby state of the ambulance services sector in Bangladesh

06Ambulance services, necessary for emergency situations, is still beyond the affordability of general patients, especially poor patients and their families in the country. As such, even in Dhaka, people have to depend on paddle-powered and CNG-run auto rickshaws to take patients to the nearest medical centre. Public health officials that ambulance services, as is understood in the developed countries, is not adequately available in Bangladesh, other than from few private and public hospitals in Bangladesh, who charge exorbitant rates.
On April 27, New Age Xtra talked to Sabiha while she was bringing her wounded mother Halima Begum home by rickshaw from the Dhaka Medical College Hospital (DMCH). Halima (65), with fractured leg, had been undergoing treatment for the last few days at the hospital. She winced and suppressed her groans of agony as the rickshaw wheeled through the bumpy and pockmarked roads.
Sabiha says, ‘Ambulance was not available at the DMCH while the fare charged by commercial ambulances were very high. As the passenger space within an auto-rickshaw is not wide enough to keep a bandaged leg straight, we had to opt for a rickshaw.’
On the same day, some friends of Fahim Uddin brought him to DMCH from the Sir Salimullah Medical College Hospital (SSMCH) by a CNG-run three wheeler. Fahim had severe injuries on his head following a road accident. He was initially admitted to SSMCH and later referred to DMCH.
One of his friends tell New Age Xtra, ‘We failed to arrange ambulance at the SSMCH. But he [Fahim] needed a quick transportation. As we did not have contact numbers of private ambulance services, we took a CNG-run three wheeler instead.’
Every day, thousands of patients like Halima and Fahim, have to accept uncomfortable and risky rides on their way to receive emergency medical care in the hospitals. Such trips are actually risky, as health experts point out.
Due to unavailability of ambulance in the public hospitals and the costly service charges in private clinics, private commercial ambulance service has been mushrooming in public hospitals, where the number of patient’s admitted is still very high. Some owners of second-hand microbuses are now operating unauthorised and unregulated commercial ambulances, just by installing a siren, stretcher and oxygen cylinders in microbuses or similar vehicles.
These so-called ambulance service providers are taking advantage of the fact that public health authorities have left this sector entirely unregulated and guideless.
07Hence, fare of the emergency transportation depends totally upon the will of drivers of these commercial ambulances. Some drivers share with New Age Xtra that Tk 10,000 to Tk 15,000 is charged usually to carry patients from different parts of the country to hospitals.
Chan Miah, vice-president of an unregistered Ambulance Owner’s Association based in DMCH, informs, ‘An up-down trip from DMCH to Khulna or Chittagong takes Tk 10,000 (non AC) and Tk 12,000 (AC), while Tk 13,000 (non AC) and Tk 15,000 (AC) is charged for Thakurgaon or Panchagarh trip.’
Chan Miah also informs that they charge Tk 600 to Tk 1,700 for an up-down trip within the Dhaka city area.
Some family members allege that, auto-rickshaw drivers also charge extra, even double if they see critical patients who need to be taken to hospitals or residences. Sabiha, a garments worker, shares, ‘We were going to Kamrangir Char from DMCH that day. A commercial ambulance asked for Tk 600, while a three wheeler asked Tk 250. So I had to hire rickshaw for only Tk 60.’
Health experts point out that commercial ambulance services in the city has been running in the same manner as rent-a-car businesses.
Dr Iqbal Arslan, secretary general of the Bangladesh Medical Association (BMA), tells New Age Xtra, ‘Due to absence of government guidance, these [commercial] ambulances are decorated only with a single stretcher and benches behind the driving seat. No first aid box, diagnostic equipment or injecting equipment, emergency medicines are kept in these usually. These items are very necessary for critical patients on their way to hospital.’
He adds, ‘Some of them keep oxygen cylinders. But they do not know how to properly use it. They also do not know how to treat a critical patient, as all of them are not trained paramedics.’
Mostly drivers along with helpers, with automobile mechanic experiences, run these unregistered ambulance services.
According to Bangladesh Road Transport Authority (BRTA), currently there are 1,686 registered ambulances in the capital city. Besides, more than 400 ambulances are providing commercial emergency services in Dhaka without approval from the BRTA.
Concerned physicians allege that owners of vehicles, even ambulance, get registration under the BRTA Ordinance 1940, where no provision or requirement for an emergency medical transportation is specified. Taking advantage of this, many owners are now transforming their old microbuses into poorly-equipped ambulances.
Dr Arslan suggests, ‘Government and its public health wings should address this issue with great importance. There should be a mandatory guidance to decorate an ambulance with all necessary equipment and ensure presence of paramedics.’
He adds, ‘Introducing a unique help line is necessary to bring the ambulance services available for the people. It will also help to bring commercial ambulances under a single and regulated network.’
Professor Dr Md Shamiul Islam, director (Hospital and Clinics) and also line director of hospital services management of the Director General of Health Services, admits that emergency medical services are one of the many rights of citizens. He adds, ‘For a long time in the country, emergency ambulance services, especially privately-owned ones, has not been organised. I think, we [government] should respond to the demand as soon as possible.’