Wednesday, June 03, 2015

India's Emergency Response System Needs Urgent Fixing

I was riding with Gowtham on his Yamaha FEZ motorcycle from West Mambalam, Chennai to Kovalam further down the coast to meet our friend when we drove up to a little boy and an older woman in the middle of the road. There was blood. There was confusion. Nobody knew what to do or how to help.

I told Gowtham to stop. I ran to the boy, about 10 years old, who was spitting copious amounts of blood out of his mouth. He and his "Akka" (older sister in Tamil) were squatting in the middle of the road, terrified. The boy was screaming and spitting bloody murder.

I examined his mouth and found that his entire lower lip had been completely avulsed (yeah, torn off). And he was bleeding uncontrollably.

I have no idea how this could have possibly happened. Did he fall off a moving vehicle and fall on his face? Here in India, it's almost as likely that a wild dog bit him and he ran to the street for shelter.

I really wasn't thinking about how it happened. I was thinking about not letting this boy die in front of me.

My baby Tamil completely failed me. I could not quickly articulate that I wanted a piece of fabric, like a kerchief, so that I could apply direct pressure to the bleeding point. So I took my own shirt off (my beloved Chennai Diwali shirt) and grabbed on to what was left of his lower lip so that he would stop bleeding.

All I could remember to say in Tamil at that point was "seriyaagividum" ("it will be all right") because I knew that I had at least some control over the bleeding point. Who knows if he was bleeding from other parts of his mouth?

The boy was in excruciating pain and all I could do was to hold him tightly, put pressure on his lower lip and say "seriyaagividum" over and over to him and his Akka. I told him in English that I knew that I was hurting him but that I wanted to stop his bleeding.

Okay. Now where is the emergency response team? The police arrived quickly (via two-wheeler) and the larger police vehicle to bring the boy to the hospital seemed to take forever to come, but it was the urgency of the situation that completely distorted my sense of time, and in retrospect did arrive in a timely fashion.

"Seriyaagividum, seriyaagividum..." it will be all right, it will be all right.

At first, in my ridiculously impatient manner as a transplant surgeon, I was in no mood to wait for emergency transport. We should take the boy now to the hospital. No one driving a four-wheeler and no autorickshaw drivers answered my plea that we take this boy now or else he will bleed to death.

I had developed a small crowd of supporters at the scene and we were ready to take the boy by motorcycle to the hospital. I couldn't imagine at first how I would be able to hold this (quite heavy) boy on the back of a motorcycle while holding pressure on his bleeding point, but there would be a way. I lugged him onto the back of the motorcycle, still putting pressure on his lower lip as he screamed in pain.

But then his screaming changed.

At the thought of being separated from Akka, the boy went completely nuts. I couldn't blame him. Of course Akka should be with him at all times. Akka will and must be with him for the trip to the hospital.

By then, the police had arrived and I was starting to feel exhausted. I could barely lug him into the back seat of the police jeep. I tried to give instructions that they should continue putting pressure on his lip, but I'm not sure if anyone was listening at that point.

"Seriyaagividum, seriyaagividum..." I knew in my heart that this boy was going to live.

In Dr. Philip G. Thomas's lucidly and eloquently written new book "Transplant Story," he describes the broken emergency response system here in India. The main problem is, and has been for a long time, one of money. Trauma care is extremely expensive and most corporate hospitals capable of delivering this level of care are reluctant to admit patients who won't be able to pay (in cash!). The trauma system is highly privatised and therefore very selective. People are often left to die. Or, if they are unfortunate enough to come to a government hospital and their GCS ("Glasgow Coma Scale" -- a measure of consciousness where 15 is awake and 3 is deep coma) is less than 8, no further resuscitative efforts are likely to occur.

As pointed out by Dr. Sunil Shroff of the Multi Organ Harvesting Aid Network ("MOHAN") Foundation, 138,258 deaths from road traffic accidents occurred in India in 2012 (Ministry of Road Transport and Highways). India has -- by far -- the highest rate of deaths due to road traffic accidents in the world. There are no (or poorly enforced) helmet and seat belt laws here. It's like it was in the U.S. 50 years ago when the main source of organ donors was young, previously healthy, brain dead head trauma victims. There is, as of yet, no effective movement to improve emergency first response capabilities and trauma care in India.

This boy was lucky. Someone who just happened to know how to save his life just happened to be there. India cannot afford to rely on luck to improve her ability to save victims of road accidents and other trauma victims. The people of this overwhelmingly caring society can and must do whatever is necessary to improve the broken trauma system in India. Seriyaagividum?

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