On Sunday, after the others left for Rishikesh, I was chatting with a friend from college. He’d heard about Grassroutes (I’ll find out how!) and was quite impressed with the opportunity the whole Grassroutes experience offered.

Out of the blue he asked me if I was interested in a trip in an ambulance.

He was referring to the 108 service that the EMRI (Emergency Medicine Research Institute) (www.emri.in) runs across 10 states in India. “The impact they’ve had in Uttarakhand is huge”, he said. He happened to know the person in Dehradun overseeing the state operations, and after a couple of calls things were arranged. I’d be able to go with ambulance on one of its trips.

I reached Almora on Tuesday morning and promptly went to the district Government Hospital where the ambulance was based. I exchanged numbers with the driver and asked him to give me ring when they went for their next case.

The government offices are all Raj-era colonial buildings

Most North Indian towns have a clock tower

I had some time to kill, so I walked along the two km long “pedestrian-only cobbled Lalal Bazaar, lined with intricately carved and painted traditional wooden shop facades.”

The wooden facades along the Lalal Bazaar

The only change I have to make to Lonely Planet’s description is that it’s not cobbled anymore. Dr Sushil (from Aarohi) told me that for some reason the cobblestones were replaced with stone. It was still really fascinating!

The Lalal Bazaar

I called the 108 guys at two in the afternoon. “No case yet”. Then again at three. “Still no case”. At four - the guy’s laughing now - “we usually would have had three or four cases by now”.

I’d given up hope when my phone rang at six. “There’s a case now. Are you coming?”

“I’ll be there in two minutes”, I said.

Finally!

I met Sanjay the ambulance driver, and Dhirendra and Rashmi, the two emergency medicine technicians (EMTs), who were already in the ambulance, waiting for me.

Our patient was a nine month pregnant lady from a village called Someshwar, around 40km away. The Auxillary Nurse and Midwife (ANM) had called saying “I can’t manage this case. You’ll need to take over”. The patient and her family had already left the village in a jeep.

After half-an-hour of hair-rising driving (at 70km/hr on those winding roads!) we met the jeep midway. She was a 20- year old woman who was expecting her first child. She seemed quite calm, almost apathetic. She was in early stages of labour. She wasn’t sure exactly how many months pregnant she was. “Nearly nine”, she said. “The baby’s due in two weeks time”. Forget an ultrasound scan, she’d not seen a doctor before, hadn’t taken any iron or calcium supplements, nor had she been immunized against tetanus. Her husband was working in Punjab, and had come home for the delivery. She claimed the baby wasn’t moving as much as before, something which made my heart sink.We reached the Almora District Hospital in half an hour. The patient was taken to the labour room where the obstetrician examined her. My fears had come true. She couldn’t hear the baby’s heartbeat clearly. She’d need to do an ultrasound scan to confirm.

I left the hospital, feeling a curious mix of anger and despair. The child, if it survived, would probably be underweight, the mother unprepared to face pregnancy. Imagine running the 100m in the Olympics barefoot, with ankle weights and with no prior training. This is a story being repeated all over the country day in and day out.

Quality antenatal care is cheap and easy to provide. Rural health programmes revolving around village health workers and the trained dais (birth attendants) are doing wonders all over the country. But a lot more needs to be done. According to 2005 WHO data for India, four hundred and seventy women die in childbirth for every 1,00,000 babies born (its 1 in Ireland and 58 in Sri Lanka) ; 57 of every thousand children born do not see their first birthday (the corresponding figures are 2 in Iceland and 11 in Sri Lanka). Think about it.

Back to the ambulance. I’ve no idea what happened to mother –to-be or her baby. It’s unlikely the child survived.

Before the service started, people had a really bad time. The villages in Uttarakhand are far apart, and the terrain does not allow one to cover more than 40 km in an hour. In case of an emergency, they’d have to arrange for a taxi - which would cost nearly Rs. 2000-3000. At night things would be worse, compounded by the fact that most of the males in the family were usually away working, and the women would have to go on their own. It is a really long walk from their villages to the road. Most often they would reach the hospital too late. Sanjay told me nearly five out of ten patients used to die on the way.

Now things are much better. The ambulance services villages in a radius of 30km. Once they receive the call they rush to the village. After a quick assessment the EMTs call the doctors who are based in Dehradun, who give them further instructions on what to do next. Except in really bad cases, the patient usually reaches the hospital alive, where the doctors take over. A good number of patients are referred to the bigger towns (for a number of reasons - the chief being a lack of facilities), which are often an hour or two away. So not only do they have to take the patients there, but they can’t attend to other emergencies in the meanwhile. Their 12 hour shifts often get stretched to 16 or even 18 hours for the same reason.

The ambulance service is good, but it’s got a long way to go. The EMTs are learning a lot on the job, and as one of them confessed, they’d feel a lot more comfortable if there was a doctor with them.

Healthcare in India is facing a huge crisis. The 108 service is making a big difference, but a lot more needs to be done.