Medical need -- Indian style

I was just commenting last night to a friend that there is a significant amount of organization within what seems to be a lot of superficial disorganization in India. Here is one example.

I was on my way to work, having negotiated by pantomime and broken English my standard 50 Rupee rate . I find that speaking broken English to Indians who don't really speak English is much more effective than speaking actual English. (I am still taking auto-rickshaws everywhere, as I have yet to procure a bright red scooter to match my frames.) Anyhow, we were on our way as usual when I heard the shriek of a female voice bellow from a car stopped in the middle of the road. Somehow, I have become immune to most unnatural noises after coming to India, so I did not really think twice about the noise. Fortunately, my auto driver had enough of a sense of civic duty to pull over. Looking in the direction of the now calamity (Indians love to congregate around just about anything), I realized that this was not a simple fender-bender or petty dispute. My auto driver and I ran over to see what was happening. When I approached the driver of the stalled car, I saw he was foaming at the mouth, occasionally jerking and twitching. His eyes were partly opened and he was not responsive. He was breathing without problem and his pulse was fast, but regular. It seemed like a tonic-clonic seizure of some sort. Knowing that the gentleman in the driver's seat may be epileptic and may carry an injectable seizure-breaker (not unheard of in the developing world), I asked (again in broken English) if there were any family members around? I was pointed in the direction of a young girl, I would guess 16 years old, with distinctly non-Indian English. I asked her if the affected man (her father I found out) had a known disorder. He had had something similar long ago, she said.

At this point I asked if anybody had called for an ambulance. That question was met with blank stares from everybody around. I could not be sure if people did not understand me (ambulance is commonly understood in India once you add the Indian accent to the word) or if nobody had thought to do so. Previously, I have been quite vocal about my disinterest for learning Tamil, but tor the first time, I really wanted to be able to speak Tamil. I wanted to pick up my cell phone and call 911 and be assured that an ambulance was on its way. No luck. I recruited the daughter, who speaks English like me and also Tamil, to translate. She told me that nobody knows the number of a hospital, but that the rickshaw drivers were telling her there was a hospital nearby. I then realized that there probably was no single number one could dial to get an ambulance in Chennai. The father had since bitten his tongue, causing him to bleed from his mouth and causing people to become more and more aware and disturbed by this. I explained to the daughter this happens frequently during a seizure and that she need not worry. During this time my auto driver was on the phone as well, though I am not sure who he was calling and what he was saying.

In all of this, I realized I was fairly helpless. The patient was upright, his head against the headrest -- I did what I could to position him to prevent aspiration. He was breathing, though gasping at times. Aside from this, without phenytoin or benzos or phenobarb, I was fairly useless. I instructed the girl that her father would likely be fine (to calm her primarily but also quite likely), but that she needed to speak Tamil to someone who could figure out how to get him to a hospital. She asked if I could drive her father's car there because she did not know how to drive. I declined because I did not know where the hospital was, did not consider myself adept at driving in India, and was not good at driving manual transmission cars. For some reason, the auto drivers were also reluctant to put him in an auto and take him to a hospital.

While all this was going on, traffic behind the scene was amassing. People were becoming angry, honking horns and instructing the bystanders to move the car to the left side of the road. At this point, I saw one policeman walk (at an incredibly leisurely pace) toward the scene. He had with him a walkie-talkie, but nothing else. I had decided for myself that there was nothing more that I could do; since then, I have continued to ask myself what more I could have done? Perhaps hire an auto to transport the man to a hospital? Perhaps drive the car myself? But these are all things the daughter could do as well as I (and probably better). Having decided that I was now contributing to the hysteria instead of actually helping the man's cause, I left the scene and headed to work.

On the way to work, I took a chance and asked the auto driver if he spoke Hindi. I had seen earlier that he had a Muslim nametag, and many Muslims are at least conversant in Hindi. It turns out he spoke Hindi well enough for us to have a conversation. He told me auto drivers are reluctant to transport people in these situations, but he could not communicate why this is so well enough for me to understand him. He confirmed that there is no single number to dial for an emergency in Chennai, and I think he said he had called the police (which may explain why the policeman showed up with his walkie-talkie in hand). When I told my cousin this story later, she confirmed that there is no number to dial for medical emergencies in Chennai, adding that I should carry around the number of several hospitals in my phone in case I should ever need them. Apparently, each hospital sends its own ambulance.

As we parted ways, I thanked my auto driver for stopping and trying to help; he relayed that it was the best he could do. I think in spite of the abounding disorganization and my inability to communicate, I do take heart in the fact that people like the auto driver and others stopped to help (admittedly, some stopped to observe only). When the seizing father finally got to a hospital, it was mostly because of the goodwill of people like the auto driver. In some ways, that is what India is about. The facilities exist; it's only a matter of knowing how to take advantage of them amidst the seemingly abundant chaos. For instance, had I had a hospital's phone number on me, I would imagine that the lack of organization would have quickly turned into some semblance of organization, with an ambulance taking the patient to a well-equipped hospital with many incredibly smart physicians to treat him. Again, the resources are there (at least for those who can afford them), but much can be done to organize and streamline the public's ability to use these resources. I hope things improve soon.