India's Health-Care System 'Saturated'

'We Are at a Saturation Point'

Rama, 55, shows a photo of his daughter Puja, an attack victim who died because she did not get prompt care.
Rama, 55, shows a photo of his daughter Puja, an attack victim who died because she did not get prompt care. (By Emily Wax -- The Washington Post)
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By Emily Wax
Washington Post Foreign Service
Monday, October 6, 2008

NEW DELHI -- In the frantic moments after five bombs tore through markets across the city, Rama ran to the road, cradling his 17-year-old daughter, Puja, in his arms. Blood rushed from her head. Her pulse was slow. She wasn't speaking.

His wife, who had lost vision in her right eye, pushed through the crowds, shouting, "Help us!"

"My baby girl is lost," Rama, 55, recalled screaming. "No one is coming."

Forty minutes went by before an ambulance arrived. By the time it navigated the snarled traffic to reach the hospital, 1 1/2 hours had passed and Puja had died in her father's arms.

The chubby-faced girl with long eyelashes had hoped to be married soon, said Rama, whose family, like many here, does not use a last name. Rama said Puja would probably still be alive if they had made it to the hospital sooner.

Rama's story is not uncommon in India, where 44 bomb blasts in six cities have killed more than 150 people since May. But medical experts say the toll would be lower if ambulance services and public hospitals had the resources to treat more people during the "golden hour," the crucial period after a trauma in which a life can be saved.

"In India, it should be called 'the golden four hours' since the response times tend to be slower. If we can get the patients here more quickly, we can work to save them. We have to learn to live with terrorism and do better," said Mahesh C. Misra, chief of trauma surgery at the All India Institute of Medical Sciences in New Delhi, considered one of the country's best public hospitals. "Ambulances are not sufficient. Public training in CPR is not there. And there are huge disparities in health care in smaller cities."

Public outrage over the bombings has focused largely on poor police investigations and the government's inability to prevent attacks. But an equally pressing problem is the overburdened health system, according to surgeons, emergency response experts and others frustrated by India's trauma services.

In New Delhi, for instance, there are 35 working public ambulances with life-saving equipment to serve a population of 14 million, according to the capital's government.

Attacks in major cities occur almost weekly, often targeting areas with heavy traffic, such as bus stops, amusement parks and shopping bazaars. The bombings usually result in high death tolls, mainly because more than half of those injured do not receive prompt medical care, experts say.

"We have to combat terrorism not only with security or policies, but with our hospitals," said Ashok Randhawa, president of the Sarojini Nagar Mini Market Traders Association. Randhawa's best friend died in an attack in October 2005 that killed 50 others and injured 155.

"We all wonder if he and other loved ones could have made it if the care was better," Randhawa said. "That pain haunts us."


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