20 July 2020

Suwa Seriya: How Harsha De Silva redeemed ‘Yahapalanaya’

I was skeptical about Suwa Seriya, the emergency ambulance service launched by the Yahapalana Government with Indian funding. My skepticism is rooted in disappointments with that regime which we need not go into here. Later I figured that I was too quick to judge the project. Still later, in December 2017, something happened that shed all doubts I may have entertained.

It’s a personal story. My father, then 79 years old, suffered a TIA (Transient Ischemic Attack) which left him partially paralyzed. I was out of the country. The man who was taking care of him had called my brother who immediately went to our father’s house. On the way he had called the healthcare outfit that has attended to such situations before. He had been told that they would take 45 minutes to get there. Then he had called ‘1990.’ This is how he related what happened thereafter:

‘They picked up at the first ring and asked me clearly where the patient was. I was told that the ambulance was being dispatched right away. The lady who answered the call contacted me three times to check if the vehicle had arrived. The ambulance arrived within minutes. He was rushed to the Kalubowila hospital. It would have taken us no more than three minutes to get there from Pamankada. Ten to eleven minutes after I made the call, he was being attended to by a doctor. When I turned around to thank the Suwa Seriya people, they had already left!’

I still recall responding to a post by Dr Harsha De Silva on Suwa Seriya where I mentioned the above incident. He replied my comment saying how happy he was that the service had helped ‘Uncle Gamini.’ Harsha’s father was a contemporary of our parents at Peradeniya University and Harsha was my brother Arjuna’s classmate. I’ve hardly ever agreed with his economic theories and have rarely had occasion to applaud his political decisions. We are friends though and I will refer to him as ‘Harsha’ henceforth.

I remember promising myself to write about Suwa Seriya. So let’s start at the beginning.

In 2015, the new Government headed by President Maithripala Sirisena and Prime Minister Ranil Wickremesinghe were seeking to improve ties with India. India expressed interest in helping with projects that have a directed impact on the people. Proposals were solicited. The Prime Minister announced this to the Cabinet setting the stage for a wish-list to be made.

Harsha had a personal story too. He had realized the need for a service such as Suwa Seriya when a friend met with an accident in Kantale. Coincidentally, Harsha’s classmate and close friend Dumindra Ratnayake had been contacted by another friend, Prof Asitha De Silva about a project on these lines.  

‘Asitha is a close friend of Karthi Gajendran, a Sri Lankan working for Indian conglomerate GVK, heading the Airport Division. GVK has a not for profit arm called GVKEMRI (Emergency Medical Research Institute), which operates such a service across India. Karthi had suggested to Asitha that a similar service could be set up in Sri Lanka. So Karthi, Asitha and I met Harsha and discovered that Harsha had told the Prime Minister that the Indian grant could be used for such a project. Harsh went to see Ranil again, but the Prime Minister had told him that list had been finalized, but suggested that he could try convincing Prime Minister Modi when he visited in August.’

So Harsha met Prime Minister Modi and discovered that the latter had played a key role as a Chief Minister when such a service was launched in India. He approved funding for a year. It was a grant and the only condition was that GVKEMRI would be involved. They had helped with with budgets and estimates. The first phase was limited to the Western and Southern provinces. India allocated USD 7.75 million was allocated for 88 ambulances, equipment, training and a year’s operational costs.

Contrary to fears expressed about the entire operation being a cover for covert Indian intelligence operations, there were just three Indian technicians involved. All the Sri Lankan technicians were trained in a special facility in India dedicated for such medical operations.

So in July 2016 the project kicked. The ambulances were housed in police stations for efficiency and security under the supervision of a project committee headed by the Director, Health Services.

After a year, funding was requested by Harsh for the second phase. At the time he was the  Deputy Minister, Foreign Affairs. Harsha who worked closely with the Secretary, External Affairs of India, Dr Subrahmanyam Jaishankar, kept the Indian Premier updated in each of his four visits to that country. He had to visit India 4 times and each time he met PM Modi and gave updates. In May 2017 when he visited Sri Lanka again Prime Minister Modi announced a second grant of USD 15.02 million.

There was one condition— Sri Lanka should take responsibility to sustain it beyond the grant.  In order to develop a sustainable model, an Act of Parliament was drafted and approval duly obtained. In August 2018 ‘The 1990 Suwaseriya Foundation Act No 18 of 2018’ was passed.

Accordingly a Foundation was set up and operated by a Board with four independent members appointed by the President. The Secretary of the Treasury, Secretary of the Ministry of Health and the IGP were ex-officio members of this board. The independent members were Dumindra Ratnayake (Chairperson), Vijay Malalasekera, Sandhya Salgado and Prof Asitha De SIlva. The Act also allowed the Foundation to have a fund by which grants can be received with the Government making good on any shortfall of funds to have the service in operation. The assets of GVKEMRI-Lanka assets transferred to the Foundation.

Under the second phase operations were expanded to cover the entire island with the Eastern Province being reached last (July 2019), the delay due to the Easter Sunday attacks that year.

There had been some glitches at the beginning, Dumindra acknowledged, but these had been ironed out.

‘There are nuisance calls. If we get nuisance calls from the same number three times, we block it, but only for an hour because even this idiot might need the service; we just want to save lives, that’s all,’ he said.

That’s an important line, I found it. The motto is ‘we save lives.’ By way of elaboration, Dumindra related an interesting anecdote.

I asked a single question from each of the first 600 persons we recruited: “what is your job?” So they would say ‘pilot,’ ‘technician’ or whatever it happened to be. I would say ‘wrong, try again.’  It’s saving lives. We stop everything to save lives. If we have to we skip meals, we refuse to answer a call of nature. Every second counts. It could make the difference between life and death.

‘In fact everyone is committed to adhere to this. Every life matters, be it a rich man or a beggar. It’s the same for them. If anyone is out of line in this regard he/she is terminated. We can’t afford to take a risk in these things.

Today there are 297 ambulances covering the entire island. They are fully equipped not just with ‘medical stuff’ but tools that may be required to respond to any situation including cutting through to pull out someone from a wrecked vehicle. The average time taken to reach the distressed party is 11.4 minutes. An average of over 1050 cases are handled by Suwa Seriya. That’s a ratio of 1 call out of 5, most of the others being multiple calls for the same patient or accident, nuisance calls and inquiries. Dumindra said that 98.9% of the calls are answered on the first ring itself.

Yes, 98.9%. Suwa Seriya has all the data and it’s constantly updated. I spoke with Dumindra to ask about Suwa Seriya on March 15, 2020. He pulled up the numbers: Calls answered — 2,103,576, emergencies assigned — 456,705, hospitalizations 403,643, baby deliveries — 298, major mass casualty incidents — 5, multisite mass casualty incidents — 1. The data is separated by the kinds of cases, average response time and district as well. There’s near real time vehicle positioning, google traffic integration to select the fastest ambulance, call to wheel time targets and monitoring and follow up.

I was amazed by the sophistication and the attention to detail. I learned, for example, that there are separate protocols on patient handling processes, that it is compulsory to obtain a doctor’s advice, that there’s always a doctor at the call center and that on-call doctors are always available and that all of them are from the Sri Lanka Society of Critical Care and Emergency Medicine. The doctor decides which is the suitable and nearest hospital.

‘Protocol violation is a very serious matter. We enforce strict discipline. We have to,’ Dumindra explained.

Suwa Seriya is also marked by remarkably low overheads. It’s a voluntary board. The chairperson doesn’t have an office and doesn’t use any facilities. They are guided by the Shop and Office Act. Office closes at 5 pm. No chauffeurs, no secretaries, no assistances and no vehicles apart from the ambulances.

And they keep improving. For example a separate ‘crisis management call centre’ has bee set up so that the regular call center can be operated without interruption in the event of situations such as the Easter Sunday attacks. The software has been updated. It’s all Sri Lankan software, Dumindra revealed.

‘It’s optimized for efficiency. I want ambulances to be sent in five specific steps: a) number, b) district, city c) location (the fastest and not necessarily the closest ambulance), d) reason, and e) dispatching of ambulance. Every ambulance has GPS. So the system knows where each and every ambulance is and what’s happening; whether the engine is running or not, being cleaned or not etc.’

There’s constant training as well. The Society of Critical Care and Emergency Medicine conducts refresher training courses for EMTs every three months for example. Every driver is trained in google navigation and in listening to the ‘Google Aunty’ as Dumindra put it. People at the call center are also trained to improve location accuracy. And every EMT and pilot is evaluated every month. No one can slack off: ‘it’s a performance-based culture that we have created,’ Dumindra pointed out.

Dumindra lamented that although there are supposed to be 5 million smart phones in the country, only around 10,000 have downloaded ‘1990,’ the Suwa Seriya app. ‘People don’t think they might need an ambulance until they get hit,’ he observed. He’s correct. I hadn’t thought I might need one either. I downloaded it immediately!

It’s a free service and, like my family does, those who benefit are appreciative. They don’t know how much it costs though. Suwa Seriya plans to issue receipts mentioning the cost in each case and also carrying a note stating that it is borne by the people of Sri Lanka. ‘Universities should do that too,’ Dumindra quipped but quickly became serious, saying that an option for donations for the will be created.

Soon: a receipt. No payment..this is the cost….borne by the people of Sri Lanka (Univerities should do that too). Options for donations for the fund.

Suwa Seriya is now a fully state-run operation with an important voluntary component at the top-end of operations. It’s a model that can be replicated — at least in the use of technology, maintenance of high standards and the zero-tolerance of indiscipline.

Another noteworthy fact is that in a country where change of government typically sees not just changes in personnel but even complete abandonment of strategies including those which clearly work, Suwa Seriya has not been touched. The Government didn’t change the board of directors. The new Minister of Health had given the assurance that there would be no interference.

Dumindra runs a tight ship, but he insisted that if not for Harsha it would not have happened. ‘He managed all the negativity, he got the Act passed, the worked to obtain the second tranche and made sure that we got all the support we needed from the government.’

There’s not much to applaud in the Yahapalana years. Indeed, even those who placed a lot of hope in ‘the change’ of January 2015 were quickly left disillusioned. Nevertheless, it can be argued that it was all redeemed by Suwa Seriya. It is certainly the one stand-out project of that period.

As I mentioned Harsha De Silva and I don’t see eye-to-eye ideologically or politically.  In this instance, to him I raise a cheer. And this has nothing to do with the fact that we’ve been friends for half a century. I am grateful that it saved my father’s life, but that’s not it either. It’s much more than that. Much more than all the lives saved. It’s a sustainable endeavor which has taught and keeps teaching us how things could be done, how things could be changed.

Most politicians and all political parties owe the nation much more than the nation owes them. Harsha De Silva is an exception. We owe him. Knowing him, he would brush it off with a smile and perhaps a joke, but I am serious. Take a bow, Harsha.

This article was first published in the SUNDAY ISLAND (July 19, 2020)



Anonymous said...

Coming from a strident critic of 'yahapaalanaya', these are strong- and truthful- words. Yes, please take a bow indeed, Harsha.