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)
malindasenevi@gmail.com