Death by Absence of Generosity

What happens when Mumbai’s municipality decides to outsource its ambulances

The telephone number 108, that connects to an ambulance service, is the closest that India has to a universal emergency response system. It is a non-profit initiative by state governments along with a private company. One of the things 108 has become famous for are the number of deliveries of children that happen inside ambulances because it takes time to transport expectant mothers from rural places to hospitals and the baby doesn’t have the patience to wait. All in all, the service touches lives.

And therefore, consider the recent odd report in DNA newspaper that 108 had refused to ply patients to a municipal tuberculosis hospital in Mumbai. An anonymous senior doctor was quoted saying a patient had even died because he couldn’t be shifted to another hospital in time. Our immediate reaction would be to castigate the ambulance service, but it is not really to blame. The 108 ambulances are air-conditioned and ferrying tuberculosis patients would mean risking infections to other patients later. The real culprit lies hidden in the question of how TB patients got transported earlier.

The answer is that the hospital had its own ambulance. But recently, the Brihanmumbai Municipal Corporation (BMC) decided that it didn’t want to replace its ambulances whose lifespans were ending and would start banking on the state government instead. And so, this hospital’s retired ambulance has no in-house replacement.

How does one of the richest civic bodies in India with a large number of hospitals under its management decide that it doesn’t want its own ambulances? That’s a question whose answer will be buried in a file noting under a mountain of paper as big as the Shivaji statue that is being planned on the sea outside Mumbai. But it probably has something to do with only the poorest coming to these hospitals and they really don’t deserve anything more than the bare minimum.

The bureaucracy, it is often said, is mired in corruption and incompetence, the combination of the two leading to black holes from which it is impossible for trapped individuals to escape. But the case of the Sewri hospital is somewhat different because an improvement in the quality of service—an air-conditioned ambulance—has led to the trap. No bureaucrat foresaw that there would be a category of patients who couldn’t travel by air-conditioned vehicles. This leads to a third characteristic of the bureaucracy— absence of generosity.

The idea that they could do both, use the ambulances of the state government as well as have their own, just didn’t occur to them because they are trained to think like machines. That is why you see people floundering for years to get a simple little pension cleared: because the fear of cheating makes the government demand enormous paperwork. Generosity should trump such pettiness.

Enormous losses are accepted when it comes to scams of businessmen, but for old, retired and sick people, the system is made impossibly rigid. A hundred ambulances more are never going to go empty in a city that reeks of filth and disease. But it takes a heart to know it.

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