1050 becomes 1298, but the Heart Brigade beats on in its new 'avatar'

Their heart's in the right place and it's beating for Bombay.
Ms Shweta Mangal (Director) and Mr. Christopher Walker (Head,
Marketing) of the 1298 service describe its salient features

The Bombay Heart Brigade which answered to the telephone number 1050, is now emerging in a new avatar which will respond to the old number as well as to a new one -1298.

Announcing this at the last meeting, Heart Brigade Chairman Dr. Anand Somaya stated that the original 105 Heart Brigade (which subsequently became 1050) appeared to have outlived its purpose.

He did not say it in so many words, but what he was driving at was the fact that the 105 Heart Brigade was an idea that was far ahead of its time and so had run into problems.

The 12 ambulances belonging to the Heart Brigade had now been presented to a new organisation AAA (Ambulance Access for All), formed by a group of young professionals with a high degree of social and public commitment.

You've done an outstanding job. Dr. Mukesh Batra greets Manubhai Chawda, who
launched the Heart Brigade in 1995. In the picture at right, Heart Brigade Chairman
Dr. Anand Somaya (seated, right) with IPP Harry Singh Arora, who proposed the
vote of thanks, and Mr. Christopher Walker

Set up in association with London Ambulance Service, a British government agency, AAA had already refurbished seven of the 12 ambulances and sent them out on the streets of Bombay to provide succour to those caught in any medical emergency.

Apart from the fact that the Heart Brigade would have a new telephone number 1298, there were a few other significant changes.

The most important of these was that the service would no longer be available free of charge. This model of running a public service had proved to be unsustainable as it was primarily dependent on charity in the shape of grants, donations and so on.

Now, those calling 1298 would have to pay a modest sum for the service, with the exception that those being transported to government hospitals, as well as those who cannot afford it, being charged subsidised rates or even nothing at all.

Dr. Anand lauded Manubhai Chawda who launched the service in 1995.

Making startling revelations. Ms Shweta Mangal, Director of the 1298 service,
disclosed that during the first two weeks of its operations in 2004, the service
did not receive a single paisa from the patients it took to Breach Candy,
Jaslok and Hinduja Hospitals. President Dr. Rumi is at right

"It was excellently conceived and well executed for the times. A fleet of ambulances was acquired from various corporate donors and distributed to various hospitals around Bombay. The number 105 was maintained and run by MTNL.

"This worked excellently for the first ten years. But, the hospitals which were given the ambulances started facing some problems, viz., the doctors working in the ICUs found it difficult to spare the time to separate the genuine calls from the crank calls".

(Call centres, the vogue today, were unheard of in those days.)

As Chairman of the Heart Brigade, Nandan Damani set up a call centre to monitor calls. But some operators were unable to appreciate the seriousness of a patient.s condition or failed to keep track of the ambulances.

With the passage of time, the number of problems kept rising and finally, when he took over as Chairman, Dr. Anand said, a survey showed that each of the 14 ambulances handled hardly a couple of cases every month. The vehicles were used by the hospitals for other purposes.

"We felt that this was not doing justice to the money being spent by the Club. Our representatives went to hospitals for spot-checks and found that the ambulances were being used to ferry staff, some were not running due to disrepair and misuse and their equipment had deteriorated due to lack of upkeep. Finding the money to repair and re-equip the old ambulances was difficult".

It was around that time that the 1298 ambulance service approached the Club. The young persons associated with it admitted that the 105 Heart Brigade had served as their role model when they started their service. They expressed a desire to work with the Rotary Club of Bombay.

"For us this was a wonderful opportunity to work with a really professional outfit having a tie-up with the London and the New York Ambulance Services.

"We have, therefore, withdrawn our ambulances from the various hospitals; these have been repainted, upgraded and re-equipped to international standards by our partners. The service is highly subsidised, especially for patients going to municipal and government hospitals".

Dr. Anand said the number 1298 could be dialled directly from any cell phone or landline in Bombay. Even this was an achievement that, despite all its efforts over many years, the Heart Brigade had been unable to accomplish for 105.

He then introduced the guest speakers, Ms Shweta Mangal, one of the pioneering five behind AAA, and Mr. Christopher Walker, Head, Marketing and Sales, of 1298.

Ms Mangal, Director of AAA, is an MBA from the Rochester Institute of Technology, New York, and a Chevening Scholar (2007) of the London School of Economics. Mr. Walker, on the other hand, is on a fellowship from Acumen Fund and has worked in Africa and other developing countries, as also with the US Treasury department.

Speaking first, Ms Shweta Mangal said the other four members of the 1298 team were Mr. Ravi Krishna, Mr. Naresh Jain, Mr. Manish Sacheti and Mr. Shaffi Mather. All of them were educated abroad and, on returning to India, plunged into professional careers with various big corporations.

Interestingly, all of them studied the ambulance services in the USA and the UK, especially the 911 and 999 services. Mr. Mather, who was at the London School of Economics, studied the London Ambulance Service in detail and on his return discussed the project with the others, saying it was time to do something on similar lines in India.

There was no precedent in India at that time, when ambulances were mainly used to carry dead bodies. Hence it sounded like a dream. But since all of them felt that there was a big need for such a service (and because they wanted to do something that would help society and also be sustainable), they launched their ambulance service four years ago.

Ms Mangal clarified that none of the founders of AAA was a doctor and money-making was not a motivating factor. They had observed that for citizens caught up in an emergency, there was no single telephone number, no emergency rescue service and a total lack of facilities that could help save life or limb.

"At the time we started, the scene was such that 90% of ambulances were used to carry dead bodies. There was no single telephone number to call. If something happened to you or your house, you were left wondering whom to call. If you called 102, there was no one to pick it up. There was no networking among ambulance providers and the response time was very, very long".

In case of accidents and emergencies, one either took a taxi, an autorickshaw or a neighbour's car. Or one could call the ambulances run by Shiv Sena or some other NGO.

There was a very large number of registered ambulances in Bombay in 2004 -1,400, in fact. But only 100 were operational; further, a mere 12 were advanced life-support ambulances with life-saving equipment.

"So basically, in Bombay, we have lots of vans but not enough ambulances. That.s why we started the service".

Ms Mangal said they had noted that in the developed world ambulance services were provided by the State (through the taxes that the people paid), but in India they were run either by NGOs or by clubs and organisations like Rotary.

As there was no self-sustaining model existing at that time, they had to come up with ideas to become selfsustaining and not dependent on grants and donations.

In 2004, the pilot project was commenced and the 1298 service was officially launched in May, 2005, with ten ambulances. There were three clear goals uppermost in their minds:

One, to make the service efficient, it had to be made sustainable; this meant that they would not rely on donations and grants;

Two, although there was no .big money. backing from .big. families, the service would be made the best in the field. For this, a tie-up was arranged with the London Ambulance Service which shared freely all its protocols because it also wanted a project. like this one succeeding in India.

Three, to provide a service in which the rich would pay and subsidise the service offered free of charge (or at highly subsidised rates) to the poor.

In drawing up this cross-subsidy model, they received amazing ideas and inputs from their mentor and guide, Dr. Sam Pitroda, Chairman of the Knowledge Commission of India (and a close associate of the late Mr. Rajiv Gandhi), "who has been with us since the day we started".

Ms Mangal said the AAA call centre at Parel was manned round the clock (24x7) and 1298 could be dialled from any telephone, whether a cell phone or a landline.

The reason why few people had heard about it was the fact that there were just ten ambulances at its disposal, a number inadequate to meet the demands of a teeming city like Bombay.

"We need about 20 to 25 minutes to reach a case. Ten ambulances are just not enough... But they are stateof- the-art ambulances equipped as per London Ambulance Service standards. The ambulances come with a doctor, a helper and a driver.

"The city is divided into ten zones and each zone has one ambulance stationed in either a hospital or a nursing home. All ambulances are tracked by global positioning system (GPS). At our call centre, on a computer screen, we know at any given time where each ambulance is stationed.

"When a call comes, we know exactly where the call is coming from and we are able to figure out which ambulance is the closest from the place from where the call has come; then, using radio trunking, GSM or CDMA technology, we inform the driver and the ambulance team goes to the place".

What about the doctors manning the ambulances? Were they medical graduates? No, said Ms Mangal, they were mainly Ayurvedas or Homoeopaths, but all of them trained in a special emergency course, post-graduate diploma in emergency medical service, which allowed them to do certain things in an emergency.

Even the drivers were trained in basic life support and in navigation and fast driving.

Coming to payments, Ms Mangal said those who were taken to private hospitals were supposed to pay for the service, while those who went to government hospitals paid a subsidised rate, or nothing at all if they could not pay.

"When we started, we left it to the ambulance team to decide whether or not the person could pay. And for two weeks we didn.t have a single rupee collection! Then we saw from the data that people went to Breach Candy, Jaslok or Hinduja hospitals but could not pay for the ambulance!

"Therefore, with the help of Dr. Sam Pitroda, we came up with this model wherein if you are going to a private hospital, you have to pay the ambulance charges; and if you are going to a government hospital, then there is a subsidised rate; and if the person really cannot pay, then it is absolutely free".

A cardiac ambulance cost Rs. 1,500 per hour. This was 30% to 50% cheaper than other ambulances. The basic Omni ambulance, given by the Rotary Club of Bombay, cost Rs. 450 per hour if a person was taken to a private hospital.

Ms Mangal said funds were generated through renting out the space on the exteriors of the ambulance to likeminded sponsors. The fees received helped sustain the day-to-day operations, whereas the monies received from paying patients helped defray the cost of maintaining the ambulances and the equipment.

Three years since its launch, the 1298 service was receiving 40 to 60 calls a day. Roughly 30,000 people had been transported till date and the total cost came to US $3 million.

During the first year, 23% of the calls were free calls. In the second year, the number went down to 12%. Now, in the third year, the average was 15 to 20% free calls.

Enthused by these figures, AAA launched the project in two districts of Kerala with five cardiac ambulances on December 31, 2007, and hoped to cover the entire state by 2010. It also planned to launch its service .in the top ten Indian cities. in the next five years.

Apart from the London partnership, there was a tie-up for training with the New York Presbyterian Hospital, rated as one of the best in New York. Besides, CII and Harvard Humanitarian Initiative were working with them. And so was Acumen Fund working closely with AAA towards scaling the service all over India.

Ms Mangal said that during the Bombay train blasts of 2006, the 1298 ambulances were the first to reach the spot, even before the media got there. They did not ask anybody, but just dispatched the ambulances.

Nor did they apply for awards. In fact, it was Times of India that put forth a recommendation and the Godfrey Philips Bravery Award for Social Act of Courage in 2007 came to be given to the 1298 service.

Already, 1298 had become a subject for case studies by several colleges and universities, including Oxford Business School and Columbia Business School, because it was the only ambulance service model that had worked in an emerging country and that, too, on a self-sustaining basis, Ms Mangal added.

It was then the turn of Mr. Christopher Walker, on a fellowship from Acumen Fund, to speak about how organisations like Rotary could work with 1298 for the benefit of society.

"This is an exciting time for us. We are in the process of expanding our service to 50 ambulances with the support of the Rotary Club of Bombay which has promised us 12. By the end of March we intend to have all 50 ambulances operating in Bombay; this will allow us to respond to any emergency call within ten to 15 minutes".

Mr. Walker confessed that no effort had been made to market the 1298 service because of the paucity of vehicles. But once 50 ambulances were on the road, it would be time to market the service. The second marketing challenge was to help people remember the number 1298.

"We have to try to make that number memorable at the time of crisis. Besides, people have to be made aware of the need to call an ambulance in a medical emergency because the first hour after an emergency is crucial to your chances of survival".

A customer satisfaction survey was also on the cards; each of the customers would be called and asked about his/her experience. This would allow the service to address any problems that cropped up and also ensure a high quality of service.

Making a plea for additional support, Mr. Walker said help was needed to equip the ambulances. Since the bigger ones had difficulty moving on narrow streets and faced traffic snarls, it was necessary to equip the smaller, basic ambulances with an automatic external defibrillator and a monitor.

"We would appreciate any support in equipping the ambulances. With your help, we believe that we can offer Bombay a world quality ambulance service," Mr. Walker added

Answering questions, Ms Shweta Mangal told PP Kalpana Munshi that it was on account of AAA's refusal to pay bribes that it was unable to obtain an easy-to-remember number such as 1299 from the government of India.

She told PDG Manibhai Doshi that although the Club used to send ambulances free of charge, things had changed. The new principle was simple -the rich would pay for the poor.

"If you can afford to pay for an ambulance service, then you should pay because this service is then provided free to those who cannot afford it. At the end of the day, we have to pay the doctors, the attendants, the drivers, they have families to care for. We are passionate about it, we are working free, but not them".

Kamal Bulchandani came up with an interesting observation. He said whenever a free service was provided, it was invariably taken advantage of by those who could afford to pay.

For example, as Chairman of the Club.s Legal Aid Committee, when he advertised the availability of free legal advice for the poor, he found a queue outside his office -including people sporting gold chains-all waiting for free legal advice!

Therefore, it was likely that people calling 1298 would first have themselves taken to a government hospital (free of charge) and then shift to a private hospital.

Ms Mangal agreed with him, pointing out that in the first two weeks that the project was started, not a single paisa was collected; even though most people went to Jaslok or Hinduja Hospital, they said they could not pay for the ambulance service.

"But I will admit that in the last three years that we have been operational, people have been quite honest. We have not had a single bad experience, no case where a person has misused this service or tried to make a fool of us.

"In fact, when it comes to the poor, they get the community to pay for it, somehow or the other. It is the rich who always keep negotiating. There may be 5% people who may try to fool us, but why should we have a process that will penalise the remaining 95%?"

The vote of thanks was proposed by IPP Harry Singh Arora.