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Answers to Pakistan’s Paramedic Problem
Pakistan’s first trained paramedics are operating on the streets of the restive southern port city of Karachi. The initiative by Pakistan-based non-governmental organization, the Aman Foundation, has trained 75 paramedics since the service started in 2009, and now operates a fleet of ambulances across the sprawling megacity.
Emergency services in Pakistan have long been run by charitable organizations, which fill the gap where the country’s cash-strapped government services leave off. The Edhi Foundation, headed by Pakistan’s most famous philanthropist, Abdul Sattar Edhi, has been running such a service in cities across the country for over 60 years.
Ambulances from the Chhipa Welfare Association and Khidmat-e-Khalq Foundation, run by the Muttahida Qaumi Movement, a political party, can be seen hurtling through the streets to respond to crises across Karachi. These ambulances though are simply vans with a stretcher manned by a single driver who relies on bystanders to shovel patients into the back before speeding off to hospital.
The Aman Foundation’s 80 vehicles are equipped with all the medical equipment found in ambulances in developed countries. Each one is manned by a fully qualified doctor or paramedic, and an emergency medical technician. The crew is trained by the Aman Foundation, which has developed its own paramedic-training course based on the curriculum followed by the London Ambulance Service in the U.K.
Since the service was launched in March 2009, the Aman Foundation’s ambulances have responded to over 460,000 calls – an average of 400 a day. The foundation charges a nominal fee of 200 rupees ($1.90) for its service, but only asks for the fee from those who can afford to pay.
Working in Karachi where political interests and ethnic tensions play out in an endless violent battle for votes and land, presents unique challenges for the new paramedics. Muhammad Sokaib, who has been working as a paramedic with the Aman Foundation for a year, says he once found himself at the scene of a shootout in New Karachi Town, an area mostly populated by the dominant Urdu-speaking population. The shootout was between two rival gangs, and three members of one gang lay injured in the street, Mr. Sokaib said. The other gang threatened to open fire on the ambulance if they approached the victims, he added.
“It was difficult to see people dying in front of you when you are there to save them,” recalled Mr. Sokaib. All three men bled to death on the street, he added.
Jan Sahid, who has been working as an EMT for a year, describes a similar scenario. He says he was in an ambulance called to pick up a gunshot victim in North Nazimabad, another area of Karachi dominated by Urdu-speakers. As the paramedics approached, he recalls, three gunmen opened fire on the ambulance.
Sometimes finding the patient in the first place can be a challenge. Many areas of Karachi have developed haphazardly as an informal sprawl and lack a proper address system. Patients usually use landmarks to explain to the paramedics where they live. The paramedics are generally stationed in areas where they come from so they can interpret the sometimes idiosyncratic directions, explains Kurram Latif, who has been with the Aman Foundation since 2009, first as an EMT and for the last year as a paramedic.
The Aman ambulances are changing people’s perception of emergency medical services, says Mr. Sahid. He explained that when he first joined the service and turned up at the scene of an accident in his smart green uniform, people didn’t know who or what he was. “Now we get respect,” he said.
“It was a new concept. Many people don’t know about emergency medical services,” said Mr. Sokaib, “An ambulance is just a transport service.”
The Aman ambulances are now well known throughout the city, and have built a strong reputation as a reliable service – though sometimes with unexpected consequences.
Mr. Sokaib says he was once sent to pick up a man who had called complaining of chest pains and had asked to be taken to a specific hospital. Because of the symptoms he had described, he had been classed as a life-threatening case, Mr. Sokaib, says, adding that he rushed to respond.
“I arrived and asked ‘Where is the patient’,” Mr. Sokaib recalled, “The man said, ‘I am the patient.’” Mr. Sokaib examined the man and couldn’t find anything wrong with him. He radioed back to the command center. The instructions came back that he had to take the man to hospital because he had been classed as an acute case.
They were on route to the hospital, when, according to Mr. Sokaib, the patient suddenly sat up and announced he wanted to be let out of the ambulance, just as they were just passing the railway station. A rickshaw to the station would have cost around 400 rupees ($3.80) from the man’s home, Mr. Sokaib says the man explained to him unapologetically, but the ambulance ride cost half that.
Pakistan’s first trained paramedics are operating on the streets of the restive southern port city of Karachi. The initiative by Pakistan-based non-governmental organization, the Aman Foundation, has trained 75 paramedics since the service started in 2009, and now operates a fleet of ambulances across the sprawling megacity.
Emergency services in Pakistan have long been run by charitable organizations, which fill the gap where the country’s cash-strapped government services leave off. The Edhi Foundation, headed by Pakistan’s most famous philanthropist, Abdul Sattar Edhi, has been running such a service in cities across the country for over 60 years.
Ambulances from the Chhipa Welfare Association and Khidmat-e-Khalq Foundation, run by the Muttahida Qaumi Movement, a political party, can be seen hurtling through the streets to respond to crises across Karachi. These ambulances though are simply vans with a stretcher manned by a single driver who relies on bystanders to shovel patients into the back before speeding off to hospital.
The Aman Foundation’s 80 vehicles are equipped with all the medical equipment found in ambulances in developed countries. Each one is manned by a fully qualified doctor or paramedic, and an emergency medical technician. The crew is trained by the Aman Foundation, which has developed its own paramedic-training course based on the curriculum followed by the London Ambulance Service in the U.K.
Since the service was launched in March 2009, the Aman Foundation’s ambulances have responded to over 460,000 calls – an average of 400 a day. The foundation charges a nominal fee of 200 rupees ($1.90) for its service, but only asks for the fee from those who can afford to pay.
Working in Karachi where political interests and ethnic tensions play out in an endless violent battle for votes and land, presents unique challenges for the new paramedics. Muhammad Sokaib, who has been working as a paramedic with the Aman Foundation for a year, says he once found himself at the scene of a shootout in New Karachi Town, an area mostly populated by the dominant Urdu-speaking population. The shootout was between two rival gangs, and three members of one gang lay injured in the street, Mr. Sokaib said. The other gang threatened to open fire on the ambulance if they approached the victims, he added.
“It was difficult to see people dying in front of you when you are there to save them,” recalled Mr. Sokaib. All three men bled to death on the street, he added.
Jan Sahid, who has been working as an EMT for a year, describes a similar scenario. He says he was in an ambulance called to pick up a gunshot victim in North Nazimabad, another area of Karachi dominated by Urdu-speakers. As the paramedics approached, he recalls, three gunmen opened fire on the ambulance.
Sometimes finding the patient in the first place can be a challenge. Many areas of Karachi have developed haphazardly as an informal sprawl and lack a proper address system. Patients usually use landmarks to explain to the paramedics where they live. The paramedics are generally stationed in areas where they come from so they can interpret the sometimes idiosyncratic directions, explains Kurram Latif, who has been with the Aman Foundation since 2009, first as an EMT and for the last year as a paramedic.
The Aman ambulances are changing people’s perception of emergency medical services, says Mr. Sahid. He explained that when he first joined the service and turned up at the scene of an accident in his smart green uniform, people didn’t know who or what he was. “Now we get respect,” he said.
“It was a new concept. Many people don’t know about emergency medical services,” said Mr. Sokaib, “An ambulance is just a transport service.”
The Aman ambulances are now well known throughout the city, and have built a strong reputation as a reliable service – though sometimes with unexpected consequences.
Mr. Sokaib says he was once sent to pick up a man who had called complaining of chest pains and had asked to be taken to a specific hospital. Because of the symptoms he had described, he had been classed as a life-threatening case, Mr. Sokaib, says, adding that he rushed to respond.
“I arrived and asked ‘Where is the patient’,” Mr. Sokaib recalled, “The man said, ‘I am the patient.’” Mr. Sokaib examined the man and couldn’t find anything wrong with him. He radioed back to the command center. The instructions came back that he had to take the man to hospital because he had been classed as an acute case.
They were on route to the hospital, when, according to Mr. Sokaib, the patient suddenly sat up and announced he wanted to be let out of the ambulance, just as they were just passing the railway station. A rickshaw to the station would have cost around 400 rupees ($3.80) from the man’s home, Mr. Sokaib says the man explained to him unapologetically, but the ambulance ride cost half that.
