Sunday, September 18, 2016

6 things to change in Indian Railways and an unforgettable story from my journey

10-Sep-2016 train number 17604 Kachiguda Express, I was on my way to Hyderabad from Bangalore.

It was around 11.15 pm, I woke up from my already disturbed sleep for two reasons.  Firstly, the roof lights were on. Secondly, amidst the quite A/C sleeper coach humming noise and the constant titak-titak-titak-titak's from the running train, I heard someone coughing continuously.  When I opened my eyes, from my lower berth seat, I saw a lady in Burqa with a man sitting next to her in the side berth on the other side of the aisle.  The man sat with a kerchief in his mouth was slowly coughing and the women appeared to be consoling him.

I got up and requested that lady to turn off the lights.  The lady responded to me in Hindi and said "my husband has been vomiting blood and he is unwell…. I don't know what to do now"

Hearing this, I was thrown off from my sleep completely and I felt a sense of uneasiness.  I got down to assess the situation and see if there was someway I could assist them.  I asked the lady about her husband's condition.  As she spoke, she took out a medical records file from her bag.  I opened the file and found a document with, "DEPARTMENT OF MEDICAL ONCOLOGY, DISCHARGE SUMMARY" printed.  I understood that the couple were on their way to Hyderabad to get a chemotherapy treatment for the man.

I really couldn't connect with all the medical terms typed in the discharge summary but was able to understand he was getting treatment for a carcinoma on his tongue.  I thought, its a possibility that he was having bleeding from his mouth and they both were panicking for a blood-vomit which could be a much more serious issue.  I was losing patience and realized trying to understand the discharge summary was a futile attempt.  I was driven by the situation and was in a hurry to find some help.

Since April 2016, my life had taken an interesting twist (read the story here...).  I have started paying a lot of attention to the First-Aid and emergency response topics and also started few initiatives to raise public awareness through "Be Safe! Be there to Save!" & #424242running campaign through my NGO SahayaLRTS.  In theory, I know a variety of first-aid procedures for injuries due to accidents and for few commonly occurring medical conditions.  A cancer victim possibly vomiting blood was something I had only seen in movies and had no idea about what first-aid procedures to follow. 

Was he supposed to sit or stand? should he eat or drink anything? is he allowed to lie down?  I was also thinking about the possible choking from blood entering his lungs and concerned about it.  I was clueless at that time and only wished I was some kind of doctor with super powers to heal the man's condition by a simple touch.

I opened Google maps in my phone to find out the exact location of our train.  The train had just crossed a place called Veldhurhi and the next closest station was Kurnool around 35 kms away.  I also launched the phone browser to search for the first-aid procedure for a medical condition like this but couldn't continue due to poor network signal.  I hated that moment.  To my luck, I was able to dial the Omega Hospital emergency number found in the Discharge Summary.  After two rings and a short chat the operator connected me to the emergency duty doctor.  I explained the situation, shared the patient number and asked guidance.  The duty doctor advised me to immediately admit him in a nearest hospital to get the bleeding arrested.   He also asked me to have him sit or stand till he gets to the hospital to avoid chocking.  I passed on the instructions to the lady.

I then rushed to the adjacent compartments to look for the TTE (Train Ticket Examiner) to see if he could alert and get an ambulance or doctor in Kurnool.  After crossing through 3 compartments I was relived to see the TTE.  I greeted him and found his name to be Mr. Janardhanan.  I explained the situation and urged him to make some calls to get some help.  He was very calm and accompanied me to meet the couple and asked them if they wanted to request any doctor.  He appeared to be following protocols and I learnt later that stopping a train for any emergency, the TTE needs to answer a lot to his authorities.   He looked for some number and dialed, spoke in Telugu, explained the situation and requested to arrange for a doctor.

I asked the TTE to look for any doctors traveling in the train.  From the passenger manifest we were lucky to find a doctor by the name Dr. V Rao traveling in the first class compartment.  I was relieved a bit.  I assured the lady some support and with the TTE we rushed towards the first class compartment to fetch the doctor.

After crossing 2 compartments I was jolted to find a very old man in white shirt and white pants lying down in the vestibule on the floor between the compartments.

His head was down and tongue was drooping out and he was leaning on the toilet wall.  I sprinted near him and started tapping the man's shoulder.  I shouted and asked if he was Ok!   I checked his shirt pocket to see if he had any ID and to my disappointment there was no ID in his pockets.

I was thinking about the situation and about what I had gotten myself into.  It all started with the man with cancer in one compartment with blood on his mouth and now there is another emergency like situation with this old gentleman.

We were very fortunate there.  The old man started responding and moved his head.  He could barely open his eyes but was trying to lift his right hand to get up from there.  I continuously shouted and asked him what really happened and if he was hurt.  He did not say anything but he wanted to get up.  He appeared to be fine but had fallen down in between the vestibules due to the compartments constantly shaking.  He was really old too.  I palpated his spine to look for injuries and found nothing.

While he was lying down I requested the TTE to get into the A/c compartment to find out who he was traveling with and to get some more support.  The TTE went inside and came back real quick.  This old man was traveling with his wife and she had no idea that her husband was lying down outside the compartment.  With the help of the TTE I lifted the old man and took him inside the cabin.  We made him lie down on his side berth seat.  He was extremely week and fragile. His wife confirmed about his diabetic condition and that he was running really low on sugar.

The TTE turned on the light and I started waking up the co-passengers in the compartment and asked to get some sugar or any sugary soft drink.  Few hands extended towards me with chocolates and cakes but there was no sugar or sugary drink.  I took some cake and started feeding the old man.  He showed a bit of reluctance in the beginning but started eating.  We settled him down on the lower berth bed in the recovery position and I measured his pulse.  The pulse was alright.  She mentioned that another possibility that the man had consumed a sleeping pill.   The situation was very confusing for me to deal with.

After standing there for a few minutes, I checked his pulse again- he also started moving and was looking for his pillow.  Now I was gaining confidence and all of us attending to him felt much relieved.  The lady told us that her husband (79 years) and herself (69) went to Puttaparthi and were returning back to Hyderabad.  Till about 30 mins before his fall she was sitting next to him but dozed off and at that time the old man decided to use the bathroom and had fallen down.  He was lying there for more than 20 mins unattended.

All of a sudden, we realized that we had a task of finding a doctor to help the man with cancer and we got dragged into attending another situation involving an old man.  Now that the situation with the old man was under control, I asked TTE to take me to the doctor.  He flipped the manifest again and said "Sir- problem…"  after a short pause he continued "this old man is Dr. V Rao - seat number 11 LB…"

With a lot of reluctance we had to accept the situation and move on.  At that time the train was probably 15 mins away from Kurnool.  We went back to the couple and gave them further assurance to find some support in Kurnool.  I then decided to call 108 and was connected to an operator.  I explained the situation and requested him to send an ambulance to the Kurnool station within the next 10-15 mins.  He suggested me to call after the train arrived in Kurnool since there would be an ambulance readily available (usually) at that time of the day.  In the meantime, the lady had contacted some of her relatives living in Kurnool and asked them reach the station.  I was getting anxious.

At the Kurnool station the trained pulled in and the couple got down. They bid good bye and I prayed to the God to take care of this man and his family.

After reflecting on what just happened, the TTE and I decided to move on and settle down and catch some sleep.  I felt extremely relieved but ended up dozing off with mixed thoughts.

The train finally arrived at Hyderabad in the morning.  I got down from my compartment and ran towards the first class compartment to meet the old couple.  I was so happy to find the doctor and his wife slowly walking towards the exit with their bags.  The doctor was looking absolutely fine and sound.  His wife smiled and thanked me. She introduced me to her husband.  He was completely clueless about the series of events in the night and the amount of panic and confusion he managed to create.  I offered my help to get their suitcase and bag till the exit and also requested them to pose for a selfie.  They obliged with a smile.

While walking towards the exit we chatted and it came to my surprise that this doctor was an oncologist.  

6 things to change in Indian Railways system

This train ride and the disturbing experience kept me agitated about the uncertainties that we get to deal around us.  It kept me wondering about the safety of the medically vulnerable population and the fragile senior citizens traveling in India - especially those using public transportation.

Since the system around is not so friendly and has no science behind its design it is prudent to be prepared.  It is also my humble request to the Rail Minister to bring in drastic reforms to make the train journey a memorable and a safe one.

1.  If you are diabetic and there is a history of becoming hypoglycemic (abnormally low sugar), it is absolutely necessary to wear a medical tag or an ID explaining your medical conditions.  Also don't forget carry a sachet of sugar or a small candy in your pocket.  Indian Railways should have Emergency Response kits in the trains - could be under the care of the TTE but its a must.  I also hope all the TTE's and the train attendants are trained on First-Aid & CPR.  Indian Railways also must insist the medical condition of the travelers to be declared while making the reservations.

2.  The Indian Railways, the world's largest rail network, do not have any means to help medical emergencies such as cardiac arrests or to deal with incidents that I came across during this ride.  There is no visible signs indicating where the first-aid kit is located.  Access to AED's are unthinkable. You will be left at the mercy of God and super natural powers.  

3.  Don't expect the TTE's to help, they are helpless too.  How many travelers can send a Twitter message to Indian Railways authorities.  Today I found a link to all the Twitter accounts belonging to Indian Railways and they are extremely confusing.  Can't Indian Railways have a simple handle for the 24x7 emergency?

4.  There is no easy mechanism to find where the TTE is located in the train.  There is no emergency phone (mobile signal is not always available throughout the train routes).  The Indian Railways could SMS the mobile number of the TTE to all passengers just before the departure along with the train departure/arrival details.  This can happen at every station and also when there is a change in the TTE.

5.  The vestibules connecting the trains are extremely dangerous (see video below - courtesy: dennis jacob).  The path ways leading to the toilets have no hand rails to support sick and senior citizens to move around safely.  This must be redesigned considering the safety of all types of passengers.

6.  There are no emergency contact number written in the posters stuck inside the train.  Indian Railways only wishes you a safe journey but do not have any mechanism to make the journey safe. Like 108, the Indian Railways should have an emergency number only for the train travelers.

The seventh one and this is for the travelers.  If your parents are old or have any medical condition please don't allow them to travel without any support system.

Finally, we have a million Gods to pray. As they say, trust on God, but lock your car, let's be always prepared for any avoidable situations.  It should be a constant reminder to Be Safe! Be there to Save! always

p.s On Thursday, after returning back to Bangalore, I called the lady to find the condition of her husband, the man with cancer.  After getting down at Kurnool, they went to a hospital and got him admitted.  His bleeding stopped after 2-3 days of treatment and they had already returned back to Guntakal (their home town).  It was shocking to know that this man was just 45 years and was suffering from tongue cancer because of chewing Gutka for many years.  He was found to have cancer 4 years back and underwent surgery.  The cancer has relapsed now.

I also would like to thank Mr. Janaradhanan, TTE for providing assistance despite the limitations in the system.

Editorial support: Meera Kannan & Aditya Kannan

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