The only way to travel - Mumbai, Dec. 16, 2009

Log margin notes:

The sights and the museums and Western-style restaurants can't match it. To get the actual feeling of place, go as a reporter, I say.

I admit that publishing has been a hefty challenge in these first few weeks (a trend which looks to continue), but the struggle has been all the fun.

After waiting a few days for help on an article reviewing of the city's lacking ambulance services, I took up the cause on my own.

Last week, a new friend, Amey Polekar, from a television station new what I was working on and asked if I was interested in attending a conference, Hinduja Hospital's second annual Conference on Healthcare @2020. He sent over a company car to pick me up and burrow through traffic to get me there. Just riding in a car that wasn't a taxi was a luxury as we passed by all of the pedestrians who were forced to squeeze in the narrow lane between the parked cars and the moving cars.

Once I made my way upstairs I found a seat in the conference room.

At a passing glance, I was sitting in a darkened room with a bunch of suits (and sarees) listening to PowerPoint lectures; but with a closer look, this was a small piece of how this huge country is really just beginning to tackle its own healthcare puzzle. These were the people who would make decisions and lay the foundation of this basic need of the world's most populous democracy.

The best part is that the puzzle of healthcare is still in its early stages where real noticeable progress is within reach.

Ideas came out about organizing healthcare malls containing dozens of individual specialists, clinics and pharmacies so that records could be used by all. A movie presentation showed the value of electronic record-keeping which could be viewed remotely and not only by personal physicians, but by research doctors who would have easy access to countless new bits of data.

During a break in the conference, I was able to pin down the hospital's CEO for a fast interview for my ambulance story. I spoke to another physician as well.

The two confirmed what I had been hearing. There's no central, recognizable number like the U.S. has 911. Each competing company has it's own number and sets its own standard of quality. People are also unaware of what companies offer or how to reach them. Sometimes, the companies don't answer the phone at all, I heard anecdotally.

While at my local coffee shop I asked a girl, Blossom, what she would do if she needed an ambulance. She said she would have to call the city's information line, 022 8888 8888, and ask for a number of an ambulance company.

The Hinduja CEO and others also complained that drivers were often poorly trained and much of the public views ambulances as a hearse. Most are only equipped with an oxygen bottle and a first aid kit, so there's not much to be done anyway by the un-uniformed and often tobacco-spitting drivers.

Plenty of people just use taxis and public transportation for emergencies, the hospital staff said.

I saw first-hand the future of the city's services the next Tuesday when I rode with one of the city's modern ambulance companies: 1298.

1298 has a training partnership with NY Presbyterian Hospital (where the Lost Nav would drop patients during days working with the Central Park Medical Unit) so the staff was happy to have me along.

I was concerned not to hold up the crew, so my nerves ran high when cab drivers refused to go one neighborhood away the morning of my shift. It's tough to tell if they can't understand me or if they're just refusing to go for a 15 minute ride. Finally, I found one guy who would go, but insisted on a no-meter Rs. 150 ride. That steep price comes in at just over $3 so I agreed. As it is typical, when drivers leave their usual surroundings they have to ask people on the street for directions. Many buildings do not really have addresses and "landmarks" are very important. It's difficult to depend on people who expect me to know my way around a new city, but that's the only option I had.

We finally arrived on time, but I had already missed the first call. When Dr. Saeed (an actual doctor, not just a paramedic) returned with his green-shirt clad crew of one attendant and one driver, I introduced myself and we started rolling around.

Their second call came just a few minutes after. We flipped on the siren, but it was no help to push aside Mumbai's infamous, smog blasting traffic. People still drove and ran out in front of us as we crawled along. It took 35 minutes.

It was a transport job, an old woman on a ventilator. I hopped out behind Dr. Saeed and headed to the door where I saw a big hap-hazard pile of shoes (mostly loafers.)

"I have to take my shoes off?" I asked Saeed, as he took of his own and the answer became obvious.

I was glad I had a decent pair of socks on and slid along the tile floor down the narrow dimly lit hallway to the patient.

Saeed was given a handover brief on the woman's condition by the attending physician Dr. Anees.

While the nurses made ready for the transfer, I was able to ask Dr. Anees what he thought of the city's ambulance services.

He agreed (with me) that 1298 is the best in town, but did not give the whole system a perfect bill of health. Still, I began to feel like people were reluctant to tell a foreigner what they really thought of the city's system. Maybe they didn't have an American reference point as I did.

The patient and her family were loaded on board. Saeed kept an eye on her oxygen saturation which dwindled at a hypoxic 90%. Even in America we don't trust those "pulse-ox" meters, but he was satisfied with the reading.

At the receiving hospital we waited a long time for a manually operated elevator to take us directly to the ICU. (Typically, U.S. EMTs do not find themselves that deep inside a hospital and it was shoes off again... more typical for an ICU in the States.)

I stood around with the doctors and nurses for observation purposes although no one seemed to know what I was doing there (dressed in a navy long-sleeve t-shirt tucked into cargo pants.) A doctor finally asked me who I was and I told him I was an "observer from the U.S." and an EMT. He asked if EMTs are trained to ausculatate lung sounds as part of our patient assessments. I said we are.

He picked up a recently used stethoscope from the old lady's new bed and handed it to me.

"Tell me what you hear," he said.

I tried to politely refuse (the strange new earwax), but he insisted so I asked if he had any alcohol swabs.

"You're right, you're right..." he nodded and cleaned them off with something or other.

I figured that was good enough and found clear sounds on the left, stridor on the right. (Stridor is a whistling sound, not unlike an asthmatic wheeze, but upon inhaling.) Another doctor wondered what I was doing and I said: "Clear on the left, stridor on the right."

"That's because of her condition," he said.

"Thanks doc," I thought to myself.

We were back on the road after waiting a similarly long time for the elevator again. The Marathi-speaking driver insisted that I have a tour of the new white Bandra-Worli sealink, the fourth longest sealink in the world.

We drove around, got some lunch and sat around like ambulance crews do. Saeed is not severely religious, but he left for mosque and came back after his afternoon prayers.

Saeed and I were busy shooting the breeze while the driver and attendant slept. We spoke about politics and an American's impression of India. I dwelled more on the interesting part rather than the polluted and congested part.

People, seeing my old age, often ask if I'm married. I usually say something about not being a very good husband if I were, by being here in India. They consider and agree that a wife would not let her husband come to India by himself.

"So you've decided not to get married?" Saeed asked.

"No, we'd say in America, that I haven't decided to get married yet," I said.

I read (in a book on India that I found while waiting to speak to the police commissioner) that marriage (and within your own caste) is for many Hindus is the only expression of religion they practice. In the way that some Catholics only go to Mass on Christmas and Easter.

The conversation went on and the afternoon ended. Time was getting short in Mumbai and I wanted to get the ambulance story wrapped up. There were still a few more people to talk to.

The next day, while snapping a few shots of ambulances in action, another great new friend, Kaustubh Kulkarni, from the same television station called. He said he could get me into Boeing's press brief following the maiden flight of the 787 Dreamliner, if I was interested.

I went just out of interest in aviation. I didn't think any news services (other than the Lost Nav) would be interested in anything I could get on the new jet.

Again, Kaustubh came along in the company car and we got to the outskirts of town at the posh Marriott.

I listened and took the opportunity to follow another story. An editor had asked me if I could find anything on rumors that India was fielding a Marine Corps. I asked the India Boeing chief if he was competing for any Marine Corps contracts, since in the course of his comments he did mention a few airframes that the USMC flies.

"No, India does not have a Marine Corps," he said. I guess I couldn't get any great state secrets out of him either.

After a quick briefing, they insisted I have a few of the free refreshments. (Some) reporters try to limit their appetites when PR types are paying, but with the way the are here about "guests," I ate a little. The polite small talk went on between the reporters and PR people and one Boeing woman asked: "From what country do you come, Germany?"

I said: "No, America; but what made you think that?"

"Or if you prefer I can continue on like this," I said in a (pretty good, I think) German accent which is based on an old friend and German exchange officer at NAS Pensacola.

She didn't even flinch and could not pick up the accent.

It was time to go and Kaustubh with his crew dropped me a little way from my place since traffic makes it easier by foot (and they had to get back to file.) I thought it was no problem and wandered around a new side of town for a few minutes as it got dark. The Lost Nav had to guess at a few turns and took a dead end. As it often happens, I was glad I did.

I hit the gate of a slum next to a Catholic cemetery and when I turned around to retrace the street I saw that the adjacent cemetery was Jewish. A few of the stones dated about 100 years back, but most were fairly recent.

I walked through to pay a few respects and leave some rocks at the rarely visited graves (as is the tradition.)

I thought it would be alright to take a few pictures, but a local woman walked right over to me to ask in Hindi what I was doing.

I wasn't in the mood to answer any questions so I reached back to an experience earlier in the day and said: "Ich bin Judisch." That got rid of her. I did it again after a few kids, who actually spoke English well, came to stare at me and my camera.

I thought that this is the only way to travel.

In the past few days I had gotten some insight into the city and the country's healthcare mystery, rode in an ambulance, heard about the future of Indian civilian and military aviation, had free car service around town, got free food and then dropped off in an interesting part of town. (Real reporters actually get paid to do this... I'm told.)

Tourism is great, but traveling as a journalist is really the way to go... if you can afford it.