Dial M for medical care

The fabled Indian call centre has finally turned its gaze inwards to serve its own people. Soon, medical call centres...

The fabled Indian call centre has finally turned its gaze inwards to serve its own people. Soon, medical call centres based on the Indian model may be available to other nations. Dialling 108 connects to emergency medical, fire and police services in two Indian states, Andhra Pradesh, and Gujarat. It takes an average of twenty minutes for a fully equipped ambulance, with a well-trained medical technician, to arrive. A doctor from a call centre is in continuous contact with the emergency technician beside the patient. Dispatchers use up to-the-minute computer-generated traffic information to direct the ambulance along the shortest route to the hospital. Soon this service, provided by the Emergency Management Research Institute (EMRI) will be available throughout India.

EMRI dispatch centres are modern marvels. Addresses and map locations of fixed line callers are displayed on computer screens that summarize their call histories. The lines are then transferred to medical, police and fire professionals for action. By the time the call reaches the doctor, the location of nearby ambulances and local hospitals, together with data describing available hospital services, is on the screen. Life saving procedures can become accessible within the golden hour, the crucial first hour following the emergency crisis.

A single call centre handles calls from an entire state. In Andhra, EMRI fields a fleet of 500 ambulances, staffed by about 3000 qualified medical technicians and drivers. Estimates indicate that about 22000 lives were saved in Andhra last year through such interventions. This EMRI service is slated to become available throughout India with ten thousand ambulances by 2010.

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Call from anywhere in Andhra, and you will be connected to qualified professionals providing free medical advice over the phone. The service, provided by Health Management & Research Institute (HMRI) immediately sorts and prioritises calls. Those needing an ambulance pick up are guided to 108 and EMRI. Acute non-life threatening cases are given advice on how to stabilise their condition and directed to appropriate nearby clinics or hospitals.

The majority of 104 calls are not for emergency help, and often seek advice on difficult psychological problems. Calls are routed to a doctor, nurse practitioner, or psychologist as required. Ayurvedic and homeopathic doctors are also available for advice. The 104 workers currently operate from a call center in Hyderabad. The target for the year is to increase the number of doctors in the call center to about 200 and hire about 2000 paramedics, from about 50 doctors and 250 paramedics currently on staff. About one quarter of the calls require professional medical advice and about half the calls originate from small farming villages with no permanent medical infrastructure. Shortly EMRI will field-test a mobile hospital.

The Indian government ensures that each village is visited weekly by a health worker trained to give basic medical assistance, primarily to pregnant women. These women are called accredited social health activist (ASHA) workers. Doctors at HMRI have begun to provide non-prescription drugs to the ASHAs for dispensing upon advice from a 104 call.

The 108 and 104 call centers were conceived by Ramalinga Raju, founder chairman and CEO of Hyderabad-based Satyam Computer Services Ltd.; Ranga Rao; and Balaji Utla. Mr. Raju had previously created the Byrraju Foundation to support rural health development in more than 100 villages in Andhra. Dr. Rao worked for many years within the state health ministry. Dr. Utla, responsible for creating one of the largest corporate volunteering efforts in India is also CEO of HMRI.

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The Satyam Foundation, with personal funds from Mr. Raju, initially funded EMRI’s world-class call centre, helping develop hardware and software needs, ambulances, staffing and office space. EMRI also established a two-year post graduation programme in emergency care with guidance from the Stanford School of Medicine. The EMRI team visited emergency response centres throughout the United States, Europe and Asia to discover best practices. EMRI and HMRI have also benefited from continuous inputs from McKinsey management consultants. Operational funding for the programme was arranged through the state government. Today, EMRI is a public private partnership. EMRI and Ramalinga Raju, through a private foundation, provide support for senior management, continued software development and research. Recently, the Indian government contracted EMRI to undertake expansion of the emergency response network, which will be operative in ten states by the end of 2008.

Satyam Computer Services Ltd has recently formed a joint venture with Cisco, Satyam Global Life Net, to bring together communication technologies and applications for health services. They hold the intellectual property rights of EMRI and HMRI and will soon be offering consulting services to countries, states and municipalities outside of India to provide similar services. In calling home to serve her own health needs, India may also help the rest of the world meet theirs.

The writer is a biophysicist, entrepreneur and philanthropist