‘Shops won’t even sell us water’ — Kerala’s ambulance staff on Covid duty battle prejudice

Workers associated with Kerala’s 108 ambulance service have been at the frontline of the state’s response to coronavirus. But it’s been a tough life on the road.

The staff of the 108 ambulance helpline outside the Cochin International Airport last month | By special arrangement

Kochi: Eighteen-hour work days without leave and no scope of returning home to their families at the end of a tough shift. Being on the frontlines of the Covid-19 battle has been a harrowing prospect for the employees of Kerala’s 108 free ambulance helpline. 

But it’s not the work they grudge, it’s the discrimination they face on the road as they ferry patients and suspected cases around the state for treatment as well as home isolation. 

Speaking to ThePrint, multiple technicians said they had been facing ostracism at shops and eateries, which often refuse to even sell water to them. One technician relayed an incident where an eatery told him and the ambulance driver that they were out of tea even as other patrons continued to receive steaming hot cups of the beverage.

A call away

The 108 free ambulance service, launched in Kerala in September last year, allows residents to call for help through the helpline number or a dedicated mobile phone app.

Each ambulance generally consists of a team of two — a driver and an emergency medical technician (EMT). 

A 33-year-old Kochi nurse who joined the service last October as a technician said he was drawn to the job by its profile. He was supposed to be the sole authority — to administer emergency treatment under the basic-life-support-vehicle protocol, to track the nearest government hospital for admission, and to lead the driver there in not more than 30 minutes. 

From the time patients boarded the vehicle, up to the moment the resident doctor sent away the ambulance after receiving the patients with a signed declaration, all the decisions would be his.  

“It’s the reason why I wanted this job,” said the nurse. “Unlike in a hospital, there would neither be a hierarchy to obey nor routine orders to follow. After each run, the mobile app in our vehicle would be updated and it was back to the rest room until the next call.”

Each 108 ambulance is assigned to a government hospital, which is mandated to arrange a rest room where the staff can spend the time between their runs. 

The hours were tempting too. Their stipulated duty time was 12 hours a day and they needed to complete 26 duties a month — which meant 312 hours or 13 days, leaving them free for the better part of the month. 

However, their job, an emergency service by its very nature, gained an unprecedented urgency as the Covid-19 pandemic began to gain ground in the state, weeks after Kerala reported and cured its first three coronavirus patients. 

The ambulances were pressed, initially, to take international passengers from airports to different hospitals for screening, and then onwards to their homes for quarantine if found negative for the virus. 

On 10 March, the ambulance where the Kochi nurse served was among 16 108 vehicles from Ernakulam that were asked to report to the Cochin International Airport Limited (CIAL) for Covid-19 duty. 

“We took the first call. The trip was to Kasargod, the northern-most district bordering Karnataka,” said the nurse. “The passengers were two brothers who had taken the Vienna-Doha-Kochi flight. We took them to the Aluva district hospital for their initial medical assessment. By 2.30 pm, we left for Kasargod.”

Fully attired in personal protective equipment (PPE) — the gear mandated for personnel dealing with Covid-19 cases, comprising, among other things, shoe covers, head covers and masks — he and his pilot (driver) Musafir had strict instructions: Don’t step out of your vehicle, stick to the front seat, communicate with patients only through mobile phones, and don’t create alarm. 

“When the patients sought a loo break, we stopped once near a deserted paddy field. But we couldn’t stop anywhere for food during the six-hour journey because the patients, being in isolation, couldn’t walk into any eatery and we couldn’t risk being seen by the public in the protective gear,” the nurse said. Luckily, he added, they had water supplies and snacks in the vehicle. 

“As we neared their house in Kasargod, we switched off the siren and the headlights,” he added. Within five minutes, they had dropped off their passengers and set out on the return journey. 

On their way back, they removed the PPE, ate from the food packets their passengers’ family had kept ready for them, and snoozed for an hour: Musafir on the front seat and the nurse on a shop verandah somewhere in Calicut. 

Once the vehicle was fumigated at the hospital, they reported back at CIAL at 6 am the following day. 

The second day, 10 more 108 ambulances from Trichur were called in, and, within a week, each of the over 50 pilots and EMTs (including some backup staff) was pitching in 18 hours of daily duty. Musafir’s ambulance alone, the nurse said, clocked 6,000 km in 16 days. 

“I have no recollection of how many trips I made”, the EMT said. “As more global destinations began to be recognised as Covid-19 hotspots, the number of airline passengers ordered into isolation increased three-fold. It was back-to-back trips and some of us EMTs pitched in with the driving too.”

‘Cornered at an eatery’

A second EMT from Trichur, who also preferred to remain anonymous, recalled how a quick stop for food on one of their ambulance runs led them to be cornered by irate patrons. 

“We were two ambulances carting seven passengers. When we reached Calicut (Kozhikode), they told us they wanted to eat… Since we had already returned our PPE to the hospitals that were then facing a shortage, we were dressed normally, without gloves and masks,” the EMT said. “We parked the ambulances way ahead of the restaurant. We planned that the four of us would eat first and then get food packed for the passengers.”

However, they were recognised. “It was humiliating,” the EMT said. 

“People asked us how we could be so careless. We kept telling them we hadn’t even seen our passengers properly. All we do is open and shut the door for them,” the nurse added. “But no, they refused to let us leave and wanted to report us. One of them was filming us. Finally, we told them — you have filmed us, allow us to go now.”

On their return trip, when they made a stop for tea, the shop owner allegedly refused to serve them. “The owner told us the tea was over,” said Shibu, one of the pilots. “We could see others ordering tea and getting it too. We realised why he was not willing to serve us. We just left quietly.”

Just another day on the job 

In March, Kerala registered among the highest number of coronavirus cases in India.

By 17 March, the hospital rest rooms set aside for the ambulance staff had been converted into isolation cabins. Since going home was not an option as it meant exposing their families to infection, the staff had to find a spot on the dividers inside the arrival terminal of CIAL, the Kochi nurse said.

Once a day, three or four of them would cram into the front seat of an ambulance (the rear is strictly reserved for passengers), and drive 14 km to take baths in the river.

By then, multiple EMTs said, people had started to notice them more and were refusing to sell them food and even water, the staff added.

“So, a restaurant inside CIAL took pity on us. They allowed us to have whatever we liked on the menu, free of cost. It was a high-end restaurant,” said Shibu. “We couldn’t have afforded its rates normally. That was one good perk of this ordeal.”

Mohammed Shihab, general secretary of the Trichur-based Indian Nurses Association, a registered trade union, said the personnel of the ambulances worked in an insecure environment.  

“During any outbreak, the emergency services work on the frontlines,” he added. “When the airline passengers first step out, no one knows if they are positive. Their first contact is with the EMT, whose only source of protection is the sanitiser.”

In the initial days, after they had to turn in their PPE for hospital workers, Shihab said all the ambulance staff were given only cloth masks, which don’t fully serve the purpose or protection against Covid-19. These masks are supposed to be changed every six hours, which wasn’t done either, he added. Surgical baths after each run should have been mandatory, he said, adding, “But unlike hospital healthcare workers who can negotiate for precautionary care, these EMTs had no such option.”

It was only after the lockdown was announced on 24 March, that the ambulance staff was again equipped them with PPE. 

According to Shihab, there is also no clarity on whether the staff will be compensated for the extra hours, with the Hyderabad-based firm that employs them through a public-private partnership not saying anything about it, or any proposal for a high-risk allowance. 

“Simply put, these EMTs do not have a public platform to raise their voice,” said Shihab. “They are scared to ask questions related to their post-Covid-19 salary. Those who did try asking their coordinators were given the immediate response — this is a government order and you are all on contract — so do not take risks with your job.”

ThePrint approached the emergency medical executive who coordinates the staff on behalf of the Hyderabad firm for a comment, but multiple calls yielded no response.

Home a distant prospect

In light of the lockdown and travel restrictions, the ambulances no longer have to cater to airport passengers. This has brought down the number of daily trips to three each, mostly to get the discharged patients back home and, at times, for taking samples to laboratories.

Of the 50 EMTs (including back-ups) previously on CIAL duty, around 15 are in home-isolation by choice. The majority, however, are still on duty. 

Since the rest rooms at hospitals are still occupied by Covid-19 patients, the authorities cleared a government building for their lodging. Around 24 EMTs and pilots live there now. 

Meeting families, however, remains as distant a prospect as it was in the early days of the pandemic. 

“The one time I had the chance to go near my house was last week,” said a 24-year-old recruit attached to the Ernakulam General Hospital.  “I told my parents to stand at the gate. I walked up to my mother. She gave me tea in a Styrofoam cup. That was it,” he added. “I left before any of the neighbours could see me.”

Kerala’s effort in tackling Covid-19 has been lauded around the world. Where it was one of India’s worst affected states until March, it is now recording just a few new cases daily. Of the 402 people who have been diagnosed with the disease in the state, only three have died. 

Shwetha E. George is a Kerala-based freelance journalist