Coming to rest against a tree at the side of the highway, the car had narrowly avoided catastrophe. Jennifer Farrell’s first instinct as a doctor was to help the motorcyclist. Just moments before, a bus had been crossing paths with the young American medic’s vehicle on the N2 – one of the world’s deadliest highways – when the motorcyclist had overtaken at speed. Running from the wreck towards the injured man, she had already anticipated that he would swiftly get up, grab his motorbike and flee.
“There’s a lot of vigilante justice in the world of road traffic accidents in Bangladesh,” she says. “People will pull people out of cars and beat them to death.” The ever-present threat of injury, or worse, on the country’s roads is a harsh reality that many in Bangladesh have simply become accustomed to.
Comparatively speaking, for every two fatalities in road accidents in the US, there are 160 deaths on the streets and highways of Bangladesh. Just under half of those killed are pedestrians, with 82% of injured parties in all road accidents succumbing to their wounds because of a lack of basic medical care at the scene.
“We’re trained in the US from the time that we are two or three years old how to dial 911, and you always just think that it’s there and you don’t realise that it’s not like that in most parts of the world,” says Farrell. Even as we speak by Skype, as if to underline the problem, the invasive and repetitive sound of car horns fills the space of her sixth-floor apartment in Dhaka.
Farrell, a Duke alumnus and Tulane University-educated doctor from Santa Monica, California, is the founder and CEO of CriticaLink – the world’s first mobile app-driven emergency medicine system, currently undergoing a trial in Bangladesh’s capital.
According to the World Health Organisation, fewer than 10% of road traffic accidents are attended by ambulances, a commodity in limited supply in a country with a population of 149m. To date, there is also no emergency telephone number to call to report accidents or summon emergency services, nor is there any emergency medical training available to doctors or nurses.
It wasn’t until her final year of college that Farrell had her first taste of trauma medicine in the developing world. With four years as a volunteer paramedic with her campus ambulance under her belt, she received a grant that took to her to South Africa to work in prisons and schools, teaching first aid to medics. By 2012, she had arrived in Bangladesh to assist a trauma surgeon in conducting similar training sessions in Asia.
“We spent about a month doing trainings with youth volunteers, doctors, medical students and security guards. We trained hundreds of people, but my biggest concern was how to connect these people with the people who need them. So this is when the idea for CriticaLink came: using mobile technology to connect these people to the people on the streets that need their help.”
Having seen the extent of mobile usage firsthand after her own car crash on the N2 highway, Farrell is adamant mobile technology has a vital role to play in bringing emergency medical care to developing countries.
“I have a picture that someone else took of everyone taking a picture of us. There’s a crowd of a hundred people and everybody is pulling out their phones to snap pictures and upload it on Facebook. If they can snap a picture and upload it on Facebook, they can snap and a picture and send it to the reporting centre.”
The premise for the innovative system is simple, and it works much the same way as Uber – the only difference is that someone is coming to potentially save your life rather than give you a ride. Using the CriticaLink mobile app, a phone call or an SMS message to report accidents goes to a call center, where volunteer operators are able to alert nearby first responders with the help of location-based technology. Within seconds, the responders have the whereabouts of the accident, with maps, up-to-date information and images at their fingertips.
So far, Farrell has trained some 3,000 people from all walks of life, with 500 registered unpaid volunteers, both male and female, aged on average 21 or 22 years old.
They are rigorously trained by qualified medics in triage, checking vital signs, protecting the head and neck, controlling bleeding, caring for burns, performing CPR and splinting fractures before they are allowed into the field. Even then, they must pass a gruelling process of review sessions, a series of practical workshops, and written and practical exams.
Although still in the pilot stage, with 125 fully certfied first responders participating in the beta test, the system seems already to be having an impact: since the start of the trial in November, it has had a number of success stories, most notably last month when a garment worker was severely injured falling from a bus.
After receiving a report from a bystander who witnessed the accident, the call center alerted through the app one of the CriticaLink first responders, who headed to the scene. “It was actually outside one of our areas, but he was close by and he went. He then alerted some of the others through the app to come and help and to meet him in Uttara, where we do have a team,” Farrell says.
From the Uttara suburb of Dhaka, they took the victim by auto-rickshaw to the nearest hospital, where she was refused treatment due to the severity of her wounds. After she was stabilized, she was eventually accepted and operated on at Dhaka Medical College and Hospital, where the responders had called ahead to make sure that a blood donor was waiting and then informed the family.
“This was a poor garment worker who probably wouldn’t have made it. She had no money to pay for transport to a hospital and had multiple internal bleeds and a head trauma,” says Farrell.
Providing a good Samaritan service free of charge in a country where the national average annual income per capita is just $700 presents the greatest challenge to the project thus far. “This kind of system has never existed in Bangladesh, so the idea of someone coming to help you out of their own free will is one that people are very sceptical of. ‘Are you going to steal from me? What do you want from me? Are you really here to help?’” explains Farrell. “I think it’s going to take time for people to recognise that we’re there to help them.”
Each year, accidents claim 5.8 million lives worldwide, nearly all of which happen in developing countries like Bangladesh. It is not uncommon to find 4,000 patients in an 800-bed hospital awaiting attention: on the floors, in the stairwells, two to a bed and, in some cases, in between and underneath them as well. To add to this, up to 100 trauma patients a day can arrive at emergency rooms seeking urgent treatment.
Of course, it is not just road traffic accidents that are pushing the overburdened healthcare system to breaking point. Bangladesh has been awash in waves of political violence in recent months amid ongoing deadlock between the government and opposition. Over 100 Bangladeshis have been killed, including the murdered American-Bangladeshi blogger Avijit Roy, in a rising tide of violence, train derailments and petrol bomb attacks on buses and buildings. And there are of course well-documented disasters, such as the Rana Plaza factory collapse on 24 April 2013, which crushed 1,129 garment workers to death.
Farrell found out the day after the disaster that she had been successful in obtaining a Fulbright scholarship to help set up CriticaLink. “I remember hearing the news about Rana Plaza and going, ‘If they don’t give this to me, they’re crazy. This is exactly why we need to do this project.’
“For me it was a sign to the rest of the world that this was something that was necessary. It was also when I knew this concept would work, as people were already trying to use social media, WhatsApp and mobile messaging to coordinate themselves.”
With plans in place to expand the project to other parts of the country by the end of 2015, Farrell is already leading training sessions in Bangladesh’s second-largest city, Chittagong, which came to world prominence due to its infamous shipbreaking yards. Workers here toil dismantling the asbestos-ridden hulks of oil tankers and container ships with limited or inadequate safety equipment; they account for a third of the trauma patients at the city’s medical center.
Ultimately, CriticaLink is a blueprint for helping millions across the developing world access medical services currently out of reach or non-existent in their countries. For her part, Farrell is confident that the app will bring about much-needed change in Bangladesh and elsewhere in the world with a greater importance being given to emergency medicine in particular – so long as there is a will and the human resources to deal with the problem.
“The skeleton of this whole system can be adapted not just to handle emergency services, but to help sexual assault cases in India or obstetric complications in rural areas. My goal is to see CriticaLink functioning and working in Dhaka, but with the ability to go anywhere. There is something there that tomorrow you could take to Ghana, to Nairobi, to South America. There’s room for technology and innovation in health, even in places with limited resources.”
Friday 13 March 2015
http://www.theguardian.com/world/2015/mar/13/bangladesh-deady-road-accidents-criticalink-app-emergency-services
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