The ambulance, despite its bright yellow colour and blaring siren, becomes just one more vehicle on Mumbai’s famously congested streets.

“We can’t do anything,” says Dr Ahmed, as he points out the window to the bumper-to-bumper traffic. Most people take public transportation like taxis or rickshaws to the hospital, he says, because they know an ambulance cannot get them there quickly. Some of India’s private hospitals provide such top quality, and relatively inexpensive, healthcare that the nation has become a hub for medical tourism. And yet a combination of infrastructure challenges, rigid behavioural norms and lack of political will has created a situation in which the country’s pre-hospital care and emergency services for its own residents are lamentable, say public health specialists.

“It is the golden hour [the first hour after being stricken] that is most important especially for cardiac patients or even stroke patients,” says Dr Ahmad Mecklai, the chief of operations and projects-in-charge at Mumbai’s Prince Aly Khan Hospital. But India, he says, does not have a system in place to serve people during this critical time.

In countries like the United States emergency services are centralised, and everyone knows exactly what to do: Dial 911. In India, Dr Mecklai says, there are multiple services that all operate on their own with no coordination.

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