Indian Railways Incompatibility to terminally ill patients and PH passengers article - Part 3

Indian Railways Incompatibility to terminally ill patients and PH passengers article - Part 3

Apart from physically challenged persons there are passengers with other kinds of disabilities who need special treatment on Indian Railways. As of now mentally retarded persons with escort are eligible for concessions on both seasons’ tickets and 1st and 2nd class tickets in passenger trains in both mail and express trains; these concessions are also available on the elite Shatabdi and Rajdhani trains. They also get 25% concession in 3rd AC and AC chair car in all inclusive fares of Shatabdi and Rajdhani trains – except Durantho and Garib Rath trains. “In Durantho and Garib Rath trains concessions are not available because the fares are low in any case” F. R. Michael Senior PRO South Central Railway Vijayawada Division clarified. 

Concessions are also available for Thalassemia, cancer patients, TB patients, heart patients who get 75 % concession in 1st class and 75 % in sleeper and 2nd class… if they are travelling for periodical check-ups or admission in a recognised hospital / sanatorium or return, Michael told this writer.  

Persons with mental health disorders (like Schizophrenia or Bipolar Disorders, clinical depression etc.) are not eligible for train fare concessions even if they deserve accompanying passengers’ concession. Passengers with certain mental health disorders could be prone to violent behaviour in stressful circumstances - justifying the need for accompanying passengers. 

However in European and North American trains, persons living with mental health issues with ID card are eligible for 100% fare waiver for themselves, accompanying passengers as well as a pet animal. Room is made available for wheelchair, pram and cycle too.

“All persons who have a "Schwerbehindertenausweis" (an identity card for severely handicapped passengers) can travel for free on the entire network of Deutsche Bahn AG - the German National Train Service. Accompanying persons or dogs can travel for free as well” Julia Haas, Sales & Marketing Executive non-European Markets International Sales of Deutsche Bahn AG told this writer in an email interview.

Apart from the physically challenged persons, there are terminally ill cancer patients who are referred to the Kidwai Memorial Institute of Oncology (KMIO) in Bangalore from all over the country. Although the cancer patient and his / her attendant gets 75% fare concession for train travel, it is not in the least comfortable for the terminally ill patients.

Neither the Indian Railways nor the Kidwai Memorial Institute of Oncology offer ambulance transfer facilities at the Bangalore Railway station for patients referred to KMIO in Bangalore. Ambulances cannot drive upto platforms in most railway stations - so necessary for terminally ill cancer patients. This ‘ground service’ / infrastructure connectivity or lst loop compatibility – so to say – is the need of the hour and is necessary at all railway stations across the subcontinent. I learnt this from personal experience in February 2005.

Box item: Hazardous for terminally ill patients (Extract from an article published by this author in the Statesman Kolkata on 11.03.2007)  

“Sixteen year old Panduranga could barely board the train from Mysore to Bangalore. He had been injected with drip syringe and his mother was holding the drip bottle. Panduranga was suffering from acute leukaemia and was referred by the Govt. Hospital in Mysore to the Bangalore based Kidwai Memorial Institute of Oncology for further treatment. That prescription / reference for transfer qualified him and his attendant to travel at 75% train travel concession to Bangalore indeed. But boarding the train was exhausting for the frail lad. A tall boy, he could not be carried into the train by his weak and emotionally drained parents either. Given his terminal illness both his parents decided to travel with the frail lad regardless of fare concession, understandably. The railway staff in the Mysore railway station was looking helpless because the doorway to the train compartment was not wide enough to facilitate carriage of a wheelchair. How is the terminally ill boy expected to board a train from a platform three feet below the train steps, that too with the steps being vertical - one under / top of the other? We are normally used to climbing in a forward / sloping motion. But in the Indian trains we need to ascend vertically without supporting rails.

When I saw the boy lying on his parents’ lap panting for breath after boarding the train, I was very moved. I asked them why he couldn’t be taken by ambulance. His parents told me plainly that they could not afford the service of an ambulance. I felt upset, guilty, helpless and determined to do something…Mysteriously the K.R Hospital in Mysore – a government hospital - did not think of sending the boy and his parents by ambulance to Bangalore. When cancer patients and their attendants are eligible for 75% concession on Indian trains why would an ambulance be necessary one might think. But terminally ill patients with a blood count of 7 with drip bottle and syringes hanging out of his frail body cannot be expected to board a train and survive an exhausting ordeal.

His arrival in Bangalore was even more dramatic. The platform at which the train arrived in Bangalore was far too low for even normal healthy / persons to toss off. Adding to the nightmare of having to jump off eight feet from a set of three vertical steps one under the other, was the frailty of the situation. With tears in my eyes, I requested the law and order policemen present on the platform to facilitate an ambulance / wheelchair for the boy’s transfer. The effect was enormous. To be honest I did not mean to dramatise, but I admit I am not one to easily overcome tears. All the well-built cops went up to the compartment, and literally carried the boy down. But he was in no shape to stand that hot afternoon. Seeing the commotion, people on the platform did make way and a bench was cleared for the boy and his mother to rest. It so happened that on that particular platform, cargo was often loaded and unloaded so there was a direct passageway unknown to the public, for cargo vehicles’ movement. The cops hailed a taxi driver and even pooled in money to offer for the taxi ride because Bangalore railway station does not have an ambulance service. The boy’s father was so moved, he started falling at my feet. I was honestly trying hard to fight the tears in my eyes. I needed to be calm and exercise presence of mind. The driver of the taxi had been instructed by the cops not to charge for the ride as they had pooled resources for the drive upto Kidwai Institute for Oncology.

Three days later, the boy died because his blood count fell to four. His exhausted parents hired a vehicle to take the corpse to their native place in Mandya for funeral. This incident happened on the 10th of February 2005. But even today the railway stations in Bangalore or for that matter anywhere in India, lack elevators, escalators, luggage escalators, wheelchairs, ambulatory services and ramps. Exploitation of porters for carriage of luggage is unfair, but justified in the name of socialism … employment opportunities”.

Speaking to this writer, the PRO of the Bangalore based Kidwai Memorial Institute of Oncology (KMIO) (http://www.kidwai.kar.nic.in/) Siddalingaswamy said “indeed there is a need for coordination for transit of terminally ill patients referred to KMIO.  This needs to be taken up by the Railway Board at a national level possibly based on the recommendations of KMIO. For us it is difficult to do this because only about 5% of the patients referred to KMIO are terminally ill, moreover those who come here get themselves admitted only a couple of days after arrival in Bangalore. When terminally ill patients are coming by train, on a humanitarian basis we do send an ambulance for transit from railway station to the KMIO hospital; but it does not happen often” he concedes. “Relatives of the patient stay in their relatives homes. So coordination is also difficult. The best way of doing this is by offering 100% concession / ticket waiver to the referred patients. This is the space for NGOs to do their bit for society” he adds. 

Not just terminally ill cancer patients coming to KMIO in Bangalore, patients are referred cross country to facilities like AIIMS, PGI Chandigarh, and NIMHANS in Bangalore etc. Those referred to private sector hospitals like Narayana Hrudayalaya in Bangalore or Medanta Hospital in Gurgaon, Escorts Hospital New Delhi, are not eligible for train concessions. Thus the need for a dedicated train car in every train is necessary for critical / terminally ill / severely handicapped / referred patients.  (See box at the end of the article). That it needs to be staffed by trained personnel needs no reiteration. Attempts to seek a response from India Inc. through the good offices of Confederation of Indian Industry met with evasive responses. Ambulances cannot easily be brought to the railway platforms in most of the railway stations in India because of inadequate planning.

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Facilities mandatorily required for physically challenged persons in Indian Railways:

Separate AC train cars for physically challenged persons with the requisite facilities on each train. These facilities are, among others:

•          Separate handicapped friendly toilets with room for wheelchairs, mirrors, shelves, sinks, taps, faucets, flush handles, latches, all accessible for a person seated on a wheelchair

•          WCs or western commodes with disposable paper rims, automatic flushing with biodegradable sanitisers.

•          Flexible stairs that can extend to become a ramp for boarding and alighting wheelchair passengers

•          Ramps, ambu-lifts, room for stretchers and fully equipped first aid / emergency medical staff on call in such cars

•          Telephone connection in such cars, meant strictly for the use of authorised personnel and bona fide physically challenged and referred terminally ill passengers only.

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The infrastructure needed at railway stations are inter alia:

• •   Escalators, (horizontal and climbing escalators on platforms, wide enough to accommodate wheelchairs)
• •          Elevators on every platform at a distance of one serving every alternate train car
• •          Luggage escalators / conveyor belts beside every stairway in the railway stations
• •          Electric wheel chairs at every platform,
• •          Important offices like ticketing counters, waiting halls, cloak rooms, public toilets should be easily accessible by ramp entrance at the front of the railway stations itself.
• •          Separate lines for physically handicapped / persons living with mental health issues should be policed for misuse by touts and unauthorised mala fide applicants.
• •          Uniform height of all platforms in all railways stations in India. It is hideously dangerous to expect passengers healthy or challenged to jump off trains to depths of 3 metres below the train floor! 
• ·           Toilets in all railway stations should be compatible to Physically challenged passengers and people suffering from mental health issues.

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Sensitising the society is necessary for the benefit of physically challenged persons:

·   Eligibility of tickets / priority for booking tickets for persons accompanying mentally challenged persons in 2nd class train travel.

·     

    While mentally retarded persons traveling with an escort for any purpose  can avail of concession for upto 75% in II, SL, I, AC CC & AC 3-T and 50% in AC 2-T and AC I. (for both) 50%

·     (for both)… sensitizing staff and crew of their needs is much more important.

·     

     Automated services and signboards without the nuisance of touts are very important in this context.

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Malini Shankar

Malini Shankar is a wildlife photojournalist radio broadcaster and documentary filmmaker based in Bangalore. Malini is one of the directors of Digital Discourse Foundation (www.digitaldiscourse.org.in)