Satish Saroshe, MBBS, MD
MGM Medical College, Indore, India (Winter 2015)
|Photograph of the Lifeline Express is from the Indian Health Initiative blog.|
Lifeline Express, colloquially known as the Magic Train Hospital of India, is the world’s first modern technologically advanced hospital-train. Established in 1991 and completing twenty-three years of service, it has travelled the length and breadth of the country, bringing medical aid and relief to the remotest and most inaccessible areas of India. The train is run by the non-governmental Impact India Foundation in partnership with the Indian Railways. It is funded by various organizations—the Impact UK, other international charitable organizations, some noted Indian corporation such as the automobile giant Mahindra and Mahindra, and other individual philanthropists and donors. According to the World Health Organization, the total expenditure on health by India as percentage of GDP is merely 4.1%. With this meager investment in the health sector, the Lifeline Express is trying to fill the gap by providing healthcare to rural India, which normally has less access to medical services. Over almost twenty-three years, the train has travelled to many parts of India from Bihar and West Bengal in the east to Maharashtra in the west and from Madhya Pradesh to God’s own land down south, Kerala.
Operating across the extensive network of the Indian railways, the largest in the world, the Lifeline trains move from one station to another, parking in a platform at each town’s railway station for perhaps a week or so. It provides advanced medical services (often beyond the capabilities of local medical centers) to those who apply for them, through a simple vetting or triage process that ensures services are provided to those most likely to benefit. These trains are staffed by doctors and nurses, but for surgical procedures, they rely on the talents of Indian surgeons, who volunteer their time on the trains. Most of the surgical patients are pre-screened in the nearest local hospital by local health authorities. The train is fully equipped with a state-of-the-art operating theatre, a diagnostic centre and post-operative ward, nursing wards, teaching facilities, a laboratory, and a workshop.
Surgeons on board the train have performed many key procedures—disability correction surgeries (especially those resulting from polio), corrective procedures for cleft lips and cleft palates, dental services, cataract removal, intraocular lens implantation and other ophthalmological procedures, audiometry and surgical interventions to restore hearing. A neurologist runs a screening and treatment clinic along with counseling and education about epilepsy given by epilepsy counselors. The hospital staff also teaches surgeons from smaller towns the finer skills of micro-surgery, provides nutritional assessment, and promotes health through behavior change communication. The Lifeline Express also seeks to improve the efficiency of the existing local government and voluntary health infrastructure and services, as well as providing initiative and encouragement for the local bodies to become involved in the program and provide follow-up services after the train has left.
By December 2010 the train had served more than 800,000 poor in rural India. Many patients are treated at no cost; others are referred to nearby hospitals. Restoring sight, movement, and hearing; correcting cleft lips; and treatment for dental and neurological problems are provided for free with the help of the donated skills and voluntary services of over 80,000 surgeons. Thus with meaningful community participation the train has become an international model for other countries such as China, Central Africa, Bangladesh, and Cambodia, which operate their own Lifeline Express trains.
The original Lifeline Express, which had travelled the rail network since 1991, had to be de-commissioned due to wear and tear; and five brand new carriages gifted by the Indian Ministry of Railways were renovated and equipped to allow this special train to be re-launched in August 2007 with five coaches. The first coach is the power car, which also has a pantry and a staff compartment with a twelve-berth staff-quarter, kitchen unit, water purifier, a gas stove, electric oven, and refrigerator. The second coach has offices, the medical store, a drawing room, and two autoclave units. The train has a main operating theatre with three operating tables and a second self-contained operating theatre with two tables. In the main theatre, each table has its own set of anesthetic equipment, shadow lights, Boyle’s apparatus with halothane vaporizers, an imported Carl Zeiss microscope, a multi-purpose monitor, a defibrillator, a diathermy cautery machine, an anesthesia ventilator, etc. The theatres are equipped with a closed circuit television camera used to train local doctors for live surgical procedures. An attached six-bed recovery room is situated beside the main theatre. The Lifeline Express also has a self-contained operation theatre. The second theatre can be detached to form a stand-alone operation theatre and is used for disaster management. There is also an eye-testing room, a dental unit, a laboratory, an X-ray unit, and an auditorium with a large LCD display unit, a public address system, and closed-circuit TV.
Financial stability is ensured by meticulous planning, management, and coordination with local sponsors and district health services. The project costs around $60,000 and is covered entirely by one sponsor, who pays for medicines, for the volunteer doctors’ travel and accommodation costs, patients’ food and lodging, ambulances, fuel, and water. Recent sponsors have included the Rajiv Gandhi Foundation, Tata Steel, and Dr Michael Chowen, a private sponsor in the UK.
With the World Health Organization’s 2000 World Health Report ranking India’s healthcare system at 112 out of 190 countries and India’s economy growing almost at 8.5% a year, the country’s healthcare system is deplorable and poor. Although the train alone cannot plug the gaps in India’s public health system, it is an effective initiative in bringing about change and educating the rural population of India about their medical needs.
- Website www.impact.org.uk › About IMPACT › Project Highlights accessed on 2 January 2015
- Website healthmarketinnovations.org/program/lifeline-express-hospital-train accessed on 2 January 2015
- Website economictimes.indiatimes.com › Slideshows › Infrastructure accessed on 2 January 2015
- Website www.mahindra.com › How We Help › Health accessed on 2 January 2015
- Website https://www.impactindia.org/lifeline-express.php accessed on 2 January 2015
- Website www.railnews.co.in/lifeline-express-the-first-hospital-train/ accessed on 2 January 2015
- World Health Organization’s 2000 World Health Report
SATISH SAROSHE, MBBS, MD specialized in community medicine and is presently assistant professor in the department of community medicine, M.G.M. Medical College, Indore, which is a government medical college affiliated with the Devi Ahilya University, Indore. He is also sentinel surveillance monitor for Indian government’s National AIDS Control Program. He is also associated with organizations such as UNICEF, UNFPA, and WHO through various public health projects. His area of interest is epidemiology and biostatistics.