Young or old, rich or poor, the greatest wealth is health.
LIFELINE EXPRESSThe World’s First Hospital Train
Over the past 25 years, the Lifeline Express has treated over a million patients in rural India & over 80,000 surgeries have been conducted on-board.
The Impact India Foundation is an International Initiative Against Avoidable Disablement, promoted by the UNDP, UNICEF and WHO, in partnership with national governments.
Hope on Rails
It is this extensive reach of the railway network that gave birth to the idea of a hospital train. The Impact India Foundation now works in close partnership with the Indian Railways, who provide and help maintain the coaches.
Filling a Gap
The Lifeline Express was intended to be a temporary measure to build awareness, but growing gaps in India’s public health system have necessitated the continuation of the project.
Government hospitals are often under-staffed and under-resourced and private hospitals are unaffordable for most.
A Simple Dream
Impact India Foundation
The staff work tirelessly to maintain the highest standards on the train, as seen here.
Here, a medical practitioner from the Lifeline express is holding an awareness workshop at a local Jain temple. The children come to the temple every other evening for classes on the scriptures.
Some people volunteer to help – motivated by sense of duty or ‘seva’; for others it is an opportunity to experience something outside of their everyday life while earning some extra money as well.
They are supported by an extensive technical support system - from electricians that help link the train to the local electricity supply line to local water tanker suppliers.
He is responsible for maintaining the equipment necessary to run the train as a hospital– from the generators that keep the air conditioning working to the medical machinery.
Thanks to the technician, life on the train is comfortable for everyone – from watching television after a long days work to finding respite from the heat under the air conditioning.
The Cancer Team
“I was supposed to go to Canada to study medicine, but I wanted to be here, in India…and I can’t work a 9-5 to job in a clinic…I have so much energy to share…and I feel a sense of duty, to help others."
“I wanted to see the world…have some adventure”, says a 22-year-old nurse from Madhya Pradesh who completes this team and will go to John Hopkins University for a nursing residency next year.
The Lifeline Express recently included cancer services – a dedicated doctor, a mammography room, and awareness workshops – to facilitate prevention and early diagnosis.
“I come from a small village, so I understand the needs. I am happy to be here.”
There is a great deal of camaraderie that characterizes interactions across staff and volunteers on the train, much of which is a related to the experience, knowledge, and humor of the technical staff on-board the train.
“I used to work at a local hospital earlier, but now with Lifeline Express I can leave a larger footprint.”
Deputy Director, Lifeline Express
The administrative team is the glue that binds the Lifeline Express together.
“As a doctor, it is my duty to help. Once I heard about the Lifeline Express, I knew I wanted to be part of it….I wish we could do even more.”
From Eye Doctors to Plastic Surgeons
Over the course of one train-stop, as many 40-50 doctors work on the train.
Call of Duty
Here, a middle-aged man, unable to walk on his own, is being carried by his mother to the patient consultation. They have walked many miles like this, in the scorching heat, desperate to receive medical attention.
Spreading the Word
The Lifeline Express also publishes its schedule of medical services in the local newspaper and puts up posters in and around the town. Local political leaders sometime use association with the train to win political favor among local constituencies. But perhaps this is a small price to pay when the medical needs are so great.
Consultations and Surgeries
People come from far and wide to meet the doctors; many are desperate to receive some kind of medical attention, even if only a strip of multi-vitamins. Some patients are treated right away with medicines, others are scheduled for surgery, and a few referred to local hospitals for consultation.
Hope and Frustration
People are disappointed, sad, and angry, having walked many miles and waited many months…But the doctors have no option either.
As a young woman in this profession, it is often difficult for her to make sure her advice is being taken seriously - but she is gentle and patient, combining humor and compassion in her interactions with patients.
For the Ladies
A young doctor from the Lifeline Express has been trying to raise money through the local women groups and temples to support their surgeries. In the mean time, all she can do is provide advice and support – but even this is a lot more attention and care than many of these women have ever received.
Prevailing patriarchal attitudes make this a sensitive issue – most women are often embarrassed to ask for help. For many, this is the first time they have spoken about such issues to anyone at all – hugs and tears regularly accompany these interactions.
Local businesses help out, providing food and water, along with chairs and pedestal fans.
Most patients are scared and nervous, at least partly because their previous experiences at government hospitals and private clinics has been either poor or expensive. Many said they find it hard to trust doctors. Hearing this, the nurses go out of their way to reassure and comfort them.
In the OT
Some of the surgeries are quite routine, while others are less common in the urban hospitals in which these doctors typically operate.
Here, a young girl is joined by her mother in the recovery room – both were scared and unsure of what to expect, but are hopeful and happy as the doctors have assured them that the surgery went well.
Cleft Lip Surgery
But often cleft lip causes much more serious problems – like difficulty in eating and breathing.
Caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture, cerebral palsy causes permanent and severe movement disorders, making it almost impossible to have a normal life.
Here, we see a doctor administrating a form of spinal anesthesia, a complex and potentially dangerous procedure. As the only anesthesiologist on the train, he has an incredibly tough and demanding job.
The doctors are notably impressed by the quality of services on the train. “The sterilization facilities here are better than most hospitals in New Delhi.”
Here, a girl with severe cerebral palsy is being taken to the local hospital after surgery – the doctors are hopeful for a full recovery, but this will also depend on the availability of post-operative care, particularly physiotherapists. Unfortunately, such care is expensive and local hospitals are not adequately equipped.
For many, the Lifeline Express might be the beginning of a new lease on life. For others, while full recovery might not be possible, there is at least some improvement and therefore hope.
This is perhaps the biggest challenge faced by the Lifeline Express - unless their work is supported by the local hospitals and medical practitioners, particularly in the recovery stage, many patients will not be able to make a full recovery.
Miles to Go
But, as the Lifeline Express Team are themselves painfully aware, theirs is only a temporary 'seva' or service - more permanent solutions supported by the Indian state are urgently needed to address India's growing health inequities.
Maybe one day, each Indian state will have its own Lifeline Express...But for the time being this is just a distant dream.