Targeting the vulnerable: A critical analysis of helicopter transport for obstetric emergencies in Nepal

In tandem with national efforts to develop a system of pre-hospital care via ground ambulance services, leading private hospitals in Nepal are competing to institute air ambulances, or helicopter emergency medical services (HEMS). In a nation with limited infrastructure and extreme geography, helicopters offer a high-tech solution to overcoming transportation delays in emergency medicine. Private HEMS, due to the exorbitant costs, invites intersectional analysis along the lines of how wealth, caste or ethnicity, gender, and remoteness shape who is able to utilize it. In contrast, the launch of a governmental program devoted to transporting rural obstetric emergency patients to hospitals, using army helicopters, stands out as an unexpected transformation of a status quo in which only wealthy, elite individuals could access such medical care. Through a review of the trends in maternal mortality and ethnographic field research with doctors in Kathmandu and Kavrepalanchok who are leading the development of emergency medical transport, this paper explores competing interpretations of the driving forces and implications of HEMS, analyzing the benefits and drawbacks to targeting the vulnerable in health interventions.