I vividly remember a case I suspected of stroke and decided to refer to a higher center. There are myriad of decisions and hurdles to work around in order to make the referral smooth. I remember being worried about my patients back in internship about not getting the 30 minutes earlier slots for CT scan. That compared to sending my patients to a different city for the scan seems like a funny worry. Even when you convince a patient that a referral is necessary, which is in itself a rigorous and overwhelming process for both the health practitioner and the patient party, there arises many hurdles to the process. Convincing a patient that half of his monthly income is worth the ambulance ride to a city with CT scan facility that will cost him his other half of the salary can never be an easy process. That combined with the possibility that the CT will come out to be normal is paradoxically a nightmare. Hurdles start to emerge from the least expected places. Spinal board to transfer patient to the ambulance, a simple start to make sure the patient does not move when the ambulance speeds on a bumpy road, oxygen cylinder for the travel, all are privileges that patients at Beltar PHC scarcely have.