For most of us an emergency trip to a health facility is a matter of dialing 911 or having a family member drive us. However, for most rural Africans, a medical emergency is something altogether more serious. Many face long distances to health facilities. Family members are unlikely to own a bicycle, let alone a car. And public ambulance systems are virtually unheard of.
Imagine it’s four o’clock in the morning and you or your wife goes into labour, but there is no transport to help you reach the hospital. Or you suffer from a chronic illness that requires you to make frequent trips to a distant hospital, but you have no way to get there and you keep missing your treatments, making the illness even more resistant to medication. Or you fall off your bike and break your leg and, again, no transport – you have to wait until someone can help you, and that might take a few days.
Namibia in Southwest Africa faces enormous healthcare challenges, especially among its largely rural population. Its national HIV/AIDS infection rate stands at around 20 percent, and maternal mortality rates have doubled in recent years. The need for locally managed medical transport is more pressing than ever.
In a recent assessment of the link between transport and healthcare, the Bicycling Empowerment Network Namibia (BEN Namibia) found that people living with HIV/AIDS are hit hard by the lack of transport. Patients either miss their treatment because no transport is available, or spend most of their income (up to US$8 per month) on paying for lifts in private vehicles, leaving little money to pay for the food that is an essential part of their treatment. The situation worsens in an emergency, when rural dwellers may pay up to US$66 to reach the nearest hospital.
In order to change this picture, in October 2006, BEN Namibia launched a bicycle ambulance manufacturing plant in Namibia’s capital, Windhoek. Bicycle ambulances are ‘stretchers on wheels’ that attach to normal bicycles and tow a sick person or pregnant woman to a hospital or clinic where no other transport is available. In other African countries where bicycle ambulances are in use, there have been marked declines in infant and maternal mortality rates.
BEN Namibia has distributed 54 ambulances, and more are planned for 2008. The ambulances are delivered to community-based organisations in the rural North of the country. Healthcare volunteers receive training in use, maintenance and reporting on the performance of the ambulance. A management discussion also helps partners address issues like storage, access and covering costs of maintenance. Volunteers report that the ambulances have been very useful for their work, enabling them to take clients to hospitals, clinics, or even to the nearest road where they can take a lift if the health facility is too far.
The bicycle ambulance is not intended to replace motorised ambulances, but to fill a gap where no services are provided. Indeed, for most of Namibia, there is no public emergency ambulance system, and people often die because they can not afford to pay for private transport. Until Government is able to develop adequate policies and procedures on emergency medical transport, it seems that bicycle ambulances will have a role to play.
Individuals can support the delivery of more bicycle ambulances. BEN Namibia’s US partner, ITDP, can issue tax receipts for all US donations. For every US$480 raised, an ambulance can be delivered to a Namibian community, along with tools, training and ongoing field support.
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