Bush ambulances cycle people to
They look like rickshaws and can traverse bad roads but no licence is required to drive them
It is a sweltering day in Malawi’s Nsanje district and the gravel p a t h s i n Ne l s o n v i l l a g e a r e deserted. Two young women lie under the shade of a big tree that hangs low over their mud house.
The women’s father, Stephan Nkhono, watches them from the doorway. “I didn’t think I would be here today,” he says.
Last year Nkhono fell ill. He had diarrhoea, a high temperature and was vomiting. He had malaria, which is endemic in the area. Although Trinity hospital is less than 2km from his home, Nkhono was too weak to walk.
“My relatives came here but there was no motor vehicle to take me to the hospital,” Nkhono recalls.
Even if the family had access to a car, they would have struggled to get him to the hospital. Nsanje is one of the districts hardest hit by the floods of 2015 and the infrastructural damage is yet to be repaired: the road leading to the Nkhono’s home is narrow, steep and bumpy.
“My family had to run to the hospital to collect the bicycle ambulance and used it to transport me to the hospital. That way they didn’t have to carry me and I was able to get help before it was too late,” he says.
The bicycles are especially designed to pull a stretcher or a similar structure, turning them into ambulances for use in rural areas where people struggle to get to clinics or hospitals because the facilities are too far away and the patient is too weak to walk.
“Normally, when we talk of ambulances, we always think of motor vehicles. But here in the rural areas our village is difficult to access because our roads are very bad. It’s not everywhere where you can have motor vehicles,” says William Allan, the chief administrator at Trinity Hospital.
He removes his spectacles and wipes the sweat off his face and neck with a washcloth. In long, quick strides he walks down the crowded corridors of the hospital towards his office.
“A lot of people were dying, obviously, because they couldn’t reach the hospital. Many pregnant women would not make it to hospital in time and delivered their babies on their way here. As a result, many babies died, and so did some of their mothers.”
Transport is critical in healthcare access, according to a 2015 article in the journal BMC Health Services Research.
Allan says many women in his village turned to traditional birth attendants when they could not get to the hospital, which often results in babies and mothers dying. Trinity Hospital has a catchment population of about 150 000 people.
“This hospital is strategically situated, because the other hospitals are far. The nearest hospital is in Thyolo, which is 70km from here. Nsanje District Hospital is 80km to the south, but you cannot drive directly from here. Because the bridge we had was washed away by the floods, you have to travel 200km just to get to the other hospital,” says Allan.
A 2014 Pan African Medical Journal study in Kenya found that pregnant women whose medical care was delayed because of the long distance between their homes and the nearest health facility resulted in “some women arriving at the hos- pital too late to save the life of the unborn baby”.
Failure to access healthcare is also a key contributor to child mortality. A 2014 survey published in the Journal of Health, Population and Nutrition showed that children from poor households were less likely to be seen by a doctor when they are ill than their wealthier counterparts. Conducted in Malawi, the survey found that “families from rural households spent more time travelling compared to urban households. In addition, visiting a trained healthcare provider was associated with longer travel time and higher direct costs compared to visiting an untrained provider.”
Bicycle or bush ambulances were introduced at Trinity Hospital in 2002 when businessmen from Blantyre, Malawi’s commercial capital, donated the bicycles.
“Every group village headman was allowed to keep a bicycle ambulance so that if anybody in the village fell ill they could use the bush