Mo­tor­bikes, side­cars, and phone plans rev up ru­ral health care

A Google-backed startup is set­ting up ru­ral 911 ser­vices “We had to find a way to in­cen­tivize peo­ple with­out money”

Bloomberg Businessweek (Asia) - - CONTENTS - Polly Mosendz

While driv­ing along the wind­ing dirt roads of El Copey in the Do­mini­can Repub­lic, you crashed head­long into a cow. The bovine seems OK, save for an ag­gra­vated moo, but you’re hurt, and the clos­est city is dozens of miles away. Di­al­ing 911 is an op­tion only in the cap­i­tal of Santo Domingo, not out in the coun­try­side.

In­stead, call the re­gional fire­house. There, a dis­patcher uses Bea­con, soft­ware cre­ated by non­profit Trek Medics In­ter­na­tional, to send a group text to a team of vol­un­teer emer­gency med­i­cal tech­ni­cians in the area. One of the vol­un­teers texts back a con­fir­ma­tion num­ber and heads to the scene on a mo­tor­cy­cle equipped with a side­car gur­ney, which he uses to take you to a physi­cian. Trek Medics seeks to bring a 911

al­ter­na­tive to coun­tries where such ser­vices are rare. While the trans­porta­tion re­search group at the Univer­sity of Alabama at Birm­ing­ham found con­ven­tional am­bu­lances cost an av­er­age of $1.46 a mile, one 2008 study found the mo­tor­bikes can op­er­ate for about 18.6¢ a mile. So Trek has been able to build a vol­un­teer net­work of about 200 peo­ple in the Do­mini­can Repub­lic and Tan­za­nia with a shoe­string bud­get sup­ported by Google, Car­di­nal Health, the U.S. Agency for In­ter­na­tional Devel­op­ment, and pri­vate do­na­tions.

Founded in 2009 by for­mer para­medic Ja­son Friesen, the New York non­profit em­ploys only a hand­ful of peo­ple to man­age oper­a­tions. Re­spon­ders vol­un­teer in ex­change for a first-aid train­ing cer­tifi­cate, a pressed uni­form, and, for 1 in 5 vol­un­teers, free mo­bile phone ser­vice.

“We knew we had to find a way to in­cen­tivize peo­ple with­out money,” Friesen says. “We tar­get 18- to 24-yearolds, gen­er­ally speak­ing. And what are they most con­cerned about in this age group in these com­mu­ni­ties? Phones. In­ter­net con­nec­tions. So­cial net­works. It’s their gate­way to a larger world.”

The phone sub­si­dies are al­lo­cated by a lo­cal fire chief or other com­mu­nity leader, who has some dis­cre­tion to choose which 20 per­cent of the vol­un­teers get their bills paid, based on how many calls they re­spond to and other fac­tors. This helps ad­dress a ba­sic lo­gis­ti­cal prob­lem, Friesen says, mak­ing sure re­spon­ders con­firm they’re head­ing to a scene to avoid du­pli­cat­ing ef­forts. In early tests, pro­hib­i­tively high mes­sag­ing costs of­ten dis­suaded vol­un­teers from re­spond­ing. In the Do­mini­can Repub­lic, one text re­ply to Bea­con costs vol­un­teers as much as 2.6¢, mak­ing reg­u­lar use ex­pen­sive in a coun­try where the av­er­age worker’s an­nual in­come is lit­tle more than $300.

“It was a lot be­fore they started pay­ing it,” says vol­un­teer Ray Apoli­nar Tor­res Muñoz, who’s re­sponded to 98 emer­gen­cies in the past three months in the north­west­ern prov­ince of Monte Cristi. Fel­low Monte Cristi-area vol­un­teer Ed­nawel Vasquez, who’s been on 300 calls in eight months, says that re­sponse rate would’ve been im­pos­si­ble with­out fi­nan­cial help. Both men are in their early 20s and say they hope to pur­sue ca­reers in medicine.

By the end of the year, Trek will have vol­un­teer net­works in Mex­ico, Guinea, and Malawi, and will be able to serve about 1 mil­lion peo­ple, Friesen says. The next step will be to add bet­ter in­cen­tives, like smart­phones with comped In­ter­net ac­cess, for se­nior vol­un­teers be­ing groomed for su­per­vi­sory roles. Even­tu­ally, he says, every­one who registers as a vol­un­teer re­spon­der will get a Trek phone, but the non­profit hasn’t yet reached that point.

Trek is in talks with mo­bile car­ri­ers in Tan­za­nia and the Do­mini­can Repub­lic to sub­si­dize smart­phone pur­chases, too. For now, that may be the tough­est part, says Friesen. Car­ri­ers “are so re­luc­tant to get in­volved, so we are just go­ing to have to eat the costs up­front.”

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