A PILOT PROGRAM IN ZAMBIA DRASTICALLY REDUCED FATALITY RATES, PROMPTING CALLS TO EXPAND THE MODEL ACROSS THE CONTINENT.
BY JACOB MESCHKE, Bicycling Magazine, SEP 21, 2018
Malaria is responsible for roughly 400,000 deaths in sub-Saharan Africa each year, more than two thirds of which are children under five years old. The disease, caused by parasites transmitted through mosquito bites, is both preventable and curable, with the right tools.
But in the Zambian bush, where health facilities are sparse and roads wide enough for cars are rare, access to life-saving medicine is a constant challenge.
Enter bicycle ambulances, a core element of an anti-malaria pilot program in Serenje, a northern district of Zambia. Since its implementation in July of last year, the program has reduced child fatalities from cases of severe malaria from an expected 8 percent to just 0.25 percent, saving an estimated 94 lives over a 12-month period, according to an internal study.
“The number of lives saved is a real testament to how important timely access to healthcare services is, and we’re delighted to be able to share such excellent results,” said Caroline Barber, CEO of Transaid, an NGO that managed the program’s logistics.
The ambulances, locally manufactured bikes and trailers designed to cover long distances, are only one component of the program. Volunteers, trained in each community, test patients and administer artesunate, a medication used to cure malaria, as a suppository. This lengthens the window of time for volunteer transport cyclists to deliver patients to the nearest health care facility, where they receive injectable artesunate to further their treatment.
Improving awareness and medical knowledge among community members, and the greater availability of both forms of artesunate, were both important factors in the program’s success. But it was the transportation element that had long been the thorn in the side of governments, health officials, and international aid organizations working to reduce malaria fatalities, which increase in likelihood the more time passes.
“[The results were] a really pleasant surprise,” said Pierre Hugo, project manager for Medicines for Malaria Ventures, an NGO that funded and coordinated the program. “A lot of that was down to actually ensuring [patients receive treatment after being diagnosed]. It’s a real challenge, and that’s why these bicycle ambulances were so important in ensuring these kids were treated.”
The journey between a Serenje community and a health facility can reach up to 40 miles. Often, the most direct route involves crossing a river without a bridge. If the river is swollen and uncrossable, as is common in the rainy season, that means precious hours lost. Those making the journey must gamble on which route to take—a shortcut could turn into a dead end, but a more established path could put off treatment too long.
Bike ambulances alleviate that problem, cutting travel time down drastically and providing an effective, reliable method of patient travel.
“It’s quite a drive to some of these community settings,” said Hugo, who oversaw the project’s implementation in Serenje. “You couldn’t bear the idea of having to walk to these health facilities, let alone with a child that’s unconscious. Just the though of having to carry your child that’s dying the 10 or 20 kilometers to a facility is beyond belief.”
The bikes are manufactured and outfitted with trailers by Disacare, an organization based in the Zambian capital of Lusaka. Bicycles are not common in rural Zambia, but Transaid determined them to be the most sustainable, cost-effective option over alternatives like trucks or motor bikes.
“You couldn’t bear the idea of having to walk to these health facilities.”
The bike ambulances, which began with an earlier Transaid project in Zambia but were expanded for this program, have also become a symbol of community. In a series of case study interviews, Serenje patients and parents expressed a consistent appreciation for the volunteer services. One cyclist told Hugo the community repaid him for being constantly on call by helping him with his harvest.
Though the pilot program ended in July, the bike ambulances continue to operate in Srenje. Medicines for Malaria Ventures recently secured funding to expand its reach to several other regions in Zambia, and the Zambian Ministry of Health is fully on board. The eventual goal is for the national government to take over the program completely, eliminating the need for NGOs like MMV and Transaid, which could then focus on launching similar projects in other countries struggling with malaria.
According to Hugo, the type of transportation could change based on a given country’s geography and economy—motorbikes are much more readily available and affordable in Nigeria, for example—but overall, bicycles, a crucial part of the success so far, aren’t going anywhere.