|On the road to better healthcare|
|Monday, 03 June 2013|
The College has named Riders for Health as its adopted charity for 2013. The 20-year-old social enterprise works in sub-Saharan Africa, providing transport to connect rural communities with healthcare providers
From Nigeria to Lesotho, Riders for Health’s fleet of vehicles facilitates emergency referrals, transports samples and supplies, and mobilises community health workers. This case study outlines the charity’s work in The Gambia, where Riders for Health have managed healthcare vehicles on behalf of the Ministry of Health since 2009.
Basse, The Gambia
The small town of Basse sits on the bank of the River Gambia, in the very east of the West African country which shares that river’s name. The water moves slowly here, cutting its way through mangroves, birds skimming along its surface. Further upstream it is possible to spot hippos enjoying the cooling waters.
Basse itself is a market town, with traders taking advantage of the closest river crossing to the country’s most easterly border with Senegal. Everyone is busy here but in the stifling March heat the pace of life slows down.
Basse may be a long way from the twenty-first century world we know, but the people who live here are still in need of the kind of healthcare that we would take for granted. In the past, for many people in Basse simply getting access to that healthcare has been almost impossible. But now, Riders for Health – The Royal College of Surgeons of Edinburgh’s official charity for 2013 – are making sure healthcare reaches everyone, everywhere.
Ambulances – a lifesaving link
Manyo Gibba sits in her office at the town’s maternity ward. As she speaks the ceiling fan tries to stir the air and in the ward next door women in the last few days of their pregnancies try to find some comfort from the heat.
Manyo explains that while it is currently hot and humid, when the rainy season arrives her ward will be full of women suffering from malaria and anaemia. They become too weak, causing complications in their pregnancy. Untreated, she explains, they will have the baby dangerously early or at a low birth weight.
Manyo and her team try to encourage all women to give birth at the clinic. ‘If women deliver at home they may come across complications like postpartum haemorrhaging or retained placentas. Traditional Birth Attendants cannot manage that at home,’ she explains. ‘They have to be referred here. If we can’t treat them here, we normally refer them to Bansang hospital using our ambulance.’
In the past, when women in Basse faced issues that were too complicated to deal with at their small hospital or if their doctor was not available, it would be a challenge to get the mother to the larger hospital in Bansang, 40 miles and two hours away.
Now, thanks to Riders for Health women have access to an ambulance that can take them quickly and safely to hospital. In 2009 the Northamptonshire-based social enterprise began managing all of the healthcare vehicles for the Ministry of Health in The Gambia.
Each clinic in The Gambia now has a referral ambulance to take emergency cases to hospital as well as a trekking vehicle that allows teams of nurses to travel to rural villages and carry out monthly surgeries for child immunisation and ante- and post-natal care.
Delivering healthcare on two wheels
The largest number of vehicles Riders manages here are the motorcycles which are used by community health workers. Away from the two major towns, most people in The Gambia live in remote villages many miles away from even small towns like Basse. Their primary source of healthcare is from community health nurses like Bubacarr Jallow.
Bubacarr works in the village of Marakissa in southern Gambia, and uses his motorcycle to check up on pregnant women, new mums and young children, as well as other people at risk. He also monitors the nutrition of children under the age of five, running tests every three months and administering supplementary nutrition programmes when needed.
A motorcycle doesn’t just transform the health of Bubacarr’s community; it transforms the life of Bubacarr as well. He no longer has to walk for hours between villages, he can be reliable, he can do the job he trained to do. When the retention of health workers in rural communities is such an issue for government in Africa, reliable transport has a massive role to play.
Momodou L Sawanah, a teacher near Marakissa, can’t praise Bubacarr enough. ‘Bubacarr communicates well with everyone,’ he said. ‘He trained my wife how to give supplementary food to our children. They are all healthy now. But that’s not all he’s done. Before Bubacarr started his outreach work here, these villages were at loggerheads. Somehow as well as bringing better healthcare to the communities he has brought cooperation.’
The Gambia is now the first country in Africa to have a fleet of health vehicles that covers the whole country. But the truly innovative part of this story isn’t the vehicles; it is the way they are managed. In most cases in Africa vehicles are bought or donated without a thought to who will pay to run them or how they will be maintained. The result is that motorcycles and ambulances soon break down and people in rural areas don’t get the health care they need.
Imagine our health service without transport. It is fundamental to the logistics service that carry drugs and equipment, the ambulance service that moves patients, even to our own cars that bring us to work. Imagine what would happen if the health system had no reliable transport.
In The Gambia, Riders for Health’s team of technicians service each vehicle every month; there is always a supply of replacement parts and there is sufficient fuel. Vehicles no longer break down, clinics are not cancelled and health workers can make their appointments.
The most important thing is that the Ministry of Health have committed to paying the running costs of this programme, ensuring its long-term sustainability for the people of The Gambia. It is the ultimate goal of all of Riders’ programmes for the government to pay for the service on a not-for-profit basis in this way. But, until that time, the organisation relies on supporters like the Royal College of Surgeons of Edinburgh to get to this stage.
In seven countries in Africa, Riders for Health is improving health care for 12 million people. They are providing a medical sample courier system to improve TB and HIV monitoring in Lesotho, Zimbabwe, Zambia and Malawi and they are mobilising hundreds of health workers who can provide care to some of the most remote communities. But, at the heart of it all, is transport – the key to making sure healthcare reaches everyone who needs it.