Preparing for a Bicycle Ambulance

The more remote the communities we work in are, the further off the main road and the more difficult access is for them, the better partners they make, it seems. And pretty much all of the communities we work in are remote. Remote in this part of Uganda usually means deep poverty. It also means people are hardy and work cooperatively to tame the steep slopes into plantations.

BBC radio, Have Your Say, had a program about the African middle class last week. Middle class was defined as having $1-2 to spend per day! The other day I was shown a photo of children supposedly from our area. At first glance I could tell they were not. Later we were able to make out the name on their uniforms, a private school in Mbarara. In Uganda where education is highly valued, the middle class send their children to private schools.

Many of the Health Center II and Health Center III in Mbarara and Bushenyi District have at present a single health worker, although I have heard they are going to get a second health worker soon. The majority of the health workers are Nursing Assistants, a cadre that has only 3 months formal training. For many of them it was a long time ago. When they are away or sick, the health center is closed.

Often in the community they are referred to as doctor. In the health center in Namiyonga, it is clearly evident why Agnes is referred to as doctor. She sees all the sick children, provides family planning advice, organizes immunizations, makes home visits, trains the community health workers (CHW) and holds community meetings to discuss and advocate for clean water. The walls of her small tidy but sparsely furnished health center are covered with bright posters and charts of the monthly cases of malaria. Even when she is presiding over a drama competition with her CHWs providing humorous health education, after it is finished, a line of mothers and children forms at her clinic door.

In Agnes' community, they have done some health planning and decided that their priority is a transportation plan, a way to ensure pregnant women in distress and sick children needing referral can be taken to the Health Center IV on the main highway for treatment.

A couple of groups who design bike ambulances, came to our area last year. One fellow, supposedly with vast experience in the developing world, took one look at the roads and headed back to Kampala the very next day. But the idea was planted. Huge loads of 5-7 bunches of matooke (banana) are ferried to the market by bicycle in this area, even if it means they have to walk the bicycle through the rough spots. Even I have been scouring the net for possible designs.

Then during a visit from a friend from UNICEF, she mentioned they were going to try some out. When she learned we had two communities that had developed transportation plans and were seeking solutions, we struck up a partnership. The bikes as yet are still in the pipeline, but the community recently brought down to the project office, 300,000 UgS (more than $100) in cash, their contribution to the bike ambulance. We require community contributions to our efforts and while this is a community that has little, they always prepare lunch for us and provide volunteer labour. But this is a sizable amount of cash for the community. As the bicycle when it comes will be a donation, the money was put in the safe to be used for maintenance. Recently they sent a message inquiring as to progress on the bike and indicated they had collected a further 200,000 UgS but would wait until bike was delivered.

Photos: Recently painted clinic; young boys; training session; coop work in field.