Thursday, 11 April 2013

A "boda-centric" initiative that saves lives. GUEST POST that doesn't involve fashion (not even one little bit) by Michael Miesen.

 BodAmbulance in Mbale. Photo by Jon Shup.

The irony that a boda might actually be the quickest way of getting to hospital in Uganda after I'd had my first boda accident wasn't lost on me. (Btw, there's a reason I'm saying "first" here, as you'll discover in the next post). Despite being branded as dangerous, in some parts of the country these bikes are doing this speedily but safely. I know this from my many memorable visits to the wonderful Shanti Birth House in rural Nsaasi village, Luweero District. Tabitha, below, is just one woman who I've met who used a boda to get to hospital when she went into labour, albeit as a paying passenger. In other parts of Uganda though bodas are now helping pregnant women access previously-unavailable health care services for free. 

Yes, I know what some of you might be thinking - isn't this supposed to be a fashion blog? Yes, it is. But as soon as I saw this awesome story originally on ThinkAfricaPress by Michael Miesen, a health care consultant and freelance journalist from the US living in Mbale, eastern Uganda, I was blown away. I knew I wanted to feature it on this blog so Mike has kindly written this awesome piece for Bodaboda Baby below. Before you panic, no, we are not throwing boda fashion out the window, but some boda stories must be told. Thus, we are departing from tradition momentarily to feature a MORE SERIOUS (as some of you may say - the author of this blog still thinks boca fashion is a serious business) piece. Over to you, Mike:  

"Riding a bodaboda is probably safer than you think it is. And it’s basically necessary for day-to-day functioning in Kampala, Mbale, and most large cities in Uganda; their economies would crater without the only real public transport that boabodas facilitate.

But that’s not to say they’re altogether safe, as research from Makerere University’s College of Health Sciences shows; 15 per cent of Mulago Hospital’s budget in 2008/2009 was allocated to boda boda-related injuries, and an eye-popping 62.5 per cent of the surgical budget goes to the same. Accidents are, to be sure, all too common.

Tipping the scale back towards benefit and away from cost is a boda-centric initiative to increase access to health services in the mountainous, rural villages of east Uganda. Known variously as eRangers (the term the producer, The Ranger Production Company, prefers), mAmbulances, and BodAmbulances, bodas equipped with a side-car passenger seat are helping pregnant women access previously-unavailable health care services. The initiative, which began in December 2010, has seen seven BodAmbulances take more than 4,200 emergency cases within the Budada, Manafwa, and Mbale districts.

The idea of using a motorcycle as an ambulance isn’t new – the British, French, and Americans did so in World War I – but Uganda is one of the first countries in Africa to implement it for rural emergencies. The scheme was thought up by Welsh paramedics and students from the University of Glamorgan while on a visit to Mbale, Uganda.

The BodAmbulances are an innovative solution to a vexing problem as healthcare access for mountainous, rural villages is notoriously poor here. Sick patients and pregnant women cannot be expected to walk miles to the health centre, and cars are expensive and often unavailable – even when they can make it up the mountain. As a result, patients stay at home and aren’t tended to by a skilled birth attendant or other healthcare provider.

Indeed, poor access to health facilities is one reason that Uganda’s maternal mortality rate is stubbornly high – 310 deaths per 100,000 live births in 2010 – and, unlike some of its neighbours, is unlikely to meet Millennium Development Goal (MDG) 5a of reducing maternal mortality to 170 maternal deaths per 100,000 live births by 2015.

Purchased by Partnership OverseasNetworking Trust (PONT) with funding from Rotary International-UK and maintained with funds from Kissito Healthcare International-Uganda, the BodAmbulances have one simple purpose: to save lives by helping sick patients access healthcare facilities that previously may have been out of reach.

Over 60 per cent of runs take a woman in labour to the nearest Health Center IV or District Hospital. When every minute counts, a reliable BodAmbulance may prevent a mother-to-be’s uterus from rupturing, or allow a baby to be born before pre-eclampsia progresses to the life-threatening complication of eclampsia in the mother.

Tabitha cradling Prossy Patience, just a few hours old in this photo, with Livingstone at the Shanti Birth House. The first time Tabitha gave birth her husband rushed her to hospital via boda.

By reducing the time it takes to get to a health centre, BodAmbulances are helping to save the lives of mothers and babies alike. Jayne Brencher, project coordinator for Primary Health Care for PONT, says, “The clear objective is to reduce maternal and neonatal deaths. And in that sense, it has had an impact and reduced both dramatically”.

Crucially, BodAmbulance rides are free, which allows all women in the region access to necessary health services, regardless of their ability to pay. All BodAmbulance drivers carry a cell-phone with airtime, and Village Health Team members are trained to call the BodAmbulance if a woman is in distress. BodAmbulances also serve as an important conduit between Health Centres and the local hospital, Mbale Regional Referral Hospital, for cases that require a higher level of care.

This allows the BodAmbulance intervention to positively affect two of the three components of the Three Delays Model: by reducing the financial, time, and “exertion” costs of reaching a health centre or hospital, it decreases the barrier to reaching care; and by giving health centres an easy way to transport patients to higher-level facilities, it reduces the delay in receiving adequate healthcare.

As a result of their success at saving maternal and neonatal lives and strong community support, PONT plans to purchase another 23 in 2013. And the effect the BodAmbulances have had on the community is tangible, says Brancher: “It began to strengthen the way the communities help themselves through the Traditional Birth Referral Attendants. One woman said, ‘It’s given us back our self-respect; we have value within the community, and the community itself has become stronger.’”

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