Motorbike ambulance -Saving pregnant mothers lives by saving delay in transfer when urgent interevention is needed

Author(s):

Biku Ghosh ( [email protected]) Aberra A Gobeze ([email protected]) , Metasabia Joffe([email protected])

Topics: Maternal, Newborn and Child Health

Region and Country: Ethiopia

Organization:

Southern Ethiopia Gwent Healthcare Link |

UK Wales

The Report

Problem:

More than 80% of maternal deaths worldwide are caused by five conditions namely hemorrhage, sepsis, obstructed labor, hypertensive disease of pregnancy and unsafe abortion. Timely intervention is regarded as the key to reducing maternal mortality. Ethiopia is well-known by high maternal, perinatal and infant mortality rates with the risk of 1in 27 women dying in pregnancy.

In Ethiopia more than 80% of people live in rural areas, majority living more than 5km from any health centre (HC) and 20% living beyond 10km. HC are typically between 30- 100 km from any nearby hospital. Access to the HC and subsequent transfer to hospital for seriously ill patients and mother with complications in pregnancy is made more difficult because of lack of any proper road and no ambulance.

During the link’s visit in November 2007 a MOU with the Health centre staff, local health council, the local community and the link was developed to work together to improve delivery of health care in the Yirgacheffe, Alaba and Wondogenet health centres each serving around 100,000 population. During the open discussion with the community leaders, mothers groups and the HC staff recurring theme was serious problem in managing critically ill patient such as patients with complications of pregnancy, following trauma or other serious acute illness due to the absence of any mode of transport for these patients. It was not uncommon for these patients requiring to walk or be carried on makeshift stretcher between 10-20 km to travel to the HC on rough terrain and if needed then from the HC to the hospital which is 60km in the back of a truck only if lucky to have one available. A survey was carried out recently in one of the district hospitals for pregnant mothers with complications who needed urgent obstetric operation. Average time taken for them to reach the hospital, once the decision was made for them requiring transfer, was 8 hours. In some instances it was over 12 hours and in one instance the mother was carried by family on home made stretcher for 14 hours to reach the hospital. I in 5 mothers and 3 in 4 newborns did not survive. The local communities desperately needed help with safe transport of these critically ill patients to improve care and reduce maternal and new born mortality in particular.

Intervention:

The E-Ranger Motorbike ambulance, already used in other African countries, was considered by the link to be the best solution. This is due to relatively low cost, ease of training, low maintenance cost and more importantly being user friendly in the difficult terrain and improper road surface.

In 2008 November the link donated a motorbike ambulance each to Yirgacheffe and Alaba HC, to be followed by one to Wondogenet HC in March 2009, another to Shone HC in November 2009 and a motorbike ambulance each to Chelelektu and Chichu HCs in November 2010.The link is proud to have introduced motorbike ambulance for the very first time in Ethiopia. Initial training of the motorbike ambulance drivers was supported by the link. But since then the already trained drivers train future drivers for other HCs. The cost of fuel, which is minimal and the allowances for the drivers are taken care by the local community. The link has agreed strict guidelines with local community and HC about usage of these important vehicles.

Results:

Our link coordinators in Ethiopia regularly monitor and report usage of these motorbike ambulances which is also verified by us during our 6 monthly visits to Ethiopia from UK. In November 2010 we visited and evaluated the use of motorbike ambulances in all of the above 4 HCs. In all of these places the motorbike ambulances are regarded by the HC staff and the community as a very special gift and highly valued. All the vehicles were in good working order although now in need of full servicing which the link has agreed with the local team. By March 2011 between them these motorbike ambulances have so far made over 2200 patient journeys, mostly with pregnant mothers. Many of these have been in the nights and often over 20km distances and in one instance over 40 km. No doubt between them they have so far saved many lives of mothers and babies.

‘We express our appreciation on behalf of benefited mothers and our community. The ambulance service has minimized delay of transportation ------. It has a great economic, social and psychological relief not only for mothers but also for family members, community and the health workers’

Wubeshet Mekuria, Head, Gedeo Zonal Health, SNNP Region, Ethiopia

Few examples of motor bike ambulances benefiting the community:

Alaba - January 2009 –

In the last week of January 2009 in Chobare village 18 year old Shemsia Sultan was going to have her first baby. Unfortunately her labour went on for many long hours without any progress and by the evening she was getting weaker. The nearest medical help was in Alaba health centre 40 kilometers away through poor road conditions and the nearest hospital was over 100km away. Shemsia’s family had heard of the recent arrival of motorbike ambulance in Alaba health centre and the training of the midwives there. They telephoned the health centre in the middle of the night and soon the motorbike ambulance was on its way. Later that night Shemsia gave birth in the health centre, with help from the trained midwife, to her 3kg baby girl. Thanks to the Link donating the ambulance and training the staff, Shemsia did not become part of the statistics for maternal death or serious complications with fistula still so high in Ethiopia.

Yirgacheffe- November 2009: The community leaders cited an example of use where the husband walked 15km to contact the health centre and motorbike ambulance went to collect the seriously ill pregnant woman from home. It took a total of 1 ½ hours but had a good outcome. The Mayor said he had feedback that there were big celebrations in the village following the mothers return home with the baby, both alive, which has so far been uncommon, and thanked the link for the service.

Another example was cited in Yirgacheffe when a heavily pregnant woman with obstructed labour walked for several miles from her home trying to get to health centre. Nearly 5km from health centre she could not walk any more because of exhaustion. They were spotted by a passerby with a mobile phone who telephoned the health centre and soon the motorbike ambulance came to collect her. Fortunately she also had a successful outcome.

Shone March 2010 - 25 year old Tayech Ermias lives 5km away from Shone health centre. She knew that last year one woman near her home died in labour. ''The woman could not get to the health center in time because of lack of transport. After many long hours in labour by the time her family could bring her to the health center she had already passed away''.

Tayech heard about the motorbike ambulance during her antenatal check up. When she went to labour around 4:00pm her family called to Eshetu, the motorbike ambulance driver, who came within 20 minutes and brought her to the health center. Dawit, the midwife (trained by the link in October 2009) helped her to give birth around 6:00pm to a 3kg healthy baby boy. She stayed at the health center for 3 hours. During these 5 hours the driver waited for her to take her back to her home. She is very happy with whole service and was keen to come back to the health centre to tell her story."

Shone November 2010- We visited 19 year old Workenesh with her one month old boy Yetanette in her home. Workenesh had to use the motorbike ambulance in the middle of the night when she went into labour in her first pregnancy. She spoke very highly of the service she received. Also as she is herself is a community health extension worker, and has already seen the benefit of the motorbike ambulance in Shone for the rural communities with other pregnant mothers.

Lessons:

Motorbike ambulances have been ideal solution in rural Ethiopia for transport of pregnant mothers with complications who needed urgent intervention in health care facilities. In rough terrain where there is no proper road these light weight vehicles can be used with ease. They are relatively cheap, easy to maintain and highly valued by the community and the health workers.

The lessons learnt in Ethiopia from our inititaive has been taken forward by other UK health links with other sub Saharan African countries and motorbike ambulances have been introduced in Uganda and to be introduced shortly in Timbaktu and Kenya.

More recently following our contact and request Liya Kebede, World Health Organization's Goodwill Ambassador for Maternal Newborn and Child Health, from USA of Global Philanthropy group, has been very interested in this project and visited Ethiopia last week to see one of our motrobike ambulance being used in a rural health centre and since has discussed with the key people in Ethiopian Govermnent regarding how more can be introduced.

Year:

2010