‘Zambulance’ the Zambian Ambulance System

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A Zambian hospital workers shows off the “Zambulance,” a bicycle ambulance recently introduced to the area. April 2010 (Darcy Wintonyk/CTV)

GWEMBE, ZAMBIA — A rusting Ministry of Health truck sits on the grassy lawn in front of the Gwembe Hospital in Luumbo, Zambia. It has no wheels and is resting precariously on cement blocks. Judging from the height of the foliage around it the vehicle it has been stationary for quite some time. This is the facility’s only vehicle.

In an area flanked by tall corn crops and sugar plantations built into rolling hills and forested valleys, most residents here have been struck hard by the yearly alternating bouts of floods and droughts. Compounding these woes are the plagues of malaria that have seen, at times, up to 80 per cent of Luumbo’s citizens sick at the same time.

Gwembe Hospital’s head doctor, an amiable man named Joseph Chimuete, says transportation is far and away the biggest obstacle to administering heath care in this mountainous region. The hospital serves 25 villages, some separated by distances of 20 kilometres. Most villagers are at least a four-hour walk away from the facility.

“It keeps a lot of people away,” he tells me in his office, a cramped space with a cigarette calendar on the wall. “The reality is that we’ve lost children and some mothers. Actually, a lot of them.”

Last week, a pregnant woman was taken to the hospital on an ox cart from her village 40 kilometres away because there were no ambulances or vehicles to take her. She had labour pains and delivered right away, bleeding to death on the cart before arriving.

“If the hospital was closer, or she had reliable transport, she would still be alive,” Chimuete says.

Only five per cent of births in this region are assisted by a doctor or health care provider. Most will be assisted by a family member or friend, often with disastrous consequences. Many young people die at home without ever seeing a health care worker. The 2009 United Nations Children’s Fund Report found that one per cent of pregnant Zambian women die in child birth. One in 16 will die from maternal health problems — often treatable conditions — including infections, malnutrition or pneumonia.

The maternal mortality rate in Zambia is 200 times that of North America’s.

The Zambulance

Enter the “Zambulance.” Recognizing a lack of reliable transportation to bring women to hospital, a pilot program in Luumbo funded by NGOs will see three bicycle ambulances, or Zambulances, brought into the region. The yellow mountain bikes are specially fitted with a trailer on the back which fits a single mattress. It even has a removable canopy. The idea is that a woman going into labour can lie down on the back of the bike and be comfortable when being transported.

There’s just one problem: the mountains.

Community health worker Alex Muchiindo is the first person trained by the Ministry of Health to use what locals have termed “The Zambike.” He says they are useful but is wary about how effective they will be.

“You must be very strong to get up the hills; we have to get off and push them up a lot. The women yell at us,” he says, shaking his head.

An instruction on the side of the bike reads: “Operators must use more energy.”

Muchiindo said the bikes will only be useful for part of the year because of the crushing floods that sweep the region in the winter.

“In rainy season this will not be very useful. We’ll be stuck in the mud.”

Still, the attitude of hospital staff and health workers like Muchiindo is that something is better than nothing when it comes to the new six-wheel wonders. In a region that sees an average of 20 births a month, half with complications, they’ll take what they can get, even if it isn’t perfect — or particularly useful.

“Of course we want motorized ambulances but that’s not going to happen. We need these women to come in to help them,” Joseph Chimuete says.

I ask what happens if the mothers do not come in to have birth.

“Death, usually,” Chimuete says. “Sometimes the child dies, sometimes the mother. Sometimes both.”

The long and winding road

Leaving the hospital, I drive six kilometres down a dusty and winding mountain road to the Lukonde Rural Health Centre. It’s tough for our Land Rover to make the climb on some of the bone-dry portions of the dirt road and it’s hard to imagine the Zambulance could make it up any of these hills. The road is noticeably absent of bicycles of any sort.

The health centre, which is designed to give aid to the rural regions, is a three-room open-air space in the middle of a tiny village. It is the only concrete building in view.

Traditional birth attendant Violet Kadingi gives me a tour of the buildings. The reception area has stacks of children’s notebooks, some moulding. I am told this is the filing system. The surgery room has a sterilization station but no fresh water. Kadingi admits conditions are less than ideal, but it’s still safer than women giving birth at home.

“The water tank is not holding water so we have to perform deliveries without water. What can we do?” she says, shrugging her shoulders.

The centre’s answer to the region’s transportation problems comes in the form of Traditional Birth Attendants, or TBAs. Practitioners, all women, visit mothers during their last term of pregnancy and advise them on neonatal issues, including the importance of going to a clinic, even though most refuse to do so.

Birth attendants here are working with bare-bones supplies. They often have no drugs to administer, no sheets to lay under their patients and, in the most extreme cases, no light to even see what they’re doing because huts do not have electricity.

“We must deliver babies in the dark and we can’t see complications. We need torches (flashlights). We need to see with our eyes what we’re doing,” Kadingi says.

The TBAs are currently in negotiations with the health district to get uniforms and rubber boots, which they say will protect them from the poisonous snakes that live in the forest and have a tendency to crawl up their skirts during nighttime house calls.

Miles to go

Kadingi says some women are more than 22 kilometres away from the nearest clinic, so most TBAs travel great distances, often on foot, to see their clients. Like the hospital, the group too cites transportation as the largest obstacle to their work.

“We use an ox cart sometimes to bring women in but it’s too bumpy,” Kadingi tells me.

Birth attendant Mary Haunduka says many pregnant women would rather give birth at home because they are concerned about the distance they must travel to the hospital.

“They know it is a dangerous journey,” she says.

There are 30 bicycles shared by the group, but, like the Zambulance, TBAs say the cycles are an unreliable method of getting around because of the mountains and flooding.

Mother shelters

Zambian health care practitioners are trying to bridge the gap between villages and hospitals by establishing something called mother shelters near the health facility. Full-term pregnant women move into the shelters a month before they give birth and move out a week or two later.

“They only need to go 10 metres instead of 10 miles. The dangers are decreased,” Dr. Chimuete says.

Family is also encouraged to come and stay — something health care workers hope will cut down on jealousy from husbands.

“Women are dissuaded by their husbands to go. It’s one role of tradition of African men. They don’t want to feel left out and will discourage health care visits,” TBA Paulina Cheelo says.

Cheelo says the addition of kitchens to the shelters has increased the number of men who will accompany their wives for the birthing process.

“They can’t cook for themselves so they don’t have much choice,” she says.

So progress, however slow, is coming to Luumbo.

“We can’t move the mountains, so we have to work around them,” Chimeute says. “It’s slow, but even if we can save the life of one mother we know we are making a difference.”

Darcy Wintonyk travelled to Africa on a fellowship funded by the Canadian International Development Agency and administered through the Jack Webster Foundation.