The Emergency Health Crisis
Patients with life threatening illnesses in rural communities cannot safely access healthcare with existing transportation options. Traditional transportation options are too expensive and alternative solutions can exacerbate medical issues or are unsustainable solutions.
Sada Ziwadi is a woman we spoke to while iterating on our ambulance, in the Usangu Flats. She told us...
ANALYZING THE PROBLEM
We can see the dire need for better medical care when looking at the issue of childbirth complications. The World Health Organization (WHO) estimates that over 300,000 women die every year because of preventable pregnancy complications, an overwhelming 99% of these women from developing countries. According to the World Bank, transportation is the one of the top two obstacles in receiving healthcare. Two years ago, there was no viable transportation option that was simultaneously versatile and affordable. We’re working to fill that gap.
We are working in Tanzania, where an estimated 5,000 women die each year to due pregnancy complications alone. 37% of Tanzanian women have chosen not to go to the hospital at all in fear of making the journey alone, and an ever greater 50% lack the transportation to choose at all. In rural communities, motorcycles are the primary form of transport because they are more affordable and can navigate the narrow, rocky roads. In an emergency, the best option for patients in crisis is to hire a motorcycle driver and face the long, dangerous journey alone. Those without motorcycle access face the road to treatment via wheelbarrow, bicycle, or foot. These realities lead to unattended road side births, exacerbated medical conditions, and discouragement from going to the hospital. Then, add into the equation that less than half of Tanzanian mothers are accompanied by a skilled attendant during childbirth, which can lead to serious issues when complications in the birthing process arise. It comes as no surprise that Tanzania’s maternal mortality rate is far higher than that of most other nations.
Less than 50% of mothers have a skilled attendant at their side when they give birth to their children, which has led to serious issues when complications arise. As a result, the maternal mortality rate for Tanzania is extremely high when comparing it to international numbers
3 Conventional Delays in Receiving Healthcare
1. Delay in the decision to seek care due to: previous poor care, poor understanding of risk factors, acceptance of maternal health, or financial implications.
2.Delay in reaching care do to: distance to clinics, availability and cost of transportation, poor roads, or geography.
3. Delay in receiving care due to: poor facilities and lack of medical supplies, inadequetely trained/motivated staff, or inadequate referral system.
Problems with Traditional Ambulances
Cost: A refurbished land cruiser is (at best) $8,000, and that is not including the costs to buy a gurney and other medical supplies.
Maintenance: Many organizations donate ambulances and refurbished taxis, and use them for a couple months or a year, but as soon as they break, very few people know how to fix them or have the money to. We have seen this in several clinics and heard it from customers as a norm.
Integration into existing systems: There are no ambulance or emergency services in these areas. To drive the ambulance, a full time driver must be trained and paid, but clinics and citizens hardly have the funds for medical supplies. Providing an ambulance, even a working one, is extremely difficult to sustainably implement given these circumstances.
Problems with other Motorcycle/Bicycle Ambulances
Integration into existing systems: eRanger is a permanently attached sidecar ambulance, that can only be used as an ambulance. It has the 3 issues that traditional ambulances have ($6600, UK modeled motorcycle so difficult to maintain, must hire a driver). Pulse/Zambikes trailer can only be used with their model of motorcycles, so drivers must buy a whole new bike, which is not available in every country.
Safety and Comfort: Other ambulances do not have the recycled motorcycle suspension or the roll cage, which is more dangerous. The ride is more painful and the vehicle cannot handle extreme terrain as well.
User experience: Patients must climb into the ambulances, which is not always possible in critical conditions. Only a patient can fit in the ambulances, and so they cannot bring a family member with them, leaving them alone on the road with the driver in case of road side births or other issues. Drivers cannot use it for anything else, so drivers do not make as much money from it. Therefore there are less funds and incentives to buy or maintain the ambulance.
How We Are Reducing the Delays
Distance to clinics: Creating a vehicle that utilizes the cheapest, most common and fastest means of travel in the areas we are working.
Availability and cost of transportation: Offering a trailer that is less than the cost of a motorcycle, and improves the usage of them.
Poor roads and geography: Our trailer has a robust suspension system that has been testing in a variety of conditions, including varying speeds, inclines and weather conditions.
Additionally, we are addressing…
Previous poor care: Many choose not to go to the hospital because the previous journeys to the hospital have been painful and long, which can exacerbate medical conditions. People have also heard of and seen friends have serious complications along the way, resulting in giving birth on the side of the road or having a child die on their way.
Financial Implications: By offering a less expensive product, NGOs, communities and emergency services can afford a vehicle to use for emergency services and mobile health clinics.
Lack of medical supplies: The Okoa ambulance has a versatile inside that can be used to cheaply transport medical supplies. Now, clinics can use our ambulance in the downtime to collect medication and blood samples.
Maternal Mortality per 100,000 births:
TZ: 398, US: 24, International: 216
Neonatal Fatality per 1,000 live births
TZ: 21.1, US: 3.6, International: 19
90% of maternal death are preventable
6% of women die in childbrith or pregnancy
Statistics: (data.worldbank.org)(all numbers from 2015)
Locally sourced materials: Affordable to build and maintain for our customers. Any fundi (metal worker) in the villages can fix any issues, and they since they have experience with the materials, do not charge as much. The Quality Assurance on this maintenance will be monitored by having close monitoring of the warranty’s and regular check ins for “certifications” every year.
Modular inside: Stretcher and seats are on tracks which allows for two things: the first is that it allows patients to be loaded onto a stretcher outside the ambulance (like a gurney) and the second is that it allows for the seats to be removed when they are not needed. When the seats are removed, the trailer can be used to transport medical supplies. There is also a possibility to create custom interiors for delivery of specific items.
Space for a second passenger: Going to the hospital in an emergency is scary enough, let alone if you have to go alone. Our ambulance can fit a second person and medical supplies for patient comfort during a traumatic time.
Integration into existing systems: Our trailer can fit on the back of any motorcycle that has our semipermanent attachment. Therefore, several trained motorcycle taxi drivers in the villages (they are main form of transportation in these areas) can attach and detach our ambulance, depending on if they want to use it or not. This allows them to continue to use their vehicle as they usually do, reducing behavioral changes for the motorcycle driver and the community and creating a more sustainable implementation option.
Our Potential for Impact
Okoa is an affordable trailer for any potential ambulance operator, including motorcycle taxi drivers, private emergency services, clinics and governments.
Transport patients from the home and accident sites to clinics.
Shuttle referral patients from dispensaries with little medical capabilities to clinics with surgical abilites
Integrate into medical supply chain by transporting medicine and equipment to and from clinics
Expand mobile medical clinic capabilities with a less expensive vehicle with several uses
Our ambulance has an extensively tested suspension system for a safer ride over the narrow, bumpy roads. It includes a seat for a second passenger for patient support, and space for a first aid kid and birthing kit for when emergencies arise.
The trailer can be integrated into existing transportation norms because it is a removable attachment that turns any motorcycle into a life saving device. It is made of locally sourced materials, making it a longer term solution with easy maintenance. In the downtime, the inside can be transformed with customizable inserts, making it possible to run mobile health clinics and transport medical supplies between hospitals.