bicycle ambulances in rural Africa: mediocre aid?
I must confess to being troubled by the increasing frequency of the donation of bicycles to be used as ambulances. In the 21st century, it is both sad and shocking that any people should be using bicycles as ambulances. By definition, ambulances are supposed to provide primary care and quick transport to hospitals to those in need of urgent medical care. They are supposed to have life-saving equipment on board, managed by trained para-medics that provide a first line of medical assistance before one can be transported to be seen by a medical professional…
If anyone outside Malawi wants to help the country, they should be told in no uncertain terms that Malawians need and deserve real ambulances. Bicycle ambulances do not belong to the 21st century, in Malawi or anywhere for that matter. It is as simple as that. Even an ox-drawn cart can make a better hospital ride than a bicycle in my view.
That was Boni Dulani, a recent Ph.D. in political science from Michigan State University, lamenting the acceptance of what he deems mediocre aid.
If you don’t know what a bicycle ambulance is, here is a short clip from a group in the UK:
I searched for any evaluations of the impact of bicycle ambulances (perhaps naively, I thought there must be evidence supporting the value and ubiquitous adoption of bicycle ambulances). I found only one article, and it evaluated the use of bicycle ambulances in Malawi. The research compared villages that had bicycle ambulances to villages with community transport plans to villages with no transport intervention for health. The outcome measured was the impact on obstetric care. Unfortunately for proponents of bicycle ambulances, the evidence is unsupportive. The conclusion from the study’s abstract read:
In this study we were unable to demonstrate any benefit for obstetric referral systems when [bicycle ambulances] and [community transport plans] were introduced. The dearth of international literature coupled with these findings highlight the need for further detailed studies prior to wide-scale adoption of transport schemes.
Providers of bicycle ambulances and aid agencies that have bought bicycle ambulances have only positive things to say. For example, even when confronted with the truth that bicycle ambulances were used very little if at all, VillageReach put a positive spin on it:
Of the three communities I visited, one community had used their bicycleambulance twice, another once, and the third had still not used theirs. While at first this seems like the bicycle ambulances are being underutilized, to me it reflected a real valuing of the bicycle ambulances;the communities were not allowing them to be abused and were reserving them for truly grave emergencies. This was a perfect (and heartening) example of real community buy-in, which at the end of the day is one of the few variables that can really support true sustainability.
Given the evidence, it’s hard not to agree with Boni’s original post. Though it sheds light in particular on bicycle ambulances, it also highlights a more general pattern of how aid agencies can not only fail to improve the situation for ordinary people in rural Africa, but also try to “help” in a way that is almost insulting. Yes, roads are bad in much of Malawi. Yes, the current fuel shortage in Malawi would certainly make it difficult for motor ambulances. Sure, vehicles are incredibly expensive to purchase and maintain. And, hiring paramedics or ambulance drivers will certainly cost more than getting some volunteer to pedal a bike around. But by giving some village a bicycle ambulance, are we simply saying they’re not worth that cost?