Years ago in Namibia, I was standing by the rutted track from Onesi to Uukwaludhi waiting for a ride. It was a 12 kilometer walk through the parched mopaniveld and I, like most rural Namibians in this region, had no motorized transport. Along came an open pickup, its bedsprings straining with the weight of many riders perched on both sites, and it stopped when I flagged it down. I negotiated a fee of 1N$ for the ride to Uukwaludhi -about 20 cents back then- and swung aboard. It was only after we got moving that I saw the child, lying on the lurching floor with blood seeping from his head and eyes numb with shock. I learned from the other passengers that this boy had climbed a baobab tree in search of its cream of tartar fruit and had fallen hard. They were on their way to the distant clinic, yet the driver still stopped for passengers all along the route. I believe death rode with us in the back of that truck, though I left before they reached the clinic.
I've been haunted by that memory, of the perilously thin line between life and death for those who live on the margin of subsistence. Perhaps nothing could be done for the child in the bed of the truck. Perhaps it was a spinal injury, or a grievous head wound. But the utter dependence of the family of the injured child on an informal "bush taxi" in no particular hurry to get him to medical attention infuriated me then as it disturbs me still.
So it was with surprise and interest that I read in The Namibian newspaper that the Bicycle Empowerment Network, a local non-profit, has announced that it will start manufacturing bicycle ambulances in its workshop in the capitol Windhoek this October.
"Bicycle ambulances are stretchers on wheels that attach to normal bicycles, allowing sick people and people in need to be towed to a hospital or clinic. BEN Namibia has been distributing donated second-hand bicycles in the North and has discovered a tremendous need for emergency transport solutions in the rural areas, especially for people living with HIV-AIDS. In other African countries where these bicycle ambulances are used, a decline in infant mortality and maternal mortality has been noted, as pregnant women benefit greatly from this mode of emergency transport. In 2005 BEN Namibia developed and built prototype ambulances that were tested by home-based caregivers in Oshakati, who provided vital input to the design and improvement process. BEN Namibia has since received numerous requests from other organizations for bicycle ambulances and it decided to establish the manufacturing plant in Windhoek.
The concept is not unique, although this is the first project of its kind in Namibia. Practical Action, an NGO founded in 1966 as the Intermediate Technology Development Group and inspired by the "small is beautiful" philosophy of economist E F Schumacher, has designed and produced these ambulances in Nepal and Uganda, where according to its developers "it may not be the fastest or the most comfortable way to travel but in case of medical emergencies, it remains the only readily available means of transportation." Users have suggested modifications that the designers had not considered, such as a seat section for a family member to attend the patient while traveling and trailer covers made of treated cotton to give shelter to patient and attendant in poor weather.
In Namibia, many of the patients who may be transported by these bicycle ambulances will be affected by HIV. The HIV/AIDS crisis places extraordinary strain on community resources and caregivers and has quite literary decimated the population aged 15-49. 20% of the adult population is infected, and over 1/3 of pregnant women in northern hospitals test positive for the disease. In 2003, there were 17,000 AIDS deaths in a country of less than 2,000,000 inhabitants. There are nearly 100,000 AIDS orphans.
Faced with this Goliath health care crisis, a bicycle ambulance seems a fragile sling. But for those who live without help it may offer the hope that comes from self-reliance - hope that I failed to see in the eyes of the family, watching the child on the floor of the truck.