Monday, January 9, 2012

Saying no to mediocrity: refusing to accept ‘bicycle ambulances’

A story in the local Malawi media a few weeks back about the donation of 'bicycle ambulances' in Salima district got me thinking about how as a country we have come to accept and embrace mediocrity.

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.

The idea of a 'bicycle ambulance', on the other hand, reduces the function of an ambulance service to mere transport for patients, albeit one without the requisite speed or comfort. Granted, ambulances in Malawi are very rarely used to provide urgent access to hospitals, with the possible exception of road accident victims.

Indeed, the definition of an ambulance in Malawi appears to be reduced to simply a vehicle that has a thick red cross painted on the sides. There are no phone numbers that people in need of urgent medical care can call to request an ambulance. Like their bicycle cousins, ambulances are simply a means of transport to or from a hospital. Most lack basic life-saving equipment on board. And off course there are no paramedics on board Malawi's ambulances.

More often than not, people only see ambulances in villages when they come to deliver dead bodies – a role that is meant for hearses, not ambulances. Many a time, ambulances are used to carry fee-paying passengers, even when they have patients or dead bodies on board, with the money going into the pockets of the drivers.

For a people that have no reliable access to ambulances or other means of transport to take patients to hospital, perhaps there is something to celebrate in receiving a bicycle ambulance. Indeed, in this day and age when fuel has become such a scarce commodity, perhaps bicycle ambulances are the way to go.

However, I still fail to see anything worth celebrating about the increasing trends of 'bicycle ambulance' donations. Several of Malawi's NGOs seem to have carved a niche in soliciting and handing out these foot-propelled 'ambulances'. 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 we celebrate these donations and make them to be such big events as happened in the Salima episode reflects sadly on our own acceptance of mediocrity. Perhaps this should come as no surprise. It all starts with our acceptance of mediocre leadership, which trickles down to many other areas, including poor quality buildings, poor roads, poor services to mention but a few.


Chris said...

I have to admit - I'm not overly familiar with the needs of Malawi, but I don't think you should knock bicycle ambulances that hard. I think sometimes, it can be easier to access certain places on bicycle, and it's a faster way to provide primary care to people, some of the time. Check out this story about a folding bike that's used by first responders. This might be a little bit of a different situation, but I don't think the idea of the bicycle ambulance should be wholly discounted.

Boni Dulani said...

Thanks for writing Chris. I checked out the folding bike blog. I see the bicycle is playing some useful role in getting the paramedics to emergency sites quicker. Still, it is clear that these have not become a substitute for the real ambulances as is the case in Malawi. In the Malawi case, the bicycle ambulances are meant for ferrying patients to hospitals, not to get the paramedics to the emergency sites quicker. Plus the Malawi bicycle ambulances have no emergency equipment and are 'peddled' by ordinary citizens who might not have basic first-aid training.

Smith said...

Thanks Mr Dulani for the eye opener article.As one who have been in the village i used to think that ambulances are solely used for carrying the sick from home to hospital or the dead from hospital to their respective homes. But what you have pointed out about lack of phones in the ambulances, no medics etc makes sense. Thats makes me think we are losing people in transit to the hospital because they are not attended. However, the bike ambulances are archaic and old fashion to be promoted in the 21st centuary but what can a country like Malawi do when there is no fuel because of 'no reasons'? They can still be used when in need but not be promoted as the case no.

Anonymous said...

Boni,refusing to accept bike ambulances might mean saying NO to Life.Most clinics or hospitals have one or no Ambulances at all.Is this not an initiative that we should support?Sick people or accidents occur when all roads show no sign of traffic or ambulance and telephones/mobile phones are sometimes an insult in the name of network coverage,dont we need these bikes in this critical moments?.Which one is better,to have bike ambulance in the absence of the "real one" or the absence of both here in Malawi.The "1st centuary"life cannot wholly be applied to MALAWI.Boni,i enjoy the stuff you blog about.

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