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Motorbike ambulances help cut maternal mortality in Southern Sudan

A motorcycle ambulance being tested in Southern Sudan
© UNICEF Sudan/2009/Peter Martell
A motorcycle ambulance on the road in Hiyala, Eastern Equatoria State. The new machines, funded by the Government of Japan and UNICEF, are aimed at improving women's access to maternal health care in the most rural parts of the country.

By Peter Martell, UNICEF writer

Hiyala, Southern Sudan, July 2009 – Navigating a rough track of road east of the Juba in Southern Sudan, a motorbike ambulance driver tests a new vehicle with a ‘patient’ laid  out on the sidecar stretcher.

Five of these powerful scrambler motorbikes, each with connected ‘bed on wheels’, have been donated to Southern Sudan’s Ministry of Health, aimed to improve access to health facilities for pregnant women.

The vehicles may appear unusual, particularly in remote Hiyala, a poor settlement made up of thatch huts and simple tin shacks in Southern Sudan’s Eastern Equatoria state. But with a woman in Southern Sudan having a one in six chance of dying during the course of her lifetime from complications during pregnancy or delivery, the kind of innovative referral support an ambulance motorbike can deliver is badly needed here.

Deaths that are preventable

Maternal mortality levels in Southern Sudan are among the worst in the world. Yet many such deaths could be avoided, with better access to even basic healthcare.

Watching the first use of the motorbikes in this rural village was grandmother Josephine Lado, who gave birth to her children in a simple thatch hut without medical help.

“Giving birth is very hard, and I lost two of my children,” she says, slowly shaking her head. “Many women die, and their babies too, because we are far from people who can help” “Many women die, and their babies too, because we are far from people who can help,” she adds, pointing to the rough and dusty track of road.

Conditions here are extremely tough, with a dry sub-Saharan climate marked by sparse vegetation and made harsher by continued sporadic conflicts. The region was hit hard by Sudan’s 22-year civil war, which ended in 2005. Militia fighters from the Ugandan Lord’s Resistance Army (LRA) also used this area as a base for many years.

As a result of ongoing strife, basic infrastructure was left in ruins. 

Women dance to celebrate arrival of motorcycle ambulances in Southern Sudan
© UNICEF Sudan/2009/Peter Martell
Local women from Hiyala in Southern Sudan perform a traditional dance to celebrate the arrival of motorcycle ambulances in the district - the ambulances are a new initiative to help reduce rates of maternal mortality in Southern Sudan.

A multi-partner motorised solution

It is hoped that the ambulances installed here, the first among others being deployed in Southern Sudan, will improve the chances of pregnant mothers reaching health facilities in medical emergencies.

“If I had been able to get help, then perhaps I would not have lost my other children,” Josephine adds quietly.

The motorcycles, each costing approximately US$21,380, including freight, driver training, and related costs, allow a patient to sit or lie down on the padded stretcher on wheels, secured by seat belts. Funding for the motorcycles came from the Government of Japan, which has also contributed generously to HIV/AIDS and education programme activities.

The motorbikes were chosen because of their ability to carry patients across even the roughest ground, and navigate roads that normal vehicles could not, particularly during the rainy season. Motorbikes are also cheaper and easier to maintain in remote areas.

Each vehicle has space for a health worker to sit behind the patient to provide care and supportEach vehicle has space for a health worker to sit behind the patient to provide care and support, while a sunscreen cover provides shade from the hot sun. Two mechanics have also been hired to service and provide training in the bike’s unique features.

“The vehicles are cost-effective in terms of the fuel they use, and they can travel more easily to remote places without roads, inaccessible to cars or other vehicles,” says Joyce Mphaya, a safe motherhood specialist with UNICEF.

“The advantage of the motorbikes is that they can easily be managed at a lower level health facility,” she adds.

Tackling constraints on basic access

Only 10 percent of all maternal deliveries in Southern Sudan are assisted by skilled health personnel.

“We have a problem bringing critically sick people to the few referral facilities available,” says Atem Nathan Riak, director-general of primary healthcare in Southern Sudan. “If the bikes are successful then we will expand their use.”

The motorbikes have already proved useful in other remote areas, including in Uganda and Malawi, where the number of women giving birth at health facilities increased to 49 percent from 25 percent over a period of four years.

Many in Southern Sudan become pregnant at a young age, and complications in pregnancy are common.

The benefits these motorcycles offer in this remote village are not lost on community members, who danced as the motorbikes were formally handed over to the Ministry of Health.

One boy asks for a ride then changes his mind when the vehicles’ aims are explained.

“Just take my mother when she needs it,” he says simply.



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