by Don Kossick with Jessie Forsyth
Last week, the community of Savanguane in Morrumbene District initiated the use of a local ambulance provided by the project. The handover ceremony took place quite close to the new maternity that the project recently built. A community ambulance contributes to the quality of care available there. Many levels of leadership of the district were there – district administrator, district health services, community leadership and representatives.
Community ambulances are very important to making sure pregnant women have a way of getting to the nearest health centre safely and quickly. One of the biggest barriers to accessing health centres during delivery is the distance that people have to travel and the lack of public transportation from many of the communities to where they are going. This is simply because of the remoteness and the kinds of roads they would have to go on.
We have had a community ambulance in operation in a different community for two years now. It is not necessarily in use every day for pregnant women, but in the space of a month it would take 4 to 5 women to hospital, who might otherwise not make it. And there are other medical emergencies it would serve, such as severe cases of malaria, or accidents at home where someone is seriously injured.
The community ambulances really are a community strengthening mechanism that resides in communities and is always available to community members. It is not something they need to contact a health care centre to access.
The design of the community ambulances is that they are essentially a motorcycle with a cabin attached either to the side or the back. The cabin is the place for the patient, plus someone who would be accompanying them. They have a roof covering that protects them from the wind. They are equipped also with basic first aid boxes. The drivers are community health workers (APES) who receive additional training in first aid. The community ambulance operates like a larger ambulance but is smaller, more flexible, and more able to get through difficult road conditions.
We are currently in the process of piloting a second type of appropriate ambulance for communities with even more difficult conditions for access, such as sandier roads where motorcycles cannot operate. It is the same model but with four-wheel traction to get through the heavy sand. It will have the ambulance trailer attached to the back.
Response to the community ambulance has been very positive. Ways to increase women’s use of health services – especially maternal and child health services and sexual reproductive health services – are very much welcomed. It is a known fact that delays in getting to the health centre create one of the major complications that could lead to dire situations such as death. The communities are very excited about having something at their disposal, something that they feel really helps them by helping to interface with the local health facility. They feel more involved – and feel the health centre is more respectful of their needs.
Implementing community-based ambulances has been an ongoing challenge. People have spent much time at each stage of this process of trying to find the community ambulance that would be most appropriate for communities in which we work. Pilot testing, preparing agreements at the local level about how they will work, who maintains them – all of these things had to be done. Also required was special training for those driving the community ambulances and providing first response. It’s exciting and important to acknowledge that more are coming into use.
It is important to give recognition to everyone who worked to obtain and operationalize local community ambulances. It is a significant challenge but one that is worth the health benefit to women’s health and the community as a whole.