Maternal Mortality and Morbidity: Beating death to the speed

Death, the robber of daily breath, has slower days, too; days so slow a bicycle travels faster.


Clever minds merely attach carts to such bicycles during death’s slower days, load the sick before conditions worsen, and rush to the nearest health facility. Chances are that the sick will more likely be embraced by hospital wards than the jaws of death- beating death to the speed.


Sounds strange? This knowledge has been widespread in Malawi, spanning from the days of the ox-cart, when pregnant women, the seriously ill, among others, depended on community goodwill and human-animal (donkeys/cattle) relationship to tame death.


At least until the beef cattle owner realized that, beaten more often at the back, the beef animal develops thick skin and fetches little in kilos at the market. You beat the cow and you squeeze some meet ‘into’ the animal, hitting oneself in the pocket.


Cattle are also scarce these days, apart from earning hefty head prices- and so the bicycle took over. The Centre for Reproductive Heath (CRH), a department at the College of Medicine (a constituent college of the University of Malawi) in Blantyre was among the institutions to buy into the idea.


A pilot project on bicycle ambulances was born in Makanjira and Nkumba areas in Mangochi. This was time, in early 2000s, when well-founded fears about high mortality and morbidity rates animated the nation.


There was a decree- silent decree confirmed by the Demographic Heath Survey of 1998- that, out of 100, 000 births, some 894 Malawian citizens had to die. Just like that.


“This is too high a rate”, complained the then CRH executive director Dr. Agnes Chimbiri “It is too high a rate we cannot attain sustainable, social-economic development. The woman, more than men, contributes a lot to national development.”


While the Malawian father is still very much the patriarch, it is the woman who controls the home, crop fields, and life.


Hers were sentiments made with logic and a modicum of documented evidence Traditional Authority Makanjira had no more task than to concur:


“We can only achieve real well-being by investing in the health-needs of our women. It is good that Mangochi is among the districts exploring the use of bicycle ambulances,” Makanjira said at the time.


Today, women continue to die. What does not continue, however, is Dr. Chimbiri at CRH; She now is at the United Nations Development Programme (Malawi office), taking the message home, perhaps, that for development to live by its name, is must wear the ordinary woman’s face.


This development begins at the maternity wing.


What has changed, also, is that new innovations on how to utilize bicycle ambulances are emerging- this time around from strange destinations, Take, for instance, The Netherlands. Anything Malawian about the Netherlands?


“Very well so,” quips Roel Barkhof, chairperson for a Dutch foundation called Transport4Transport. This is a foundation that promotes innovative transport technologies in a bid to speed up the time it takes one, in this case pregnant women, to reach health centres and get their lives back.


“He who cares for you, and your health, is a friend in deed; it goes beyond blood. It is something that has to do with the inner connection. In that respect, there are so many things Malawian about Holland, and many thing Holland about being Malawian. We are all striving for good life. Well-being.”


Transport4Transport foundation is an arm of Wagenborg, a profit-making organization registered in the Netherlands. The later uses part of its financial resources and staff (who work for the foundation as volunteers) to help improve healthcare delivery systems in such countries as Malawi.


“Malawi is the only country we are working in. We want to help improve people’s lives, and this includes those with physical challenges. So far, we have funded the production of over 400 carts for bicycle ambulances and spend 280 Euro (about K54, 320) on each,” said Be Vam der Weide, foundation treasurer.


The two were in Malawi to gauge progress on activities they bankroll and, among other charity organizations, visited Stephanos, Liebemzell and Maikhanda- marking their third visit to Malawi since 2007, when they set their heart on Malawi and never want to pluck it back.


Barkhof and Weide came so silently, physically. But their actions, as good actions do, spoke louder than words and reached the ears of Reen Kachere- Minister responsible for the Elderly and People with Disabilities- at Capital Hill.


Kachere quickly asked for a meeting on Friday, July 9, 2010.


Among others, the minister said she wanted to exploit the possibility of using Transport4Transport’s kind financial hand to produce carts for physically challenged people wishing- not to reach the hospital faster this time around, but- to venture into small scale businesses!


“Mobility has always been a challenge for most people with disabilities, and this is because most of them lack amenities such as wheelchairs. Those with wheelchairs also face more challenges in terms of transport: they fail to carry bulky goods. We feel like these people could help us in that regard,” said Kachere.


Kachere said, given such opportunities, the physically challenged can operate door-to-door businesses- in the process uplifting their social-economic status.


As it stands now, most of them sit in the country’s streets looking for ‘today’, daily bread. Kachere says this is not the best way to live one’s life.


“It is my hope that, once these carts become available to these people, they will begin to live productive lives. Productive life is characterized by progress; there is no progress in looking for arms. It’s opportunities like business that offer the possibility of human progress,” said Kachere.


She envisages a time when every wheelchair shall have a cart attached to it; in the cart, goods and other materials that add value to life- supporting the one in front of the cart.


This is hope. Yet, it all started with a dream, then vision, of one Peter Meijer. In February 2009, he decided to come to Malawi with his family and venture into bicycle-carts’ production.


He opened shop on the fringes of Chemussa and termed his business ‘Sakaramento’. The locals set up bicycle taxis and call them ‘Sacramento. It all means bicycle transport.


Meijer then came across Barkhof and Weide through the internet, and so begun the process of hope for many.


Said Meijer: “We produce two kinds of carts: CareCar (bicycle ambulance) and TengaCar (transport cart). The Care Car is a bicycle adapted to transport patients and pregnant women to healthcare facilities in rural settings. It has sun and rain protectors to safeguard the life of the patient.”


It is the TengaCar that Kachere is interested in because, as a push and bicycle cart, the physically challenged and elderly can carry goods in high volumes. What with a recommended maximum load of 150 kilograms- the equivalent of three 50 kg bags of maize, rice, or beans.


Sakaramenta is also doing a social service. It encourages its workers to go for further education, both secondary and technical, offsetting 80 per cent of the costs. That is why the organization closes at 4 O’clock during weekdays to give people the chance to go to school.


Blessings Kachepa of Matimati Village, T/A Njema, Mulanje dropped out of Muloza Community Secondary School’s Form 2 class due to lack of funds. He now has the future back, having secured the opportunity to attend Form 3 at Chirimba Night School.


“I have been given the world again; school means everything to me,” he said.


Sentiments shared by Hassan Isaac, 27. Though he has no Malawi School Certificate of Education certificate, he now pursues a Refrigeration and Air-conditioning course.


In November, he will be sitting for Malawi Trade Test examinations.


It is change happening. It has happened for the hands behind the carts; will it not happen for those using the carts?


“It will (work.), surely,” Kachere can be hopefully stubborn.