Complications of pregnancy and childbirth and other emergencies need medical attention; most maternal deaths could be prevented if laboring women had timely access to appropriate care. Yet, the majority of women at risk for such complications live in rural areas of the developing world where they live a great distance from a health center, and an even farther distance from a hospital with surgical capabilities. With poor roads, frequent washouts, few and expensive transportation mechanisms, and little other infrastructure, accessing care when needed can be very difficult if not impossible. To overcome this barrier to accessing care, Safe Mothers, Safe Babies is developing a comprehensive "eRanger" motorcycle ambulance program. While several organizations have tried piloting motorcycle-based programs, none have yet achieved a fully functioning emergency medical services system (with a trained public, multiple tiers of care, and centralized dispatch system) targeting rural areas, or found a model of financial self-sustainability. These goals--a complete EMS system and financial sustainability in absence of the donor agency--is at the heart of our endeavor.

Problema

Complications of pregnancy and childbirth and other emergencies need medical attention; most maternal deaths could be prevented if laboring women had timely access to appropriate care. Yet, the majority of women at risk for such complications live in rural areas of the developing world where they live a great distance from a health center, and an even farther distance from a hospital with surgical capabilities. With poor roads, frequent washouts, few and expensive transportation mechanisms, and little other infrastructure, accessing care when needed can be very difficult if not impossible. Traditional responses have included donating large 4X4 ambulances, basing them at the hospital and pairing them with walkie-talkie distribution to rural health centers. Yet, this model has been unsustainable. The large ambulances can't handle the rough terrain, break down easily, and are too expensive to fuel; because the areas where they operate are very poor, patients are asked to pay for the fuel, which is sometimes as high as several months salary. Likewise, the walkie-talkie dispatch system, while successful at connecting the health system--breaks down frequently and is costly to install, repair, and maintain. What is needed is a comprehensive emergency medical services system that relies on existing infrastructure and utilizes inexpensive, community-sustainable technology.

Solución

The comprehensive eRanger motorcycle ambulance program includes: 1) An educated public, trained in recognition and management of emergencies and in sending for appropriate help. 2) A response team, trained in emergency management of basic emergencies, with emphasis on obstetrical medical emergencies. 3) Motorcycle ambulances. 4) Centralized dispatch system using a cell phone stationed at the host health center. 5) Dissemination of the number to reach the ambulance to community members, with special emphasis on engaging Traditional Birth Attendants, community leaders, and "Local Counselors" who are often involved in management of emergencies. 6) Financial management comes through another innovation--SAFE installed 3 solar systems at the partner health center, cutting their power bill by more than half. One third of the money they save--plus very small contributions from patients (smaller contribution than what they would pay for a TBA delivery) sustains the eRanger program. We launched our first pilot eRanger program in August of 2011, and are currently in the process of publicizing it in target communities through participatory venues to increase utilization of services. This model is innovative because it is tailored to the environment it is meant to serve, and is financially sustainable without donor funds.

Ejemplo

In contrast to a traditional 4X4 ambulance, a motorcycle is much less expensive to purchase or manufacture, fuel, and maintain. The cost for fuel is affordable to most residents living in rural areas. Likewise, it can often traverse terrain that large vehicles cannot. By relying on a cell phone dispatch system that includes text messages as a means of dispatch, the program can be more sustainable than a traditional 4X4 ambulance.