The motorcycle ambulance Eezer can help reduce high maternal mortality in low-income countries. Maternal mortality related to pregnancy and childbirth is alarmingly high in low-income countries, especially in sub-Saharan Africa. High infant mortality follows. The Eezer initiative has been developed to create a cheap and safe way to assist women to get to a delivery unit and receive qualified assistance during antenatal visits, delivery, and postnatal check-ups. Being monitored during pregnancy and delivering with trained delivery assistance is an important way to reduce maternal mortality and is supported by authorities. The motorcycle ambulance consists of a two-wheeled suspension cart pulled by a simple locally available motorcycle. The purpose is not pre-hospital care but easily accessible, safe, and cheap transportation. So far, around 30 units have been deployed in countries such as Kenya, Tanzania, and Chad. A major investment of 50 carts for Burundi and DR Congo is currently underway. Local coordinations are appointed, and production takes place mainly in the target countries. The cost of a complete unit, motorcycle and cart, is about SEK 45,000. In terms of global health and maternal care, the concept of “the three delays” applies to imminent childbirth.’ Number 1 is a delay in deciding to go to a delivery unit. This may involve hesitation on the part of the woman, her partner, authorities in the community, and economic reasons.
Number 2 concerns the actual transportation (where Eezer comes in very clearly). Delay may be due to lack of call systems, inaccessible areas, long distances, adverse weather with floods. However, Eezer has surprisingly good maneuverability compared to (expensive) ambulance cars.
Number 3 is about deficiencies in accessibility, reception, and especially competence at the care unit. Number 4 is a fourth delay, “fourth delay,” and applies when there is a need for further transportation from the first unit to more qualified care, usually from a peripheral healthcare center to a hospital. Typical examples are the need for more or less urgent cesarean section, but also heavy bleeding, seizures, uterine rupture, and more. Here, the healthcare staff must recognize the need for further transport and prepare the patient optimally. This transportation need can also often be met by the motorcycle ambulance if the distance is not too far. Ambulance cars are a rarity. It has already happened that Eezer has been used for this purpose. Spring and user motivation are further increased if all stakeholders focus on both transportation needs. There is an understandable trend in low-income countries, due to distance, economy, etc., to try to handle deliveries at peripheral units with small resources.
I have noticed in DR Congo and received reports from Nkinga Hospital in Tanzania that cesarean sections are performed at health centers with insufficient knowledge and competence, and sometimes with life-threatening organ damage as a result. This is probably a global problem of magnitude.
A research project to map the extent of these complications, causes, and care needs, with the aim of improving education, is planned at Panzi Hospital in DR Congo.
With the Eezer motorcycle ambulance, we can contribute to reducing maternal mortality and severe injuries by providing safe transport to qualified care, primarily to the local healthcare unit and secondarily to competent specialized care.
June 2021 Jörgen Rutegård Associate Professor of Surgery Umeå University