Health revolution arrives on two wheels

As the sun rises over a village in Zambia, Judith ties a toddler on her back and a baby on her front and sets off on a 14km walk. Five hours later she makes her way down a dusty track to the health post, a cement building in the middle of the bush. Nico, the only health worker for 50km, looks up from basic exercise books – the medical records for all his patients.

Everything about Judith’s baby is the wrong colour. His lips are white, his eyes yellow, his new teeth brown and black. He is thin and pale and too tired to cry. His name is Happiness and he is eight months old. His mother is HIV-positive.

Nico says: “Because of your status we need to start the child on a course of treatment. But until I get the results from his dry blood spot test there is nothing I can do.” There is a high risk that Judith has transmitted the virus to her baby. The best way to test is by taking a small sample of blood and sending it off to the lab.

That’s when things get tricky. “Even when we have taken the specimens they can stay here for two months before they leave. We keep them in the fridge, but sometimes we don’t have the fuel to power the generator and the samples go bad. There is just no way of getting the samples to the lab in Chadiza or Lusaka in time,” says Nico. “Or to get the results back. Without the results, we can’t start treatment.”

This scene is repeated through sub-Saharan Africa thousands of times a day. But the issue is not medical. It’s failed transport. “I set off at sunrise,” Judith tells Nico. “I’m not sure I can come back here again. It is too far.”

Suddenly something close to miraculous happens. The door crashes open and a young woman in motorcycle gear struggles to remove her helmet. “I am Violet,” she declares as she wrestles an oversized rucksack from her back. “I have come to collect your specimens.” Nico had heard that a fast specimen referral system was supposed to be starting in the district. But he hadn’t believed it, there are so many promises. He holds Violet’s hands tight. Then he gives her the blood specimens and paperwork as he calls in his next patient from the hundred-long queue outside in the clinic.

The lab is in Chadiza, a rural town in the east of Zambia, a country five times the size of the UK. Mostly the “roads” are pot-holed, dusty tracks, and the Ministry of Health has few working vehicles. So the work of most clinics is undermined by their isolation. But there is a change: managed transportation thanks to Riders for Health, a global leader in social enterprise, which has six established programmes from Lesotho to Nigeria.

The group emerged from the world of motorcycle racing and is the official charity of MotoGP and motorcycle sport’s ruling body, the Federation Internationale de Motocyclisme. Its mission? “Working to make sure all health workers in Africa have access to reliable transportation so they can reach the most isolated people with regular and predictable healthcare,” its website says.

Riders now manages almost 1,500 vehicles and reaches about 10.8 million people. Zambia’s is the latest Ministry of Health to benefit. Riders started in 1989 when the founders, visiting Africa, looked in horror as a woman in life-threatening obstructed labour had to be pushed to a clinic in a wheelbarrow. “In a world of well-engineered vehicles, it was pretty obscene,” says Andrea Coleman, “especially when the clinics and hospitals were surrounded by broken-down vehicles.” Coleman turned her skills to publicising the scandal and raising money to end it.

At first it met with resistance. Eventually officials in some countries saw the benefits.

Slowly, the Riders’ system of remote fuel management, outreach maintenance and training began to take hold and move from country to country. Setting up the Zambia programme are Alfred Gonga and Lloyd Chipere – long-serving members of Riders’ Zimbabwean team.

“It is not directly about healthcare,” says Gonga. “Here we are sample couriers. We save lives just by making sure people can get a diagnosis.” Chipere says: “One of the most important things we do is train our riders. Every single day they do their own maintenance routine. It’s a sustainable system. And it’s Africans working for Africa.”

A child started on antiretrovirals early enough can have his or her chance of developing full-blown Aids reduced to a mere 2%.
“Imagine,” says Violet, “I am girl from the village who learnt how to ride a motorbike. And now I might save the life of Happiness.” As Violet gets back on her bike Judith and Happiness are starting on a journey of their own: the long walk back to their village. Judith will get the result in three days and the child’s treatment will begin. “Now I can actually do my job,” says Nico. “And all because of a motorcycle.”

• Visit the the Riders for Health website.

[guardian.co.uk]