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The roads lest travelled

How many lives are lost on the roads of Sub-Saharan Africa? And not just in accidents. Our ride to a village in Kenya was an eye-opener on the many lives that are lost in the journey to healthcare.

We were on our way to assess impact of availability of oxygen in remote areas. As we turned off the highway to head toward Uradi, a village in Siaya County in Kenya, the tarmac was as smooth as a baby’s skin. Even before you could finish that thought, the tarmac gave way to bumpy, slippery dirt roads. It was fun for us healthy individuals, like riding a camel running for his life. What happened to those who were already battling for their lives and were trying to reach some place where they would get life-saving care?

We got an idea when we reached our destination, a faith-based health center. “The nearest hospital with oxygen is just 15 km away. But it’s an arduous journey that can take over an hour. We used to lose 30-40% of our patients on the way in the ambulance,” says Nurse Lillian.

This was before the facility decided enough was enough, especially when there is finally a scope to access oxygen from an organization that is reputed to be reliable and affordable. Hewa Tele has been providing the center with oxygen for some months now, and it has been a happy picture of change. More and more patients have been coming from further away while the number of patients the health center refers to the town hospital has gone down by 60%.

“We also have oxygen in the ambulance now. So the patients survive the short trip to Siaya,” said Nurse Lillian. “We see a lot of accidents here because of the increase in number of motorbikes. Having oxygen has made it easier for us to attend to patients.”

According to a WHO report1, poor road conditions make even short trips difficult, costly and time consuming for the average patient. The average travel distances to a government hospital in some countries in Africa is often less than 80 km, but this distance can be a multi-day journey, and in the rainy season many areas are impassable.

How does distance and time to healthcare impact mortality rates? One study in the UK 2 shows a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality. Also, patients with respiratory emergencies showed the greatest association between distance and mortality. And this is in a developed country. What happens in Sub-Saharan Africa?

The same study says on the relationship between accessibility and mortality in asthma patients: a 10% increase in the relative risk of death for each 10-km increase in distance, 9 and a 7% increase for each 10-minute increase in journey time.

At places, villagers—including pregnant women and children—do not have the option of travelling in ambulances to reach healthcare. A report from Burkina Faso 3 shows that the average time that children travel to the closest health facility in the dry season can be 91 minutes while the average walking time was 65 minutes. Although the median walking time over the whole study period was 1 hour, some children had to travel as far as 6 hours in the dry season and 8 hours in the rainy season to reach the closest health facility.

Access to oxygen can be an even grimmer picture in Sub-Saharan Africa. So much so that the watchman at a health-facility serving rural areas in Kisumu County was trained to urge critically ill patients to not waste precious time and continue to their journey to the town hospital which has oxygen. He has probably saved many lives over the years this way, but he is a much-relieved man today not having to do this any longer. This facility has not turned anyone away since it started taking oxygen from Hewa Tele.

As Natalie, one of the founders of the health center, said: “Now we have oxygen. What else do we need? It’s a life giver. Having oxygen means bringing services to the door of the people.”

The road to Uradi runs parallel to a smooth, wide road that has been under construction for a long time. Huge boulders block the kilometers-long new road, preventing anyone from using it. It will take years to build good roads and improve access to healthcare. In the meantime, Hewa Tele has been shortening distances to better health outcomes.


Hewa Tele Communications Team


 

 


1 Kingham, T., et. al. “Quantifying Surgical Capacity in Sierra Leone A Guide For Improving Surgical Care
2 Jon Nicholl, James West, Steve Goodacre, and Janette Turner, The relationship between distance to hospital and patient mortality in emergencies: an observational study
3 Anja Schoeps*, Sabine Gabrysch, Louis Niamba, Ali Sié and Heiko Becher, The Effect of Distance to Health-Care Facilities on Childhood Mortality in Rural Burkina Faso