Boda bodas playing huge role in health care delivery

Sangale Long’odo had never been one to appreciate modern medicine, but as his wife lay writhing in pain, he realised that the village herbalist could not treat whatever was ailing her. Yet the doctor whose skills he desperately needed was almost 35 kilometres away.Luckily, his cousin called a man who owned a motorbike, who rushed her to Kacheliba Level Four Hospital where she was diagnosed with kala azar and admitted. That is what saved her life.

In Kacheliba, which has extremely poor road networks, the only means of transport for people who need urgent health care like Long’odo’s wife to the county’s few hospitals are motorcycles. Motorbikes have caused many deaths in different parts of the country but in Pokot, they are assisting the county in its journey towards meeting the sustainable development goals on health, especially with regard to maternal health and immunisation. A ride through the villages in Kacheliba shows roads that meander over dry, dusty streams. 

When it rains, the locals say, they become impassable even for  four-wheel drive vehicles.  After years of neglect, the county government is struggling to establish the most basic healthcare infrastructure by employing healthcare workers.During a recent visit to the area, DN2 saw motorbikes coming in and out of Kacheliba Level Four Hospital, some carrying critically sick patients supported by a relative.

“Between 9am and noon, you will be surprised at the number bikes  parked here,” the hospital’s deputy medical superintendent, Mr Michael Makari, said.Women come to the hospital from as far as 18 kilometres away under the scorching sun, with babies strapped on their backs.

DIRE SITUATION

There is a direct link between some of the social and health problems that West Pokot is experiencing and lack of holistic healthcare.The locals need education on preventive medicine such as immunisation and nutrition, as well as why they should seek clinical services that involve diagnosis, prescription and treatment. Of the 8,497 births at the Civil Registration Services, 20 per cent (1,700) were home births. That might explain why only 35 per cent of children in this county, the Ministry of Health’s Division of Vaccine and Immunisation reports, are fully immunised: some of the vaccinations are given to children after birth at health facilities.

This is an incredibly low number when immunisation has been established as a public health intervention that can save the lives of children by protecting them from fatal childhood diseases. Only 27 per cent of  the women, the 2014 Kenya Demographic Health Survey indicates, were attended to by a skilled health provider during childbirth.

The  county’s fertility rate is  the country’s second highest, with each woman having an average of 7.2 children. This is not surprising, considering that more than 85per cent do not use any contraception. Two out of five children (46 per cent) are stunted, the highest levels of malnutrition in Kenya alongside Kitui County. Then there is the disenabling demographic profile of the patients. Take Tuweiti — that is the only name he knows — for instance. He is one of the 19 per cent of illiterate men  and was admitted to Kacheliba Hospital’s kala-azar centre.

In addition, almost 80 per cent of the population has no access to any media (newspapers, television, radio or social media).Asked how old he is, he responds: “Haki sijui” (Honestly, I don’t know).”

Obviously unaware of the danger kala-azar posed to his life, he did not pay much attention when he started noticing the initial signs of the disease.

“I went to the health centre and when I was told to come here, I was very discouraged because it is really far,” he said.Kacheliba is the only hospital in the county that treats kala azar. Tuweiti comes from a village called Masol in Sigor Location. He says it would take him at least four-and-a-half hours on foot to get to the hospital.Meanwhile, the motorbike taxis would charge him at least Sh800 one way.

In a county where poverty levels are estimated to be above 70 per cent, the motorbikes save lives and provide a way out of need and destructive activities.

David Lomakori, who owns one, makes about Sh1,500 a day from his business, money that he says saved his life. Lomakori, in his late forties, says before he got his motorbike, he would participate in cattle raids against the Karamojong in neighbouring Uganda. “I did not like what I was doing, but now I have a decent way of  earning a living using this bike,” he says. Uganda is an hour’s drive from  Kacheliba Level Four Hospital.

Lomakori, who bought his motorbike for Sh85,000 in 2011 after selling some cattle to raise the money, adds that he receives calls as late as midnight begging him to  take a sick relative to hospital, a request he says he takes seriously because on one occasion he took his time, with disastrous consequences.

“I took time to get to a village called Karita and the patient died on our way to the hospital, which that really broke my heart,” he says.

Joseph Longoyi, who also has a motorbike, says that in emergencies, he takes patients to the hospital on credit.  “They say it is not a market day and they do not have money.  I take their word  for it and take them to the hospital on credit and they pay me later”, he explained, adding, “I cannot put money ahead of a life.”

SNAKE BITES

Even though motorcycles have been recognised internationally as a bridge between the rural poor and healthcare,they remains largely unexploited.The Kenya Revenue Authority (KRA) has indicated that motorbikes constitute 70 per cent of  the vehicles registered annually.

Meanwhile, British singer Elton John, through his foundation, the  Elton John Aids Foundation, has donated many bikes to Africa for this purpose.And English couple, Andrea and Barry Coleman, founded Riders for Health, a non-profit organisation operating in six African nations — Kenya,  Lesotho, Malawi, Nigeria, Zambia and Zimbabwe — that assists in taking patients to hospitals.

Meanwhile, the United Nations Children’s Fund (Unicef) presented the Guinean government with dozens of motorcycles  to help in the fight against Ebola in 2015. 

The urgency is especially heightened in the case of snake bites. Kacheliba hospital’s medical superintendent, Dr Solomon Kokuo, says that they receive at least two snake-bite patients every week.Ideally, one is supposed to seek medical attention within six hours to stop the negative effects of “envenoming” (the injection of poison into the bloodstream from the fangs of a snake).

It is important to seek medical attention promptly because it is difficult for the healthcare workers to treat a patient since they cannot tell which type snake bit him or her.“And depending on the snake, the poison can cause paralysis, shut down your nervous system, make your body swell, or make your arteries and blood vessels bleed,” he says.

A snake bite can kill mice and frogs within minutes but since human beings are bigger, the internal bleeding or paralysis takes a bit longer.Kacheliba and three others in Pokot — Kapenguria, Ngoror and Chepararia — are the only facilities with antivenom, but most people live very far from these centres.

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The flipside: When boda bodas go haywire

IN KISUMU, JUST at the roundabout near Kisumu Boys’ High School, a motorcyclist shouts  at a matatu driver: “Omera, kwee wiyi, wan be wachulo tax” (Hey you, calm down, we also pay taxes).Meanwhile, private motorists watch from a distance because, as one told DN2, they fear run-ins with the motorcycle taxis.

It would be quite entertaining, were it not for the fact that it leads to disaster from time to time.  In Kisumu, motorbikes and cyclists continue to endanger road users as they flout traffic rules with reckless abandon. And now healthcare workers are noting with concern that children are increasingly featuring among the  victims.

In February and March alone this year, the Jaramogi Oginga Odinga Teaching and Referral Hospital) — or Russia as the local people call  it— attended to serious injuries sustained in 46 motorcycle accidents. Of the 46, 13 involved children under the age of five,and more than 20 had serious head injuries.

Earlier this year, DN2 spent eight hours at Russia’s Casualty Department observing patient traffic. There were burn  and  fall victims, and then there were road accident victims.

Barely an hour after DN2’s arrival, six-year-old John Onyango was brought  in by his hysterical mother. The little boy was terrified and kept touching his grazed arm and legs.His mother said he was knocked at the Obunga junction. Janet Otieno, a senior nurse in the female patients’ ward, said that two out of five of those she attends to in the ward are victims of motorbike accidents.

DISASTROUS RIDES

The nurse in charge of the hospital’s Casualty Department says that she dreads the early mornings and evenings when children are brought in with soft tissue injuries, but sometimes with serious ones. Seven-year-old Consolata is a patient in her ward. Her grandmother said she was knocked by the road as she bent to pick up her pen which had dropped.

The biker sped off, leaving her bleeding on the road. The Standard Three pupil at Central Primary School in Nyalenda needed to stay at the hospital for six weeks as she nursed fractures on her thigh bone.Next to Consolata are other children, all on skeletal traction — orthopedic exercises to relieve pressure from the spine when one breaks a bone to ensure it heals properly — and obviously in pain.  While the motorbikes help get children to school, the riders do little  to make them safe, especially on highways.

On the way to the hospital, DN2 saw a little girl in uniform, her little pink bag with bunny ears strapped on her back, holding on loosely to the rider’s jacket. She was dozing, and would jerk awake every time the rider braked. As they rode out of view, another rider passed by with a boy seated in front of him and two others behind him.The children were thrilled as they whizzed past. Neither the riders nor the minors had helmets.

Asked why he doesn’t wear a helmet, a rider nicknamed Ochy,  who regularly transports schoolchildren, replied: “When you are fated to die you will die, even if you wear metals on your body.”

Then there is Mark, whose helmet is strapped to the front of his bicycle because it “looks cool” there. Asked why he does not offer it to his clients he says: “Hii kitu ina joto sana” (This thing is too warm).

Neither Ochy nor Mark, nor most of the 16 riders DN2 spoke to, went to a driving school. “There is a field in Lumumba Estatenear Nakumatt where you go and learn to ride with friends and then you can start your business,”one offered.

Kisumu Deputy County Police Commander Kipkemboi Birir said the traffic situation in Kisumu is “optimum” and that he “has no challenges restoring order in the city”.

With a staff of 20 to police the hundreds of boda boda, Birir says, “We makes use of what we have to sensitise, arrest and arraign.” Mr Birir would not comment on the riders’ disorderly conduct, only saying he needed time “to go back to my statistics and look at the number of arrests and also investigate the people you claim are in hospital because of motorbike accidents.”

The management of traffic in Kisumu is so sensitive that not even the county officials who are supposed to handle it would agree to comment.

A worker at the county government said that it is almost impossible to end the menace because those who are supposed to stop the lawlessness have riders on the roads as well.