Ambulance Mashinani: A lifeline for expectant mothers in rural Kenya

One night in December 2016, Mary Njeri from Kagumo-ini village in Kandara, Murang'a County, recalls the sudden onset of labour pains. Heavily pregnant with her 10th child, the commencement of labour brought excitement. However, deep down, she was troubled, having no money to hire a taxi to the hospital at that late hour.

Distressed and unable to figure out what to do as the pains worsened, Mary remembered a local ambulance service that helped take expectant women to the hospital for free. She called her mother, who found the contact information, and within 20 minutes, the ambulance arrived at Mary's home. She was swiftly transported to Kagundu-ini Level Four Hospital, where she delivered a healthy baby boy after three hours.

When we visit her home on a sunny morning, we find Mary tending to her cows in the farm. She vividly recalls the events of that night. Inside the ambulance, she remembers three women and the driver. The social worker provided her with basic first aid, checking her blood pressure and temperature.

"The ambulance was very fast and kept its siren on to clear the road. Without it, I could have delivered at home or on the way. It's crucial for women and the sick in the community," she notes.

Two years later, in 2018, the situation was no different when Mary gave birth to her last-born child. The ambulance came to her aid once again, saving her from the more than 20km walk to the hospital she previously had to make due to lack of transport money.

About 20 kilometres away in Runjeri village, Agnes Wanjiru, a mother of seven, praises the ambulance service. In 2017, after a grisly motorcycle accident, the ambulance took her to Maragua Level Four Hospital, where she was admitted for two weeks. "I would have died without timely hospital access. I'm forever grateful," Wanjiru tells us, pleading for more ambulances to serve needy residents.

Afford transport

At the height of the Covid-19 pandemic, Thomas Ngumba from Ndiri-ini also recalls how the ambulance came to his aid in his hour of need. A cobbler in the village, Ngumba developed an orthopaedic issue that left him immobile and unable to afford transport. "The ambulance took me to the hospital and back home for free. It has helped hundreds of financially challenged locals access healthcare," he says gratefully.

These are just a few stories from beneficiaries of Ambulance Mashinani, an initiative by Dr Stanley Kamau, founder of Ahadi Kenya, to help the needy and vulnerable access health facilities easily.

"Most poor people in rural areas, especially those with disabilities, cannot walk or afford transport to medical facilities. They miss appointments or lack means to communicate emergencies. Ambulance Mashinani provides dignified transport for these groups," Dr Kamau explains.

The ambulances, designed for hard-to-reach areas, are equipped with beds, first-aid kits, child-delivery kits, and mobile phones for emergency communication with doctors. Expectant mothers, accompanied by caregivers, are rushed to hospitals by social workers in the covered, comfortable ambulances.

Besides transporting expectant mothers, the ambulances have portable ultrasound machines for scanning, and the staff are trained as midwives to assist deliveries enroute if necessary.

So far, the 485 Ambulance Mashinani units across 47 counties, have helped more than 100,000 expectant mothers. "Thousands benefit weekly, able to give birth with dignity. In emergencies, they coordinate with county ambulances," says Dr Kamau.

After discharge, mothers are transported home, and the ambulances are available for follow-up visits. The service also aids accident victims, jigger-affected residents, and people with disabilities.

Beyond Zero Campaign

Dr Kamau's work earned him the Male Champion of Women's Agenda Award from Women on Board Kenya in 2023. He is motivated to continue empowering women, having previously led anti-jigger campaigns and advised the Beyond Zero Campaign under former First Lady Margaret Kenyatta.

Limited resources, cultural practices, and lack of political will hinder women's empowerment, but Dr Kamau supports initiatives like He for She that involve men in the cause.

Eunice Kiunga, a Murang'a social worker overseeing the ambulances in Murang'a, calls them a game-changer, providing free hospital access to thousands of women and sick residents who cannot afford transport. She adds that the Ambulance Mashinani has helped reduce cases of maternal mortality in the area as many more women are able to give birth in hospitals.

According to UNFPA, Kenya's maternal mortality ratio is 355 deaths per 100,000 live births, with nearly 5,000 annual deaths from pregnancy and childbirth complications.

While skilled birth attendance has improved from 62 per cent to 70 per cent in seven years, over 80 per cent of maternal deaths are attributed to poor care quality. Many women want to deliver in health facilities with trained personnel, but long travel distances are a barrier.

In urban areas in Kenya, 98 per cent of births are overseen by a skilled birth attendant in a health facility. In the rural areas, this number drops to 94 per cent of births with any available health personnel in any facility. This leaves a significant number of patients without any skilled birth attendant coverage. With over one million pregnant patients residing in rural areas, it means approximately 75,000 deliveries happen without any skilled healthcare coverage.

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