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Last Updated: Thursday, 25 October 2007, 18:42 GMT 19:42 UK
Driving to save lives in rural Tanzania
By Daniel Dickinson
BBC News, Haydom

Maria Guadence holds her baby
I would have died on the road if I had not been helped
Maria Guadence

Emmanuel Salim makes what could be a life-saving call on a crackling radio from Wandela village deep in Manyara region in rural Tanzania.

He is calling for ambulance assistance from the Haydom Lutheran Hospital 40km (24 miles) away for a mother who is going into labour.

Before the ambulance service was set up this woman and her unborn child probably would have died, but she is one of many mothers for whom the hospital ambulance service has made the difference between life and death.

"I make at least two emergency calls a week," said Emmanuel Salim. "The ambulance comes quickly. It is good to be able to save lives."

Wandela is one of 36 villages with radio contact to the ambulance service of Haydom Lutheran Hospital.

No siren

There are two ambulances which are on call 24 hours a day, seven days a week; one of which is dedicated almost exclusively to mother and child services.

Emmanuel Salim
Emmanuel Salim makes at least two emergency calls a week

The hospital's maternity ward is living proof that that service is needed and more importantly successful.

Maria Guadence cradles her five-week-old baby Zawadieli, a healthy boy who weighed in at 2.9kg at birth.

She called for the ambulance from her village 25km (15 mile) away after collapsing by the side of the road in the searing heat of midday.

"I tried to get to the hospital, but I knew I could not manage it alone," she says.

"My village radioed for the ambulance which brought me to hospital. I think I would have died on the road if I had not been helped."

Each of the hospital ambulance travels up to 1,500km (932 miles) a week.

map

The farthest radio call station is 150km (93 miles) away down challenging dirt and sometimes muddy roads, a journey which under good conditions normally takes up to four hours.

The ambulances themselves are relatively basic.

They are converted four-wheel-drive vehicles whose back seats have been removed and in their position a mattress placed.

There is no permanently installed medical equipment; instead a paramedic takes a specific medical kit from the hospital depending on the emergency.

And unlike most ambulances it has no siren.

Costly

Although an ambulance service is a basic tool of most hospitals, it is expensive to operate and as a result it is rare to find a functioning service at rural hospitals not just in Tanzania, but across Africa.

Wandela village
Thirty-six villages have access to the ambulances

Haydom Lutheran Hospital received the vehicles and radio equipment worth around $100,000 (50,000) as donations but Isaack Malayeck, the assistant medical managing director of the hospital, says the challenge is not securing the equipment but rather making the service sustainable.

"The capital outlay is large, but the problem many hospitals have is not being able to afford the equipment but making the service pay for itself," he says.

Patients pay a charge per kilometre to use the ambulance, which covers the driver's salary as well as the petrol and maintenance costs.

The hospital subsidises those patients who are too poor to pay.

"It is a vital service - not just because it saves lives, but also because it creates the physical link between the hospital and the people we are serving," says Mr Malayeck.

"Our patients know they can access our services and that is important for a rural hospital."

The ambulance service, the hospital believes, is one reason why its maternal mortality rates are well below the national average.

The cost of access can, however, be daunting.

Back at the hospital's maternity ward Ms Gaudence is enjoying her new baby boy.

Her ambulance bill is around $25 (14), a huge amount of money in this impoverished corner of Tanzania.

But as she prepares to leave hospital she promises to find a way to pay it; after all she says, you cannot put a price on life.

SEE ALSO
Country profile: Tanzania
16 Aug 07 |  Country profiles

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