Good Intentions…

The story of Kibera’s “wheelbarrow ambulances”, where wheelbarrows retrofitted with a siren are used to ferry people to hospital was broadcast by Citizen TV at the beginning of the year.
First, to be very clear, this is an innovation born of necessity. Queen Wambua, the Traditional Birth Attendant who thought up the idea explains in the clip above, that she needed a way to ferry women who were bleeding-out during childbirth to Mbagathi Hospital. This is an invention that arose out of our informal settlements where a deplorable lack of basic infrastructure, state neglect and a sheer disregard for citizens created conditions extremely hostile to basic rights to health and other social services.  To reiterate, they needed wheelbarrow ambulances because people were dying in Kibera before they could get to hospital. Amref, the organization supporting the initiative, decided to do so because the only viable way of getting people out of Kibera’s non-roads and narrow alleyways was a wheelbarrow. These facts are undisputable.

This story however left me extremely ambivalent. I recognize the pragmatism and the life saving possibilities of the wheelbarrow ambulance. But! When we benchmark this innovation against prevailing acceptable minimum standards for healthcare including privacy, dignity and safety, it is unlikely that these are being met by the wheelbarrow ambulance. Looked at through this normative lens (“Is it right? Is it acceptable”) this invention misses the mark by a mile.

These are not pot-shots at people who are trying to make a difference. Not at all. I’m also not saying that the wheelbarrow ambulances should not exist, because the alternative, as Queen Wambua said, is probable death for some of the residents. This is a different argument. My ambivalence comes in when I wonder if by accepting this level of service; we set a standard for what ‘acceptable’ healthcare service in informal settlements is. By failing to insist that we tackle the systemic pathologies e.g. lack of security, infrastructure and health services, we deal with the symptomatic, and leave the underlying causes festering. That people can pinpoint with GPS-like accuracy where the security black-spots are but this knowledge, this certainty does not translate to the deployment of extra police to those black-spots is symptomatic of a moribund security system.  That there are 200,000 people who have no access to adequate health care system in the capital city, tells a tale of what the health system actually looks like on a national level. These injustices are unaddressed, and they need to be looked at soberly and with the seriousness that the residents of Kibera deserve. For me who works in development, it also raises questions about what exactly the over 1,000 NGOs in Kibera, many of them working on health actually do. (NGO registry and rating board coming right up!)

There are obviously many basics e.g. roads, security, and healthcare that obviously need to be put in place. And for this, every past state official charged with the oversight of any part of Kibera has utterly and completely failed to do his or her job.

The situation also calls for new solutions that would help solve, or at the very least ameliorate the situation of Kibera residents. There needs to be ways in which we are thinking of improved ways in which we can deliver basic healthcare in extremely resource constrained environments. There are groups that have been innovating, and getting traction on ways in which to provide cheap healthcare to ‘BOP’ e.g LifeSpring maternity hospitals in India where the average costs of labor/ delivery is about $70.

We need to be thinking of innovations that can change how we deliver accessible and affordable healthcare in Kenya, as the current system for public health is not working. We should develop ways in which we can get more people into affordable health care schemes because right now, the costs of medical care are the number one impoverishing factor for families.

This service innovation needs to happen as a matter of urgency.  And in the meantime, the wheelbarrow ambulance will continue saving lives.