Proposal for an emergency vehicle in Ntenjeru Sub County Mukono district.

 

Introduction

 

Ntenjeru Sub County, in the Mukono district of Uganda, has over 600,000 inhabitants whose average earnings are less than 1 US dollar a day. It is a large area encompassing Mukono and Katosi on Lake Victoria and many isolated villages.

 

In 2017 the road between Mukono and Katosi will be completed, making travel much easier and attracting more people to the fishing village of Katosi (population 16,000), Kisoga village (population 10,000) and the surrounding villages. Many people journey through the area to get to the islands on Lake Victoria. Koome Island can see its population swell to around 100,000 in the fishing season. All this adds up to a highly populated rural area without any modern medical facilities and no emergency vehicle. People can arrive from an island in critical condition after a two hour boat journey only to find themselves faced with yet another hour’s journey to hospital - if they can find transport. Patients in clinics can be kept waiting hours for an ambulance that may not ever turn up.

 

Vision

 

Our vision is for a sustainable and reliable emergency vehicle service with an ambulance based in Kisoga village in the centre of Ntenjeru Sub County. It will be fully equipped with oxygen, patient bed and a fully functional first aid kit. It will be fitted with GPS for monitoring purposes. There will be a number of local drivers on call so the vehicle will be available 24 hours a day, 7 days a week. The vehicle will be easily accessed by other clinics. An emergency number will be posted throughout the area.

 

There will be a fairly set standard price per journey, charged to cover running costs. Patients needing immediate treatment will always be taken and, if necessary, paid for by subsidy from local investments. Income from local investments, such as housing rentals can help subsidise the running of the ambulance making it more affordable to the poorest people and to help the

service be self sustaining. The transportation fee and travel times will also be significantly reduced once Herona Hospital Kisoga is fully functional.

 

Case studies

 

· I witnessed a man from Lwajje Island in a critical condition after a building collapsed on him and his family, killing his wife and 6 month old baby. He arrived on the shore in a police boat with a friend at 3 am. His friend had no money and no idea of how to get transport. It was only because the injured man was the Pastor on the island and known to our children's home that someone got word to us. Soldier Man from our home managed to wake a friend with a car who agreed, for no payment, to take the Pastor to the nearest hospital. Hours later the first hospital turned him away, the next hospital gave him painkillers but their x-ray machine was broken. Eventually the company that employed the Pastor arrived and paid for him to be transferred to Mulago hospital in Kampala; he was finally x-rayed at 5pm. The Pastor is lucky to be with us, if he was not so well connected he may not have survived.

 

· A child was bought to Herona Clinic in Kisoga with a snake bite. He had been found lying in the bushes. There are no local clinics which stock an antidote and time is crucial. An ambulance was called but it took over an hour to arrive and then another hour to get to a hospital with an antidote. Too long - the boy died on the way.

 

· A woman arrived at the same clinic a few days later. Herona Clinic is the only one with scanning facilities, they discovered the woman’s baby had grown outside the uterus and had died. The mother needed to be operated on immediately. There was no emergency vehicle available and without the operation the woman would die. Having received this terrible news, she then had to travel on the back of a motorbike to hospital. Too late - she died before they could even start the operation.

 

These instances are among many which occurred in just one week of my stay in Katosi. At Herona Clinic alone there is an urgent need for a regular ambulance service.

 

 

Problem statement

Despite having a population of over 600,000 people, Mukono district has only one hospital and one ambulance to serve the whole area. Often the ambulance arrives too late or not at all. Ambulances in government facilities are poorly maintained and breakdown, causing devastating delays.

There is a great need for our proposed emergency vehicle in the area to aid transportation of seriously sick patients and management of emergencies.

 

Project implementation

The ambulance needs to be conveniently located, enabling rapid response. Kisoga is central to Ntenjeru Sub County. It is positioned where the road forks to Katosi or Kokongera. Herona Clinic in Kisoga is the only government recognised private clinic in the Sub County. It is perfectly located and staffed to garage and administer the ambulance. Henry Garvin, the proprietor of the non profit clinic, not only has great emergency experience at other hospitals, he is also building Herona Hospital in Kisoga. Overseen by Henry Garvin and a local board for transparency, the ambulance will be monitored for efficiency and correct usage. GPS will ensure that the vehicle’s whereabouts can be monitored by an independent party.

The proposed ambulance will provide a vital link between clinics and hospital, saving lives on a daily basis.

 

There are two basic types of ambulance available in Uganda. The four-wheel drive Toyota Land Cruiser and the Toyota HiAce van conversion, both have their advantages and disadvantages.

 

The Land Cruiser has the advantage over the HiAce that it is good off road, and many of the villages are very off road. Being a four-wheel drive vehicle the Land Cruiser is more suited to the local terrain. Its disadvantage is that it is expensive to buy. There is one that has been used in Kampala for the past 15 years without any major problem.

 

The Toyota HiAce is used all over Uganda as taxis. The vehicles are cheaper to buy, with more choice. The parts are also cheaper and easily found. However, some off road terrain can be problematic for the HiAce. They are

shipped from Japan as a used vehicle so life expectancy will shorter than the Land Cruiser.

 

 

Toyota Land Cruiser, new 176,000,000 Ugandan shillings. £40,000

 

Toyota HiAce, part used in Japan 50,000,000 Ugandan shillings. £11,500

 

GPS may cost extra.

 

 

All vehicles entering Ugandan are subject 50% tax by the government except vehicles which serve their local community. As this ambulance will be for public service this tax will be avoided by importing it on a red number plate. The red number plate ensures no extra taxes are charged during import.

Henry Garvin and Herona Clinic will put measures in place to uphold a culture of regular ambulance maintenance. A budget will strictly be adhered to by the maintenance team who will supervise, monitor and report to management any repairs needed.

 

Further investment in local business or constructing houses to rent will significantly help to support this vital public service for the very poorest in the community. For example, in our first case study the Pastor arrived from the island without any money and in need of urgent medical treatment, with the help of the subsidy he could have been taken straight to Kampala , ensuring treatment much earlier than 5pm. In the case of the Pastor his employers were able to pay for the ambulance journey; but had he been unable to pay it would have been agreed what was affordable and topped up from subsidy income.

 

Conclusion

For as little as £12,000 an ambulance could begin serving the Ntenjeru Sub County community. A larger investment will not only save lives now but continue to do so for many years to come. With the proposed subsidy scheme, even the very poorest can be helped. It is vitally important to get an emergency vehicle in this area.

 

It is important to make sure the ambulance is self-sustaining. Asking patients to pay even a small contribution limits the chances of people abusing the system. If people know they need to pay something, more trivial cases will not waste precious ambulance time. These fees will be used to pay for the upkeep of the ambulance. This project needs to be established and administered by local Ugandans openly and transparently, giving much needed work to locals and gaining the trust of the community.

 

There is no government funding available for this project.

 

The Sub County of Ntenjeru needs this service and its needs will only increase with the new road bringing in new people. This vehicle will be a community asset, available to Ugandans and visitors alike, in their time of need.