{"id":42486,"date":"2018-06-29T16:32:02","date_gmt":"2018-06-29T15:32:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42486"},"modified":"2018-07-06T16:44:34","modified_gmt":"2018-07-06T15:44:34","slug":"alice-willson-what-cycling-taught-me-about-rural-rwandan-healthcare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/29\/alice-willson-what-cycling-taught-me-about-rural-rwandan-healthcare\/","title":{"rendered":"Alice Willson: What cycling taught me about rural Rwandan healthcare"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Alice_Willson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-42490\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Alice_Willson.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Alice_Willson.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Alice_Willson-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>A recent <\/span><a href=\"https:\/\/mg.co.za\/article\/2018-02-23-00-rwanda-slashes-infant-death-rate\"><span style=\"font-weight: 400\"><em>Mail and Guardian<\/em> article<\/span><\/a><span style=\"font-weight: 400\"> reported the dramatic decline in Rwanda\u2019s neonatal mortality rate. A video documentary in the article features Nyamata Hospital, where I have been working as a volunteer paediatrician with the Rwanda Neonatal Care Programme (a collaboration between the Royal College of Paediatrics and Child Health, Rwanda Paediatric Association, and UNICEF). The article particularly praises the role of community health workers (CHW\u2019s) in providing care to the Rwanda\u2019s rural population, and I was struck by references to the role of the bicycle.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As a keen cyclist, in my spare time I have been exploring the <\/span><a href=\"https:\/\/www.migration.gov.rw\/index.php?id=3\"><span style=\"font-weight: 400\">Land of a Thousand Hills<\/span><\/a><span style=\"font-weight: 400\">. Rwanda truly feels as though you are no sooner down a hill, before you are <\/span><a href=\"http:\/\/proceedings.esri.com\/library\/userconf\/proc15\/papers\/188_76.pdf\"><span style=\"font-weight: 400\">cycling<\/span><\/a><span style=\"font-weight: 400\"> up the next one. The roads tend to be built along ridges, so you are guaranteed a hill during every cycle. There are tarmacked roads between Kigali and main towns, but otherwise you will find dirt roads or tracks. In the rainy season the red dirt becomes a quagmire. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Rwanda\u2019s neonatal mortality rate has indeed reduced dramatically: from 37\/1000 live births in 2005 (<\/span><a href=\"https:\/\/dhsprogram.com\/pubs\/pdf\/FR316\/FR316.pdf\"><span style=\"font-weight: 400\">Rwanda Demographic Health Survey 2014-15<\/span><\/a><span style=\"font-weight: 400\">) to 16.5\/1000 live births in <\/span><a href=\"https:\/\/www.unicef.org\/republicadominicana\/Data_neonatal_mortality_rates_by_country_final(2).pdf\"><span style=\"font-weight: 400\">2016<\/span><\/a><span style=\"font-weight: 400\">. However, this is still significantly higher than the neonatal mortality rate of 2.6\/1000 live births in the UK. Most women only achieve one out of the desired four antenatal visits, and only 43% received a postnatal check-up within 48 hours of birth. The main barriers to health care are money for treatment and distance to the health care facility.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As a paediatrician I regularly see babies who have birth asphyxia due to prolonged labour; often the result of a long journey from home, to the health centre, to the District hospital. Having cycled around <\/span><a href=\"https:\/\/www.strava.com\/activities\/1496400713?utm_content=1794678&amp;utm_medium=referral&amp;utm_source=twitter%20#strava\"><span style=\"font-weight: 400\">Masaka<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.strava.com\/activities\/1391421764?utm_content=1794678&amp;utm_medium=referral&amp;utm_source=twitter%20#strava\"><span style=\"font-weight: 400\">Nyamata<\/span><\/a><span style=\"font-weight: 400\"> hospitals. I really started to understand the challenges faced, both by patients trying to attend hospital, and by community health workers trying to access their patients. Many villages are <\/span><i><span style=\"font-weight: 400\">only <\/span><\/i><span style=\"font-weight: 400\">accessible on foot or by bike, and even then the terrain can be incredibly tough.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bicycles are by no means risk free. Atuoye et al, in their <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26290436\"><span style=\"font-weight: 400\">assessment of transportation barriers<\/span><\/a><span style=\"font-weight: 400\"> in rural Ghana refer to bicycles as a \u201crisky\u201d form of transport. A literature search for \u201cbicycles\u201d on PubMed is more likely to bring up articles about bicycle accidents, than their transformative power in community health. But there are several examples in Uganda of <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25843491\"><span style=\"font-weight: 400\">bicycles as incentives<\/span><\/a><span style=\"font-weight: 400\"> for community health workers and the use of bicycles is attributed to <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25276566\"><span style=\"font-weight: 400\">better rural health cover<\/span><\/a><span style=\"font-weight: 400\">. In Tanzania, bicycles <\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25276579\"><span style=\"font-weight: 400\">transported medical specimens<\/span><\/a><span style=\"font-weight: 400\"> to improve TB case detection. The World Bike Relief <\/span><a href=\"https:\/\/cdn2.hubspot.net\/hubfs\/1738872\/2016-impact-report.pdf\"><span style=\"font-weight: 400\">impact report 2016<\/span><\/a><span style=\"font-weight: 400\"> reports positive stories of health care workers in Zimbabwe, Kenya, and Zanzibar. <\/span><\/p>\n<p><a href=\"https:\/\/www.theguardian.com\/books\/2013\/aug\/11\/second-chances-rwanda-cycling-lewis-review\"><span style=\"font-weight: 400\">Land of Second Chances<\/span><\/a><span style=\"font-weight: 400\"> demonstrated how bicycles revolutionised Rwanda\u2019s coffee industry by making the harvesting process more efficient. In the <\/span><a href=\"http:\/\/www.moh.gov.rw\/fileadmin\/templates\/policies\/NATIONAL_COMMUNITY_HEALTH_POLICY.pdf\"><span style=\"font-weight: 400\">Rwanda National Community Health policy<\/span><\/a><span style=\"font-weight: 400\"> community health workers argued that better transportation would solve the problem of geographic inaccessibility. Having cycled from the depths of rural Rwanda to the district hospitals that I work at, in my opinion, Rwanda would benefit from an injection of bicycles for community health workers to continue decentralisation of health care and improve communication between rural patients and their district hospitals.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Alice Willson<\/strong> is a paediatric trainee and\u00a0keen cyclist from the North West of England. She was working for the RCPCH as part of their Rwanda Neonatal Care Program, looking into ways of improving neonatal discharge processes.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recent Mail and Guardian article reported the dramatic decline in Rwanda\u2019s neonatal mortality rate. A video documentary in the article features Nyamata Hospital, where I have been working as [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/29\/alice-willson-what-cycling-taught-me-about-rural-rwandan-healthcare\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42495,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-42486","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Alice Willson: What cycling taught me about rural Rwandan healthcare - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/29\/alice-willson-what-cycling-taught-me-about-rural-rwandan-healthcare\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Alice Willson: What cycling taught me about rural Rwandan healthcare - The BMJ\" \/>\n<meta property=\"og:description\" content=\"A recent Mail and Guardian article reported the dramatic decline in Rwanda\u2019s neonatal mortality rate. 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