Sara Lubetsky and Rachel Whelan’s Blog

Thursday, July 4, 2013

We finally have a project that we can truly call our own.  While entering data, Rachel and I began observing ways that the current data collection system could be improved to enhance meaningful analysis.  This inspired a new project for us: to draft evaluation protocols for the next five years (2015-2020) of Riders’s pilot program, Transport Asset Management (TAM).  Our protocols build on the system currently in place, adding, among other enhancements, a means of retrieving post-referral patient outcomes.  We received very useful feedback from the Programme Director, and he has accepted the amended version of the protocol for pilot in the West Coast region upon delivery of some new ambulances.  If the pilot goes well, our protocol may be implemented across the entire country.

We only have a week and a half left in the Gambia, this feels like a really significant accomplishment.

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Sunday, June 16, 2013 12:45 PM

Rachel and I have been in the Gambia with Riders for Health for almost a month now.  With its Transport Asset Management (TAM) program, the organization has been working with the Gambian government to make medical transportation between health centers accessible to everyone in the country.

The health system here works differently than that in the US.  Whereas we can call 9-1-1 to be picked up anywhere in case of an emergency, people here have to find their own way to the nearest health facility.  In the North Bank Region, we saw a woman on the back of a donkey cart who had given birth to a hypoxic infant during the journey.  You do not find many taxis outside of the (sub)urban areas of the West Coast Region.  The nearest health facility is likely only a minor health center with limited capacity.  If you require treatment or testing beyond its capacity, a nurse refers you to a major health center.  Similarly, if your needs are beyond the capacity of the major health center, you are referred to a general hospital.  Those conditions beyond the capacity of the general hospitals are referred to the Royal Victoria Teaching Hospital in Banjul.

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Ambulances are needed to transport all of these referred patients.  Typically, one family escort and one trained medical escort like a nurse accompany the patient to the next health facility.  Paper records are kept of all referrals in and out of each facility, but little data is collected on post-referral patient outcomes.

Under TAM, the Gambian government leases ambulances and motorcycles from Riders, and stations them at all of the public health facilities in the country.  Riders maintains the vehicles and trains their drivers.  During a one-week trip through the upcountry, our team interviewed the head of almost every public health facility in The Gambia.  Almost all of these directors gushed about the professionalism and dedication of their Riders ambulance drivers who are on 24-hour call every day, leaving at a moment’s notice to transport patients.

All over the country, we saw posters with President Jammeh’s face, stating, “The nation’s health is his priority.”  My time in the Gambia, thus far, has given me a new perspective on the breadth of work that can be accomplished in a governmental/non-governmental partnership.