Drones: village health worker describes issues facing rural clinics

Amidu holds a consultation at his village health clinic in Kasungu District
 © UNICEF Malawi/2017/Andrew Brown

By Andrew Brown, UNICEF Malawi

Thipa village in Kasungu Province is typical of rural Malawi. It’s a group of small mud brick houses nestled in the shade beneath tall trees and surrounded by maize and tobacco fields. The village is 6km from the nearest road down narrow, bumpy earth tracks. Long brown tobacco leaves hang in drying sheds, waiting collection by the tobacco companies based in this area. Chickens and goats wander through the central clearing, located around the dead trunk of a once large Baobab tree, a traditional meeting point for the community.

Early in the morning, health surveillance assistant (HSA) Amidu Malope holds his regular clinic for children under five years old, in the shade of some trees on the edge of the village. He arrives by bicycle and sets up an outdoor consultation area: a wooden table with benches and a box full of drugs, malaria test kits and other medical supplies. His waiting room is a mat on the dusty ground, which by 8am is already full with waiting mothers and children.

Amidu’s first patient is 1.5 year old Wilford Gama, brought by his mother Stella from nearby Saopa village. He has a high fever and a red rash on his body. “First I measured his arm circumference and checked his feet for swelling,” Amidu says. “This tells me he is not malnourished. Next I did a malaria test. You can see that the result is already positive. It’s early stage malaria so we can treat this with medication. I’ve given his mother three days’ worth of pills and explained how to use them.”

Stella is relieved to have her son’s condition diagnosed and treated. “This is the second time he’s had malaria,” she says. “The fever started yesterday. His whole body was hot. I knew I had to bring him to the village health clinic. I’m so happy the clinic is here. It has helped us greatly. The nearest health centre is very far away and there’s no transport to get there.”

Amidu takes a blood sample from Wilford to test him for Malaria
 © UNICEF Malawi/2017/Andrew Brown

The hardest to reach

UNICEF introduced the village clinic concept to Malawi in 2008, together with WHO and the Government. It was designed to provide basic medical services to mothers and children like Stella and Wilford in hard to reach areas. UNICEF continues to support 13 districts, including Kasungu. The organisation provides training for health assistants in the management of common childhood diseases, medical supplies and bicycles for transport.

To qualify for a clinic, the village needs to be at least 5km from a road or in an area with difficult terrain, such as impassable rivers and mountains. The clinics provide a life-saving service to these communities, but the locations remain challenging to work in, with limited access to transport and communications.

“I provide basic health care for over 2,000 people, including 400 children under 5 years old,” Amidu explains. “I can treat children for fever, fast breathing, malaria, diarrhoea and malnutrition. I also raise awareness of sanitation and hygiene practices. For serious medical conditions, I refer the patient to the health centre or district hospital.”

According to Amidu, the biggest challenge is getting to the health centre to pick up supplies. “I go by bicycle. It’s a three to four hour round trip so I only go once a month,” he says. “I have to carry so many things: vaccines, drugs, contraceptives, height boards, weight scales.”

During the rainy season from December to March, things get even worse. “The dirt roads get muddy and the rivers flood,” Amidu continues. “I have to go the long way round. Sometimes my bike slips in the mud and the vaccines get damaged. When this happens, I turn round and go back to the health centre to get more.”

An even bigger problem is that the villages in Amidu’s area rarely have mobile phone reception. “This is a big problem when I need to get patients urgently to hospital,” he says. “Recently, a three year old boy was brought with convulsions. He needed to go to the hospital, but I couldn’t phone anyone to collect him. Because of this he died.”

The final challenge is that Amidu’s map of his area is rudimentary. “I only have a basic map, hand drawn by the local community,” he says. “It’s not very accurate and doesn’t indicate water sources or other health-related information.”

Children watch a drone demonstration at Thipa village, Kasungu District
 © UNICEF Malawi/2017/Andrew Brown

Drone technology

On 29 June 2017, the Government of Malawi and UNICEF are launching an air corridor to test potential humanitarian use of unmanned aerial vehicles (UAVs), also known as drones. The corridor is the first in Africa and one of the first globally to focus on humanitarian and development use.

The corridor is centred on Kasungu Airfield, with a 40km radius (80km diameter) and is designed to provide a controlled platform for the private sector, universities and other partners to explore how UAVs can be used to help deliver services that will benefit communities like Stella and Wilford’s.

UNICEF hopes that the use cases developed will help the poorest and hardest to reach families in Malawi. The choice of Kasungu District as the location for the corridor will allow companies to test drones in a rural setting with a variety of landscape and several remote areas, where health clinics and schools struggle with transportation and mobile reception.

For mothers like Stella, the village health clinic is already providing lifesaving assistance for their children, making a huge difference for these cut off communities. But more needs to be done, and drones hold the potential for village health clinics to be better connected to the health system.

Potentially, regular deliveries by drone could allow Amidu to vaccinate children on schedule, rather than once a month. Connectivity drops could allow him to inform the district hospital of urgent medical cases and arrange transportation. And aerial mapping could help him create an accurate map of the villages in his area, along with water sources and other relevant information.

“I can definitely see the potential of drones,” says Amidu after watching a community demonstration by UNICEF and the Government. “It would help a lot if I could get supplies delivered during the rainy season, and communicate with the health centre and villages. Then I could do my work with ease.”