One Tweet Later, Wheels for Life was Born

Dr. Jemimah Kariuki shares the journey that led her to the start of Wheels For Life. Read on below or listen to Dr. Kariuki here:

Wheels For Life is an organisation that helps pregnant women get to hospital in the shortest time possible — and it came about, I think, from luck, fate, and a lot of God’s grace. When I finished my undergraduate medical course in 2016 I really didn’t think I was going to do anything clinical-related. But then I did an internship in a rural area, in Murang’a, and saw so many pregnant women with preventable issues, because they’d be travelling more than 400km to our hospital. Something as simple as delivering a baby would mean someone taking a 24-hour journey. It didn’t make sense to me.

Tending to a patient in Wheels for Life ambulance

I decided to specialise in obstetrics and gynaecology for my postgraduate degree. Fast forward to my first year of residency, and the pandemic. We’d normally have 100 women a day, maybe 140, like a conveyor belt. By March 2020, that dropped by two-thirds. We suddenly had space in the general ward, but at the same time the acute ward was spilling over with women with severe complications — often because they had given birth at home alone. One of the things that the COVIDaction Resilient Health Systems team taught me is to look at a problem like it’s a leaf on a tree. Follow the branches down until you get to the root cause, and then solve it from the roots up. And it turns out the issue was they couldn’t get to hospital.

Very few hospitals have emergency theatres for caesarean sections or blood transfusions, so women have to travel very long distances for those facilities. And there are lots of issues with public transport, especially in rural regions — homesteads can be a kilometre from the nearest road. Even in urban regions, you still have to pay to get from one point to another, whether Ubers, taxis, or mutatus [private vans/buses]. A lot of European countries are actually quite blessed because you can call, and the ambulance is there within ten minutes. Here, if I call an ambulance, it’s getting to me in an hour — if there’s no traffic — and if you’re in a rural area it’s two hours, if you know where you are. All those issues mean that many women will, if they can’t afford it, deliver by themselves, or they’ll call someone local — a local healer who knows how to do it traditionally. If there are complications, and you have a bleeding woman needing to rush to a hospital, then it’s not like you can call public transport to your home.

With the pandemic, we had a curfew — public transport closed after 7:00 PM, and without transport there’s no way to reach a healthcare facility. Many, many women were delivering at home with drastic complications, which we would then see the next morning. Women were bleeding to death, babies were dying. We’d have to go to surgery so many times to repair what were simple complications. COVID exposed how women don’t have ways to get to hospital, and that’s the gap I realised we needed to solve.

Tending to a patient in Wheels for Life ambulance

So, what could I do? I went to Twitter — I’m not really keen on Twitter, but I was on there — and said that any pregnant woman, with any issue, could let me know and I’d try my best to help. I didn’t know what I was going to do. Maybe a kind of teleconsultation, and reassure them that things would be fine. I tweeted my personal number, and the first day was 30 calls, 100 messages on Twitter, and so many messages on WhatsApp that I was overwhelmed. I just kind of guided them, telling them to ask their local chief for a permit letter so that, if they went into labour, they could leave home after curfew. But we had police brutality at the time — everyone was scared to break curfew. And when I reached out to the police, I was told it was impossible for them to take patients to hospital.

I was 26 at the time, a first year resident, and I was pregnant. When I told my consultant, “I’ve given my phone number out to help women,” he was like, “You go for it!” And I was like, “OK, I have no idea what I’m doing, but no problem, I guess.” I handled those calls for a week, when I got a call from a woman who told me she was in labour, stranded 50km from where I was. I thought I would just drive my car and get her, but then another woman called me, 40km in the opposite direction. Thankfully, a cab driver reached out and offered to help ferry one of them, but I still couldn’t go alone into a stranger’s home. So I started calling ambulances — and I was shocked. In Kenya, ambulances are used to transfer patients from one facility to another — they hardly ever take patients from home. I was told a transfer needed to be paid for up front, but the woman I was dealing with only had 150 shillings, or $1.10 at the current conversion rate.

So here’s a lady with only a dollar in her pocket being asked to pay for something that would cost $500. Again — it didn’t make sense to me. Instead I paid another cab driver to pick her up, and I was so overjoyed when the husband called and told me that his wife had delivered safely. A bountiful, big baby boy — 4kg! How could you have delivered that at home?

I had saved one life. I knew this was something I could do.

That boy gave me all the energy I needed. I realised we need to be able to get patients from home using whatever means possible. Other cab drivers started telling me they could help out. Friends gave me the contact for a phenomenal lady, Dr. Elizabeth Wala, the director of Amref in Africa, who told me about a taxi company Bolt, who had offered free rides for healthcare workers. They agreed to convert the idea from healthcare workers to patients for free. Someone else came in and offered us ten free ambulances, then they moved to 150. We got big quotations for putting up call centres, but then we met with Mr. Paul Wambugu from Telesky they said, “We can do it for free.” We got a lot of free support — well, someone was paying for it, but I just thank God it wasn’t the patients or ourselves. I went back to my friends and colleagues and asked them if they would also give their time — and so we ended up with our panel of doctors, our call centre, our cabs, and our free ambulances. We had the county government of Nairobi on board, and hospitals knew we would be sending patients to them. Patients call the call centre for free, get a free consultation from doctors, get a free ride to the facility, and then we hoped the Linda Mama package would pay for the treatment — essentially making maternal care affordable for women.

His Excellency Governor Mutahi Kahiga and Dr. Nyalita flagging off the Wheels for Life project in Nyeri county.

It’s been amazing what we’ve been able to do from that tweet. We’ve helped 3,000 women in the last eight months, 1,500 of those going to facilities. Babies have been born. And the technical team at Amref helped us secure funding, which is how we met FCDO. When I started this, it was just about a helping hand. I really hadn’t imagined having such an impact, or meeting such amazing people. The Frontier Technologies Hub and COVIDaction team have helped us develop a more sustainable business model, and given us a mentor who’s working with us as we submit new funding proposals. Now we have targets and milestones, and we’re able to actually ask, “Is the last month an improvement?” Last week we were able to roll out a TV and radio advertisement to create awareness — because women are still scared of hospitals because of COVID, and until now, unless someone attended a clinic, they wouldn’t get our message. It’s boosted our reach more than a thousand percent from where we were last week.

You don’t have to work alone to solve something. It doesn’t matter if, when you see the local Wheels For Life, my name isn’t there. What matters is that woman who’s able to safely deliver in an ambulance or at the hospital, and have their baby (or babies) be safe. That vision carries on far beyond me. It really just teaches me to work with others to get things done. That’s where you thrive — in the connectivity that you make. (And the power of marketing, my goodness! Creation of awareness is just as important as creation of a system.)

It means that even when I’m dead this project can be its own organisation, helping and supporting women. That’s my goal — that 30 years from now, 50 years even, there’s still impact from this. And if it rolls over and becomes also for other issues like hypertension, diabetes… Well and good, it would bless my heart.