In Uganda, a tougher bicycle offers hope for better health coverage in rural areas
The bicycle parked in Lucy Abalo's compound doesn't belong to her. Any one of the hundreds of people in her village can show up and ask to use it.
A man might wish to take his pregnant wife for a checkup. A woman might need transport to pick up HIV medication. An injured child might need a trip to a hospital.
'The goodness about this bike,' Abalo said, is its availability to all.
She is one of dozens of 'village doctors' in rural Uganda who recently were supplied with the Buffalo Bicycle, so called because its steel parts are reinforced to perform in areas with bad roads.
World Bicycle Relief, a Chicago-based nonprofit, promotes the Buffalo Bicycle in remote parts of Africa. It collaborates with governments, non-governmental groups and others who use the bikes to improve access to health services.
In Uganda, an east African country of 45 million people, efforts to market the bicycle have focused on supporting health workers like Abalo, who visits people's homes and reports any issues to authorities.
As a community health extension worker, or CHEW, she has gained the trust of villagers, who can knock on her door in emergency situations. She said she helps to look after about 8,000 people in the area.
And at least twice a week, she is required to report to a government-run health center about 5 kilometers (3 miles) away and assist with triaging patients.
Ugandan health authorities acknowledge that one challenge for CHEWs is transportation, part of a larger burden of poverty that can leave health facilities lacking ambulances or even gas to move them.
World Bicycle Relief, operating locally as Buffalo Bicycles Uganda, has collaborated with Ugandan health authorities since 2023 to equip 331 CHEWs in two of the country's 146 districts. One is Lira, 442 kilometers (274 miles) north of the capital, Kampala.
Bicycles have long been ubiquitous, and many families tend to have one. Cultural norms in northern Uganda don't prohibit women from riding. While the roads in Lira town are paved, dirt paths lead into the heart of the district where farming is the main economic activity.
The Buffalo Bicycle is a recent arrival. Many have never heard of it, or can't afford it. Retailing for roughly $200, it is three times more expensive than the cheapest regular bicycle — otherwise out of reach for many CHEWs, who do not yet earn a salary.
The bike's promoters cite its durability in rough terrain, needing fewer trips to the mechanic as a way to save money.
The Buffalo Bicycle's heavy-gauge steel frame is so strong that it comes with a five-year warranty, said Amuza Ali, a monitoring officer in Lira for Buffalo Bicycles Uganda.
Abalo and others told the AP the Buffalo Bicycle felt uncomfortable to use in the beginning, with a braking system that doesn't permit carefree backpedaling.
'When I climbed on it, it wasn't that easy as I thought,' Abalo said. 'I was like, 'I am trying again to learn how to ride.''
CHEWs using the bicycles reported a 108% increase in households reached each week, and the time to reach health facilities dropped by nearly half, according to a study published in May by World Bicycle Relief.
The study shows that 'mobility is not a luxury in healthcare' but a lifeline, CEO Dave Neiswander said in a statement released for the report.
Diana Atwine, permanent secretary at the Ministry of Health, has urged the distribution of bicycles to more CHEWs across Uganda, saying front-line health workers save an unknown number of lives each year.
Abalo received her Buffalo Bicycle from the health minister last year.
One of her neighbors, Babra Akello, said she has used the bicycle at least six times already. The first was for transport to an antenatal checkup. She praised Abalo's willingness to help.
The bike has also been used for emergencies. One evening earlier this year, a neighbor's 4-year-old child suffered a deep cut while playing in the dirt. With the child's parents away, Abalo transported the bleeding boy to a facility where he briefly lost consciousness before being revived.
'That bike, not me, saved the life of that child,' Abalo said. 'If that bike hadn't been there, I don't know what would have happened.'
___
For more on Africa and development: https://apnews.com/hub/africa-pulse
The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP's standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.
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The Independent
15 hours ago
- The Independent
In Uganda, a tougher bicycle offers hope for better health coverage in rural areas
The bicycle parked in Lucy Abalo's compound doesn't belong to her. Any one of the hundreds of people in her village can show up and ask to use it. A man might wish to take his pregnant wife for a checkup. A woman might need transport to pick up HIV medication. An injured child might need a trip to a hospital. 'The goodness about this bike,' Abalo said, is its availability to all. She is one of dozens of 'village doctors' in rural Uganda who recently were supplied with the Buffalo Bicycle, so called because its steel parts are reinforced to perform in areas with bad roads. World Bicycle Relief, a Chicago-based nonprofit, promotes the Buffalo Bicycle in remote parts of Africa. It collaborates with governments, non-governmental groups and others who use the bikes to improve access to health services. In Uganda, an east African country of 45 million people, efforts to market the bicycle have focused on supporting health workers like Abalo, who visits people's homes and reports any issues to authorities. As a community health extension worker, or CHEW, she has gained the trust of villagers, who can knock on her door in emergency situations. She said she helps to look after about 8,000 people in the area. And at least twice a week, she is required to report to a government-run health center about 5 kilometers (3 miles) away and assist with triaging patients. Ugandan health authorities acknowledge that one challenge for CHEWs is transportation, part of a larger burden of poverty that can leave health facilities lacking ambulances or even gas to move them. World Bicycle Relief, operating locally as Buffalo Bicycles Uganda, has collaborated with Ugandan health authorities since 2023 to equip 331 CHEWs in two of the country's 146 districts. One is Lira, 442 kilometers (274 miles) north of the capital, Kampala. Bicycles have long been ubiquitous, and many families tend to have one. Cultural norms in northern Uganda don't prohibit women from riding. While the roads in Lira town are paved, dirt paths lead into the heart of the district where farming is the main economic activity. The Buffalo Bicycle is a recent arrival. Many have never heard of it, or can't afford it. Retailing for roughly $200, it is three times more expensive than the cheapest regular bicycle — otherwise out of reach for many CHEWs, who do not yet earn a salary. The bike's promoters cite its durability in rough terrain, needing fewer trips to the mechanic as a way to save money. The Buffalo Bicycle's heavy-gauge steel frame is so strong that it comes with a five-year warranty, said Amuza Ali, a monitoring officer in Lira for Buffalo Bicycles Uganda. Abalo and others told the AP the Buffalo Bicycle felt uncomfortable to use in the beginning, with a braking system that doesn't permit carefree backpedaling. 'When I climbed on it, it wasn't that easy as I thought,' Abalo said. 'I was like, 'I am trying again to learn how to ride.'' CHEWs using the bicycles reported a 108% increase in households reached each week, and the time to reach health facilities dropped by nearly half, according to a study published in May by World Bicycle Relief. The study shows that 'mobility is not a luxury in healthcare' but a lifeline, CEO Dave Neiswander said in a statement released for the report. Diana Atwine, permanent secretary at the Ministry of Health, has urged the distribution of bicycles to more CHEWs across Uganda, saying front-line health workers save an unknown number of lives each year. Abalo received her Buffalo Bicycle from the health minister last year. One of her neighbors, Babra Akello, said she has used the bicycle at least six times already. The first was for transport to an antenatal checkup. She praised Abalo's willingness to help. The bike has also been used for emergencies. One evening earlier this year, a neighbor's 4-year-old child suffered a deep cut while playing in the dirt. With the child's parents away, Abalo transported the bleeding boy to a facility where he briefly lost consciousness before being revived. 'That bike, not me, saved the life of that child,' Abalo said. 'If that bike hadn't been there, I don't know what would have happened.' ___ For more on Africa and development: The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP's standards for working with philanthropies, a list of supporters and funded coverage areas at
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Dr Anne Merriman revolutionised palliative and end-of-life care in Africa after developing a cheap form of oral morphine with a Singapore hospital pharmacist. Originally mixed in a kitchen sink, it included a pound of morphine, a preservative and colouring: lighter doses were green; stronger ones, pink and blue. A bottle cost about $2, a fraction of the cost of western formulations. Universally known as 'Dr Anne', she said: 'It's easier than baking a cake.' She developed the pain-controlling recipe after seeing terminally ill patients discharged from hospital because 'nothing more could be done for them'. Many died at home in severe and prolonged pain. 'A wild, undisciplined schoolgirl' who became a nun and a doctor, Merriman founded the pioneering Hospice Africa Uganda (HAU) in 1993 at the age of 57. Palliative care was largely unknown in Africa when she started her work in Uganda. 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She told her mother and a nun at school that she wanted to join the order and did so at the age of 18 after leaving Broughton Hall Catholic High School in West Derby, Liverpool. Recognising a rich potential in the wayward, recalcitrant novice with disappointing exam results, MMM enrolled her in a three-year internship at the International Missionary Training Hospital in Drogheda, Ireland. She spent a further year in a medical laboratory before going to medical school at University College Dublin. As a young doctor Merriman worked in MMM hospitals in Nigeria and in Drogheda, Edinburgh and Dublin. After 20 years as a religious sister and missionary, she returned to secular life in Liverpool to look after her sick mother and to specialise for eight years in geriatric medicine. Increasingly concerned by patients dying 'without pain and symptom control', she followed the teaching of Dame Cicely Saunders (obituary, July 15, 2005), the founder of the modern hospice movement. Saunders created a new kind of hospice, St Christopher's in Sydenham, southeast London, combining compassionate care with medical care. But Merriman's vision of a hospice was not restricted to a physical building. Hospice care, she said, could be given in the most appropriate place, including the patient's home. It included emotional, social and spiritual support as well as pain control. This made pragmatic sense in Uganda where 90 per cent of the population are reported to live in rural areas where doctors are scarce. Uganda became the first African country to permit nurses and trained clinical officers (physician assistants) to prescribe morphine; and the first African country to make palliative care part of its health service. After her mother's death in 1981, Merriman worked in Calcutta with Mother Teresa whose order included a hospice; in Penang in Malaysia as an associate professor; and in Singapore as a senior teaching fellow. In 1990 she accepted an invitation to become the first medical director of the Nairobi Hospice, only to leave quickly because of 'bureaucratic interference'. A case history she published in Contact, a World Council of Churches journal, secured her future in Africa. Describing a terminally ill patient who had a pain-free, peaceful death, it attracted invitations from several African countries who wanted to develop palliative care services. She chose Uganda as it was emerging from 25 years of war and reeling under the HIV crisis. Archbishop Emeritus Desmond Tutu (obituary, December 27, 2021) said in 2018: 'Anne has created a uniquely African template of love, dignity, care and compassion for people.' Nominated for the Nobel peace prize in 2014 and appointed MBE, Merriman protested that 'caring for the dying is the lowest priority in healthcare because doctors are trying to cure, not to care'. She lived in a large house overlooking Lake Victoria with her 'family', including three housekeepers and 15 dogs, once led by Adam and Eve. When Eve died she declared that Adam was grieving and found him a new partner. A warm, welcoming hostess, she was renowned locally for her Tuesday night dinners where 12 or more guests would include local dignitaries, visiting specialists and overnighting donors and volunteers. But she could also, as she put it, create a frosty atmosphere in a tropical climate. In one notable case, she highlighted the tragedy of Robert, a terminally ill 12-year-old boy with a huge cancer, a Burkitt's lymphoma, on his face. Robert slept under a counter in his aunt's shop and Merriman regularly took him to the hospice for a change of scene. He grimaced in pain as they drove across the many potholes along the way. Merriman said: 'After his [Robert's] death, the President of the USA, Bill Clinton, visited Uganda … They levelled the road so he wouldn't get a bump on the bum. The Roberts of this world do not count. But Presidents do. How sick is that?' Anne Merriman, doctor, was born on May 13, 1935. She died from respiratory failure on May 18, 2025, aged 90
