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Kigezi Community Project
In late January 2010, Dr. John Baptist Niwagaba rode a Bicycle for Humanity deep into a rural African village to launch the “Cycle for Health”. This is the first in a series of updates on his work to create a sustainable home based health care delivery service. We thank every person who helped to make this moment possible and look forward to updating supporters on the progress.
What if I could bring health care to the home?” was the question that drove Dr Niwagaba down a path to realize the bicycle could be used in a social venture for primary diagnosis, counseling and treatment of disease in rural African villages. The idea for Cycle for Health developed while during Dr. Niwagaba worked from Mulago Hospital, the national referral hospital of Uganda.
Dr. Niwagaba was troubled to find the hospital hallways overwhelmed and crowded with families which had traveled long distances from a rural village for care. Without knowledge of how much the care would cost or how long they would be there, the families were sleeping at the hospital.
Having grown up in a rural village himself, Dr Niwagaba realized that there might be a way for him to help families avoid the up to seven hour or more journeys to Mulago Hospital in Kampala and create a sustainable income generating venture in the process.
The starting point was that many rural village homes do not have access to motorized vehicles or public transport. Households are linked by footpaths like the one seen in the pictured right, inaccessible to cars. Even when reaching the main road, for many to hire a car or motorcycle for part of the journey is just too expensive. The lack of transportation limits options for families in the rural villages. Many rely on the land for sustenance and income, and trip to even the local health clinic is a major process.
Walking the distance to the clinic and receiving care takes up to a day or more. To fall a day or more behind work on the farm can be a major economic setback, and so many who feel ill rely on local herbal remedies to treat sickness. It is only when the case becomes an emergency that the family will visit the local health center, and at that point, often the treatment requires specialized attention. Dr. Niwagaba returned to his question of the possibility of home based care.
“A dog barks only at its home”, goes an African proverb. People are most comfortable at their home, can ask many questions that they are afraid to ask in the setting of a clinic or hospital. Home health visits provide a chance to see the 4 “P” –predisposing, precipitating, perpetuating and protective factors of disease causation. In a country with a poor health worker to patient ratio means many go without vital care because of long trips, lines and waiting. Trained community members can be re oriented to provide some of the basic home care and education for needed health care services
Families could avoid so much trouble if they could receive primary treatment and information earlier in the development of the disease. Dr. Niwagaba moved to develop a model that could use the bicycle as a cheap and efficient form of transportation, to bring community health care worker to people’s homes and offer services for a small fee.
He connected with Bicycles-for-Humanity, a group which collects unused bicycles from North America and sends them to Africa to find new life. In the final days of 2009 the container of bicycles and spare parts arrived in Kabale, sent from a Bicycles-for-Humanity chapter in Calgary, Canada led by Mr. Walter Rudolph. It was secured at the local Red Cross compound as Dr. Niwagaba prepares the infrastructure needed for a sustainable future program.
 The entry point for Cycle for Health will be HIV/AIDS counseling and testing. He cites a recent Ugandan Ministry of Health report that 99% of Ugandan’s know about HIV/AIDS but only a little over 20% have been tested. He believes part of this is associated with stigma towards the disease, but he says many do want the test, but it’s the transportation problem that restricts their access.
When a community health worker offers this service at someone’s home, it improve access and reduce the stigma associated with being seen entering the clinic for a test. He Is certain people will pay for these tests, which will allow for the home based health care model to grow and scale to other services. To become involved in the Cycle for Health, please contact Dr. John Baptist Niwagaba at jbniwgaba@yahoo.com
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