Bikes for the World

Friday, September 23, 2016

Introducing the Malagasy eBox

In 2015 Bikes for the World arranged to ship two containers of used bicycles and parts to Madagascar through the USAID funded MAHEFA program. This project focused on bringing affordable health care to northern and western Madagascar.  Several challenges were identified as the program evolved, each defined, studied, and addressed through MAHEFA.

Distance was by far (no pun intended) the most encompassing challenge. MAHEFA developed solutions to this issue from several angles to ensure life saving health care could reach the most rural families.

Community Health Volunteers (CHV) provide an essential role in the delivery of health services to residents in isolated and under-served areas of Madagascar. These health workers are recognized and approved by the government, although not paid for their services.

Through the effort of CHVs, patients living a great distance from their nearest health clinic were now receiving basic health care. These services included child health, family planning, STD treatment and prevention, hygiene and nutrition.

However, because CHVs are unpaid, MAHEFA encountered a high turnover rate which greatly affected the quality and continuance of care in these rural areas. MAHEFA identified the two top reasons CHVs quit were motivation and mobility.

MAHEFA then introduced bicycles to select CHVs to ease the burden of traveling to see patients. Over 1,000 new bikes were given to these volunteers to assist in delivering life saving practices to entire communities. CHVs arriving on bikes were even seen as more 'credible' or trustworthy because they had bikes.

This introduced a new issue, one of repairs. While CHVs also received training in basic bike maintenance they still lacked the necessary parts and more complex tools to do serious repairs on bikes. So MAHEFA introduced the eBox.

An eBox is a permanent bike shop established in areas where little to no bike services are offered. Community members (often CHVs themselves) were trained in mechanics and sales. This micro-enterprise, operated at the community level, would provide jobs and income and ultimately support the health initiative MAHEFA created.

Additionally, the four eBoxes established through MAHEFA, would also provide support to the Emergency Transport System (ETS) which had previously been implemented through this project. ETS is a multi-modal system of patient transport, basically a 'creative' (and effective) ambulance. One particular approach is a bicycle ambulance, which would also need routine bike maintenance and parts.

Through these donation-supplied bike shops, job are created, income generated, transportation provided, and services and parts readily available. EBoxes addressed the issues of motivation AND mobility. Most newly trained staff also report a sense of pride in their community through their new skills and this brand new venture.

Bikes for the World donated and shipped 1,000 bikes in two containers over the past year to support this effort. Additionally, we helped place another 450 bikes in this project through sister organization Working Bikes from Chicago. Both BfW packed containers, were donated directly to the co-op known as Miandrivazo in Menabe.

Monday, September 12, 2016

Saving Baby Mahazomaro

Robin Erinesy is helping to save lives in his community as part of the Emergency Transport Scheme (ETS) in Madagascar. He operates this bicycle ambulance to help deliver patients to medical professionals.

Transaid has been working in this area of Madagascar for 30 years now. They helped establish several means of emergency transport to bring rural residents to life saving health services. These include ox cart ambulances, hand carried litters, bicycle ambulances, and canoe ambulances. They have also equipped thousands of volunteer health workers with bicycles to help with transportation.

Because the roads are poorly maintained and the terrain is difficult to navigate by motor vehicle transportation is often expensive if accessible at all.

Robin Erinesy is very familiar with transportation issues in his community. This is one of the reasons he got involved in the ETS.

Ten years ago Robin fell gravely ill. His family called the hospital to request an ambulance. The hospital refused to send help.

They were able to flag down a passing car who transported Robin and two other family members to the hospital. That trip cost Robin's family $9. This was one month's salary for his family.

Robin recovered but he was very angry about the situation. "They demanded a lot of money to help someone who was very sick," said Robin. This is typical, given there is no other option; drivers can charge any amount they want.

Five years later Robin was operating a bicycle ambulance, "I do it to help my community."

Additionally, by being part of ETS, Robin and his family are automatically enrolled in the community health insurance system. He pays 10 cents a month and the insurance covers ambulance service free and reduced cost on medicines for his entire family.
 
Robin was called to transport a baby in distress. Mahazomaro was only 18 days old when he experienced trouble breathing. Robin transported him to the local clinic, but they were not equipped to treat him there.

Robin then took him to the hospital in the bicycle ambulance where they were able to treat and save baby Mahazomaro. Mom and Dad had given up hope, but thanks to Robin and his bicycle ambulance Mahazomaro is now healthy and doing well.

Sunday, September 11, 2016

Transportation and Health Care Go Hand In Hand

In the MAHEFA regions of Madagascar there was often limited access to any type of affordable transportation. Many roads were poorly maintained and the terrain made motorized transport challenging. Regions exposed to months of rain are also inaccessible nearly one third of the year. This made preventive health care a challenge, not to mention urgent care.

In addition to introducing Community Health Volunteers (CHVs) to these rural communities, MAHEFA identified a greater need for emergency transport, ensuring that patients had access to treatments and care not always offered by smaller community clinics.

Several modes of transport were identified and introduced to help assist in urgent care needs. Bicycle ambulances, wheeled stretchers, canoe ambulances, and ox-carts were all placed within the communities. They were chosen according to the terrain and context.

Since implementing the multi-modal ambulances through MAHEFA, 253 drivers have been trained on emergency transport. 151 ambulances have been provided. 185,053 people now have access to emergency care through ETS.

Each emergency technician is responsible for the care and upkeep of their respective 'ambulance'. Identifying specific needs for bicycle ambulances, including bike parts and trained bike mechanics, MAHEFA sought to support the ETS on a more technical level.

EBoxes were established in four regions of Madagascar to help incentivize CHVs and also help physically support the ETS. The idea was to bring mechanics and spare parts closer to the ETS operation to help support and facilitate the use of these bike ambulances.

Through the sale of bikes at eBoxes, which received donated bikes from the UK and US, co-ops could help support the cost of the ETS as well as the bikes themselves. It was understood that each co-op would help fund the ETS and mutuelle (health insurance) through eBox profits. This synergy between community, ETS, mutuelle, and eBox was created in an effort to make this program sustainable.

Robin Erinesy operates his bike ambulance whenever called
Now, whenever care is needed, help is there. ETS makes transporting patients of every age and illness possible over any terrain or weather condition.

The mutuelle helps families afford transport, care, and medicines to help keep their families strong and healthy.

And the eBox is the micro-finance initiative behind the motivation and success of CHVs, ETS, and the mutuelle.




Thursday, September 1, 2016

Featured Volunteer: John Abendroth

John Abendroth's inspirational story would be enough for us to recognize him as a featured volunteer. But what John did last month made it clear that we needed to honor his commitment to our program, to his church, and to the Boy Scouts of America.

In January 2014 John was well on his way to earning his Eagle rank with Troop 1212. This honor is a prestigious rank among scouts and one that is not easy to attain.  A Life Scout must earn at least 21 badges and show many leadership skills that often include outdoor activities in the wilderness.

Often times the final step before becoming an Eagle Scout is the Eagle Project. Many guys are rushing to complete this last goal before reaching their 18th birthday, the cut off to complete the project.

This physically intensive project involves planning, organizing, and implementing a group activity that benefits the community. Many scouts choose to build something, like a bench, or a nature trail. They will typically employ the help of their troop who they lead through the project.

In February of 2014, while John was out riding his bike with friends, he was hit by car. The accident left him with severe swelling of the brain and spinal damage. He had surgeries to reduce the swelling and remained in the hospital for many months. There were questions if John would walk or even talk again.

With the help of family, friends, and an incredible medical team John fought back. He graduated high school and turned his attention back to earning Eagle rank despite being confined to a wheelchair. His scoutmaster, Jim Boothby secured a rare extension from the Boy Scouts of America so that John could finish the Eagle requirements despite his physical challenges.

A friend suggested Bikes for the World and John instantly fell in love with the mission. Given the family's connection with bikes, this project was a perfect match. "I like the bike project because it's something that I'm passionate about," said John in an interview promoting the collection event held in August.

John set a goal of  collecting 100 bikes, something we often challenge our scouts to do. Really, for any collection we hope for 50 bikes, but scouts working on their Eagle Projects can often surpass that total. 100 bikes in the heat of summer during a peak vacation time, however, is a tall order. Not to mention finding volunteers willing to fight the DC humidity to help.

But John rose to the challenge. For a guy known for making people smile and encouraging action he had no trouble rallying a group of volunteers from his troop and his church. He reached out to bike shops and police departments to secure early donations and trailers full of bikes kept arriving the day of the collection.

Clearly John led a successful collection. His quest inspired our donors and supporters, many contacting us beforehand to find out how they could support John.

Did he meet his goal? Did he ever! Troop 1212 led by John Abendroth collected 181 bikes (and still counting) for Bikes for the World on that hot August day. We had to scramble by 10am to find a solution to transport them all, including two adult trikes. We ended up making two trips to the warehouse. The bikes John collected will be included in our next shipment next week heading to CESTA El Salvador.

A John Abendroth fan and friend said it best, "You're JOHN ABENDROTH. You can do anything."

Tuesday, August 30, 2016

Madagascar: Getting Health Care Rolling

Photo: Robin Hammond, JSIMAHEFA Program USAIDMadagascar
Health care in rural Africa is compromised by distance and accessibility. As we saw several years ago in Sierra Leone, the Ebola outbreak spread quickly in remote areas in part due to misunderstandings about the disease, treatment, and how it spread.

Communicating information and delivering basic health related supplies, some as simple as soap, are huge first steps in battling disease and even death in  small rural communities.

Our partner in Madagascar is focused on providing health services across six remote regions in north and northwest Madagascar. This program is known locally as MAHEFA, a USAID-funded project.

Over the course of the program 6,052 community health volunteers (CHVs) were trained, equipped, and supervised to provide basic health services in the areas of maternal, newborn, and child health; family panning and reproductive health, including sexually transmitted infections, water, sanitation, and hygiene; nutrition; and malaria treatment and prevention at the community level.

Community health volunteers play a critic role in providing health services, especially to women and children. CHVs provide antenatal care, deliver vaccines, teach about proper nutrition and sanitation practices, among other family planning services.

The biggest obstacle for these CHVs is reaching the families who depend on them for basic health services. The primary challenge identified through MAHEFA was one of transportation.

Almost half of the villages in this region are inaccessible by motor vehicle for at least four months of the year due to the rainy season. One fifth are inaccessible for nearly half the year, placing residents at risk. While public transportation does exist for some areas, at some times of the year, it is frequently insufficient, unreliable, and/or expensive. As their title suggests, CHVs work on a voluntary basis and therefore receive no compensation to offset travel expenses.

The solution: bikes. MAHEFA provided 1,020 new bikes to select CHVs in 220 communes. They also received training in safe riding, management, maintenance, and repair of bicycles.

The effort to supply bikes was to solve several issues in providing care in these remote areas. Assisting CHVs in transportation to patients, medical supplies, and support meetings were key aspects of the program. Additionally, providing an incentive to CHVs, working long hours for free, was also a priority.

CHVs reported being able to visit patients more frequently and also further distances away, while still saving themselves time and energy. The cost of transportation also dropped significantly. Whereas before CHVs would hire a taxi or ox cart they could now ride a bicycle for free.

An unintended response came from patients who ended up respecting caregivers arriving on bicycle more than those on foot. In Menabe women perceived that CHVs who arrived at their homes on bicycle were providing services of higher value. The social status of CHVs soared just by owning a bicycle. This also increased the CHVs motivation level to perform their jobs.

Menabe eBox
Several challenges still existed. Only 17% of CHVs received bikes through this program. Of those, many still struggled to maintain their bikes due to the availability of spare parts and even service. While all CHVs received training and tools to work on their bikes, some of the more complex repairs were still out of reach.

MAHEFA identified four of these regions in which to place accessible bike shops, called eBoxes. An eBox is often staffed by CHVs, providing an even greater incentive by offering a salary to those employees. Used bikes donated from the UK and USA (Bikes for the World) were delivered to these eBoxes along with a supply of used parts.

These micro enterprises assist CHVs with parts and repairs of their bicycles. The shipments of used bikes from overseas also help fund the shops as well as contribute to the health related activities of the communes. Bikes for the World sent its second shipment of bikes to this project just last week.


Sunday, August 28, 2016

Sustaining Health Care In Madagascar

From Arnaud Flickr
Madagascar, the fourth largest island in the world, is also one of the world's poorest countries. 80% of the population lives in rural areas with difficult access to most services. In Madagascar, as in many other countries, the remote communities living in poverty are the most vulnerable segment of society. The availability of health services is extremely limited, leading to high rates of infant, child, and maternal mortality. In addition, 65% of the population does not have access to safe drinking water and sanitation.

The USAID-funded Madagascar Community-Based Integrated Health Project known locally as MAHEFA is focused on providing basic, quality health care to isolated populations in six north and northwestern regions of Madagascar (DIANA, SAVA, Sofia, Menabe, Boeny and Melaky). This project's funding ended last year, however, a new grant was just awarded to continue and expand the important work in Madagascar.

The program’s vision is for thriving families and communities to access sustained, high-quality health services at the community and facility levels that are responsive to client needs and interlinked through excellent health system and community management. To achieve this, the program will increase access to and use of key services, and improve regional, district, and commune management and systems in the seven regions identified in the program.

A need for an emergency transport system was identified and tailored solutions to fit the needs of patients in these areas were defined, developed, and implemented through MAHEFA. Community Health Volunteers (CHV) were evaluated and challenges noted. MAHEFA brought new bikes into the program that were delivered to certain CHVs in greatest need of transportation.

Antsohihy Co-op
In an effort to provide monetary incentive and technical support to these health volunteers, MAHEFA also established four eBoxes, which would serve as small rural bike shops. Some CHVs and other community members were trained to fix bikes and operate the small bike businesses.

Bikes for the World donated several containers of bikes and spare parts to this project over the last year. Bikes are fixed up by MAHEFA trained mechanics and sold to local families who use them for school and work. Many farmers are buying and using bikes to help tend to their crops and carry produce to market.

The profits from the bike sales and repairs are being used to support health initiatives in these small rural communities. The co-ops benefit from paid dividends, employees receive a small salary for work in the shop, and other revenue helps support the Emergency Transport System and health insurance in the community.

Contributors, JSI and Transaid

Thursday, August 18, 2016

Le-makesusproudtobeamerican-Decky

Katie with Team USA from Instagram
Oh Now you've heard of Katie Ledecky? And you've likely now heard us mention she volunteered at Bikes for the World for two years with Stone Ridge's Social Action Program. So what's she really like?

Exactly what you see. Katie brought to Bikes for the World exactly what she brought to the Olympics. She was dedicated, a hard worker, and a team player.

There are really three things we heard during the Olympics that stuck with us. #1 Katie told us all to enjoy the journey. This is something we saw in our warehouse every other week not just with Katie but the entire Stone Ridge crew.

Ken with Yvette
And it really started with this guy, advisor Ken Woodard. Ken brings his passion for bikes with him every time he steps into the warehouse. And that trickles down to his students. When we started working with Stone Ridge back in 2011 we had two volunteers from the school. As we excitedly await their return this September, that number has risen to 10, and many of them return from their junior to senior years.

Katie had this to say about working with Mr. Woodard: "He is a wonderful role model for all of us as his dedication and his willingness to help others is so evident. He demonstrates how important it is to help others, and how much fun can result from doing so."

Katie's first day at King Farm
#2 We heard throughout her 800 Free how Katie Ledecky was making that race cool again. Many moms were reporting that their little girls were watching Katie swim and wanted to be just like her. Long distance swimming was becoming popular thanks to Katie's success in the event. Her overall personality made her a much loved role model to, well, everyone!

And over the past three years this is exactly what Katie brought to our program. Honestly, all of Stone Ridge, each of these volunteers made an Impact. Stone Ridge took over our warehouse twice a month and spent most of their time working in the back with chain breakers, frame taps, bottom bracket tools, crank pullers...pulling parts off bikes many of us didn't even know came off!

Troop 1999
And our young volunteers were watching. During the last three years Bikes for the World partnered up with more Girl Scout Troops than ever before. They saw what these women of Stone Ridge were accomplishing and they wanted to be just like them. Putting tools in the hands of these capable young girls brought more confidence to many of them and we credit much of that to all our Stone Ridge volunteers.

Kaite with her Social Action Team
#3, finally, almost every interview with Katie Ledecky poolside ended with Katie saying into the camera, "Go USA!" Over and over sitting in our living rooms we sat watching Katie swim. Just Katie, because the camera couldn't capture the entire field, that's just how fast she is. Commentators said things like, "Katie is in the pool by herself" and "Katie is racing herself".

Katie Ledecky never once forgot Team USA. And she never once put herself ahead of anyone else in the Social Action program. Katie was just another student in our warehouse. When we met her she already had one Olympic Gold medal and she went on to break world records the entire time she was with us. But in our warehouse she joined her friends and teammates, pulling pedals off bikes and wheeling bikes on trailers.

Rolling bikes for the Philippines
During her last day with Bikes for the World she helped load the container of bikes that ended up in our Bikes for Education project in the Philippines. When Bikes for the Philippines found out, they were thrilled.  " Thank you Katie and Race on for the Gold. From us here in the Philippines. Mabuhay!" 

Likewise, Wheels of Africa in Kenya sent this message before the Olympics, "We look forward to watching Katie Ledecky as she competes in the Olympics. We wish her all the best." Katie not only brought together the USA, but the whole world took notice and cheered her on.

Congratulations Katie and thank you for your service. Welcome home. We can't help but think of everything Katie has brought to Bikes for the World and wonder how much of that Stone Ridge brought to her initially. Katie Ledecky, hands covered in grease, and a heart of gold.