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.

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.

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.

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."