E015 Artwork Building an EMS System from Scratch with Tanzania Rural Health Movement Crisis Response Podcast

Episode #15: Building an EMS System from Scratch | Tanzania Rural Health Movement

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Episode Transcript

This transcript was compiled using automated software — spelling and punctuation errors are possible.

Jason: Hello, and welcome to another episode of the Crisis Response Podcast. Today we’re joined by Dr. Marko Hingi, based in Mwanza, Tanzania, who’s the executive director and founder of the Tanzania Rural Health Movement. Welcome, Dr. Hingi. It’s a real pleasure to have you on the show today.

Marko: Yeah. Thank you very much, Jason. And I’m so happy for you to host me and hello everyone.

Jason: Excellent. Thank you so much for joining. So I’d like to really find out more for our listeners. If you could tell us about what the Tanzania Rural Health Movement is, what you do, and then how you started it, because you’ve got such a fascinating and really inspiring story. It’d be great to share that with our listeners.

Marko: Yeah. Thank you very much, Jason. Actually I’m working with Tanzania Rural Health Movement and this is a non profit and we have founded this about eight years back. And at that time, I was a medical student at, uh,  Catholic University of Health and Allied Sciences.

As a local trained medical, uh, doctor with a history and difficulties of accessing healthcare services in my settings, actually, that was a dream for me to become a doctor. I can take back, during my childhood when my mother was sick and I was with my mother and my young, uh, my young brother and my mother started wanted to go, uh, to the hospital, which is a big distance from where we are staying. So it took a whole day from morning up to the evening without my mother and my young brother.

And she went a distance and come back later in the evening. Actually, that experience was not good for me. And, uh, actually, I said to myself, but I need to work hard and to study hard to ensure I become a doctor. So when I was in medical school, I found that the challenges of accessing health care services was not only about my stories, my story about my mother, but that goes beyond my family. Even other people were struggling to get health access.

And the issue is, I came to understand that in developing countries, they have a very interesting system that, uh, whenever someone is sick at home, he can call on the phone, and the ambulance and paramedics, they can come and take to the hospital. So for me, I thought that, uh, I need to do more.

And when I was visiting the emergency department, I found that most of people are dying before arriving to the hospital. So I thought that it’s very important to start a move on establishing the pre hospital care services. Actually, it was hard, uh, because we didn’t have resources like those which are found in developed countries.

But later on, we figured out that we can use what we have. We can train first responders, we can use available transport to ensure that we can transport someone who needs medical help. So that is how we started. And apart from providing the emergency care services, which is, uh, only free available emergency care services in Mwanza, Tanzania, which is accomplishing my dream, becoming a doctor, but saving the community. And now it’s not all about my family. But it’s all the community members who are around our community.

Uh, but another thing we are trying to, see how we can help, especially underserved populations, who even, they cannot have some money to go to the hospital. But at least, providing them the emergency care is something basic, and at least can help their…their life.

Jason: That’s really, really inspiring, Mark, I, I just can’t explain or can’t really fathom the challenges that you faced and that you had to overcome and that you’ve really taken this head on to develop a system that didn’t previously exist. And that’s something that’s so inspiring about your story is that you, you really have built an EMS system, an emergency medical system from scratch.

And so I’m wondering if you could share a little bit more about, what pre hospital care looks like in Tanzania, and particularly in Mwanza, where you’re based. Before you started, what kind of emergency services were available or, more specifically, if someone got into a car accident or a motor vehicle collision, what were their options for getting emergency care and transport to the hospital?

Marko: Yeah. Thank you. Jason. Actually, I can say I could give you the experience before and after. This is started when I won a car from the Be Forward company. So the competition is like a lottery program. The competition was “Why do you want a car?” So my question was simple. “I want to start an emergency system to my community so that I can provide services at right time and at the right place.”

But I thought that only transport can do that, but that was wrong. So when I won a car, uh, the media asked me about this. And I said, “I have this car and I want to use it to transport patients when they need help and when they have emergency conditions.” But in reality, that was wrong. Or the vehicle was not enough and at that time still we had, I was an intern at that time, so I continue to see patient arriving at the hospital due to road traffic accident, some were pregnant women, and many more.

So how we started, actually, we had a very good opportunity while searching and looking up and there we came to me to Trek Medics International and Jason Friesen. And then we discussed, and they get time to visit us, whereas they saw actual challenge that we had at that time, whenever you get an accident, you won’t find any help.

The good thing you can get is good Samaritan to carry you to the nearby facility. But as you understand, you can get an accident and you can faint. You can have severe breathing. All those things are supposed to be done on time. You can’t take a patient on wide breathing to the hospital, probably you lose that. There is a way higher chance of losing the patient. The same way as when the patient is unconscious.

So, formally we understood how the emergency care services can be. How we can view it from scratch. And that is we went on four areas. That we need to do training on first responders. We need to have transport, not necessarily a vehicle. But we need to have a communication system, and also we need to have a system of management.

So when we tried to review these four areas, we found that we can manage the system because we had an organization, we had people who are educated, we can transport them, we can train layman persons, uh, who are motorcycle drivers who are doing business in town, taking people from one place to another.

But the main challenge was how we can communicate. How we can, uh, notify people about the incidents, uh, how they can, uh, just a complete logistics on emergency services. So is where we had Beacon software, and then we started training people on how to handle emergencies, trying to use available transport, either from good Samaritan or from, um, using motorcycles.

Yeah, so we continued it, marketing the program, and the community understood the program and started to call. So started to call for the help. Formerly, actually, it was hard. You can get even one call per week. But now, we are getting an average of three, up to four, sometimes, per day. So, uh, that is a little I can share about the experience, uh, how we started in the hub.

We are here up to now after a number of years trying to, uh, improving and making it better, make it usable and so forth.

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Jason: Really, again, I just can’t tell you how inspiring your story is and how impressive it is because you you’ve really gone from nothing to something very valuable and important and, you know, you mentioned that you’ve been training the motorcycle taxi drivers and for a lot of our listeners, this, this might be a foreign concept, right? Could you, could you talk more about that? Who are these motorcycle taxi drivers and, and what’s their, why would they want to be trained as emergency responders and how does that work?

Marko: Yeah. Um, thank you, Jason. Actually, I think this is a different, uh, I’ve been in South Africa. I know it’s not common. I’ve been in China. Uh, it’s not common to have the motor taxis, you know, people that have used with taxi, the normal cars. But, uh, here is quite different here, especially in East Africa.

We are using motorcycles as a means of transport. It’s a business. So it can take people from one point to another and take goods from one point to another. And, uh, that one also we can say have been shifted the law of taxis in, in my country. So taxis are there, but, um, they’re not used much by, uh, people with low income or at a lower level, even though it can be used by any person.

Uh, but most of people, those who are, uh, at the low level of income, uh, who have low incomes, so these are normal motorcycles. But, uh, instead of transporting goods and using it for like personal use, but now they’re using it as a commercial. So they transport people, goods from one place to another. And uh, these, why we decided to use these guys?

Actually at those time, these were people who are blamed a lot that they are causing road traffic accidents. You know, to be trained to become a driver is quite different as to be trained to become a, uh, motor, motorcyclist. So motorcyclists, some of them, they don’t go for the training school, but, uh, to be a driver, of course, it needs a lot of, uh, uh, steps until you become a driver to have a license.

So you can find some of them who are blamed that they are not used to drive, to ride the motorcycles, and they cause accidents, etc. So for us, we found that it’s an opportunity, uh, instead of, uh, uh, using other group within the community, we thought that using them would be good because we’ll be transforming, uh, the mindset, which is available to the community that are the one causing the accident and now are the ones who are saving the community.

So even themselves, they feel proud. They feel that they are concerned. They feel as some potential people to save the community because even the community now they are seeing them, uh, they are helping people, and not they are causing accidents. And so whenever accident happens, they are the one who become in front. To help the, those who, um, get injured, uh, try to give first aid, uh, in a professional manner and carrying the patient to the hospital.

So I can say we did a very good choice having this group, uh, which was blamed before, but now they are at the, our community in ones that they are being taken as a heroes that, uh, they are doing fantastic job because they’re the one who can do it. No one.

Jason: Yeah, that’s an incredible transition: to go from being blamed for the problems to being called when there are problems. Uh, that, that’s really just such a fascinating and, and, practical solution to a huge problem. So, could you share more, please, about what, what does it take to go from a regular motorcycle taxi driver to now one of Tanzania Rural Health Movement’s prehospital care responders?

What kind of training and preparation do you give them?

Marko: Yeah. Um, thank you, Jason. Actually, what we are trying to do is we give them basics. So we use like MARCH — MARCH like a primary surves and treatment. So MARCH we say we do, uh, we train them on how they can control Massive hemorrhage. We train them on how they can, uh, manage Airway. So, someone who has obstructed airway, how can you manage the obstructed airway?

Chin lift, chin twitch. Those are key areas that we are training them. Uh, we are training them how to access, uh, Respiration. So they can see if the chest is coming up and down, up and down. Assessment and they can decide, they can understand the condition of the patient, uh, and take the first period on in, in, in management or in in helping.

But also we train them to understand the Circulation of blood. Uh, is it good or it’s low? So if it’s low, what they should do, uh, to, to rescue the patient. But also we train them about on Hypothermia, so these like signs of shock. When they see the patient have cold extremities, what they should do so they need to do, um, they need to do quickly, uh, intervention and ensure that they keep the patient warm and take the patient to the hospital.

But before that we emphasize MARCH on, um, uh, issues of safety. That before you start doing any intervention in an emergent situation at the law to settle, you need to ensure your scene is safe. So that is very, very important because we don’t want to lose our trained first responder. Like now we have a well-experienced first responder, like a backer who has a lot of experience and have attended much for training, uh, to make himself confident. So we want to ensure them that they observe safety after observing safety, then they do those, uh, like basic first aid, uh, interventions. So from there, we also train them on how they can use the communication tool, because, uh, without communication, then their skills, we cannot use very well.

And we cannot use other communication systems that are available. Like, sometimes some of them are taking time. Because, for example, if I want to call one by one, the first responder one after one, one after one, it will take time. You can call the first one and say, I’m so far from the incident. Other one is not reachable.

But how to use Beacon properly. Because Beacon help us with a number of things to help us with data, but it helps us to communicate with, um, right first responder at right time, who is close to the scene. And as always, we are aiming that we need to provide the first aid intervention, within five minutes, as we know that everything needs to be quick, at least within an hour, the patient is at the hospital and other interventions are ongoing.

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So that’s the thing. But another thing, we are trying to train them to have a good personality as well, but also to have a sense of urgency. A sense of urgency, I mean, they are not to be selective, that I can go to this incident, I can’t go to that incident. They need to take this as a, this as, um, volunteers and, uh, to put a sense of urgency in anything, whenever they receive a call, then they need to respond on time after doing that, the trust is, is, is so huge to the community.

So people, they’re calling but themself once they have gained a good, um, reputation to the community members, most of the people are respecting them and they have good friends, they have good relationship with the police officers, with the traffic officers and so many. So you find someone who is working like, I can take you some of them who have been with them for more than four or five years.

Whenever you talk with them, they give a very good feedback that they have knowledge. They have good relationship with the people. They have more friends. So, for them, they feel good and, uh, they’re always available to help.

Jason: Tremendous. It’s just so awesome to hear about and, and we’ve been working together for almost 10 years now, but it’s always so great to hear about this, even though I’m so familiar with the story, it’s just awesome to, to hear about how far you’ve come along.

I’m wondering if you could share a little bit more about the relationship between the motorcycle taxi drivers and the community. How does the community know – because there are lots of motorcycle taxi drivers, right? – there are hundreds, if not thousands of them on the street. How does the community know, how can they tell the difference between your regular motorcycle taxi driver and one who’s been trained by Tanzania Rural Health Movement and is capable of providing care?

Marko: Yeah. So… Actually, thank you very much for this interesting question. Of course, there is a lot of motorcycle drivers and they’re keeping increasing every day. You know, being a motorcycle driver, it’s easy. It’s something that any person can do and get something for living. But for us, we try to ensure we have a unique identity and unique identity for us has a number of reasons.

First is identity of a first responder. But second, we make the community understand our first responder and also they can give us feedback. So if anything went wrong or they find our first responder is not behaving well, they can communicate with us. But also the third reason is a marketing strategy.

We need to keep our number, which is a toll free number, popular to our community and people they can sell, they can see. And. They can use it during emergency. So what we did, we designed a special uniforms. We have reflectors for them. We have t-shirts for them, and we have, uh, heavy jackets for them.

Like now we are going to the rainy season, so they can use a heavy jacket, uh, during, uh, emergency response. But they can use normal reflectors as well and t-shirt. All these have been put in the logos. For beacon, but you TRHM logos and the toll free number, which is 0800 720 112.

So this number is easily visible and those reflectors have reflective strips, so even during night people, they can see the difference. And I know you can ask me, you know, reflectors, some of the boda boda they are motorcycle drivers, the boda boda are using the reflectors, but we have tried to find the unique one, uh, which is can identify our first responders and then we can leave the others.

So we need to check the ones which are priced. The cost is up and they are of good quality. So that we can, uh, differentiate between our first responders and other, uh, motorcycle drivers. So that is the difference. But also on their motorcycles, we have tried to put stickers, stickers which show the toll free number and a message, right? Uh, that people, they need to call.

We discourage people to take pictures. Take pictures during incident. Instead of taking pictures, then they need to call the number for help. So if they call us for help, we are always being thankful that, uh, they have done something remarkable, something which is valuable, because taking pictures is not enough. You can take pictures, but someone is dying. So if you’re using a phone and you, we have a number, which is free, doesn’t need you to have credit on your phone, just call it. And then first responder, they come, they can come and help. So why not, uh, uh, calling the number and leaving behind issues of taking pictures and this putting on social media.

So whenever you come to Mwanza, you can see, you’ll meet with our first responders. Because there are many and they are moving around the city so you can see through their reflectors. Yeah.

Jason: So you have a real distributed response system, right? You run a medical dispensary and clinic called the Bisou Bailey Clinic and that’s where your operator, your dispatchers are located, but it’s not like you have a single station where all of your responders are based and then they leave from there. It’s different in that they’re all over the place and they’re moving around town all day long. Right?

So how many do you currently have? How many motorcycle taxi drivers or as. As they’re called locally, Boda Boda. How many Boda Boda do you have in your response pool right now?

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Marko: Yeah. So up to now, actually we have trained a lot of Boda Boda and some are officials from different departments from fire, from police traffic, Boda Boda themselves. So if I take the number since we started, we probably, we are nearly 200, but, uh, each different reasons, some of the Boda Boda, they decide to leave the town. They go to look at the way of income. Some of them, they quit riding motorbikes, they take cars. So there are different reasons that, um, happen, but up to now we have 25 first responders who are active, they’re active and are providing services. And what you have done, we did like a survey to check where are the hotspots for accidents? Then, for example, where are the hotspots for accidnts. And we try to recruit the first responders from those points, because these guys, they have a parking sites. In different areas within the town, they have parking sites. In one parking site, you can find maybe 10 Boda Boda.

In some parking sites, you can find even 20 Boda Boda. So it depends. So we go there and look for the best, uh, persons who can help us with responding to incidents. So we train them. So up to now, when we count about the parking sites, we have around 20 parking sites that we have our first responder, uh, who are trained.

So that distrbution is very key. It’s very important. Sometimes you can say, why, why can’t you put like your medical dispensers to be same area where our dispatching center is? Why can’t you put those first responders in one point? But the reason is we want to achieve a shorter time as possible to reach the scene that that’s the goal that we want to ensure that within five minutes we have a 21st respond at the scene.

So instead of putting them in a single point, we decided them to distribute in different points. Why? Because it’s easier for them to reach at the scene within a short distance than if we decided to put them in a single, uh, in a single point. That’s the reason why you can find them scattered all over the town.

And also this has been proved with our analysis which we have done recently. We have found that, uh, if you call for help at any point within Mwanza, you can get a first responder within a short time, less than seven minutes. So it doesn’t matter where you are, but the response time is the same. It’s almost the same.

And this also give us a strong evidence that we need to see to be, to, to, to distribute these first responders instead of putting on the same point. If we put them on the same point, it means that some of the, some of the, of the people who are asking for help will get a first responder within a shortest time, but others will get a first responder within a longest time, which is not good as we are, we are targeting on good and how, and for us, we don’t want to delay in ensuring that we, we, we do a basic first aid intervention within a short time and we can forward our patient to our, uh, nearby facility. Then they can continue with other definitive care.

Jason: It’s truly a brand new model. It seems so practical, and almost obvious, but it’s really a brand new model for emergency services, particularly in, in resource-limited settings. I’m wondering if you could talk a little bit more about, listeners are probably wondering if, if most of your responders are on motorcycles, then clearly there are some patients that can’t be transported by motorcycle.

So could you talk a little bit about how you, if, if you find a victim, a road traffic injury victim, or, you know, other patients you mentioned, pregnant women or, uh, people with acute illness. If they need to be transported to the hospital, how does that work if, if the majority of your responders are on motorcycle?

Marko: Yeah, um. Thank you for, for, for asking that question because it’s, it’s, it’s really important, especially for those people who they don’t know Mwanza, even some, some who know Mwanza, but, uh, uh, it has mountains and, uh, logs, et cetera. So sometimes you can’t use motorcycle to transport, you need to have, uh, an ambulance. So we had that challenge. And, uh, actually, it was a was a question which I was asked every time whenever I meet with Boda Boda during our training session. So whenever we do monthly training sessions, they used to ask me why we don’t have a dedicated transport for this patient. “We want to help. We want to help.” But someone who is a lower inflection. With a femur fracture, it’s probably bilateral fracture. It’s very hard. You can’t transport by using motorcycles. Patient in pain, you need to stabilize the patient. So it’s real hard. But sometimes patient with a spinal injury, with a spinal injury, actually you need, uh, some of the equipment, like spinal board, are to help you to transport this patient. At least to reduce further injuries. As always, that we target to reduce further injuries, uh, from our patient.

So, uh, I appreciate, uh, Trek Medics International and other, uh, partners that whenever, when we presented our idea that we need to have at least, a cheaper and cost effective, uh, van, which can help us to transport patient and we managed to get it last year. And, uh, what we try to do is just to do modification. So we did a modification of, uh, a small van, put a stretcher, spinal board, and some basic things that are important in, in helping the patient. So for now, that is no longer a challenge. And the best thing about the system that we are using, the Beacon system, if the first responder is there, and find that we see with the condition of the patient that our need, a transport like a van or an ambulance, then the system, there is a component of additional resources that you can ask additional resources. So when you ask additional resources, then the first responder can come.

But sometimes we, our, the community members who call us, we use them to, to identify the need. What will they need? You can find maybe a crash, a collision of vehicles. I guess you can say that the magnitude of casualties, you need to have a transporter and an ambulance. So that is easier for us to dispatch ambulances as well. So you can find that like we are selective because we have one vehicle, but we are very keen in getting light information. And, uh, like the right status of our patient, but with the help of the Beacon software, we can go, we can get an indication that, uh, the first responder to see need additional resources and what he needs is, is ambulance. So in that way, we have managed to transport some of the patient that they have spinal injuries, uh, pregnant women, uh, who are in labor, obstetric cases, um, but also some with, uh, head injuries, uh, severe fractures and many more.

So now we are like, uh, continuing to improve with what we have to meet our, our clients or community demand.

Jason: That’s fantastic. It’s really using available resources and, and, spending money exactly where it’s needed. You, you’ve overcome a lot of challenges, which you’ve discussed. I’m wondering if you could talk a little bit more, what, what are some of the challenges that you face? Well, what’s your aspirations for the future? And, and what kind of challenges are you facing that you’ll have to overcome to, to meet those goals and achieve those aspirations?

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Marko: Thank you, Jason. Uh, actually I can say, I didn’t expect how far we can go with this, with this project, actually at, at, when I was starting, it was like, I asked people to use the system, please use the system, please use the system. But now it has turned that the community wants a system. The demand is too huge.

So the demand is too huge. We means that we need to scale. We need to train more first responders. We need to reach more people, but formerly actually, I didn’t, uh, thought that it would come that very soon, but to us now it’s, it’s coming and we are getting more calls and other people asking “Why you are not in certain area, there are a lot of need. Why are you not there?” And you know that, uh, it’s something that we started from scratch. We are doing it still learning and understanding how others think, but, uh, we still need more resources to ensure now we can reach more people. Everyone can have access, a right to access. We’re based in Mwanza, but not all parts of Mwanza you can get us. Maybe we can go of 15 to 20 kilometers, but, uh, if you, you say we, we need to reach more people who are in need of it, actually. In need of it. They need of it. And then we need maybe to go a hundred radius, a 100 kilometer radius, then if it’s 100 kilometer radius or 200 kilometer radius, then we need to invest more in resources. We need to train more first responders. Uh, we need to have basic equipments like goals, uh, triangular bandages, splints, and many more. So the good thing with a system, the system can coordinate a number of incidents in whatever you are, in whatever places, in whatever number. But, uh, it comes down also to the resources that we need to accomplish.

But I, um, I believe that, uh, through, uh, partnership, actually we are trying to work closely with the government and, uh, trying to provide reports and giving them cases and evidences that, uh, they can join hands as well. But other people who are interested, try to explain to this how it works and how it helps.

Because whenever you talk about emergency, you don’t have guarantee, you don’t have guarantee that at what time or when it will happen. This, this is something that happens suddenly. It happens, uh, whenever you are not prepared. You can have money at banks, you can have insurance cards, but whenever an accident or any emergency condition happens, what you need is an emergency help, emergency help. You need first aid, with a right person who has at least basic equipment. Then others will come later, others will come later. So, we continue to make a call to the community members, to everyone we meet with, who come to our office, whenever. Just, uh, this should be a community thing, not like “TRHM, it’s ours”. Let’s contribute, let’s work together, let’s look for different resources, because you don’t know. You can be, you save, but your relatives can, can, can, can have, uh, can, can, can, can, and sometimes can experience incidents like emergency incidents.

So what we say, something that we started very slow and we thought that we’ll continue pleasing people. Please use the system, use the system. Now it is turned out that they need the system and the demand is increasing. The demand is increasing and we’re hoping next year probably we’ll be having, uh, if now we are going to three to four, maybe next year we’ll be 10. So if it’s 10 [emergencies] per day per month, it would be 300.

So if you go with that calculation for the whole year, the other year, the other year, you will find that the demand is increasing.

Jason: It’s an incredible story, Marko, uh, really you’re one of a kind and such a model for other communities across, not just Africa, but really around the world. I mean, this whole idea of limited resources it goes from community to community and the idea of having more responders available to reduce response times, and get people access to emergency care quicker, there’s really something you’re doing here that that is a model for many communities across the world.

If there’s, if people want to learn more about what you’re doing or reach out to you and talk to you and see maybe even if they can support you, what’s the best way to get in contact with you and learn about your work?

Marko: Yeah, we are now on, we have websites, we have social media, someone can Google “Tanzania Rural Health Movement” and it’s going to have our website, but, uh, I can mention maybe our WhatsApp number and email and our social media is @tanzaniaruralhealthmovement. So for email, you can email us through, [email protected]

So you can through that, but you can visit our social media, Instagram tanzaniaruralhealthmovement, Facebook: Twitter or X @infoTRHM. Also, LinkedIn is Tanzania Rural Health Movement. Uh, so we use Tanzania Rural Health Movement in most of our platforms, and we’ll be happy to hear from you, and we’re looking forward to connect.

Jason: Absolutely. We will include all of those links in the show notes. And just to confirm Tanzania Rural Health Movement is a registered nonprofit organization with the Tanzanian government, correct?

Marko: Yes, we have been registered as a non profit NGO with the minister responsible for the community development as a non government organization, and we are eligible for a number of things as far as NGO is concerned.

Jason: Fantastic. Thank you so much, Dr. Hingi. It is a real pleasure. It’s been such an honor working with you over the past few years and, and we just love your story and hope that we can get more people to hear about it and, and get behind the work that you’re doing.

Marko: Yeah. Thank you, Jason for hosting. And, uh, I’m so happy with the great collaboration that we have with you and the organization Trek Medics International. Thank you very much for making this happen.

Jason: It’s really our pleasure. Thank you.

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