HISTORY
In 2018, Tasmanian Pharmacist Brian Hanafin visited Burundi with a group of fellow Tasmanians, and saw first hand the plight of the local people, where many suffered greatly with untreated health conditions. Many Burundians are afflicted by malnutrition, malaria, diabetes, skin conditions and injuries. While visiting the Ubuntu Clinique, a Charity Hospital run by Burundian doctor Jackson Nahayo (see separate tab for his profile) a young boy presented with a leg wound that had started as a small scratch. As the family had to walk some 10km to access treatment, by the time he turned up at the clinic the leg was massively infected. Unfortunately by this stage his leg required amputation and treatment with antibiotics. (a course of the basic antibiotic amoxycillin costs over $15.00, ie: 10-20 days wages). The boy was treated and returned home. Unfortunately, the infection returned, and unable to afford another course of antibiotics, the boy died. Also found was a homeless single mum and her severely malnourished 9 month old infant son “Rodriguez” who only weighed 3kg. and had very poor prospects. He was put on a nutrition plan, and when Brian visited again 6 months later, he was 5kg and while improving could still not support his own head. By 5yrs of age, Rodriguez was almost at his correct body weight and ready to start school. Meanwhile Dr Jackson had put the family on a plot of farmland with a hut to live in, and the ability to grow crops to feed themselves and sell for some income.
While the Ubuntu Clinique provides an amazing service, often forgiving the cost, it is dependent on the patient making their own way to the clinic. Vast numbers of rural Burundians do not have that luxury due to several factors. Discussions with the director of the local government hospital, and the few international aid organisations working in Burundi revealed that there was a huge vacuum of care in this space – especially with regard to children.
Upon returning to Australia, Brian remained troubled about this situation, and what, if anything, he could do about it. Somehow the situation needed to be reversed – if patients cannot get to the hospital, then the hospital needs to get to the patients – hence the proposal of establishing a mobile health service.
THE MOBILE HEALTH SERVICE
Following discussions with Dr Jackson and others, the Mobile Health Service (MHS) was conceived. A pilot program was developed in which we employed six Burundian trained nurses, purchased three motorcycles and medical supplies. Based out of the Ubuntu Clinique and under the supervision of Dr Jackson, the MHS commenced on 23rd June 2022, as our first teams travelled into the villages of the surrounding hills. Their commission was to educate people on hygiene and preventive health, to treat conditions where possible, and to triage those needing higher medical care and transport them back to the hospital on their motorbikes.
What our MHS nurses discovered was a total shock to all in the health team, with at least three lives being saved on the first day including two infants. Undiagnosed malaria, diabetes and hypertension, infected wounds, hernias, tumours, and pregnancy complications with untreated patients lying on their hut floors dying. A heartbreak for our team is the discovery of people suffering where we could have helped if the MHS service had been available sooner.
Nurse Emmanuel describes finding patients with significant wounds that have been untreated. In many cases the outcome has been amputation, or even death, which could have been prevented with earlier treatment. Many wounds progress to a cancer without treatment.
Nurse Emmanuel describes finding patients with significant wounds that have been untreated. In many cases the outcome has been amputation, or even death, which could have been prevented with earlier treatment. Many wounds progress to a cancer without treatment.
In the case of this project, a major challenge is transporting patients. Many present with broken limbs, severe malnutrition, malaria etc that require transport back to the clinic for treatment. Transporting on motorcycles poses significant risks due to the extremely rough roads and tracks. A specific concern is pregnant women with complications, where loss of the baby in transit is quite frequent. As anything less than a serious 4WD cannot reach these areas.
In July 2024 the MHS took delivery of a LandCruiser 4WD as a dedicated patient transport vehicle, which is able to safely transport patients to and from the hospital.
Nurse Anita: “The Mobile Health Service has removed the barrier where people are afraid or too shy to seek medical help as they cannot pay. People are also more likely to open up to the nurses as they realise they can access the care. The impact will be to reduce the numbers of very sick through preventative interventions.”
Nurse Anita: “The Mobile Health Service has removed the barrier where people are afraid or too shy to seek medical help as they cannot pay. People are also more likely to open up to the nurses as they realise they can access the care. The impact will be to reduce the numbers of very sick through preventative interventions.”
The scale of need for the Mobile Health Service has shocked and surprised even the local doctors and nurses, with nurse Anita describing her personal growth as she experienced conditions she learned about in training but had never previously seen in practice. The “success” of the service has had flow on consequences including extra pressure on the already crowded hospital, to the extent that they have had to employ another doctor/surgeon to cope with the demand. The cost of medical procedures and medical supplies is largely being borne by the Mobile Health Service and the Ubuntu Clinique, which both require donations to provide the service.
Dr Whyman (consulting surgeon): “I would like to see the Mobile Health Service expanded as it is saving lives by preventing disease in the community. By treating conditions before they become serious, the service is reducing the cost of treatment and reducing hospitalisations. A further consequence is a dramatically reduced impact to the patients and families”
Dr Whyman (consulting surgeon): “I would like to see the Mobile Health Service expanded as it is saving lives by preventing disease in the community. By treating conditions before they become serious, the service is reducing the cost of treatment and reducing hospitalisations. A further consequence is a dramatically reduced impact to the patients and families”