Bicycles ‘from the past’ bring better health care

Tuesday, 02 June 2009 09:37

Every weekday morning, a stylish procession of MaAfrika Tikkum health workers cruise the streets of Delft, Cape Town, between the shacks and houses, on their retro, single-speed Afrikabikes, their wire baskets filled with the accoutrements of home-based care.

People say it looks like a ‘bike from the past’, says Esmerelda Piers, who’s been working as a home-based carer since 2006. ‘Everyone wants one of these “ambulance” bikes...’

Piers was one of 108 MaAfrika Tikkun healthcare workers who received a bicycle in late 2008, donated by US-based project BikeTown Africa. The project aims to hand over a further 1 000 bicycles to health workers in 2009. [BikeTown Africa is a partnership between Kona Bicycle company, pharmaceutical company Bristol-Myers Squibb and Bicycling Magazine USA.]

The carers make home-visits, dress wounds and ensure that people with chronic illness (such as TB, diabetes and HIV and AIDS) are taking their medication. They also monitor the growth and wellness of newborn babies.

Piers has lived in Delft for 19 years, and like most carers used to walk from patient to patient. ‘It is slow, and tiring, and sometimes you have to rush to get to the next patient,’ she says. ‘If you want to take a taxi, you have to pay out of your own bag.’

South Africa’s national government pays home-based carers a stipend to visit a minimum of eight patients a day, but sometimes carers don’t get to see everyone, says Beryl van den Heever, who manages the MaAfrica Tikkum team. ‘It can take a long time to wash and listen to just one patient. Sometimes carers were only getting to see five people properly.’

‘Now, our carers see 8-12 people a day, they spend more time with the patients, and they get to see more people, and they can respond to emergencies more quickly…’

Charles Rosant, in his third month of home-based care, tells a story of how he visited a patient who had no food in his home. ‘How can I ask him to take his medicines with no food?’

‘It is being able to help like that that makes be stand up every morning,’ says Rosant – who got on his bicycle and sped to the nearest café to buy bread for his patient. ‘With walking, I would have only gone back to him the next day.’

‘We ride slow enough to people to come out of their houses and ask us questions,’ says Piers. ‘We can give advice “on the move”.’

In terms of energy expended over distance, a casual rider can travel four times the distance by bicycle as on foot, says Bradley Shroeder of BikeTown, and carry up to five times more goods. And in terms of speed, it takes about as much effort to walk at 4km an hour as it does to ride at 16km an hour.

Cycling is four times faster than walking

So during a commuting day of 16 km travelled, a bicycle saves about three hours or more – which is something Trudy Makerman knows very well.

Makerman is a healthcare worker in the fruit farming district of Robertson, Western Cape. She travels long distances – 10-20km – on steep gravel roads to visit babies and people with chronic illnesses.

In November 2008, the Association received a delivery of bicycles from the NGO Bicycling Empowerment Network (BEN) as part of a Shova Kalula allocation. Shova Kalula (‘pedal easy’) is a South African national government sponsored initiative that provides bicycles to rural and peri-urban learners, farm workers and health workers.

Since the advent of their speedier mode of transport, the team has been able to visit between 500 to 550 patients a month (and spend more time with each of them), compared to the 100 to 200 patients they saw when they walked.

‘Walking there was not the big problem,’ says Makerman. ‘It was the eindpad [the walking back], once the day was hot’ [Their working days end at 12.30.] We were tired by then, from the work. I would want to rest before visiting the next patient, I did not always have the energy for them.’

Unlike the urban-style BikeTown bicycles, the Shova Kalula bicycles have a sturdy top-bar, three speeds and a carrier on the back rather than on the front. Both types of bicycle are donated with a lock, a helmet, pump and patch kit, and healthcare workers are taught the basics of road safety and bicycle maintenance.

 ‘My bicycle is just right for me,’ says Makerman. ‘People can shout that I am too old [she is 43] and why don’t I get a car. But for me, my bicycle takes me away from my stress. It is good for me and good for my patients. All health workers should have one! ‘

Piers also finds personal benefit in her bicycle. ‘I go to see friends and cousins in Belhar, in Bellville, I go shopping, I visit my cousins… each time, I save at least R30 in taxi fare.’

And she takes her children with her, but only on her older bicycle – ‘my 9-year-old and my 6-year-old, they both fit on the bike, but I won’t use my work bicycle for this!’

‘But you know, it is not about the bicycle,’ says Piers – unaware that she is echoing the title of that famous autobiography. ‘Some people want to become carers because they will get a bicycle, but for us, the bicycle is just the cherry on the top. When someone thanks me for a job well done, I know why I am doing this. And the bicycle helps me do it better.’