Category: Health

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NGOs – Don’t take the bicycle’s name in vain!

My PhD is on community bike projects, so I read a lot of NGO policy. I came across an interesting NGO evaluation of a pilot study undertaken in Uttar Pradesh, India.

As a development professional, educator and community bike advocate, this report entitled: The distribution of Aquatabs through a bicycle entrepreneur model in rural India caught my eye.

Expectations .. ‘bicycle entrepreneur distribution model’

Having previously worked on health and community education programs in developing countries I’m always keen to see how development interventions integrate and use bicycles to further connect promote and support positive community outcomes.

When I saw the title of this report I got excited.

I’m always keen to see what is happening in India as it is a hub of social development innovation and experimentation.

I was also keen to read about the specific focus on the ‘distribution’ aspect of a ‘bicycle’ project – I was expecting to read a lot on the use of bicycles in the communities.

I had visions of local community health and WASH workers riding bicycles around rural communities distributing free water purification tablets increasing community awareness for hygiene and clean water practices.

The report is based on the 2011 pilot of PATH’s Safe Water Project. This project was focused on implementing innovative methods to enable commercial enterprises to produce, distribute, sell, and maintain effective household water treatment and storage (HWTS) products for low-income populations in developing countries. This project brief used ‘the bicycle entrepreneur distribution model’ – and it was one of the first of a number of pilot projects that PATH undertook in India and other countries to overcome distribution and marketing barriers that make it difficult for HWTS manufacturers to reach lower-income households and rural markets.

 

NGOs - don't take the bicycle name in vain - Bicycles Create Change.com
Source: PATH (2011).

So I had a look at the report.

After scanning through the first 20 pages, the frown that had formed on my brow got deeper and more pronounced.

I found the contents of the report challenging to read.

There was scarce little detail as to the use of bicycles. Ultimately, the only reference to the use of bicycles in the whole report was that the 8 salesmen used bicycles to travel around to sell the product.

That was it. That was the extent of how bicycles were used in this project.

Talk about a let down!

It had no detail about if bicycles were provided free of change, at a discount rate, were part of a team fleet,  or if the ‘salesmen’ got to keep the bike afterwards. Nothing!

Sadly, the report was squarely focused on ascertaining commercial marketing and private sector avenues for product sales (of Aquatabs) – and not on assessing the ‘distribution’ or ‘bicycle model’ aspect of the project.

As I read the report, it seems decidedly incongruent with the ‘safe water for rural lower-income communities’ and NGO approach I was expecting to read.  The report reads more like a business/economic assessment of a failed marketing case study rather than the bicycles-helps-developing-community first impression I had. Bummer!

I skimmed over the content as I looked for the content I was interested in – which was how bicycles were used.

I found this on page 7…

In this model, BEs sold Aquatabs to rural consumers at weekly markets and through house-to-house visits.

Then this…

The model was implemented in 200 villages with approximately 67,000 households ver a 12-month period (May 2009 April 2010). Eight BEs serviced this area on bicycles, following pre-determined routes and schedules. The BEs were recruited, trained, and supervised by MART and were paid a monthly stipend of Rs 1,500 in addition to their earnings from Aquatabs sales margins.

Then this on page 18..

NGOs - dont take the bicycle name in vain - Bicycles Create Change.com

‘Peddlers’ or ‘health champions’?

I did smile at the irony of a comment regarding training, support and monitoring, whereby:

“Additionally, the BEs felt that their current job lacked pride because they were perceived as “peddlers” (telewalah) rather than health champions, and this limited their ability to interact with local leaders as well as with the community” (p 40).

(Get it…’peddlers’ or ‘bicycle salesmen’..oh dad!  Definitely cultural/vocab humour!)

Where was the ‘bicycle entrepreneur model’ in all this??

In my view, if the bicycle model term was important enough to put into the report heading, it is important enough to explain in more detail that what was provided.

Why is the mode of transportation used to get around important to mention in this project? You don’t see equivalent ‘walking entrepreneur model’ or ‘minibus entrepreneur model’ or ‘(insert mode of transport here) entrepreneur model’ – so what make the bicycle so special to mention here? And if it is special to mention – it’s reasoning needs to be better explained.

It is logical that bicycles would be used in developing contexts for project staff to travel in and around villages. Is this idea still such a revelation that it is still a new idea for NGO practice? I should think not! I was surprised that this was such a basic project feature was so prominently highlighted, yet not explained in this report.

I thought…Maybe it was bad report writing. Maybe the title was deliberately chosen to attract a certain audience. I couldn’t help but be a little miffed by ‘bicycle’ being in the report title where there was no further explanation of its use, especially considering the connotation of bicycles being synonymous with local, grassroots community development.

I felt this was taking the bicycle’s name in vain.

It kind of felt like false advertising. It was akin to supermarkets putting fresh produce into ‘green packaging’, relabelling it as ‘fresh farm produce’ and then charging double to capitalise on the current wholefood/vegan/natural eating health trend.

I ended up having to look elsewhere to find a Project Brief Document that provided some point of reference at least for the role that bicycles had in this project – which was minimal anyway. Surely this should have been in the assessment report? Even after finding this separate document, there was still a lack of detail about the provision, ownership and handover of the bicycle.

Below is as much info about how bicycles were used in this project as the NGO provided:

NGOs - dont take the bicycle name in vain - Bicycles Create Change.com

Note to self: Be wary of how ‘bicycles’ are represented in NGO and development documents.

What a disappointing report!

It was a salient reminder for me about the variation in approaches, purposes and communication styles of NGO programs. Equally, although bicycles are used in some NGOs projects, it is not always in the most productive and positive manner – sometimes bikes are just used to ride and get around!

Equally, although bicycles are used in some NGOs projects, it is not always in the most productive and positive manner.

It was a good lesson – a reminder to be vigilant and judicious when seeing that a ‘bicycle’ is included in a project somewhere. Be sure to look more closely and see to what degree the bicycle is actually used before automatically assuming the project is ‘good’ just on the basis that a bicycle is mentioned.

Despite my personal reservations, I am always supportive of more bicycles being used in communities.

Notwithstanding my critique of this particular report, it is still good to see bicycles being better recognised and incorporated into INGO community project discussions.

Viva la use of bicycles to promote greater health and community development!

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Yoga for cyclists

This last week I returned from an (informal) 3-day ‘yoga for cyclists’ retreat.

I say ‘informal retreat’ because we actually to visit an old school friend of husband’s and his gorgeous partner at a spectacular property in Dunoon, NSW. And I say ‘for cyclists’ because both husband and I have been riding bike recreationally and competitively for a number of years now.

Luckily for us, our delightful host couple have just recently returned from an extended stay in India, where they were living in a yoga ashram to undertake their yoga instructors course (hence ‘retreat’!).

It goes without saying that staying with them was blissful, gentle and wonderfully restorative.

Yoga for cyclists!  Start the day right!

We were up at 5 am for an hour of meditation, then two hours of yoga followed by some more meditation – all before breakfast.

What a way to start each day!

Although I still did some reading for my PhD, I did not ride during this trip as I just wanted to invest in some quality rest and relaxing downtime. To this end, I was really just a love sponge for the amazing views, good company, scrumptious veggo food and stunning campfire-under-an-endless-night-sky vibes (*sigh*!).

Best of all, we did yoga every day – and I mean good yoga!

We did all the yoga poses you would get in classes, but also held some for considerably longer. Plus, we did a variety of yogic purification breathing techniques that I have not tried before – super interesting!

An additional bonus was that both our hosts team-taught each session, which was brilliant for the balance of yin/yang – male/female energies.

However!

Given years of competitive and recreational mountain bike riding, this daily yoga practice really drove home how tight my thighs and hips were – and how important regular stretching is.

A month of yoga (for cyclists) challenge

Since returning, I have committed to a month’s yoga challenge – with a focus on unlocking and releasing the years of stored up cycling tension (it might take a while!). After my initial month trial ends,  our two yoga hosts suggested to check out their ashram’s online yoga practice.

Their ashram, Akhanda has a number of yoga classes free online as well as a private youtube channel, which for $10 a month, you are able to access to a series of yoga sessions (5 x 30 mins per week, or 5 x 60 mins per week, etc.).

Overall impacts thus far?

I am feeling so much better for doing daily yoga and will definitely continue.  I have really enjoyed the progress I have made in the last eight days and can feel the difference in my legs, hips and torso. I feel a lot stronger, more centred and have noticed a considerable improvement in the range of movement in my hips.

This month’s yoga for cyclists challenge serves as a timely reminder to slow down and to explore alternative approaches to getting stronger.

Maybe some days, if it is raining outside and you are not up for a ride, you can work in, instead of work out! (Oh no, dad!).

So if you have not done yoga lately, here is one of the better of many popular yoga classes designed specifically for cyclists to get started.

I hope you have fun and get as much satisfaction out of it as I am! Enjoy!

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Japan: Medical Use of Bicycles – enjoyable rehabilitation

by Sachie Togashiki

 

I found an interesting article about the development of bicycles for rehabilitation for hemiplegic patients. Sufferers of apoplexy, a percentage of which is overrepresented in mortality rate in Japan, tend to have a secondary disease, which is hemiplegic, after surgery. In order to recover from hemiplegia, rehabilitation is needed, but it usually bores patients or needs someone’s help. To solve this problem, two authors, Hiroshi Shoji and Takeshi Aoki at Chiba Institute of Technology, are trying to develop bicycles for easier and more fun rehabilitation.

How does it work?

The attraction of using bicycles as a rehabilitation tool is its sustainability, non-boringness, and refreshing feeling which comes from outside exercise. Although there is the attraction which the authors can make use of, they also need to cover some anxieties such as safety and uneasiness when pedaling. In order to guarantee safety, a foot which is not paralysed is applied a load to, so that a rider cannot pedal too fast, which results in a stable and low pedaling speed. In addition, a load is applied also to reduce patients’ uneasiness caused by a feeling of unbalanced heaviness depending on feet. The authors used an electrically-powered tricycle made by YAMAHA for an experiment and succeeded in keeping a low pedaling speed by applying a load to a healthy foot. They are going to conduct an experiment to mitigate patients’ uneasiness and to develop a smoothness when pedaling.

Significance

The article is crucial because this is an academic article which was published as a documentation of JSME (The Japan Society of Mechanical Engineers) Conference on Robotics and Mechatronics and it shows a new significant way of using bicycles. Because riding on a bicycle is lots of fun and can be done without any permanent help, the authors suggested using bicycles for rehabilitation for the hemiplegic patient, which means bicycles can be used not only for town development and disarmament, which I will report on in two upcoming posts, but for medical uses. The use of bicycles as a rehabilitation tool might enhance patients’ motivation to recover from hemiplegia and contribute to a more positive future.

Additionally, in order to get the article, I paid for it, while most of the Australian articles are available for free. This made me think about freedom for students to research in Japan, which might be a little poorer than Australia.

 

Shoji, H., & Aoki, T. (2014). Development of rehabilitation bicycle for hemiplegic patients. Proceedings of the JSME Conference on Robotics and Mechatronics, 14(3P2-G03), 3P2-G03(1)-3P2-G03(2) Retrieved from http://ci.nii.ac.jp/naid/110009967356

 

Sachie Togashiki is our Guest Blogger, unveiling some of Japan’s bicycle culture, from 11th April to 24th April.

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Fleet Farming

What is Fleet Farming?

– A community-driven, low emission distributed urban farming model
– Build home gardens less than .25 acres throughout the community
– Use bike-powered transportation for maintenance and harvest of produce
– Sell produce at local farmers markets, food trucks, and local restaurants

Fleet Farming

The ‘Fleet Farmer’ name refers to ‘Farmers’ on a ‘Fleet’ of bicycles, helping to manage the grow-to-harvest process of urban farming. These Farmers will be made up of members of the surrounding community and members from partnering organizations. Each Farmer will sign-up for a scheduled bike ride once per week, traveling an average of 8-10 miles from the Winter Park Urban Farm to East End Market, and back.

Throughout the ride, the Fleet Farmers will stop at various home gardens participating in the program. Each garden will be regularly maintained, including tilling, watering, removal of weeds and pests, application of organic fertilizer, harvesting of the fruits and vegetables throughout the year, and distribution of the local produce to local venues using pedal power.

In Phase 2, the Fleet Farmers will also help in collecting compost from the restaurants in route that are interested in providing pre and post-consumer food waste to develop the final piece of the closed-loop system.

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This bike has Multiple Sclerosis

This remarkable health education initiative really personifies how bicycles can innovate positive social change – in this case, raising awareness about Multiple Sclerosis (MS).

MS Community Education

This initiative brilliantly mixes science, bicycle design, expert collaboration and cyclists to produce a community education campaign where a normal bicycle was augmented in a variety of ways to represent the MS symptoms.

To achieve this, each of the major executive functions on the bike such as the fork, handlebars, seat, frame and gears were altered so that the impact of the disease could be experienced first hand when you try to ride the bike – thus demonstrating the daily challenges that suffers have trying to operate their bodies as this autoimmune disease destroys their nervous system.

Ad Week promoted this ad campaign by giving it international recognition for its ingenuity and creative approach – and very effectively linked this issue to the lived experience of Penelope Conway who is an MS Suffer and informatively and humorously writes about what Multiple Sclerosis really feels like.

The Ad

This bike has Multiple Sclerosis video (2 mins) explains the rationale and research that has gone into the strategic design of this bike.

 

This community awareness campaign is not only effective in reaching a wide audience and communicating its message, but it is clear and has immediate impact. One of the best aspects is that it is specifically designed to be experiential and engaging for the public.

This campaign is a great example of how a creative approach to presenting a public health issue can generate excitement, consideration and interest about an issue such as MS. In doing so, it is highly successful in prompting public education and discussion about what MS is – and the metaphor of a ‘rider’ trying to ‘control a bike’ as being similar to what an MS suffer experiences to control their body, is a stroke of genius. Most people who have no contact or exposure to MS, will be able to easily relate to how difficult it can be to ride a bike if there are mechanical problems.

If only there were more interactive, dynamic and enterprising projects such as this one that can equally correlate the public’s normative experience (of riding a bike) with a emerging/public issue (MS Awareness).

Want to try riding it?

Those in Melbourne next month (March 2016), will have the opportunity to try to ride this bike for yourself at the MS Melbourne Cycle on March 6, 2016 by registering at bike@thisbikehasMS.com.

The team
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African Bicycle Ambulances

The research I looked at today was how African bicycle ambulances are being used to provide a more effective maternal health services.

 

This is an area of health services that has a high priority within the UN Millennium Development Goals and in Africa, this is an area of significant concern and where much aid effort is concentrated. One older Transaid project from Zambia, which implemented a number of bicycle ambulance projects in various regions in Africa, stood out for me in particular, so I thought I would share the project highlights with you.

 

Background to African Bicycle Ambulances

Transaid is a charity organisation established by the Charted Institutes of Logistics and Transport in association with Save the Children Fund. Its primary objective is to address major transportation issues faced by poor rural African health services. This project focuses on maternal health, as these indicators provide a solid representation of the efficiency of the overall health care system in a given area. Rural Africa faces severe patient mobility issues, even for short distances, with access and cost being the most critical factors, especially in emergencies and fistula cases. Additionally, the further demand and requirement for Immediate Modes of Transport (IMT) ‘is significant among maternity cases’ and this is most significant given that ‘one of the biggest reasons for the large number of maternal mortalities in developing countries is the time and distance pregnant women have to travel to the nearest clinic to receive proper care’ (Forster, Simfukwe, & Barber, 2010, pg 13). One example of the seriousness  of this situation comes from an Ethiopian Fistula Hospital, which reports that it takes women in labour an average of 11 hours to reach a health facility that can provide for their needs – and this is in the urban capital city of Addis Ababa!

 

Project

To increase access to urgent health care services, 40 bicycle ambulances were provided to rural communities in Zambia in 2008, which provided a free bicycle ambulance service for community members. This project was better thought out than a number of others I have read, mainly as the bicycle ambulances were allocated to community-based home carers (personal) and not assigned to be stored and/or work out of a health clinic (location). This is much more appropriate, as location issues such as access to a bike (if they are in a room or shed on location which is locked), or only having one particular staff member who has a key, limited clinic opening hours or collecting oxen to be hitched to a cart from surrounding areas, – have all often hampered response times in similar projects. Additionally, ten local field mechanics were trained to construct and service the ambulances, which was found to be a major success factor.

Bicycle Ambulance Design considerations: Three different bicycle ambulance designs were trialled and assessed. A design with a stretcher, full canopy and a non-flexible hitch was the considered the most comfortable and popular by riders and patients. Other interesting feedback considerations were:
• The bicycle should be permanently attached to the ambulance to extend the life of hitch apparatus.
• Rear wheel post frame hitching made turning more difficult than seat post hitching.
• Provision for a pump, basic maintenance tools and a first aid kit is needed.
• Lights were required for night-time call-outs.
• Bicycles needed to be lighter or adequate gears used for uphill trips.
• Clothing should be provided such as a high visibility vest and a rain jacket.
• The size of local door frames was an issue as the original prototype ambulance was too wide to fit through a standard Namibian door frame – which impacted on patient transference.

 

 Results
• During the whole program, the bicycle ambulances took 251 life-saving journeys – the longest trip being 40 km.
• During the pilot program (first 4 months), the bicycle ambulances were used 82 times to transport patients to health care facilities.
• By having a personal bicycle ambulance, 96% of the recipient caregivers were able to be more effective in their work.
• Travel time was significantly reduced (from 2.5 hours by ox-cart down to 30 minutes) by using bicycle ambulance.
• Patient safety and comfort increased – they could lie down on the bicycle ambulance instead of sit (or ride) on a personal bike.
• The bicycle ambulance canopy provides shelter (rain, mud, sun, animals) and privacy for patients (especially important for women who are nearing birth – i.e. waters breaking etc).
• Having a stretcher attached meant that river crossings were much safer and easier and the bikes were able to take walking paths that oxcart transportation was unable to manage.

 

Comment

There has not been any further monitoring and evaluation data from this particular project – but as it stands, this project seems to be a step in the right direction. It is encouraging to see bicycles being utilised to help address some of the most pressing and urgent health issues that disadvantaged poor African women face. It is incredibly important that such initiatives are investigated, promoted and disseminated. It is also a very humbling reminder for people living elsewhere, (like Australia) who can often forget how significant and urgent basic (community) health services can be.

 

Source: Transaid

Forster, G., Simfukwe, V., & Barber, C. (2010). Bicycle ambulances have impact. Appropriate Technology, 37(3), 13.