Are drones taking off as the future of African healthcare?
On a hilltop in rural Rwanda, in three shipping containers under a white marquee, a Silicon Valley startup is plotting world domination. “We want to create an instant delivery system for the planet,” says Maggie Jim, chief of staff for Zipline, a San Francisco-based drone manufacturer and operator.
Revolutionising Africa’s healthcare delivery system is just a means to that end.
The first stage of Zipline’s lofty ambition has brought the company to Muhanga, a small town about an hour by winding, undulating road from the capital Kigali. For such a high-tech product, it is a low-tech environment from which to work.
But that’s the point.
Zipline figured out early that it would be difficult to test its drones in the developed world. There are too many rules to work around, and too much opposition from lawmakers to technology with this much potential for disruption.
Instead, they needed somewhere with less regulation and a quiet airspace, and a government willing to grant them all the necessary permits and exemptions.
Incidentally, Zipline doesn’t like the word drone – too many negative connotations, especially in a region with a recent history of conflict – and wants people to refer to their aircraft as “zips” instead.
Zipline approached several governments, and Rwanda responded with the most enthusiasm. It helped that Zipline’s proposition, carefully tailored for a developing world audience, catered to such an obvious need. “It was an easy conversation,” said Jim.
As she speaks, a doctor phones in an order from Nyanza Hospital, one of nine hospitals in western Rwanda that Zipline now caters to. He needs some blood for a patient.
The Zipline crew get moving. Gladys grabs two plastic bags of A-positive from the fridge inside one of the shipping containers, and puts it in a specially designed cardboard box. The blood was delivered earlier in the day in a cooler from the national blood bank in Kigali. Meanwhile, Innocent fires up the drone. He attaches a battery, sticks in a few flash sticks that contain the flight instructions – where to go, what altitude to fly, what the weather is like – and instructs the onboard computer to do the pre-flight checks.
Gladys brings over the box, about the size of a shoebox. Innocent stuffs it in the tiny hold. The aircraft itself is not big – it’s got a 2m wingspan – and looks surprisingly fragile. The nose cone is made of polystyrene.
Checks complete, Innocent picks it up and takes it to the launchpad. There’s no runway. The take-off mechanism is basically a giant rubber band, tightened to near-breaking point, that catapults the drone into the air – 0-150kph in the blink of an eye.
Before Zipline, the doctor in Nyanza would send someone to Kigali to get the blood. It is a seven-hour round trip, without traffic or holdups at the blood bank. With some 81% of the population living in rural areas, most Rwandan medical professionals face similar difficulties.
The drone – sorry, the zip – takes just 20 minutes. That might be the difference between life and death. It’s also cheap: although Zipline is cagey about its pricing, it claims the service costs roughly the same as overland transport.
Above the hospital, the package is dropped. The parachute deploys instantly, and two pints of A-positive float gently to the hospital grounds. The aircraft heads back to Muhanga. Instead of landing, it is caught on a high-strength wire strung between two poles, and tumbles safely onto a giant inflatable mattress.
The audience of about a dozen children, watching from the other side of the fence, cheers and claps.
‘We help save lives’
Zipline believe in their product. They’re not the only ones. At the World Health Organisation’s (WHO) Africa Health Forum, held in Kigali in June, Zipline was the only commercial organisation given a stand in the conference hall. That week, Jim and her team in Muhanga were overrun by health officials from various governments, reporters and delegations from the likes of the United States’ Centers for Disease Control.
The company is in talks to begin operations in Tanzania and Costa Rica. The Rwandan government is so enthusiastic that it has asked Zipline to extend its services into other parts of the country, and into other sectors.
“We started with blood, but we’re looking into drugs and vaccines. Basically anything that can fit inside the package, and weighs less than 5kg,” said Jim.
She said the company’s next generation of drones will be able to carry more weight, and fly even further than the current 75km radius.
For Jim, Zipline is the beginning of a fundamental change in how health supplies are delivered in the developing world. “We like to think that we help save lives.”
The testing ground
In theory, it’s obvious that drones have the potential to revolutionise healthcare delivery across Africa. But in practice, the idea still needs to be tested, trialled and tailored to local environments.
Zipline in Rwanda is just one case study in one country – hardly a proof of concept.
Which brings us to Kasungu, in central Malawi. In some parts of this country, network connectivity is so bad that people must walk 200m just to make a call. Again, it is a low-tech area in need of some high-tech solutions – perhaps the reason it was chosen as the site of Africa’s first humanitarian drone corridor.
The idea is simple: with the co-operation of the Malawian government, various international agencies have organised for a small patch of sky to be reserved to test different kinds of drones. If they work here, then they can be rolled out to other areas of the country and the continent.
The United Nations Children’s Fund (Unicef) and the Malawian government began working on the idea in 2016. A feasibility study suggested the project was possible. A task team, which included the ministries of transport, health and justice, put together draft regulations. The country’s civil aviation authority is responsible for tracking drones in flight.
In March last year, some drones successfully transported dried infant blood samples for HIV infection diagnosis to laboratories. Earlier this year, drones were used to take images of flood-affected regions in Malawi to co-ordinate disaster relief.
For Alfred Mtilatila, director of Malawi’s civil aviation, these tests proved drones could be used for aid. “We bring the good side of technology to people. People used to associate drones with military operations,” he said.
A call was made for drone companies and individuals to begin the process of applying to use the drone corridor. The government was responsible for ensuring the safety of the drones, and Unicef looked at the humanitarian benefits.
“Malawi has limited road access to rural areas even at the best of times, and after a flash flood earth roads can turn to rivers, completely cutting off affected communities,” said Johannes Wedenig, Unicef’s representative for Malawi. “With [drones] we can easily fly over the affected area and see clearly what the impact has been on the ground. This is cheaper and better resolution than satellite images.”
The corridor is, more accurately, a circle with an 80km radius around the Kasungu Aerodrome. Unicef says it will benefit 301 schools and 486 health service points inside the circle over the next few years.
Despite government’s enthusiasm for the project, getting people’s buy-in took a lot of coaxing. Some residents of Kasungu feared drones would violate their privacy, cause harm or were an instrument of witchcraft. The government had to win them over.
In partnership with Unicef, the government sent representatives on buses with loudspeakers to inform people that the drones would be used to improve healthcare, provide internet connectivity and take images during crises.
On launch day – June 29 – anxious drone operators contended with unusually windy conditions. The mayor of Kasungu, Ireen Katola, detailed the potential benefits of the drone corridor in a country without adequate healthcare or road infrastructure. “This [corridor] is such a milestone for Kasungu and the country as a whole,” she said.
Despite the bluster, the drones made it into the air. One made an immediate impact. The Skywalker X5, made by Swedish company Globhe, is designed to deliver wi-fi connectivity to the region. It’s a tiny aircraft, so light that it can be picked up and thrown into the air for take-off.
But it works, for those with the necessary devices. The Mail & Guardian turned on the wi-fi and keyed in the password provided. Kasungu was connected. No walking required.
‘We will not have to walk’
Judifi Mwale is six months old. She is one of the people the drones are to help, eventually. The baby sits in the arms of her mother, Gladys. They are at the clinic in Thipa, 27km away from the main town, Kasungu.
She is sick, but her mother doesn’t yet know what’s wrong with her. Maybe pneumonia, maybe malaria.
“I get worried when my children are sick often. Although I worry, I’m always at peace because I get support from the clinic,” Mwale says.
The clinic is outdoors. It consists of some blankets on the ground where patients wait, a table and two chairs. One chair is for Amidu Malope (37), the healthcare worker. People in this profession are officially called health surveillance assistants. They work in the villages where they treat children from the time they are born until the age of five.
The assistants are on the frontline of primary healthcare in Malawi, but they are overworked and under-resourced.
Malope monitors Judifi’s breathing, then pricks her finger for a blood test. She doesn’t have malaria. He prescribes paracetamol for her fever, and a chewable tablet to help fight the pneumonia.
For Malope, these supplies are not easy to come by. He must cycle 27km to the district clinic to pick them up. He carries the medicine in his backpack. But on rainy days, which come around all too often in Malawi’s tropical climate, the river overflows and Malope can’t get the medicine and testing devices he and the people he serves so desperately need.
Drones could solve these problems. They could deliver directly to Malope’s clinic, even when it’s raining. One that is being tested for this purpose is the Pixhawk 2 – a shiny, black spider-like craft that can be programmed to land almost anywhere. Malope hopes it won’t be long before he sees it swoop into his clinic, leaving behind a box of supplies.
“It will help us a lot. We will not have to walk a long time and we can say it’s a big relief to us,” Malope says.
Drones have a bad reputation. They have been used to take lives. But why not use that technology as a force for good? Why not save lives?
It is a seductive vision, science fiction made real: imagine a world where life-saving drugs rain down from the skies, where mud-clogged roads are not obstacles to the provision of medical supplies, where cold chains stay cold, and where patients can receive the treatment they need in the clinic or hospital closest to their homes.
But it’s not that simple. Dr Olushayo Olu, Rwanda country director for the WHO, said: “The use of drones for healthcare services is a very solid innovation, but we still need to look closely at the cost and effect.”
He also cautions that they are no replacement for doctors, nurses and medical facilities. It doesn’t matter how fast you deliver drugs, if there is no one around to administer them.
No matter how efficient they are, drones can never replace health surveillance assistants like Malope, or the doctors at Nyanza Hospital. But drones can make their jobs easier – and that is more than enough to reason to celebrate as they begin to take off on the African continent.