August 29 2017

MUHANGA, RWANDA - 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 decidedly low-tech environment from which to work.

But that’s exactly the point. Zipline figured out early that it would be very difficult to test its drones in the developed world. 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.

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.

Zipline approached several different governments, but 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 a some blood for a patient.

The Zipline crew get moving. Gladys grabs two plastic bags of A-positive blood 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 2-metre 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 to 150 kph 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 challenges.

The drone - sorry, the zip - takes just 20 minutes. That might be the difference between life and death. It’s also cheap: although Zipline are cagey on their pricing, they claim their 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 onto 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 into a giant inflatable mattress.

The audience of about a dozen fascinated schoolkids, watching from the other side of the fence, cheers and claps.

‘We help save lives’

Zipline really believe in their product. They’re not the only ones. At the World Health Organisation’s recent Africa Health Forum, held in Kigali in late June, Zipline were the only commercial organisation given a stand inside 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 US 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 already 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 five kilograms,” 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, at least, it’s obvious that drones have the potential to revolutionise healthcare delivery across Africa. But in practise, the idea still needs to be tested and trialled and tailored to local environments. Zipline in Rwanda is just one case study in one country - hardly a proof of concept.

KASUNGU, MALAWI - Which brings us to Kasungu, in central Malawi. In some parts of this region, network connectivity is so bad that people must walk 200 metres just to make a call. Again, it is a distinctly low-tech area in need of some high-tech solutions - perhaps why it was chosen as the site of the Africa’s first humanitarian drone corridor.

The idea is simple: with the cooperation of the Malawian government, various international agencies have organised for a small patch of sky to be reserved to test different kinds of humanitarian drones. If they work here, then they can be rolled out later in other areas of the country and the continent.

Unicef and the Malawian government began working together in 2016 on the idea. A feasibility study proved the project was possible, and they then developed a task team which included the ministries of transport, health, and justice which put together draft regulations. The country’s civil aviation authority is responsible for tracking drones in flight.

In March 2016, some drones successfully transported infant dried blood samples used to diagnose HIV infection to laboratories for testing. Earlier in 2017, drones were used to take images of flood-affected regions in Malawi to help coordinate disaster relief.

For Alfred Mtilatila, director of Malawi’s civil aviation, these tests proved drones could be used for humanitarian aid. “We bring the good side of technology to people. People used to associate drones with military operations,” he said.

A call out was placed for drone companies and individuals to begin the process of applying for use of the drone corridor. The Malawian government was responsible for ensuring the safety of the drones, while 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 [Unmanned Aerial Vehicles] 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 described as a circle with an 80 kilometre radius around the Kasungu Aerodrome. Unicef says it will benefit 301 schools and 486 health service points inside the circle over the next couple of years.

Despite government’s enthusiasm for the project, getting community buy-in took a lot of coaxing. A year ago, some people in Kasungu feared drones would violate their privacy, cause harm, or were an instrument of witchcraft. The government had to win them over.

In a partnership with the United Nations Children’s Fund, the government sent representatives on buses with loudspeakers to inform communities that the drones would be used to improve healthcare access, provide internet connectivity and take images during humanitarian crises.

On launch day on 29 June 2017, anxious drone operators contend with unusually windy conditions, while government officials and local community members look on. The mayor of Kasungu, Ireen Katola, detailed again the potential benefits of the drone corridor in a country without adequate healthcare or road infrastructure.

“This [drone corridor] is such a milestone for Kasungu and the country as a whole,” she said.

Despite the bluster, the drones on show eventually make it into the air. The Skywalker X5, made by Swedish company Globhe, is designed to deliver wifi 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. Once launched, the Mail & Guardian turned on the wifi and keyed in the password provided. Suddenly, for the few with compatible devices, 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 new drones is supposed to help, eventually. The little girl sits patiently in the arms of her mother, Gladys, as her eyes dart around the clinic in Thipa, some 27 km away from the main town, Kasungu.

She is sick, although her mother doesn’t yet know what’s wrong with her. Maybe pneumonia, maybe malaria. Gladys Mwale’s eldest child is three years old and has already been to the clinic on numerous occasions.

“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, and a table and two chairs. One chair is for Amidu Malope (37), the community healthcare worker at this clinic. People in his profession are officially called health surveillance assistants (HSAs). They are scattered around villages in Malawi where they treat children from the time they are born until to five years of age.

HSAs are on the frontline of primary healthcare in Malawi, but they are often woefully 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 nearest district clinic to pick them up. He has a backpack where he carries everything on his back as cycles. 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 that both he and the community he serves so desperately need.

Drones could solve these problems. They could deliver directly to Malope’s clinic, even when it’s raining, providing potentially life-saving supplies. One that is being tested for this exact purpose is the Pixhawk 2 - a black, shiny spider-like craft that can be programmed to land almost anywhere. Malope hopes that it won’t be long before he sees it swoop into his clinic, leaving behind a box with all the vaccines, medicines and testing kits that he requires to do his job.

“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.

Reputation management

Drones have a bad reputation. They have, until now, mostly been used to take lives. 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 no obstacle 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.

It’s not that simple, of course. “The use of drones for healthcare services is a very solid innovation,” said Dr Olushayo Olu, Rwanda country director for the World Health Organisation. “But we still need to look closely at the cost and effect.” Olu wonders if drones will be financially sustainable in the long run. 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 and will make the jobs of healthcare professionals easier - and that, surely, is more than enough to reason to celebrate as they begin to take off on the African continent.