AP PHOTOS: Sidecar ambulances help moms give birth in India

Dec 20, 2022, 7:06 AM | Updated: Dec 21, 2022, 9:57 pm
A motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, travels...

A motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, travels on a dirt road through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)

(AP Photo/Altaf Qadri)

              Bhupesh Tiwari from Saathi, non-profit organisation, poses with a first motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, which he had designed in 2014 with the support of UNICEF, in Kodagoan in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Tribals walk back to their villages after visiting a weekly market, where hundreds gather from far-flung villages to buy basics, in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. Motorbike ambulances are helping pregnant women and very sick patients to reach hospitals in Naryanpur district, in central India's Chhattisgarh state. Many of the heavily forested district's villages are nearly inaccessible, often miles away from motorable roads and connected only by rough paths spanning over streams and hills. The state's health system has struggled to reach remote villages that can be ten miles or more from roads. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick. (AP Photo/Altaf Qadri)
            
              Tribal women walk back to their villages through Abhujmarh, or "the unknown hills," after visiting a weekly market, where hundreds gather from far-flung villages to buy basics, in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. Motorbike ambulances are helping pregnant women and very sick patients to reach hospitals in Naryanpur district, in central India's Chhattisgarh state. Many of the heavily forested district's villages are nearly inaccessible, often miles away from motorable roads and connected only by rough paths spanning over streams and hills. The state's health system has struggled to reach remote villages that can be ten miles or more from roads. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick. (AP Photo/Altaf Qadri)
            
              Tribal men participate in cockfighting contest at a weekly market, where hundreds gather from far-flung villages to buy basics or to attend the keenly contested cockfighting tournament, in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. Motorbike ambulances are helping pregnant women and very sick patients to reach hospitals in Naryanpur district, in central India's Chhattisgarh state. Many of the heavily forested district's villages are nearly inaccessible, often miles away from motorable roads and connected only by rough paths spanning over streams and hills. The state's health system has struggled to reach remote villages that can be ten miles or more from roads. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick. (AP Photo/Altaf Qadri)
            
              Government health workers screen people for diseases like diabetes and malaria at a weekly market, where hundreds gather from far-flung villages to buy basics, in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. Motorbike ambulances are helping pregnant women and very sick patients to reach hospitals in Naryanpur district, in central India's Chhattisgarh state. Many of the heavily forested district's villages are nearly inaccessible, often miles away from motorable roads and connected only by rough paths spanning over streams and hills. The state's health system has struggled to reach remote villages that can be ten miles or more from roads. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick. (AP Photo/Altaf Qadri)
            
              A nurse checks Phagni Poyam, 23, a nine months pregnant woman, as a health worker Basanti Warda, left, holds Poyam's one-year-old son Dilesh at a hospital in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              A paramedic takes blood samples of Phagni Poyam, 23, at a hospital in Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, centre right, sits on a bench as she waits for her turn to get checked up at a hospital in Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Basanti Warda, left, a health worker, holds one-year-old Dilesh as his mother Phagni Poyam, 23, a nine months pregnant woman, disembarks from a motorbike ambulance as she arrives for a checkup at a hospital in Orchha in central India's Chhattisgarh state, Nov. 16, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Basanti Warda, right, who works at an early referral center, plays with one-year-old Dilesh, as his mother Phagni Poyam, 23, a nine months pregnant woman, looks on inside an early referral center in Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, a nine months pregnant woman and her son sit inside an early referral center in Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Lata Netam, a health worker, pushes a motorbike ambulance carrying Phagni Poyam and her son, up a steep slope through Abhujmarh, or "the unknown hills," on their way to a health centre, near Kodoli, a remote village in Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Villagers, carrying a sick man in a makeshift palanquin, cross a stream through Abhujmarh, or "the unknown hills," on their way to a nearest health center, some 20 kilometers away near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. Motorbike ambulances are helping pregnant women and very sick patients to reach hospitals in Naryanpur district, in central India's Chhattisgarh state. Many of the heavily forested district's villages are nearly inaccessible, often miles away from motorable roads and connected only by rough paths spanning over streams and hills. The state's health system has struggled to reach remote villages that can be ten miles or more from roads. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, a nine months pregnant woman, left, and other health workers look on as motorbike ambulance driver, Sukhram Vadde, 24, remove boulders from rocky riverbed for the ambulance to pass through Abhujmarh, or "the unknown hills," near Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Lata Netam, right, a health worker, holds Dilesh son of Phagni Poyam, who is expecting a baby as they disembark from the ambulance before crossing a stream through Abhujmarh, or "the unknown hills," on their way to a health centre, near Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, a nine months pregnant woman and her son sit inside a motorbike ambulance outside her home in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, centre, a nine month pregnant woman carries her one-year-old son Dilesh, as she leaves her home to reach a health centre, in an awaiting motorbike ambulance in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Phagni Poyam, 23, a nine months pregnant woman, dresses her one-year-old boy, Dilesh, as they get ready to shift to a health center in a motorbike ambulance in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Motorbike ambulance driver, Sukhram Vadde, left, health worker, Lata Netam, centre, and a villager digs a steep riverbank to make a road for a motorbike ambulance through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Health workers with the help of two passersby physically lift the motorbike ambulance, off the river bed onto the muddy and steep riverbank through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Lata Netam, a health worker, unsuccessfully tries to push a motorbike ambulance, up a steep riverbank through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Lata Netam, a health worker, tries to remove a boulder as Sukhram Vadde, 24, awaits on a motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, to cross a stream through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              Sukhram Vadde, 24, drives a motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, across a stream through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)
            
              A motorbike ambulance, a two-wheeler with a sidecar consisting of a hospital bed on wheels, travels on a dirt road through Abhujmarh, or "the unknown hills," to reach a pregnant woman in Kodoli, a remote village near Orchha in central India's Chhattisgarh state, Nov. 15, 2022. These ambulances, first deployed in 2014, reach inaccessible villages to bring pregnant women to an early referral center, a building close to the hospital where expectant mothers can stay under observation, routinely visit doctors if needed until they give birth. Since then the number of babies born in hospitals has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy related deaths for mothers per 100,000 births. (AP Photo/Altaf Qadri)

NARAYANPUR, India (AP) — The motorbike roared as it strained to carry the ambulance sidecar up a steep river bank. The bike’s rear tire whirred in place, kicking up water and mud while the sidecar — a hospital bed on wheels, under a white canvas canopy — lolled dangerously. Two health workers, who had been following on foot, tried pushing it, but it didn’t budge.

Eventually, the three gave up and settled for digging a new path.

After 40 minutes of digging and a push to lift the vehicle from the river bed onto the muddy path, the team was on its way again. The bike ambulance resumed its nine-mile trek across the forest known as Abhujmarh, or “the Unknown Hills,” to reach 23-year-old Phagni Poyam, nine months pregnant in the isolated village of Kodoli.

When the team arrived, Poyam was waiting next to her sleeping 1-year-old boy, Dilesh. Like many babies in Kolodi, Dilesh wasn’t born in a hospital, both because of the distance, and distrust of authorities. But in recent years, Poyam said, she has seen women or their babies dying during childbirth and she doesn’t want to take any chances.

“My baby will be safer,” she said in Gondi, a language spoken by an estimated 13 million members of the Indigenous Gond community.

Motorbike ambulances are helping mothers give birth in Naryanpur district, in central India’s Chhattisgarh state. The heavily forested district is one of India’s most sparsely populated, with about 139,820 inhabitants spread over an area larger than Delaware. Many local villages, like Kodoli, are 16 kilometers (10 miles) or more from motorable roads. The state has one of the highest rates of pregnancy-related deaths for mothers in India, about 1.5 times the national average, with 137 pregnancy-related deaths for mothers per 100,000 births.

While authorities and health workers agree that bike ambulances don’t offer a long-term solution, they are making a difference.

The state’s health system has struggled to reach remote villages. Residents of Kodoli usually walk the 20 kilometers (12 miles) to Orchha, the nearest market town. It takes about two and a half hours. The lack of roads often forces villagers to resort to makeshift palanquins to transport the very sick.

Although the government has been trying to build a road network, road works are often targeted by armed rebels, who’ve been operating in the region for four decades. The rebels say their fight is for the rights of Indigenous communities, who make up 80% of Chhattisgarh state’s population.

Bike ambulances were first deployed in Narayanpur in 2014. Today, there are 13 bike ambulances operating in three districts of Chhattisgarh, run by local authorities and a nonprofit called Saathi with the support of UNICEF. The idea stemmed from a similar project in Ghana, said Bhupesh Tiwari of Saathi. The ambulances focus on bringing mothers to and from the hospital, but have also been called to transport victims of snake bites and other emergencies.

Since 2014, the number of babies born in hospitals in Narayanpur district has doubled to a yearly average of about 162 births each year, from just 76 in 2014. The bike ambulances have helped nearly 3,000 mothers and their babies in the 99 scattered villages of Narayanpur district.

Once Poyam and her son were safely aboard, the motorbike ambulance retraced its route back to Orccha, taking Poyam to an early referral center close to the hospital where expectant mothers can stay under observation and see doctors. Mother and son had to disembark a few times while the motorbike ambulance negotiated a tricky slope or a rocky river bed. Sometimes, the driver, Sukhram Vadde, 24, had to lift large stones that threatened to jam under the carriage.

By the time they reached Orccha, it was dark. Lata Netam, the health worker in charge of the center, had called ahead when they left from Poyam’s village to ensure dinner was ready. One-year-old Dilesh gurgled happily, playing with others who work there, while Netam answered questions from Poyam: “What will the doctor ask me? Do I need documents? Can my husband come to visit me?”

“We are from here. We know these villages. We want mothers to feel like they have not left home,” she said.

Trust in hospitals and modern medicine is growing. In the villages, there are mothers who speak glowingly of the hospital. In the weekly market at Orccha, where hundreds gather from far-flung villages to buy basics or to attend the keenly contested cockfighting tournament, government health workers are busy screening people for diseases like diabetes and malaria.

Blood tests revealed that Poyam’s iron levels were dangerously low, likely because of a poor diet. This can lead to complications, like excessive bleeding while giving birth, so doctors prescribed supplements to help her.

Dilesh also tested positive for malaria. He immediately was hospitalized and treated for the virus, which kills thousands of children every year.

Dilesh has since returned to the village to stay with his father. Regular meals, boosted by supplements, have raised Poyam’s iron levels and she’s put on 9 pounds.

And a little after 2 a.m. on Wednesday, she gave birth to a healthy baby boy.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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AP PHOTOS: Sidecar ambulances help moms give birth in India