Meet the inventor of the sidecar ambulance and clinic
The road has been long and winding – from a north London workshop on a chilly morning into the imagination of a Saudi prince, on to the rural home of Nelson Mandela, through Africa, and smack-bang into a political mud-slinging battlefield with choruses of “outrage” from the sidelines. And there’ve been a few adventures on the way.
We are talking about the eRanger motorcycle sidecar ambulances and clinics that have raised dust in South Africa. For the past 15 years, they have been produced in a factory in Zwelitsha in the Eastern Cape and distributed, via organizations such as UNICEF, CHAI and the Gates Foundation, through much of Africa and parts of Asia and the Middle East.
In my previous post, I detailed the scapegoating of the units after the producer, Fabkomp, won a tender to provide 100 clinic units to the Department of Health in the Eastern Cape, where the health system is weak and much of the population live in remote rural areas. The furore continues.
So I chatted with Mike Norman, the inventor of the eRanger, to find out where and why these motorcycles came to be. Mike is now in retirement and still fiddling in his Northamptonshire workshop.
First off, he tells you, it’s nothing new: motorcycle sidecars were used in the first world war as ambulances. There’s an entire history: have a look at Wikipedia for more, and do note that the eRanger features there.
“A sidecar has been proven to be a useful bit of kit in difficult conditions,” Mike says. “Before I started, there were no motorcycle ambulances, full stop, in the developing world. But I’m not inventing anything new; I’ve just adapted something. I am officially an inventor because of the drive system that I put on the prototype. So it is recognised, which is quite nice.”
The first stop
The prototype came into being in his motorcycle workshop on a damp October morning in 1997. Mike, who raced, designed and built motorcycles, was going through the post and “amongst the bills and general rubbish” was an appeal from an aid agency in Ireland for donations to buy a motorcycle for use in clearing landmines in Mozambique. He’d been thinking of exploring the use of a sidecar in Africa, and was somewhat bemused when a person from the agency wondered if it would survive driving over a landmine.
Nevertheless, “I picked up the phone, ordered steel and purchased new hacksaw blades”. He had visited family in South Africa, so was aware of the terrain, and as a keen off-road biker, “I understood what was required to make a suitable unit work in hostile terrain. The project was on.”
That first unit, called the Ranger LifeCycle, was “a combination of everything … neither an ambulance nor a clinic, but a mixture of both, with the capability of powering water pumps, a small generator and even a maize mill via a patented auxiliary drive system, which used the motorcycle’s rear wheel as the power source.
“The concept was for a village-based unit that could assist in income generation through improving the growing of crops, irrigation and delivering the produce to urban areas for sale, as well as take sick villagers to clinics or hospital. It even had a basic water filtration system on board and a large battery for lighting at night so children could do their homework.”
The idea was that a charity or other NGO could place it in a rural community to help them improve their standard of living.
It was “overly complicated”, he says today. But it did get him nominated for a Worldaware award and he won its Shell Technology for Development Award for his Ranger Production Company in 1999. Previous Worldaware winners include The Body Shop founder Anita Roddick (World Vision Award for Development Initiative, 1991) and wind-up radio inventor Trevor Bayliss (1996). The prototype had journeyed to Marowa near Harare in Zimbabwe, where its uses were quickly appreciated.
With his invention firmly in the public eye, Mike was introduced to Prince Bandar bin Sultan of Saudi Arabia. The prince was enthusiastic and helped the Ranger Company secure funding. “We were able to plan to move forward. Initially, we set up a factory in the UK to carry out research and development with the intention of replicating in Africa.”
It so happened that Prince Bandar was a friend of Nelson Mandela, South Africa’s first post-apartheid President, affectionately known as Madiba. Mike continues: “During a conversation with Madiba, the prince started talking about the Ranger. Madiba wanted to know: how could a motorcycle do all those things?”
A meeting with Mandela followed in Johannesburg. “Various items were brought up, including a potential project in his home area around Mthatha,” Mike says. “He asked about setting up the manufacturing base in the Eastern Cape as unemployment was very high. It was named Project Zondwa. He scribbled the name on a piece of notepad, which is one of my prized possessions.”
Nelson Mandela invited him, with his family and team, Mike says, to his home in Qunu in the rural Eastern Cape to launch the unit in 2002. “Local kings and dignitaries attended. The launch was at the rear of his property in the hall, with food and drinks, and lasted about three hours.”
The search was on for a partner for local manufacturing, and the search was brief. Mike and his team met Brian Harmse at a British government trade investment meeting in East London in 2002.
“We managed to obtain one of the project ambulance bikes to show the type of manufacturing that we were looking to invest in,” Mike recalls. “As we were struggling to get it down the steps without damaging the walls to the meeting room for display, Brian leapt to assist us.” Organisers had listed Brian’s company as one of those to visit: “We explained the project to him and arranged to visit his factory the next day. The factory and Brian’s attitude and transport background made perfect sense to us to enter into a partnership.”
To recap from the previous post, the Fabkomp shareholding today looks like this: 60% of Fabkomp is owned by DEmPower LD (100% black owned, 100% by people with disabilities and 54.55% by women) and 40% by Choice Decisions 52 (Pty) Ltd, of which Brian is the owner and managing director. Fabkomp owns 49% of eRanger.
The new partners asked their staff in Zwelitsha if they could come up with a new name for the Ranger. They did – eRanger (in isiXhosa, this means “the Ranger”).
It was clear, too, Mike says, that the unit should be more focused on use. “To start with, that was essentially an ambulance because maternal health was a big problem and still is … the aim was to get women in trouble in childbirth to clinics as fast as possible.” In Africa, the ambulance unit is the biggest seller, used mostly to get women in labour to healthcare facilities. The clinic unit was developed at the same time.
The two units are based on exactly the same concept. Mike explains: “eRangers are built on a sidecar platform, which consists of a base unit onto which various configurations can be mounted. This standardises the basic assembly and reduces production costs.”
- The ambulance unit has a stretcher system mounted to the base unit. It includes a roll cage for patient protection, which is also the frame for cover against sun and rain. A memory foam mattress and an IV bag hook are fitted. The ambulance can carry one patient in the sidecar and a nurse or carer on the pillion. Keep in mind that these are not meant to replace traditional ambulances; these are to get people from their homes to clinics, hospitals or ambulances (if they exist).
- In the clinic unit, a separate body replaces the stretcher. There is a seat for a healthcare worker and an extra assistant can be carried on the pillion. Moulded into the front is a washbasin and a lockable drugs compartment. Opening the front and rear storage areas creates stainless steel working areas. Other features include a water carrier, a baby weighing scale, a sharps needle disposal container, a 3m2 gazebo for shelter and privacy, and two chairs.
“The suspension on all eRangers is our own, modified for poor terrain with 200mm of travel on the front wheel and 150mm on the rear and sidecar. Ground clearance is approximately 300mm,” Mike explains for the more technically discerning. “All the tyres are of the off-road type, with aggressive pattern suited to poor terrain, and being quite light, the off-road capability is extremely good.”
Making a difference
Mike’s invention has taken him all over Africa, where the eRanger continues to serve people on some of the toughest terrains. He’s formed special relationships, including with trainee drivers. “Many have heart-breaking stories. I was chatting to a driver I was training in Southern Sudan while we were having a cooldrink. He told me he had five children, but he had not seen his youngest child for three years – the boy was kidnapped by Al Shabab on a raid on his village.
“A driver in Sierra Leone told me that he had to crawl down storm drains at night to avoid being caught whilst searching for food during the blood diamonds conflict of the early 2000s. Risk of capture could have meant amputation of a limb by machete by the rebels.
“Knowing that we are making a difference to their lives and others’ is humbling and rewarding.”
The evidence is that the eRanger is indeed making a difference, although Mike is quick to add: “We’ve never said it’s a silver bullet. It’s part of a system.”
He points to a project in Mbale, Uganda, funded by Welsh charity PONT. In 2005, 25 eRanger ambulances were introduced to an area with a population of more than a million. “Up to December 2019, these ambulances had made 26,000-plus referrals. These bikes are still going well, working in hostile terrain around Mt Elgon, 24/7, and have contributed to a reduction in maternal mortality in conjunction with other interventions, such as an expanded midwife programme.”
Backing it up
But let’s not ask just Mike for this evidence. There are plenty of studies, articles and accolades that back it up. Here are a few:
- In Sierra Leone, six eRanger motorbike ambulances were provided in 2006 as part of an emergency referral system. According to the researchers: “The ambulance … is well known to the communities, is acceptable and accessible, and is valued by those it serves … Motorbike ambulances are suited to remote areas and can function on poor roads inaccessible to other vehicles.” (Maternal and Child Health Journal, August 2012)
- In Malawi, use of motorcycle ambulances at three rural health centres reduced median referral delay by 2-4.5 hours (35%-76%). “In resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector,” the researchers said. (International Journal of Gynecology & Obstetrics, August 2008)
- Also in Malawi, “many roads are in such bad condition that they are difficult for normal cars and busses to use”. “To help address some of the barriers pregnant women are experiencing, the Safe Motherhood Initiative in the Dowa district … purchased [eRanger] motorbikes for their maternal health services.” The article uses preliminary data: “Since better transportation has been made available, the district has seen a continued increase in facility deliveries – from 25% in 2003 to 49% in 2007 – a reduction of 50% in referral times, and a reduction in MMR (maternal mortality rate) from 586 per 100 000 live births in 2004 to 235 per 100 000 live births in 2007. Some Malawian hospitals have even seen a 200% increase in the number of women giving birth in the facility … women are said to find the speed, efficiency and availability of motorbike ambulances to be better than those of car ambulances.” (World Health Organization newsletter, February 2009)
- The eRanger ambulance is at number 3 on this list of top 10 ideas that are saving the world.
- If you want more, look here, here, here and here.
As Mike says: “Any delays in reaching medical assistance will inevitably result in further complications, if not death, but proving it beyond doubt is always going to be difficult.
“However, it does not take much imagination to realise that a 30-minute trip in a motorbike ambulance is far more preferable than the same trip taking four to five hours in a wheelbarrow or on a skid mounted on the back of an animal or being carried by friends or family members.”