health care by land or by sea

by by Kate Van Brocklin

illustration by by Alexander Dale


The longest lake in the world holds 18 percent of the world’s fresh water, borders four countries, and, surrounded by steep mountains and underdeveloped coastal plains, is nearly impossible to access. Healthcare infrastructure is either nonexistent or nonfunctional along the coasts of Lake Tanganyika, which borders Tanzania, the Democratic Republic of Congo, Burundi, and Zambia. The 12 milllion people who live along the lake face many infectious diseases that have been eradicated in other places. The most common diseases are malaria, cholera, and measles. In Congo, malaria is the leading cause of death and illness. Nearly 95 percent of the population lives in malaria-endemic areas. Combined, Congo and Nigeria account for about 40 percent of malaria cases and deaths in Sub-Saharan Africa each year—children being most at risk—according to the World Health Organization.

In one of the most challenging landscapes in rural Africa, two innovative models are expanding the distribution of health care to ensure consistent aid—a boat and a truck.

The Lake Tanganyika Floating Health Clinic is a proposal for a ship, envisioned by American physician Amy Lehman, which would travel for one to two weeks at a time through to isolated communities. A team of US, European, Congolese, and Tanzanian medical professionals would offer checkups and surgeries, including emergency response and trauma care, specialty care, and medical transport. The clinic would also help distribute medicine and medical equipment to areas that border the lake, which have weak overland supply chains.


The ship would offer two onboard operating rooms, intensive care facilities, a small inpatient ward, ship-to-shore loading equipment for the establishment of temporary land-based patient registration and treatment areas, and an outboard motor boat to serve as a water-based ambulance, according to the organization’s website. A large component of the clinic’s mission is to implement training for local medical providers and visiting personnel. 

The founder of the organization, Dr. Lehman claims that this regional hospital could provide resources to one of the most geographically inaccessible regions on earth. So far she’s raised about $795,000, the majority of which has been used for direct services, like supplying mosquito nets, medicine, and bandages.


As daunting as the task is, Lehman told The Daily Beast that she “loves going and doing the hardest thing.” She first witnessed the region’s abject poverty while on vacation there five years ago. At the time, Lehman was a cardio-thoracic surgery resident at the University of Chicago. The desperate situation in the region troubled her. She decided to quit her residency and commit to building a floating hospital on Lake Tanganyika.

Lehman needs to raise roughly $6 million just to build the boat, about half the cost of building a more traditional hospital in the West, which usually have 165 beds and 20 operating rooms compared to the Lake Tanganyika Floating Health Clinic’s proposed two operating rooms.



Aid on Wheels
In Namibia, the Mister Sister Mobile Health Service employs a similar solution for providing care to remote communities—a hospital on wheels. Two mobile clinics cover the Otjozondjupa, Omaheke, and Khomas regions in eastern and southern Namibia; each equipped with two nurses and a driver who is also trained to provide administrative support. In 2008, the PharmAccess Foundation and Namibia’s Ministry of Health, two investors in the new delivery service, commissioned the first clinic. PharmAccess is a Dutch non-profit dedicated to strengthening basic health systems in sub-Saharan Africa by using public-private partnerships to alleviate the healthcare burden of African governments. The clinic was established in response to a national study conducted by PharmAccess that showed how rural employees and their dependents have limited access to health services. In 2011, a second clinic was mobilized due to increased need for healthcare. At the end of January 2012, there were 53 participating employers on the Mister Sister outreach route, with approximately 4900 individuals registered on the electronic database as potential patients. As of February 2012, there were 4630 patient visits from 1824 patients.


In addition to providing care, the organization also offers health insurance for services in the communities it serves. Those who benefit from the clinic include rural employees and their dependents, whose employers contribute to the healthcare program through annual subscription and premium contributions. The clinic is also available to other community members on a fee-for-service basis. Services for poor communities, pensioners, and orphans receive scome primarily contributions of medication from the Ministry of Health, donors and other corporate sponsors.

Working with the Namibia Global Fund Programme through the Namibia Business Coalition on AIDS (NABCOA), PharmAccess conducts wellness screenings for blood pressure, BMI, rapid blood testing for glucose, cholesterol, HIV, hemoglobin, Hepatitis B, and syphilis.


Both the Lake Tanganyika Floating Health Clinic and the Mister Sister Mobile Health Service are attempts to serve those who need assistance for severe diseases and illnesses. Patients who cannot be treated by these traveling hospitals are referred to the nearest public health facility, though that may be a great distance away. Though the organizations work to connect gaps in rural Africa between medicine, vaccines, technologies, diagnostics, and patients, they provide only a piece of the ongoing conversation needed to guarantee a network of health benefits and treatment for all. These models provide emergency care for the inhabitants of remote African regions, but interventions are still needed for long-term preventative solutions.



KATE VAN BROCKLIN B’13 floats for the cure.