Drones to the Rescue: Zipline’s Blood Deliveries Save Lives in Rwanda

In Rwanda, autonomous drones are saving the lives of millions

MUHANGA, RWANDA — In mid-2015, Zipline, a California-based healthcare logistics company, partnered with Rwanda government to air-drop vital medical supplies to hospitals in remote areas. The result has proved to be a life-saver as locals now have immediate access to medicine and blood transfusions. Since it started operations in October 2016, the company has done over 7000 deliveries of more than 14,000 units of blood. About 30 percent of such deliveries are for emergencies like post-partum hemorrhage.

In October, the Rwandan Ministry of Health, Dr. Diane Gashumba, announced that maternal deaths have been reduced to zero in Shyira, Kacyiru, and Ruli district hospitals in the past seven months. These hospitals are 3 of the 18 district hospitals Zipline serve.

HOW IT STARTED

Zipline is the brainchild of founders: aviation consultant William Hetzler, and robotics experts Keller Rinaudo, and Keenan Wyrobek. The startup idea stemmed from a visit to Ifakara health institute in Tanzania, in 2014 where Rinaudo and Hetzler met Zachary Mtema, a graduate student and public health researcher in Tanzania who developed a mobile health surveillance system for health workers to text emergency requests for medicine and vaccines.

As part of Mtema’s project, a network of community health workers used the mobile alert system to make thousands of requests and log cases where they lacked the medical supplies they needed to save the lives of patients suffering from an easily-solvable ailment like post-partum hemorrhages and snake bites.

At the end of the research, they discovered that most of the medical cases which resulted in death could have been prevented if there was a rapid response to emergency health demands, especially in remote areas. To bridge this access gap, the trio decided to solve the other half of the problem by creating a drone-based logistics service that can rapidly respond to health-emergency demands.

WHY RWANDA

Rwanda wants its citizens to have access to any healthcare product or services – within 30 minutes. One of the efforts towards this is to build health centers across all villages so that if anyone is sick, they don’t have to walk more than 30 minutes to a hospital.

In early 2015, Zipline and Rwanda government began to talk about the possibility of using drones for medical supply delivery. “Technology is at the heart of the government endeavor to make sure that we deliver services in a smarter way,” Dr. Mazarati Jean Baptize, the Head of Biomedical Services at the Rwanda Biomedical Center, told Rural Reporters.

“When we heard that we could deliver blood through drone, we realized that it would save us the time it takes to deliver blood to hospitals and regional health centers.”

Dr. Jean Baptize describes the Zipline founder’s meeting with Rwanda’s President, Paul Kagame, as a “random encounter”.

“It was not like the government sat down and decided to use drones, but the conversation which led to that decision came from the conversation the president had with his friends,” Jean Baptize said. “The conversation became technical when he sent Zipline to see the ministry of health. It took 15 months to see the project become a reality.”

To make Zipline’s plan come to fruition and for the advancement of healthcare in Rwanda, the government made some adjustments to its regulation and agreed to pay for Zipline’s service.

“It took about a month to have a temporary regulation that was adopted for the operation of Zipline and it took a year to have a regulation that was published in the Gazette for drones beyond the line of sight,” said Israel Bimpe, Zipline’s National Implementation Officer.

Besides that, the government gave Zipline other incentives to shine. “Firstly, nowhere in the world has drones been used to transport any medical product,” said the price when it comes to saving lives. So there is no price tag to a Rwandan life.”

Rwanda pays Zipline a fee per delivery but neither Zipline nor the government is willing to disclose the terms and cost of the project. Dr. Jean Baptize says, “It is very small; you can’t even compare it to Rwanda Biomedical Service share of the (health) budget.”

Aside from Rwanda government, Zipline is backed by Silicon Valley giants like Sequoia Capital and development partners like GAVI and UPS Foundation.  Yet, Zipline’s operation is not without challenges. “There are very rare blood samples like 0+, red Platelets which we are sometimes unable to supply because there are only 4 donors for that in the country,” says Bimpe. “Also, Zipline falls between the section of aviation and healthcare. Those are over-regulated sectors, so each one wants to ensure that they validate each of your operations.”

Zipline’s distribution center at Muhanga, Rwanda.

OPERATIONS

Zipline delivers 25 percent of Rwanda’s national supply of blood. The blood products include Red blood cells, Plasma, Platelets, and Cryoprecipitate. On a given day, about 25 deliveries are made from the company’s Rwanda headquarters in Muhanga, about an hour drive from Rwanda’s capital, Kigali.

Zipline’s drones transport the blood to public hospitals across Rwanda. The human blood is used for transfusions during surgeries or post-partum hemorrhages as a result of complicated childbirths, or to treat young victims of malaria. Zipline also guarantees doctors access to rarely used products, like frozen plasma and platelets.

“Only the red blood cells are given to the hospital as a routine supply if the hospitals have the fridge that stores blood products from 2 to 8 degrees. The others require deep freezing but most of the hospitals we serve do not have the capacity to store in deep freezers. So it is much better to have those centrally and then deploy it during emergencies,” said Bimpe.

Zipline has 40 drones, six of which are allowed to fly at a time by Rwanda’s civil aviation. The drones, which are designed with three parts replaceable units, are flown autonomously and designed to fly in all weather.

While the whole process – from order to launch – takes an average of 10 minutes, there is a lot of work that goes into running a drone delivery operation.  When an order comes in, two Zipline technicians assemble the drone while the blood bank technicians pull the required stock from the blood storage facilities located onsite. Each drone has the capacity to carry a medical supply of up to 2kg, that is, between 2-6 units of the blood bag. The bag(s) of blood are wrapped in an insulating paper and placed in a red cardboard container roughly the size of a shoebox, attached to a parachute made of wax paper and biodegradable tape and placed on a launcher, which catapults the drones into the air at 32m per seconds.

“We fly on the regular about 80 kilometers from here so that is about 160 kilometers for a round trip,” Bimpe told Rural Reporters, adding that Zipline requests clearance from the airport before the drone flight. “Because the drones are highly autonomous, we do what we call highways in the sky which is basically pre-planned flight routes. The routes are prebuilt to avoid schools, military areas airports, and highly populated areas. This helps the drones to fly straight in line to the hospitals.”

Once the drones are airborne, an operator monitors their path on an iPad at the distribution center, staying in constant touch with the air traffic control in Kigali. The monitor allows the operator to track the drones at real time and also shows the status report of the drone – either it is inbound, delivering, or still on its way to delivering the product. When the drone nears its predetermined destination, it sends an automated text message to the hospital, announcing the exact arrival time.

Then it flies down towards the designated landing zone at about 10m above the ground and drops its payload in a special zone area at the hospital via parachute with a thud. A blood technician picks it up at the hospital. At this point, the signal changes from delivering to inbound on the iPad monitoring the drone. When the drone flies back to the central unit, a robotically controlled wire catches it by its tail, after which two people disassemble it.

THEN AND NOW

Many Rwandans now own their lives to this safe blood delivery service. In the past, hospital staff in Rwanda would drive to the central blood bank in Kigali, the country’s capital, to procure blood. In emergency cases, patients are either referred to the national hospital in Kigali or made to wait for delivery of blood via truck, motorbike or car — which sometimes result in life-threatening delays. For instance, it takes about 5 hours to drive both ways from Muhoro District Hospital to the blood bank in Kigali. The hospital is the farthest to the blood bank. But now, from Zipline’s Muhanga drone center, it takes only 20 minutes to get blood supply delivered to Muhoro District Hospital.

Now, to get blood, lab technicians in public hospitals simply tap out an order on a smartphone or call a toll-free line and Zipline’s distribution center delivers the blood. The lab technicians get a confirmation message that the blood is on its way.

Two years on, the blood deliveries have helped hospital staff cut back on lengthy road trips to Kigali where the national blood center is located, freed up time for staff to perform their duties, and allow patients to be treated promptly.  Drone delivery also means hospitals can store less blood, which means less waste as blood spoils quickly.

“We used to lose 6 percent of blood from our production yearly while using the truck because hospitals have to overstock the blood on site. But now, since it is based on demand through the use of Zipline service, we have reduced waste from about zero percent,” Dr. Jean Baptize said.

Dr. Mazarati Jean Baptize, Head of Biomedical Services at the Rwanda Biomedical Center.

Rwanda collects around 60,000 blood units a year; a volume Dr. Jean Baptize says is enough to address the country’s medical needs. The blood is collected from voluntary donors and stored centrally at the country’s National Centre for Blood Transfusion in Kigali. The center supplies Zipline with blood for delivery about three times a week.

Dr. Jean Baptize says while the number of blood donations keeps increasing, the country is yet to meet the World Health Organisation’s threshold, which says that 54 percent of the population has to be able to give blood.

The first phase of the Zipline-Rwanda drone partnership, which is ending soon, constitutes the service of 21 hospitals. Zipline is now at 18th district hospitals. Zipline is currently setting up another drone port in the eastern part of Rwanda so that it can cover more territories.

“We hope that Zipline will cover more than 80 percent of Rwandan territory in terms of servicing blood and we are looking into expanding their portfolio and making them transport not only blood but also any other medical product. We hope that as they sign the next contract, they will be able to expand into transporting other medical supplies such as anti-rabies vaccines,” says Dr. Jean Baptize.

Meanwhile, the Rwanda government is now conducting a study to examine the magnitude of the impact of using drone technology for medical services. In the future, it hopes to set up a Hemovigilance to quantify what each blood is used for.

THE FUTURE

Zipline was recently named one of the Best Inventions of 2018 by TIME Magazine.  In the future, it hopes to use drones to deliver other much-needed medical supply, which has shorter shelf-lives.

“We started with blood because that is where we could see the impact in a short time. Now, we are planning to deliver pretty much all kinds of medical product, including contraceptives,” says Bimpe. “We currently work from 7 am to 7 pm but in our expansion plan with the government, we are hoping to start operating round the clock when it comes to delivering medical supply and in the technology advancement, we may look at expanding the capacity of blood each drone can carry. This will mean manufacturing a larger drone with a bigger battery which may also require additional regulations.”

Additional countries are in the pipeline. Tanzania, another East African country like Rwanda, and a Latin American country have been identified as Zipline’s next stop. In West Africa; Senegal and Ghana have expressed interest in Zipline’s technology. Eventually, Zipline hopes to operate in developed countries like the United States, despite its strict regulations for flying drones.

To any country interested in partnering with Zipline, Bimpe says there are no specific procedures. “They just have to express interest and be ready to pay for delivery. On our part, we will prove that this solution saves money, time, and empowers providers.”