plagued with transportation challenges. A majority of Rwanda’s
478 health centers, and many of its 35 district hospitals, can be
accessed only via poorly maintained unpaved roads, which often
spiral into its famed “thousand hills” and are difficult to traverse
by vehicle, particularly during the twice-yearly rainy season.
Unlike Tanzania, though, Rwanda is compact: with 12 million
people in an area the size of Maryland, it is the most densely
populated country in mainland Africa. This meant that Zipline’s
drones, which have a flight range of 150 kilometers, could serve
nearly half the country from a single launch site.
Zipline’s idea caught on with Rwandan authorities, including the country’s civil aviation body, which altered regulations to
enable its drones to operate. In mid-2016, Zipline signed a deal
with the Rwandan government to build a distribution center
near the town of Muhanga.
This hilltop site, erected on a former maize field, is now
known as the nest: a fenced-in plot consisting of a white circus-style tent housing a blood storage facility, 13 drones (nicknamed
“zips”), and a small staff of young Americans and Rwandans. On
one side of the tent, two stainless-steel launchers, facing opposite directions to account for changing winds, employ a system
of bungee pulleys to catapult the 12-kilogram drones into the
air at 84 kilometers per hour. On the other, two brown inflatable mats cushion the zips’ landing on return. Once the drones
are airborne, cruising over an undulating landscape dotted with
banana trees, cassava fields, and tin-roofed houses, an operator monitors their path on an iPad, staying in constant touch
with air traffic control in Kigali. All routes, developed using a
3-D satellite map followed by detailed manual ground surveys,
are pre-programmed using real-time kinematic satellite navigation, which—along with an inertial navigation system—enables
the payload to drop within a target area five meters in diameter.
“Accuracy is extremely important,” says Hetzler, adding that if the
drops were less precise, packages could end up on roofs, in trees,
or in other inaccessible spots that could destroy the operation.
He says the company is developing technology that will automate
the ground surveying process.
Zipline’s plans for Rwanda include scaling up to a wide range
of medical products, including emergency rabies vaccines; drugs
to treat HIV, tuberculosis, and malaria; contraceptives; and
diagnostic test kits.
Yet blood represented a natural starting point. After all, it
has a shelf life of only 42 days, must be kept refrigerated, and is
frequently needed on an urgent basis.
Today, Rwanda’s Ministry of Health stores blood at a national
center in Kigali and four regional depots around the country; its
58 facilities equipped to handle blood transfusions, mainly hospitals, keep a small inventory of common blood types and must
continually restock from the depots or national center. Sometimes the stock on hand is sufficient for emergency transfusions.
Often it is not, particularly if the patient has a less common blood
type. In these cases, the facility must refer the patient or collect
the blood by car, motorbike, or truck.
Among the individuals most vulnerable to blood delivery
delays are pregnant women. Although Rwanda’s maternal mortality rate has declined by more than two-thirds since 2000, an
improvement linked to increases in contraceptive use and a move
away from home births, complications of childbirth remain a
leading cause of death. The World Health Organization estimates
that Rwanda has one maternal death for every 344 live births, 20
times the rate in the United States and 97 times the rate in the
top-performing countries in Europe. More than half of maternal deaths occur after childbirth, and 26 percent are the result
of hemorrhaging. Faster, more reliable access to blood could
help reduce this number, along with lives lost to accidents and
malaria-induced anemia, which is common in small children.
Kabgayi, one of Rwanda’s largest district hospitals, faces a
higher blood demand than most. The colonial-era facility, several
aging brick buildings on the site of a former Catholic mission,
uses up to 100 units per month, according to Kajibwami, the for-
A Zipline technician carries
one of the company’s drones.
The drone is monitored as it follows
its pre-programmed flight path.