Guess what this thing is?

This is what makes Ethiopians grateful to China: a Chinese refrigerator enterprise produces ice buckets that do not use electricity, do not use fuel, can cool for a long time, and can withstand long-distance transportation. It's for vaccines.

A number of international organizations took the lead in providing free vaccines to children in Ethiopia. However, in Ethiopia, where transportation is inconvenient and the climate is hot, about 20% - 30% of the vaccines will fail due to cold chain breakage.


To save all this, it's arktek, a small ice bucket.

As soon as I got out of the cabin, I just took a deep breath of the first Ethiopian air. I haven't had time to say "ah, Africa!" I was choked by the first slogan that caught my eye - "the Export Import Bank of China".

The second slogan is more eye opening: "safety first, prevention first". Eight Chinese characters, white on the blue background and bold in bold, are hanging on the outer wall of a terminal under construction, which makes me wonder where the 11 hour overseas flight has brought me.

This is Ethiopia, located in East Africa, the second most populous country in Africa. Addis Ababa, the capital city, is located on a plateau with an altitude of more than 2000 meters. It is the rainy season at the end of July. The body temperature is almost the same as that of Yunnan Province. It is totally unimaginable that Africa is hot.

Like a large number of third world countries, Ethiopia has traces of China everywhere. In my eight days in Ethiopia, the smooth asphalt roads to and from the capital are all built in China; there are always local people on the streets who warmly greet "hello" in Chinese The light rail in the center of Addis Ababa is contracted by China Railway Even the nearby toll gate is the same, except that the employees' skin is black.
If it's just these traces, it's a common overseas cooperation story. In addition to traditional investment projects such as construction, transportation and processing industry, there is a new and far-reaching cooperation in Ethiopia, public health.

Birth lottery
If a baby is born in Angola, Ta is 75 times more likely to die than a Finnish baby. Buffett described the huge difference in fate as "birth lottery".

Compared with Angola in West Africa, Ethiopia in East Africa has much better conditions: in 2016, Ethiopia's GDP has reached US $72 billion, surpassing Kenya and becoming the largest economic power in East Africa. The progress of the economic leap is clear: in 1990, one in five Ethiopian children died before they were five years old. By 2012, the situation had changed dramatically - 66 per cent fewer child deaths than in 1990, and Ethiopia had achieved the millennium development goal of reducing child deaths ahead of schedule.

However, for a child under the age of 5, Ethiopia is still not a place of birth with perfect medical resources, and the under five mortality rate (U5MR) in Ethiopia is still as high as 88 / 1000. In a village two hours from the capital, we visited a rural hospital. On the same day, there happened to be a pregnant woman who had been 41 weeks for her fourth and final prenatal examination. The young male gynaecologist warmly asked our group of foreign guests to watch his inspection process, but they were surprised to find that his only inspection instrument was just a wooden fetal heart sound tube.



A few hours later, in a large hospital in the city, we saw the modern medical equipment for the first time. As soon as the president saw us, he mentioned that in the 1980s, a Chinese medical aid team from Africa came here. At that time, medical staff from nearby cities came to learn from us. Now the hospital serves hundreds of thousands of local people, equipped with Taiwan donated B ultrasound machines and X-ray examination rooms.



But as the "foreign guests" visiting, we have no way to know the use of these modern equipment: we found that there is no lead door in the X-ray examination room, and after a careful look, we were embarrassed to find that there is no glass on the window - this kind of environment would expose people inside and outside the room to a great radiation risk.



There are a large number of patients waiting in line in the hospital yard, but the B-ultrasonic machines and other instruments are idle within half an hour of our visit, which is not proportional to the number of people waiting in line.



Even in such medical conditions, not everyone can experience it. At present, only 27% of the pregnant women in Ethiopia go to the hospital to have children. Most of them give birth at home and never have a pregnancy test. In the first rural hospital, in order to encourage pregnant women to come to the hospital for childbirth, the hospital even provides free food and accommodation. In the yard, there is a large warehouse specially for storing charcoal, oats, Chinese rice, pasta and fresh onions, tomatoes, potatoes It's a bit ironic to think about it: how can NGOs improve the rate of maternal visits? Buy food for the hospital!



The health of newborn and pregnant women is one of the most important public health issues in Ethiopia - Ethiopia is a "young" country. The population age structure of the whole country is very similar to a pyramid: 41.4% of the children aged 0-14, 53.3% of the population aged 14-59, and only 5.7% of the population aged over 60.



Ethiopia's population has exceeded 99 million in 2015, ranking 13th in the world. Unlike the pressure of geriatric diseases in Chinese society, Ethiopia's more urgent task is to ensure the health of 40 million children. Children are more vulnerable to diseases, but there's a way for them to be directly isolated from many major diseases in a very simple way: vaccinating.

"At all levels, each country will give priority to investing in vaccines because the input-output ratio is particularly large." Wu Wenda is the deputy director of the Beijing Representative Office of the bill and Melinda Gates Foundation (hereinafter referred to as the "Gates Foundation"), with medical professional background. He calculated an account for me: vaccination is the lowest cost health measure. For every $1 spent on children's vaccination, it can save about $16 for the country's medical expenses, work delay caused by diseases and so on. Considering the labor value created by life extension, the return on investment of $1 can be as high as $44.

Ethiopia's children now have access to free vaccines: by the age of two, local children can receive 10 kinds of EPI, two more than China's EPI. This is led by the World Health Organization (who), the United Nations Children's foundation, GAVI (Global Alliance for vaccines and immunization) and other organizations to promote EPI (enhanced immunization program). GAVI is paying for this. The organization is improving the accessibility and technical support of immunization programs in poor countries around the world. There are three kinds of vaccine support: free supply in the poorest countries, half each in the middle countries, and self payment in the developed countries. Ethiopia enjoys free support.



But is it enough to have a vaccine without money?

Vaccines are not a problem, the problem is temperature



A few years ago, Qingdao Aucma sent a team to investigate the rural areas of Ethiopia. It's said that Chinese people came to this extremely poor remote village, and the whole village came out to watch. A general manager named Shan Bo took a picture of a young child. The child was covered with a scarf. He ran out barefoot and watched the guests coming from afar happily.



After returning home, the employee enlarged the photo and was shocked to find that the child's face was not only covered with eye droppings, but also "nine flies fell!" This group of Chinese engineers knew that Africa was poor before, but they did not know that they would be so poor: "what is home? It's just a few wooden pillars with a grass on them. This is home. There are three stones under it to support a pot. There is only one pot at home. There is nothing else



Free vaccines can't be delivered here.



In the remote rural areas of Ethiopia, every vaccination is a huge activity: the medical staff will go to the town level hospital a few kilometers away, take the vaccine with a cold bag, and then gather the children in each village for centralized vaccination. Ethiopia's rural road laying rate is very low. Only 10% of Ethiopian rural residents can find a road with certain weather response ability within two kilometers of their residence. Many parents have to use donkeys to carry their children, and they can only go to the health station one day at the longest.



This kind of regular and centralized vaccination is easy to be missed: the news of vaccination is informed by local health workers in the village. This way of manpower publicity can't ensure that all the children who should be vaccinated appear on time. If the vaccines are taken too much, there is no place to store them, and they can only fail in vain. If the vaccines are taken too little, the parents who come late can only return without success and take the children home for half a day At one time, both parties need to pay a lot of attention to notice, Trek and replant. If a newborn misses a vaccination, it will have to wait another month. In many hot and water deficient areas, this month is a contest between the gods of death.



The cold storage in Addis Ababa, the capital city, receives a batch of vaccines every three months, which are distributed quarterly to each state, and then distributed to the county and village health station every month. At the village level, many health stations have no cold chain, so they can only use passive vaccine storage boxes to keep cold. A follow-up study on the distribution of four vaccines was conducted by the UNICEF representative office in Ethiopia. It was found that about 20% - 30% of the vaccines would fail due to cold chain rupture.



If the storage conditions are not good, can you help them build houses and buy freezers? "But what about electricity?" Wu Wenda put out his hand. "We can't pull the Internet bar for them?"



The approach of global good, a partner of the Gates Foundation, is to build an ice bucket for storing vaccines.



This ice bucket can't be a common direct cooling refrigerator - once it breaks down, it can't be repaired basically;



It can't be a natural gas refrigerator - the cost of natural gas is too high, it will account for at least 30% of the expenditure of health stations, and the transportation of gas tanks is not safe;



Can't use solar energy - no one can go to the roof for daily maintenance, and the battery panels are easy to be stolen;



You can't use gasoline or kerosene refrigerator - it's not environmentally friendly, and oil is easy to be misappropriated.



An ice bucket with no electricity, no fuel and long-term refrigeration sounds like a mirage, but now the village of Ethiopia is implementing a passive vaccine storage device called arktek. The device can be sent to the most remote mountain areas by camels or donkeys, which are filled with frozen ice rows to ensure that the vaccine can be stored for 35 days or more at a temperature of 0-10 ℃.

Arktek is invented by global good, a scientific research institution in the United States. It was commissioned by Aucma Group of China. Ark means "Ark", Tek means "technology". In addition to Ethiopia, Nigeria, Senegal, and India in Asia are all carrying out the pilot work of this non electricity vaccine ice bucket. Each white bucket is written with three Chinese characters of "okoma". The ice bucket has become another level of Chinese manufacturing in Africa.

High tech ice bucket



In the Gates Foundation Office in Beijing, I saw arktek in kind. The ice bucket is much heavier than expected, 70 cm tall and more than 20 kg. It needs two people to lift it. There are eight ice rows and three separate vaccine boxes in the barrel, and the plastic shell is bulletproof material, which can withstand the bumpy transportation in a long distance. The whole insulation is made of aerospace technology. The temperature of other vaccines will not be affected if each of the eight ice rows in the barrel is taken out separately.



From China to Ethiopia, it will span 8000 kilometers, and arktek's manufacturing route has surrounded the whole earth.


The earliest product model of arktek is designed by global good, a research institution invested by Bill Gates. When the model is designed, it needs to find a manufacturer with stable production capacity and appropriate price to produce. It can be imagined that the most suitable business should be in China.



In 2013, Aucma accepted the invitation of global good to jointly develop a mass-produced arktek. Prior to Aucma, another well-known Chinese refrigeration company declined the offer for the simple reason that arktek's sales prospects are not clear, and until now, the product still does not make money. Sending human and material resources to develop will occupy the resources of enterprises to develop other products. When Aucma's team took over, they thought, "it's very simple. It's just a can, plus a heat preservation, plus a few things?" Li Wei, chairman of the board of directors, was confidently told that "it will be done in one month".



It's been a year since the final product was made. For example, an ice bucket sounds simple. The body of the bucket is a double vacuum tank with a bimetal ring in the middle for conducting. " One is aluminum and the other is stainless steel, which should be welded together without any gap in the middle. "The technicians discussed that the adhesive will volatilize, and the welding technology can't do it. "At last, we found a military enterprise to do explosive welding, put the two boards together, and spread explosives on them to ignite. At last, the two metal rings were pressed together by the explosion pressure. "



"It took more than half a year to solve the problem of metal rings." The manager of Aucma told us that arktek is a product from scratch. If someone is willing to copy it, Aucma's technology is at least 5-10 years ahead of the industry.



At the test site in Ethiopia, arktek can maintain a stable barrel temperature even in the high temperature area of 43 ℃ in the daytime. The nurses at the health station of the experimental site directly requested that the ice bucket should not be taken away after the experiment. Penta 3 (tetanus protein polysaccharide conjugate, diphtheria, tetanus, pertussis, inactivated poliovirus vaccine) and measles coverage rate reached 97% and 90%, respectively, in some areas of Ethiopia that have been popularized.



In fact, the team of Aucma, who photographed the "nine flies", received the highest courtesy in the previous village. The local people dressed up for the Chinese people who came from afar and put on the costumes used for the celebration to perform the hunting and harvest dance for them. "I can't understand their local language, but I can hear the words' China 'and' arktek '." Ren Yizhao, deputy general manager of Aucma vaccine cold chain company, said that with arktek, health workers can move to work or even go to the home of newborns for vaccination.



"Each arktek can cover a community of about 6000 people, and 144 newborns can be vaccinated at a rate of 2.5%. Now, by conservative calculation, arktek has increased the local vaccination population by 5% every year, which is 7.2 newborns. Each arktek has a 10-year service life, which means that 72 more children have been vaccinated. " Ren felt very proud, "this is a matter of great merit."



Contraceptive implant



There are not many Chinese medical products entering Ethiopia like arktek.



Each arktek ice bucket costs about US $2000. Most African countries that purchase arktek ice buckets receive assistance from relevant United Nations organizations. To enter the list of large-scale public procurement of the United Nations, products must pass PQ certification. PQ certification is the pre qualification of the World Health Organization (who). It is the precondition for the governments of most developing countries or the procurement systems of GAVI, UNICEF, UNITAID and other international organizations to purchase and use a piece of equipment.



PQ certification is mainly aimed at drugs or medical devices urgently needed for treatment of some diseases, such as anti HIV / AIDS drugs, malaria drugs, tuberculosis drugs, reproductive health drugs, influenza drugs, acute diarrhea drugs and neglected tropical diseases drugs, as well as some anti-cancer drugs.



In 2015, arktek officially entered the African market after passing the PQ certification. There are not many medical products that have passed PQ certification in China. For example, there are more than 30 vaccines that have passed PQ certification in India, but only two in China. One is the live attenuated encephalitis B vaccine of Chengdu Branch of China National Health Group, and the other is the split influenza virus vaccine of Hualan biological vaccine Co., Ltd.



In fact, the competition in the domestic medical market is increasing year by year. The dividend period of the medical market has already ended, and the competition has been nearly saturated, and vicious price bargaining has begun among manufacturers. At the same time, like construction and transportation, public health in Africa is a huge market. For many enterprises, it is a necessary choice to start PQ certification for products and go to Africa through international procurement.



At the rural health station in Ethiopia, I saw condoms from Guangzhou, China and South Korea, which will be distributed to the local people free of charge. In town hospitals, there are more options for contraception than avoidance

What's the difference between these contraceptives? Wu Wenda told me that most of the IUDs used in China are the upper ring, which is a very dangerous way to operate in the body in Africa: the operation of the upper ring needs to use multiple tools, and it is difficult to achieve complete sterility under African medical conditions. The local HIV infection is serious, and the infection rate and mortality rate of the operation in the body are much higher. Once the infection occurs in the operation, the follow-up treatment is also very troublesome.



”There are also many long-term contraceptives that can be administered for three months with one injection, but this is also very troublesome. It's not realistic for a woman to walk one day every three months to get a doctor's injection. "In the future, a four-year subcutaneous implant called levoplant will also be added to drug cabinets in Africa, said Wu wenda. This is a product that Shanghai Dahua Pharmaceutical Co., Ltd. just passed the PQ certification in June this year. According to the Gates Foundation, this is the most stable and safe method of contraception.



What is an implant? Even for women of childbearing age, I've heard about this product for the first time. In each bag of Levoplant, there are two silicon capsule tubes containing levonorgestrel (a synthetic progesterone). Like injection, the contraceptive needle "is injected" to the inner subcutaneous side of the female upper arm. Without any incision, the progesterone can be released slowly, and the effective period is generally up to three or four years.



In several hospitals in Ethiopia, I saw a wide range of maternal ages, including just 18-year-old primiparas, as well as middle-aged pregnant women in their forties. The average first childbearing age of Ethiopian women is only 20 years old, and each woman will have five children on average. Now, many Ethiopian women have expressed the need for birth control.



"With convenient contraceptive products, Ethiopian women can decide the time of pregnancy on their own," Wu said.



First, we can postpone the time of first pregnancy, so as to avoid pregnancy at the age of 15 or 16 and girls will give up their study and personal life;



Second, we can lengthen the interval between pregnancies. If we just have a baby and get pregnant three months later, our mother's body can't be recovered, and the lactation period is only three months, it's not good for the health of the newborn;



Third, unwanted pregnancies can lead to more illegal abortions. Once an abortion is infected, it can also lead to death. We can reduce this part of the death rate. "



Independent family planning is one of the most cost-effective investments a country can make for its future. For every $1 spent on family planning, the government can save $6 to improve health, housing, water, sanitation and other public services. The market of subcutaneous contraceptive implant in China has been small. After PQ certification, the relevant medical enterprises actually have a larger market space.



China's cooperation in health care in Africa is just beginning.



In Ethiopia, we have seen flea filled mud hut with straws on the ground, and a wedding ceremony of the upper class in the five-star hotel in the capital. All the guests are well dressed and the huge diamond rings of the young bride are shining in the spotlight. Back to the original "birth lottery", the difference between rich and poor brought by this birth environment will always exist. Reducing child mortality in countries with high risk for children, so as to make "birth lottery" more fair, is the direction of international organizations and institutions such as the Gates Foundation.



As a distant country on the other side of the earth, China can play a more active role in the development of Africa. Li Wei, chairman of Aucma, told us that arktek has not brought much economic benefits to the company so far, but the publicity benefits of the brand cannot be estimated.



"A refrigerator company can make the world a little better." Li Wei thinks that improving public health can benefit every common people, and the health of an African child is actually closely related to the whole world: "let every child have a fair right to exist from small to large. If children in poor areas have the right to survive, they will have the right to education later. In the future, they may have more opportunities to see the outside world, or receive higher education. They can change Africa, change the world, and be more effective than us. "

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