MUHANGA, Rwanda – Noella Mukanoheli was nine months pregnant and bleeding out.
It took her three hours to see a doctor.
First, she made a 50-minute trip to the clinic that serves her village, riding on the back of a friend's motorbike. There was no doctor on staff so they called an ambulance to take her to the nearest hospital. It was only about 10 miles away but took two hours to get there because of the country's challenging roads.
Her husband, who was with her, says she lost consciousness en route. When she arrived, doctors said she needed five liters of blood. That's considered a "massive transfusion" in medical terms –– an emergency measure to replenish virtually all the blood in a human body.
But the hospital didn't have her blood type, so doctors had to order it.
The blood arrived in mere minutes.
The method of transport: two drones, which dropped their precious packages in the Muhanga hospital courtyard.
When Mukhanoheli awoke hours later, her hand immediately went to her belly.
"My doctor said I had given birth and the baby was alive, but I would have died without the drone," says the 42-year-old, who experienced the traumatic event in April.
This harrowing story shows the promise of drones in a country where it's famously hard to get around. Rwanda is known as the land of a thousand hills and when drivers get stuck behind a slow-moving truck on winding and narrow roads, there's no way to pass.
In 2016, seeking an immediate solution for emergency blood deliveries, the Rwandan government contracted with American robotics company Zipline for drone shipments. Today, drones play a critical role in ferrying all kinds of medical supplies to those in need.
But the drone success story is only part of the healthcare landscape in Rwanda –- a landlocked country of nearly 15 million people in East Africa. The majority of the population lives in rural areas.
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In the three decades since the Hutu genocide against the Tutsi in 1994, the country has sought to reduce poverty, improve healthcare and lift itself from lower income to upper-middle income status, and has championed high-tech solutions.
Yet its a complicated and costly task that includes expanding electricity and building and maintaining roads on hilly terrain.
In 2025, the Trump administration announced a $150 million grant to expand Zipline's work in Rwanda and four other African countries. Its caught the attention of others too: Zimbabwe sent a delegation to Rwanda in June to look at their drone program.
At the same time, Trump has cut about $200 million in funding for aid organizations that provide food and health aid to rural communities in Rwanda. This reflects the administration's new strategy favoring American businesses for global health work over nongovernmental organizations.
NPR reached out to the State Department for comment on the funding cuts and the drone program but did not receive a response. A statement announcing the grant to Zipline in November 2025 said:
"The Trump Administration, in partnership with U.S. and African innovators and policymakers, is advancing cutting-edge technologies that are strengthening health outcomes and enhancing emergency responses to infectious disease outbreaks."
A sky full of drones
The drone story in Rwanda is nothing short of remarkable.
To see the impact, all you have to do is look up at the sky, where drones are constantly zipping across the country.
The drone itself resembles a tiny airplane. It has a white Styrofoam body and red wings. A battery sits where a cockpit would be; the package rides in its belly.
On average, a drone carrying medicine, vaccines, blood and diagnostic tests for humans and animals is dispatched every 50 seconds, according to Pierre Kayitana, the company's country director. Zipline now manages virtually all of Rwanda's pharmaceutical supplies and deliveries.
The drones that saved Mukanoheli's life launched from a facility in the rural town of Muhanga.
"This is actually the very first Zipline distribution center in the world," says Kayitana. "It started here in 2016. This place, just so you locate yourself, this is the exact center of Rwanda."
The Muhanga location is one of two distribution centers operating in the country. A third is set to open soon, funded by the grant from the United States.
"Rwanda will be the first country in the world to be fully covered with drone technology," Kayitana predicts.
At the Muhanga facility, orders pour in from medical workers across the country, through phone, text message and on WhatsApp, and are fulfilled from a small warehouse full of pharmaceuticals.
"It's the highest standard of a medical warehouse by FDA [standards]. Anything you may need in a hospital, you can find in here," Kayitana says. The supplies themselves belong to the Rwandan government; Zipline manages the logistics, delivery and inventory.
In one corner of the warehouse, half a dozen technicians assemble outgoing orders. There's a minimum weight requirement of one kilogram, or 2.2 pounds, Kayitana explains, anything lighter risks being blown off course by the wind.
When the package is placed in the drone, an engineer carries it to a launch pad, and with the press of a few buttons, the drone slingshots into the sky.
"The drone is embedded with AI software," Kayitana says. "It knows where to go and can make its own decision on how to avoid the wind, how to reach the hospital faster depending on what it sees."
They can fly at a speed averaging 64 miles per hour and reach an altitude of 400 feet – about as tall as a 35-story building.
"We can reach any point of Rwanda in under 30 minutes [with a drone]," Kayitana says. By contrast, the same trip could take up to seven or eight hours by vehicle.
Many of the drones from Muhanga are bound for Kabgayi Hospital, the largest hospital in southern Rwanda and the one that treated Mukanoheli. The 4-mile drive from Zipline's center takes 30 minutes; the drone makes it in four, dropping its cargo by paper parachute.
"We are lucky, it takes like five minutes to bring blood here," says Dr. Evariste Ufitihirwe, deputy director general of Kabgayi. "It's faster than telling a person to go in stock to bring blood."
A decade ago, before the drones, he says, doctors had no choice but to manually clamp blood vessels to slow bleeding in emergency cases while they waited, sometimes for hours, for blood to arrive from a bank in the capital city Kigali, about 30 miles away.
"A decade of transformation"
The drones represent a major part of a government plan to improve overall healthcare and reduce maternal mortality rates that includes policies like universal healthcare and investing in midwives.
"Every time a mother dies, it triggers everyone's attention, we investigate and we find the root causes," says Rwanda's health minister Dr. Sabin Nsanzimana. "There is, of course, accountability, there are lessons learned, there's adaptation of the systems and supplies are a critical aspect of that."
The benefits of this multipronged approach are reflected in government statistics. Twenty-six years ago, Rwanda recorded roughly 1,000 maternal deaths for every 100,000 births. Today, that figure has fallen to 87, according to Nsanzimana.
"It has been a great decade of transformation," he adds.
"We used to [only] see drones in war zones taking lives," says Nsanzimana. "But now we're seeing drones in health systems saving lives, which is really the best use of technology we could want to see us as doctors, as patients."
The drones are also taking on disease management, carrying diagnostic tests and medication for cervical cancer, HIV/AIDS, tuberculosis and malaria.
"It's an evolving technology, so drones really to me are going to be a game changer in what we do," Nsanzimana says. The government hopes that Zipline can also play a role in tackling the growing traffic problem in the capital city of Kigali.
"Kigali has busy roads, [imagine] you have a paramedic who needs some kind of materials and emergency products to save a life, but traffic is bad," he says, "A drone can deliver such kind of products to paramedics.
"And maybe one day there will be flying doctors, flying paramedics who can fly [in a] drone [and reach patients]. Why not?"
The impact of the U.S. aid cuts
But the hope for a brighter future is being jeopardized by the U.S. aid cuts announced last year. Nsanzimana says the government had to redirect limited resources to keep some lifesaving programs running.
That's a concern echoed by aid groups that provide health services to hard-to-reach communities and partner with Zipline.
"It's a partnership that can create lasting change," says Marcel Sibomana, program manager for Save the Children in Rwanda, adding that local communities benefit most when both private sector and NGOs work to help them.
But Sibomana is worried that some of the health facilities for pregnant women and children that the group runs will have to close when the U.S. cuts take effect in September.
This is one reason why donors like the United States, as well as recipient governments, need to take a comprehensive approach to solutions, according to Enoh Ebong, president of the global development department at the Center for Strategic and International Studies.
"Without the underlying infrastructure, like roads, energy and power and unless there is accessibility, rural and otherwise, then all of these solutions will stop short," says Ebong. "These basics need to be addressed in order to be able to get the full benefit of [high-tech solutions] like the Zipline deal."
Historically, this is where U.S. foreign assistance has played a significant role for low-income countries, Ebong says.
What Drones Can't Deliver
Many of the smaller health centers closest to rural populations struggle with basic equipment and staff.
At a health post in a remote town called Ituzi, head nurse Rosaline Uwera receives regular vaccine shipments from Zipline.
"I'm grateful for the steady resupply of medicines and vaccines, it means we can get all the children in this area vaccinated," says Uwera. "I used to have to travel many hours to acquire them myself from pharmacies."
Still, she can't get oxygen or an ultrasound machine, which means she has to refer many of her pregnant patients to the nearest hospital, two hours away, Uwera says.
Two months after giving birth, Noella Mukanoheli is still recovering from the complications and blood loss, dealing with pain and fatigue.
"It would have been better if the drone could have delivered blood directly to the health clinic I first went to," she says, and if that clinic was staffed with doctors who could have treated her there.
Her baby lies still in her arms, his breathing faintly wheezing. He looks small for a two-month old. "He's malnourished," Mukanoheli says.
She has not been able to breastfeed him because she doesn't have enough to eat. She says she's had to resort to giving him cow's milk, which is not safe for children under 12 months.
Soon, she'll need to make the long trip back to the health clinic to get him checked out.
And even as she's grateful for the lifesaving help from the drones, Mukanoheli knows she can't turn to them now.
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