Josiane Mukashyaka remembers with startling clarity the instant her life changed. One moment, she was like everyone else on the road – moving, walking, and working freely. The next, she was gravely injured in a motorcycle accident, fighting to stay alive.

"I was coming back from work in the evening,” Mukashyaka said. "I was on a motorcycle taxi heading home when a car hit us from behind. The accident happened in Kanogo, in Nyamabuye Sector,” she recalled, her voice steady as she traced the moment everything changed.

Today, people struggle to reconcile the woman before them with who she once was. "They look at me and can’t believe I was once like them,” she said. "I tell them not to lose hope. Healing takes time.”

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Mukashyaka spent nearly six months at Kabgayi Hospital, suspended between pain, uncertainty and survival. Although her injuries would eventually cost her both legs, her immediate battle was simply to live.

Severe blood loss placed her among trauma patients whose survival depends not only on medical expertise, but on how quickly lifesaving supplies reach them.

"I would not be here today if the process had been delayed,” she recalled. Her condition worsened more than once, forcing doctors to act within minutes. Each blood transfusion marked a critical turning point – restoring not only her strength, but also her chance to imagine a future.

At Kabgayi Hospital, located about 50 kilometres from Kigali, such emergencies are common. The facility serves patients from across the Southern Province, many arriving with injuries or complications that require urgent blood replacement.

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For years, accessing blood meant transporting it by road from Kigali, a process vulnerable to distance, traffic and delays. In cases of massive bleeding, those obstacles could be fatal, even when medical teams were ready to act.

Doctors say Mukashyaka’s survival reflects not only her resilience, but a broader transformation in Rwanda’s emergency care system – one increasingly shaped by speed, access and logistics that match the realities faced by hospitals beyond the capital.

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On January 28, we drove into Gasharu, a quiet village in Nyamabuye Sector, Muhanga District, in search of the home of Mukashyaka. After a few wrong turns, she called to guide us and soon appeared on a motorcycle taxi, scanning the road until she spotted us.

Wearing black jeans and a light yellow blouse, Mukashyaka climbed down, smiled, and joined us, leading the way to her home tucked deeper into the village.

Inside her modest house, she welcomed us warmly and, without hesitation, began recounting the evening that reshaped her body, her livelihood, and her understanding of survival.

Before the crash

Before that day, Mukashyaka, now 36, lived a life defined by routine and responsibility. She worked at a salon, braiding hair and offering nail and grooming services to support her children.

"I was a mother who worked to provide for my family,” she said. "That salon work was how I earned a living.”

A violent impact

The routine ended abruptly that night.

"When the car hit the motorcycle, I was thrown off,” she said. "The car ran over both my legs and my right arm. I immediately lost consciousness.”

She lay on the road for nearly an hour, drifting in and out of awareness as blood pooled beneath her.

"There was no immediate help,” she said. "There was no ambulance at first, and I was losing a lot of blood.”

The motorcycle rider sustained minor injuries. Mukashyaka did not. By the time an ambulance rushed her to Kabgayi Hospital, her condition was critical.

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"At the hospital, doctors told me my condition was very serious,” she said. "They said both my legs could not be saved.”

‘Without blood, I would not survive’

At Kabgayi Hospital, doctors raced to stabilise her. Blood transfusions were urgently needed, a prospect that frightened her even as she struggled to remain conscious.

"I was confused and scared,” she recalled. "I even asked how they could give me blood without knowing my blood group.”

Doctors explained that in life-threatening emergencies, blood can be administered safely, and that without it, she would not survive.

"They told me that if blood was delayed any further, I would die,” she said. "I received many transfusions. That blood saved my life.”

Those transfusions became the foundation for everything that followed – surgery, stabilisation and survival.

‘She was not stable’

Dr Jean-Baptiste Muvunyi, the Director General of Kabgayi Hospital and an orthopaedic surgeon, performed Mukashyaka’s surgery and has followed her case for five years.

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"When she arrived, she had severe crash injuries to both legs and massive bleeding,” he said. "Although she was awake, she was not stable and had already lost a very large amount of blood.”

Stopping the bleeding was the immediate priority. But the hospital’s blood bank alone could not meet the demand.

"We realised immediately that we needed more blood,” Dr Muvunyi said. "Because of the urgency, we contacted Zipline to request blood products.”

Minutes that mattered

Surgery continued deep into the night.

"Having blood available allowed us to replace what she had lost and proceed with fracture stabilisation,” Dr Muvunyi said.

The speed of delivery, he added, changed everything.

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"With Zipline, blood arrives within 10 minutes, sometimes less,” he said. "Before, if we lacked blood, we had to send someone to Kigali, about 50 kilometres away. That could take two to three hours, which can be fatal in cases of massive bleeding.”

In Mukashyaka’s case, the outcome was clear. "We could not have saved her without rapid access to blood,” he said.

Six months in hospital

Mukashyaka spent nearly six months at Kabgayi Hospital, undergoing repeated surgeries, tissue removal, fracture stabilisation and skin grafts.

"I could not stand or walk. I depended entirely on nurses,” she said. "Those months were extremely difficult.”

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The physical pain was compounded by emotional exhaustion.

"I lost hope many times,” she said. "I felt like I was dying and did not know if I would ever live normally again.”

Going home, still broken

Discharge did not mean recovery. She returned home unable to walk and without a wheelchair, spending most days lying down.

"It took nearly two years before I began to walk again,” she said. "I learned slowly, like a child, using chairs and furniture. Using crutches was difficult because my right arm was also injured.”

She fell often, endured swelling and pain, and required constant follow-up care.

Invisible wounds

The trauma reshaped how she saw herself.

"Emotionally, it affected me deeply,” she said. "I became afraid of people looking at my scars, so I stopped wearing skirts or dresses.”

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Faith, prayer and encouragement from others helped her through moments when the burden felt overwhelming.

Adapting to survive

Unable to resume work outside the home, Mukashyaka adapted.

"I started braiding hair and doing nail services from home, working while seated,” she said. "I refused to give up because I wanted to live.”

She later learned to make home décor items and joined a group of 10 people with disabilities who craft together – work that provides income and social connection.

Giving others hope

Today, Mukashyaka often visits patients still recovering in the hospital.

"When they see me walking, they are surprised,” she said. "I tell them not to lose hope. Healing takes time.”

Her presence alone offers encouragement. "Life does not end with an accident,” she said. "Even small progress matters.”

‘Designed for moments like these’

Pierre Kayitana, Zipline’s Country Director in Rwanda, said Mukashyaka’s case reflects exactly why drone delivery exists.

"When a trauma case needs urgent transfusion, hospitals can place an order immediately,” he said. "At Kabgayi, the average time from request to delivery is about seven minutes.”

That speed allows clinicians to focus on saving lives rather than logistics, he said, across trauma care, obstetric emergencies, severe anaemia and cancer treatment.

‘I am grateful to be alive’

Life remains challenging for Mukashyaka, but gratitude now outweighs despair.

"Without the doctors, the blood transfusions and the care at Kabgayi Hospital, I would not be here,” she said.

Her survival was not a matter of chance, but of minutes – medical skill, rapid blood delivery, and a woman who refused to stop fighting.