2nd
post on the “Boda Boda” Trauma series
Theme:
Road Safety
MY RED HELMET
1. Bad
roads
2. Bad
driving habits (speeding, intoxication etc…… )
3. Unrestrained
and Unprotected drivers and passengers
Every
day from dusk till dawn, these 3 ingredients; mingle, collide
and touch, twisting across the country like a death-dance, fueling the trauma
epidemic in Uganda.
It is not surprising, therefore, that road traffic injuries (RTIs) contribute
over 70% of Accident & Emergency Department admissions at Mulago National Referral Hospital with boda bodas involved in 25% to 41% (Naddumba et al, 2003. Kigera j, 2010 ) of these cases. Records
at the hospital trauma unit show that at least one patient is admitted daily
with severe brain damage resulting from an RTI directly involving a boda boda.
Chances are that
everyone reading this in Uganda will either have lost a close friend, relative, or work
colleague in a road traffic crash in the last couple of years.
Road
traffic injuries are a huge public health and development problem that kill between 800,000 to 1.18 million people, and leaves another 20 to 50 million
more with severe injuries and disabilities every year1. Data from
the WHO and World Bank shows that without appropriate response, these injuries
will rise dramatically by the year 2020, particularly in rapidly motorizing
countries like Uganda. In addition, apart from the enormous impact on families
and communities, road traffic Injuries cost governments between 1 and 3 percent of their Gross Domestic Product.2 Health facilities in
particular are over-burdened with victims of road traffic injuries,
overstretching their already meager health budgets.
Every
day from dusk till dawn, at the receiving end of this
“death-dance”, Health workers across the country dedicate their time to
minimizing the impacts of these injuries; winning some battles and losing others.
However, despite our firsthand interactions and knowledge of the impacts of this
epidemic, our attitudes and choices do not reflect our experiences. It
surprises me to see those who interact with these victims of “irresponsible
road use” hop onto a boda boda and at break-neck speed weave through the city
traffic or dusty village paths; heads bare, unprotected, and without a care in
the world, joining in the death-dance.
For those few minutes in the death-dance, your life is in
the hands of a dance partner who could be leading you back to the Accident and
Emergency Ward where you just ended your shift. There is no way to ascertain if
he has a valid license, if he is intoxicated (a common thing in an attempt to
work long hours), if he is experienced or just “borrowed” a friend’s boda boda
to make a quick buck.
Like many of you, I pray! I say a prayer every time I sit on a
boda boda because at that time I know there is a thin line between life and
death. And I fear. Four months ago I nearly crashed. Actually, I crashed!!! On a “regular” day, I flagged down a “regular”
boda boda for a short ride that nearly cost me my life! Falling off the boda boda
was not at all scary. It was the dirty blue, heavy laden truck, smoke billowing
from somewhere at its rear, making that sound and moving straight for my head
that I will never forget!! Like a 10-tonne sand compactor accelerating towards
a 10cm melon. The thought of my mangled brains thinly spread on those huge tires
jolted me in time into a dash for the safety of the pavement. Like I said, I
pray. This time God had answered my prayers long before I prayed: the day those
speed bumps were placed just meters from where I fell. Those few seconds of
“bump” slowed the truck, giving me the time I needed to survive. To survive
death or the disability and quality of “life after a road traffic Injury”.
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You see, once you survive death at the scene, you could
lose all your belongings to what I call roadside “bad Samaritans”. Thereafter,
you may be end up shoved underneath the officers’ seats on a police pick-up truck because that’s the only place with enough room for you. Since your identification is missing, you are a
John or Jane-Doe and your file says: “unknown” where your name should be. The
hospital course, should you survive your first day of admission gets sadder and
sadder; surgery, physiotherapy, long days of antibiotics, perhaps tubes in and
out of nearly every entrance and exit of your body; taking out fluids,
putting them in, taking them back out, putting in some more. Your sad family
carrying food, buying drugs, loosing sleep, buying more drugs, then supplies,
and then more drugs. Did I mention, you might end up in the Intensive Care
Unit? Or that you may lose a limb or two or four? And if you were the
bread-winner for your family, the huge socio-economic burden will make you wish
you had died at the scene-Only because we are not concerned about road safety-because
you didn’t wear a helmet for a 50m dash across town on a bodaboda.
So this is a promise I made to myself:
1. I
shall wear a helmet every time I sit on a bodaboda.
2. I
shall only use a bodaboda whose driver wears a helmet. If he cannot be
responsible for his own life, how can he be responsible for mine?
At my place of work, for a long time I have been “the
doctor without a motorbike, who carries a helmet”. I have chosen not to be
irresponsible with my life.
My
friends joke about buying me knee and elbow caps (what you see in Motor
GP) a full spine suite and a neck collar (what you see in formula one), and
shin guards (what you see in soccer).
Helmets
reduce the incidence of fatal head injuries by between 20-45%, as well as
reducing the occurrence and severity of other injuries. They are so far
the most successful intervention to preventing injury among motor cyclists. 3
I do not care what you say about a doctor carrying a red helmet. My red helmet is the best gift I ever received .
Do
not leave your precious life in the hands of a random irresponsible guy. Get
your helmet, use it or DO NOT sit on a Boda boda.
References:
1. J.
Kigera , L. Nguku, E.K. Naddumba (2010)The Impact of Bodaboda Motor Crashes
on the Budget for Clinical Services at Mulago Hospital, Kampala . East and Central African Journal of Surgery,
Vol. 15, No. 1
- Naddumba
EK. A cross-sectional retrospective study of boda boda injuries at Mulago
Hospital in Kampala. East
and Central African J Surg (ECAJS).
2004;9:44–47.
3. Servadei
F, Begliomini C, Gardini E, Giustini M, Toggi F and J Kraus (2003) Effect of
Italy’s motorcycle helmet law on traumatic brain injuries. Injury Prevention
2003, 9:257-260
Dr.
Fred Bulumba
The
writer is a resident in anaesthesia and critical care at Makerere university
(MakCHS) with special interest in emergency medicine, Neuro-anaesthesia and
pain.
He
always carries a red helmet
Once we acknowledge
that Road Safety does not happen by accident, (and that road safety is the
state where we have “no accident”) then we are well on the road to finding
solutions. The systemic approach being recommended by the WHO moves from
defining the burden of the road traffic injuries (size, nature) to
understanding the factors that increase risk and vulnerability, to designing
interventions, testing them for effectiveness, and finally, to getting the
effective interventions implemented wherever they are needed. (Dr. Olive C Kobusingye, Regional Advisor,
Disability/Injury Prevention and Rehabilitation WHO/AFRO, Brazzaville )
