My Red Helmet ( Boda Boda Series)

2^nd 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”.

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

2. 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 )