Death on wheels

By Flavia Nassaka

Health experts, public health advocates worry as road accidents take a heavy toll on population

From April 20, Michael Haglund, a professor of brain surgery at the US based Duke Global Health Institute, started conducting surgery for different brain and head complications at the Neurology Department of Mulago National Referral Hospital in Kampala. Together with other 17 experts from the US, Haglund was worried at the high turn up of patients.

He knew that many would be left unattended to as an operation on one patient takes six or more hours yet the team was at the department for only a week. They were in Uganda for the Annual Neurology Camp, a programme where Ugandans get an opportunity to receive free spinal cord, head or brain surgery.

Under this year’s initiative, between 25 – 30 patients were expected to undergo operations. Deo Kaija was lucky to be one of them. Kaija, who has been battling a spinal cord tumor, told the Independent on April 23 that he had been advised to raise over Shs 50 million to have an operation abroad. His problem began months after he fell off a ‘Boda Boda’ motorcycle in 2010 as he tried to overtake a truck on Mityana Road.

He got minor injuries on the head and back, which healed after a few days of treatment. However after a few months, he started feeling severe back pains and headaches. He was later diagnosed with a tumor in the spinal cord.

Dr. Micheal Muhumuza, the head of the Neurology Department, says they receive over 500 cases of trauma a year, of which 80% are a result of road accidents.

According to the Uganda Police Annual Traffic Report for 2013, more than 18,300 crashes were reported out of which 2,616 were fatal and 8,874 were serious.  In 2013 alone, 2,937 people died whereas 12,754 sustained serious injuries as a result of road accidents. Last year, according to Traffic Boss Dr. Stephen Kasiima, most of the deaths were a result of road accidents mainly caused by neglect of traffic rules by road users. The incident with the highest number of fatalities was the Bakulu bus head-on collision with a truck near Nesitu Township, about 25kms from the border on the Juba-Nimule road in South Sudan, where 31 Ugandans lost their lives.

The situation is not any better in other countries. According to the World Health Organization statistics, in 2013, more than 1.24 million deaths were caused by road traffic injuries worldwide. Pedestrians and cyclists aged between 15 and 44 are particularly at risk; accounting for 59% of global road traffic deaths whereby 77% deaths are among men.  While the governments are doing their best to curb the scourge, they need to be supplemented with public and donor support.  Safe Way, Right Way, an international NGO, was formed to advocate for road safety along Africa’s major business corridors.  “These cases are largely due to poor riding skills, over speeding, ignorance of  road usage rules and negligence,” says Barbara Mwanje, the CEO of Safe Way, Right Way in Uganda. They work along the Northern Corridor the busiest roadway in Uganda, stretching from Busia through Kampala to Katuna on the Rwanda border. Mwanje says communities that live along highways also need special support as they often fall victim to fast and heavy vehicles yet they have poorer outcomes from injuries due to limited access to post-crash emergency healthcare.

Treatment Cost

On a daily basis, Mulago Hospital receives more than 20 cases of accidents, which translates into over 7,000 cases a year, according to the Injury Control Center Uganda (ICCU). Most of the cases are motorcycle ‘ boda boda’  accidents. Whereas some of these get well after minor treatment, 20% get permanent disability.

Dr. Muhumuza says more than a thousand get some type of brain injury as a result of the trauma explaining that with just about six neurologists in the country, four at the national referral hospital and the two others in Mbarara and Mbale, the facility is sometimes overwhelmed by the numbers leading to death of as a result of delayed treatment.

“Traumatic brain injuries got as a result of a speeding vehicle or motor cycle causes the brain to move inside the skull or damages the skull. This in turn damages the brain,” he explains adding that brain injuries also vary.  A mild injury may temporarily cause confusion, memory problem and headaches but with moderate injury, symptoms can last longer and be more pronounced leading to persistent problems for over a year. With a severe brain injury, the person may suffer debilitating problems. They will have cognitive, behavioral, and physical disabilities whereby they will depend on the care of others for the rest of their lives.  Accidents are also taking a huge toll on the public health budget. At least 62% of Mulago Hospital’s department of surgery budget last financial year went to accident victims. Muhumuza told the Independent that in treating a single patient, the hospital spends from Shs 500,000 – Shs 5 million depending on the severity of the injury.

“This is way too much money for something that can be avoided. This money could otherwise be used for availing ARVs and other serious health concerns the country is grappling with,” says Mwanje.

Apart from stretching the already ailing health system, these accidents have a significant economic impact. Crashes are estimated to cost African countries between 1% and 3% of their Gross National Product each year.

Injury Prevention

The loss and suffering associated with road traffic deaths and injuries are preventable, the experts say. With political will and an integrated approach that addresses vehicles, the people who use roads, and the road infrastructure, roads can be made safer. In Kampala however, where most accidents happen, there are no definite enforcement measures of traffic laws especially motorcyle riders. There are no adequate laws that address risk factors – over speeding, helmets for both rider and passenger, child restraints, drink driving and seat belts.  Properly marked roads is another concern raised especially along highways. Muhumuza says safe road design is about providing a road environment that ensures vehicle speeds will be within the human tolerances for serious injury and death. “The level of protection offered to road users is also important,” he says.  He explains that the chances of survival for an unprotected pedestrian hit by a vehicle diminish rapidly at speeds greater than 30 km/h, whereas for a properly restrained motor vehicle occupant the critical impact speed is 50 km/h for side impact crashes and 70 km/h for head-on crashes.

Mwanje advises engaging passengers in awareness programmes in order to ensure speed management where they are able to tell when the driver goes wrong while on the road and they are also able to report it to the authorities.

“Children should also be trained on better road use. These small interventions can make a difference. For example when Safe Way Right Way set up zebra crossing in Busia, three months down the road, 70% of the students were using it effectively. She adds that Uganda should adopt the approach prescribed by the United Nations Decade of Action for Road Safety (2011 – 2020) whereby measures that ensure road safety management, safe driver and other road users, safer roads and mobility, safer vehicles and post crash response should be put in place.