“What we see is so disturbing … open wounds, extensive laceration on the scalp with brain coming out, patient hardly breathing, fighting for his or her life,” says Dr Michael Muhumuza, head of neurosurgery at Mulago Hospital. “It’s quite a terrible picture for anybody to bear,” he says, describing the injuries he sees regularly as a result of boda boda accidents.
Muhumuza says he treats between seven to 12 patients daily who have been severely injured riding boda boda motorcycle taxis in Uganda. On average, 20 new critically wounded boda patients are received at Mulago every day, according to the hospital, let alone the hundreds who arrive with minor to moderate injuries.
In his emergency ward for head injuries, Dr Muhumuza points to dozens of boda victims. The patients come from around the country for treatment at the national referral hospital, the largest in Uganda, he says.
Walking from bed to bed, the doctor pulls individual patient x-rays. One belongs to a teenager who travelled from Kabale, about 400km away, for treatment. His skull was cracked open in a motorcycle accident, the neurosurgeon explains. “This is where his brain came out,” he says, pointing to a blotch of grey mush captured on the film.
With the exhausted tone of someone who has seen it all - he’s worked in Mulago’s neurosurgery department for 11 years - and who was treating fresh boda victims until 2am that morning, he laments: “these patients will be here for at least three months, maybe even six for some.”
It costs Shs8 million on average to treat just one severely injured motorcyclist at Mulago Hospital, according to a new study by the Uganda Christian University in partnership with Makerere School of Economics.
Some of this cost is borne by the accident victims and their families and friends and some is covered by “society as a whole,” the study continues; in 2012, “3,043 motorcyclists were reported to have been seriously injured as a result of motorcycle accidents in Uganda, this translates to Shs24.27 billion” in medical expenses.
To manage these cases, Mulago hospital directs 62.5 per cent of its surgery budget to treating victims of boda accidents says Barbara Mwanje, Africa manager of the Global Helmet Vaccine Initiative (GHVI), an organization advocating for helmet use and improved road safety.
“That’s the most telling indicator of just how big the issue is,” she says, adding that there are an estimated 80,000 registered bodas on Kampala’s roads, though likely thousands more. Since starting their operations in Uganda in 2010, GHVI has provided road safety training and helmets to 4,000 bodas.
She says the organization has been focusing on improving the safety of motorcycle drivers because of the “occupational hazards,” they face spending between 10 to 12 hours on bodas daily.
Riding bodas is common for Ugandans, but wearing helmets is not: only 30 per cent of drivers wear helmets and 0.02 per cent of passengers, according to the GHVI’s 2011 general population survey. Mwanje says that the percentage of drivers wearing helmets has increased to around 49 per cent, based on the organization’s 2013 study. However, the quality of helmets they wear is an issue as is the continuously low rate of boda passengers wearing helmets, she says.
SafeBoda is a new company in Kampala that aims to improve the safety of drivers and passengers. “There are lots of bodas on the streets,” acknowledges the company’s co-founder, Ricky Thomson. “What makes SafeBoda unique is [the drivers] get training from the Uganda police, the Red Cross … and they carry two helmets - one for you!”
Dr. Muhumuza says the company’s unique two-helmet approach is long overdue “The patients who are most severely injured are the passengers,” he says. The neurosurgeon attributes the predominance of injured passengers to their lack of helmet use.
Wearing helmets at the time of accidents has saved 87 per cent of boda drivers from physical injury, according to the Uganda Christian University’s 2014 study.
SafeBoda’s drivers hit Kampala’s streets at the end of November. There are currently 25 drivers working from their regular stages in Kisementi, Kololo and Bukoto, according to co-founder Thomson, who says providing helmets for customers is crucial.
“I lost my friend who fell [off a boda in an accident] and had a head injury. He spent three months in pain and then he died. He wasn’t wearing a helmet,” says Thomson, who worked as a boda driver for four years before starting SafeBoda. “I fell twice, but I never had a head injury, I always wore a helmet.”
“We believe prevention is the cure [so] we equip our bodas with helmets for themselves and their customer,” he says.
Another issue Thomson says SafeBoda is addressing is the lack of training boda drivers receive. The Uganda Police run workshops to train the company’s drivers about road rules.
Paul Kwamusii is a road safety specialist who has been delivering similar workshops on defensive driving, judgment and traffic laws for 22 years. In early December, the former police officer trained 600 boda drivers from different areas of Kampala as part of GHVI’s latest safety campaign.
“One issue coming out very clearly in these workshops is the need for more training,” he asserts. “Bodas ride before they’re trained. This is the first time they’re seeing training; one [man] told us that he’s been [a boda driver] for 21 years and has never been trained. There is a gap.”
Thomson agrees: “I learned [to boda] from the streets. No one taught me. All I knew is that if you see a space, you go. That’s why you see bodas going on sidewalks and everywhere. It causes accidents.”
While providing road safety training to boda drivers is an issue being addressed by different non-governmental organizations, like GHVI, training drivers in first aid is new and unique to SafeBoda.
“Many customers like it because I’m giving them a helmet … I’m explaining that we know how to treat someone who has been in an accident, to give the first aid,” says Ashraph Jamada Bamuwa, a SafeBoda driver located at Moyo Close stage in Bukoto, Kampala. “Some of them, they’re now my customers because of that.”
“We want boda drivers to realize that they can make more money by being safe: from having a helmet, providing a helmet for a passenger, having good customer service … from being safe and trustworthy in general,” explains Alastair Sussock, a Scottish economist and co-founder of SafeBoda.
The company’s strategy is to provide a market-based solution for improving road safety issues, he says. In Rwanda, traffic laws and helmet use for passengers and drivers is enforced. Here, the norms are different, says Sussock, whose company works with a mobile technology developer, called HeHe Labs, in Rwanda to manage a phone app that Ugandans can use to locate and call a SafeBoda driver near them.
Although it may not appear to be the case on Uganda’s roads or based on the number of head injuries that hospitals see, “it is lawfully required that everyone on a motorcycle – passenger and driver – is wearing a helmet,” says Mwanje of GHVI. “It’s in the Traffic and Road Safety Act.”
“Enforcement could be better,” she argues. “We often find there is a lot of politics surrounding the boda industry and the enforcement of traffic laws. Police need to be supported by the country in enforcing the law. I don’t think they’re getting the support they need to do this.”
Still, some Ugandan commuters say wearing helmets is their primary concern when using bodas. “If I get a boda who doesn’t have a helmet, I have to ask [for one], that’s the first thing I have to ask,” says Margaret Achieng, a 26-year-old Kampala resident.
Achieng says she has been using SafeBoda regularly because she knows they will have a spare helmet for her to wear.
Getting the majority of Ugandans to wear helmets will still require a change in the culture, says Thomson. SafeBoda’s co-founder says not all Ugandans are receptive to wearing helmets.
“Lots of Ugandan ladies put a lot of work into their hair - they don’t want to disorganize it by putting on a helmet,” explains Thomson of the reactions he has received to SafeBoda and with his work giving city tours by bodas, which also provided helmets for customers. “We tell them: ‘your hair is really good, but you can only have your hair when you’re head is okay and you’re alive so you better take this helmet.’”
Despite her advocacy work with GHVI, helmet and road safety activist, Mwanje, says there isn’t enough awareness among Ugandans of just how important helmets and reflective vests are for them on the roads. Not having vests to identify which boda drivers are actually registered with the Kampala Capital City Authority is another issue.
SafeBoda drivers wear bright orange vests bearing their names and that of the company. Godfrey Omaido is a Kampala boda driver who commends SafeBoda’s official look. “It’s really good because we have cases of stealing and so on,” he says. “I think it makes it public to everyone so they know that this is his job.”
Other boda drivers are welcoming the new company as well, despite the competitiveness of the industry, Sussock assures. SafeBoda founders are receiving as many as ten calls a day from boda drivers who want to join, he says.
The company aims to have three or four thousand SafeBodas on the capital’s streets within the next two years. “Once you have that number of people, helmet wearing and safety will be front and centre of how you make money in the boda industry,” Sussock says. “We want to change the entire perception of a country where no one was wearing helmets [for the most part] to one where everyone is wearing helmets. That’s our dream.”
The number of new critically wounded boda patients received at Mulago every day.
The cost of treating just one severely injured motorcyclist at Mulago hospital.
The percentage Mulago hospital directs of its surgery budget to treat victims of boda accidents.
Wearing helmets at the time of accidents has saved 87 per cent of boda drivers from physical injury.