Road accident injuries: the neglected ‘epidemic’

In a recent World Health Organisation report, Uganda ranked among the five countries with the highest number of road traffic accidents, with an estimated loss of 2.9 of the country’s GDP in terms of human life, lost time and disability.

The report on global status on Road Safety 2013 indicates that Uganda had 2,954 deaths in 2010 as a result of road accidents. Nigeria registered 4,065 and South Africa had the highest number of deaths at 13,768 in 2009.

According to the 2012 Crime, Traffic and Road Safety report, 3,124 people were killed while 13,137 were seriously injured.
The epidemic of road traffic injuries has been growing over time with little attention being given to the problem, both at planning and policy implementation levels.

This, according to Dr Olive Kobusingye, the Research Fellow, Principal Investigator of the Trauma, Injuries and Disabilities Project at the School of Public Health Makerere University, is because road traffic injuries, and deaths have not been looked at as an epidemic like cholera, Ebola or HIV, as it is perceived to be less dramatic.

“Yet, every day people die on the road. Needlessly, because the key sectors directly charged with the duty to prevent these injuries have not prioritised this ever growing problem,” she says.
According to Dr Kobusingye, the ministry of health – charged with the duty to prevent disease, disability and preventable deaths, the Ministry of Works and Transport – for ensuring that roads are made safe for users and the Uganda People’s Police Force – to implement the road traffic Act have not devised any strategies to prevent road traffic injuries and deaths.

In a research paper titled, “The Neglected Epidemic: Road Traffic Injuries in the Developing Countries”, authored by the chairman of Uganda Aids Commission Prof Vinand Nantulya, and published in the British Medical Journal, the growth of motor vehicle numbers, poor enforcement of traffic safety regulations, inadequacy of public health infrastructure and poor access to health services are the major leading cause of injuries.

Dr Steven Kasiima, the assistant Inspector General of Police in the Traffic and Road Safety Directorate, says the major cause of road traffic accidents that result into injuries, disabilities and deaths are due to road indiscipline and pedestrian ignorance. This, he says, accounts for about 80 per cent of road traffic accidents in the country. This includes reckless driving, speeding, inconsiderate use of the road, careless or ignorant pedestrians, incompetent drivers and driving under the influence of alcohol or drugs.

The other major cause of the accidents on the roads outside Kampala, according to Kasiima, is that roads are not lit and are not separated which is the major cause of head-on collisions at night.

“Majority of the drivers on our roads are not law abiding, they lack good training on road usage and are generally poor drivers who can only drive vehicles forward without consideration of the road safety signs,” he says, adding that the pedestrians – the biggest per cent of the accident victims – are ignorant of the safety signs, the highway code and do not know how and when to cross on a highway.

On the side of drivers, he attributes the problem to poor driving schools which pass half-baked drivers. In fact, he says that as a country, Uganda has no standard driving school. “We have things resembling driving schools.”

He also blames the driving permit licensing officers who just dish out permits to whoever can afford them without proper road tests both theoretical and practical.

“Most importantly, our roads do not have provisions for pedestrians yet they are the majority of the road users. More than 90 per cent of our roads have no facilities enabling pedestrians to cross and this has contributed to the growing number of hit and run victims,” he says.

Motorists versus pedestrians
Dr Kobusingye agrees with this, saying that there is a growing culture in Uganda that glorifies motorists at the expense of majority of pedestrians. “And that’s why even the new roads being constructed do not have any planned pathways for pedestrians to cross the road even on highways. This goes to show that while they are the majority, they are not being planned for and as long as this is not changed, deaths and injuries on the road will remain.”

Dr Kobusingye says that the accident injuries in Uganda will exist for years because the country has been laying ground for major road traffic accidents by failing to improve the physical infrastructure that is being pressured by rapid urbanisation and motorisation.

“The consequences are fairly easy to predict – because there are a lot of vulnerable road users who are not externally protected yet they share space with fast moving vehicles. With this combination of increased urbanisation and more motor vehicles coming in every day while the infrastructure remains the same, more serious accidents will continue to happen,” she says.

Worse still, the retired surgeon says, the country is also not prepared to deal with the consequences of lack of preventive measures. For instance, most of the health facilities along the highways which receive accident victims daily do not have matching supplies and human resource to deal with emergency cases.

“There is no systematic mechanism to transport victims from the site of accident to the nearest but appropriate health facilities,” she says, adding that poor handling of emergency or accident victims is responsible for 50 per cent of the deaths that occur at the site and during transportation to health facility.

“We don’t need to invent these interventions. They have been here for a long time. We just need to prioritise, have communication strategies, planned emergency medical centres and an organised ambulance system,” she says. “Here, when an accident happens, you are not even sure who to call. If you are lucky and police arrives in time, their first priority is to find who caused the accident – that is their job, instead of rescuing the victims and rushing them to a hospital.

“There is need for first care responders and prompt evacuation from the scene of injury. This can only be if there is a properly instituted transport or ambulance system which is currently lacking in Uganda,” she says. “If you are rescued under our current system, either by good Samaritans or police, certain things are likely to go wrong – either you get more injuries or you are taken to a health facility that has absolutely no capacity to take care of the patient. During such delays, most people who would have been saved will die due to lack of proper emergency care.”

Dr Kobusingye says that because of the lack of a system, the rescuers are usually not prepared; they lack basic equipment such as gloves to protect themselves from victims’ blood and other body fluids as well as disposable gear to protect victims from co-infecting each other.

“Most of the accident victims suffer more injuries during transportation than the initial accident. Some are piled up on police vehicles, others are pushed under the seats on police trucks. Under such circumstances, they are not only getting more injuries but there is also a very high risk of getting infected in case any of them has viral diseases such as HIV or Hepatitis among others.”

Dr Isac Ezati, the Director General for Planning at the ministry of health says that analysis of data collected from regional and national referral hospitals indicates that less than five per cent of patients arrive at the facilities by ambulances including referrals from other hospitals.

“As a ministry, we are challenged on establishing a trauma care system to stop rather preventable deaths and disability,” he says, adding that there is need to put in place teams to help victims by providing initial care as well as stopping the bleeding at the site of accident.

Dr Kasiima says that while Police has tried to have at least one ambulance in areas that have been listed as black spots for accidents across the country, there remains a gap that the ministry of health ought to address.

“Sometimes we are challenged. You get to a scene of an accident and the only police ambulance in that area is some kilometres away and there is heavy traffic jam, if we have to rush these victims to the health facility, we have to make a decision very fast and most times, we put the victims on the pick-up truck.”

He says they do know it has risks associated with it, such as aggravating the injuries of the victim in cases where the victims are supposed to be handled with utmost care. “In cases like that, we try as much as we can to get proper transport.”
In his research paper Prof Nantulya states that injuries occur mostly among the vulnerable poor people who constitute the bigger percentage of pedestrians.

Pedestrians, passengers and cyclists combined, account for 90 per cent of deaths due to traffic injuries while urban pedestrians account for 60-70 per cent of the deaths.

Young people most affected
According to Dr Victor Mukasa, a surgeon at the department of Accident and Emergency, Mulago Hospital, most of the victims tend to be teenagers and young adults of ages between 15 and 35. This is because this group is said to be mobile, energetic and is always on the road travelling for different reasons unlike the young children below eight years and adults above 70 years.

Data from the department indicates that there were 2,000 accident victims registered at the casualty and emergency ward in the last three months only, majority of them being boda boda victims. This means that the average number of road traffic accidents registered at the hospital daily is 26 patients.
Dr Michael Muhumuza, the Head of the Neuro-Orthopaedics department at the national referral hospital says that 90 per cent of the patients admitted at the ward at any one point are road accident victims, many of whom suffer serious brain injuries.

“Depending on how severe the injuries are, most patients stay at the hospital for at least three weeks while others are admitted for months,” he said, noting that majority of the patients die before they arrive at the facility while others die upon arrival.

“The effects are huge, for those who don’t die. They suffer serious permanent injuries limiting their morbidity. Again this depends on the injured part, if the affected area involves sight centres, the person loses their sight, while others become completely incapacitated,” he says.
Even as this worrying situation continues to claim Ugandans, very is little is being done to prevent some of these rather preventable deaths.

Dr Kobusingye says that the three key players should agree to contribute part of their budgets towards prevention of road traffic accidents. Where the accidents are not avoidable, the ministry of health should have all the hospitals along the highways prepared to handle emergencies by equipping them with the necessary human resource and equipment to prevent deaths of the victims who make it to the hospital alive.

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