Why our highways remain a deathtrap

An SUV in which Bishop Patrick Okabe and his wife were travelling had just collided head-on with a truck at Naboa on the Mbale-Tirinyi Highway in Budaka District on December 19.

Rescuers who were first to the scene said while the Serere County lawmaker died on the spot, his wife—Christine—had a fighting chance.

She, however, took her last feeble breath at a hospital in Mbale City after not benefiting from what could have been a life-saving ambulance service.

“We had to use a pick up to transport to the injured victim,” Mr Fred Mpamu, one of the rescuers, told this newspaper.

Like many highways in Uganda, the Mbale-Tirinyi one is not equipped to deal with emergencies. It is dotted with health centres that Dr Moses Mugonyi, the Mbale City Health Officer, says “have limited equipment” that limits them to handling minor—not serious—emergencies. The net result of this is a huge body count.

The police this week revealed that 55 lives were lost between December 23 and 26 after 47 fatal and 95 serious accidents were tallied. Most of the accidents were pegged to reckless driving. There is, however, a growing body of evidence that indicates that several lives can be saved if emergency medical services were streamlined.

Dr Obbo Okoth, the District Health Officer in Tororo, told Daily Monitor that they are powerless when it comes to handling emergency situations.

“We have the personnel in some of the health facilities, which are along the highways, but we do not have facilities that can store blood because most of them are at the level of Health Centre II and III,” he revealed, adding that the area has only two functional ambulances at its disposal—one stationed at Malaba and the other Tororo.

Dr Okoth says this is unfortunate because the “two ambulances cannot effectively serve”, especially since Ojilai—the farthest sub-country “is over 40 kilometres.”

No ambulances

In Pakwach District, the gateway to West Nile, Pakwach Health Centre IV, located on Pakwach-Olwiyo-Karuma Highway, is blighted by shortages ranging from theatre to human resources. Mr Geofrey Wuna Oromcan, the officer-in-charge of Pakwach Health Centre IV, told the Monitor that the solitary ambulance broke down, forcing them to improvise.

“The driver of the land cruiser, which works as an ambulance, is available all the time to transport accident victims,” he said.

In Arua, Mr Paul Drileba, the acting District Health Officer, said health facilities there are prepared to handle emergency cases regardless of the challenges.

“When we receive such cases of accidents, we do what is required,” he said, adding, “If they need referral, we prepare and refer them to Arua hospital.”

Mr Ignatius Dragudu, the North West Nile region police spokesperson, says there should be a push for a proactive approach that involves stopping accidents in the first place.

“Our people should observe traffic rules while on the road due to overspeeding and overloading passengers on vehicles,” he said.

Yet there is no running away from the implications that incapacitated health facilities hold out. Bunyangabu has no ambulance as per its district health officer, Dr Richard Obeti. He told this newspaper that Kibiito Health Centre IV, located along the highway of Fort Portal-Kasese, operates without an ambulance.

“Since 2017 when the district was created, we have lacked an ambulance,” he revealed, adding, “Even during Ebola and Covid-19, we use pick-up to transport patients.”

Kyegegwa District, which recently found itself caught in the cross hairs of an Ebola outbreak, weathered that storm without an ambulance. The district’s lone ambulance has never been repaired since being involved in an accident.

“Currently, we are using ambulances that Members of Parliament donated to the district to respond to emergencies,” Dr Pedison Kadole, the District Health Officer, said.

Huge deficit

While handing over two ambulances to Kween and Bukwo districts procured and donated by the Uganda National Roads Authority (Unra), Dr John Baptist Waniaye, a commissioner in the department of emergency medical services at the Health ministry, said the country requires 460 ambulances to attend to emergencies. By last year, it had only 201, leaving a gap of 259 ambulances.

“The road traffic accidents top the causes of death and admissions in government hospitals across the country,” Dr Waniaye said, adding that the country has 220 accident black spots on highways that need 24/7 ambulance coverage.

According to the World Health Organisation Emergency care assessment in 2017, only 25 percent of Ugandans access ambulances.

In 2018/2019, Makerere University’s School of Public Health assessed Emergency Medical Services (EMS) in Uganda. It discovered that most of the ambulance vehicles in Uganda do not meet the minimum standards for Type B emergencies, which a basic life support ambulance is recommended for Universal coverage in the country.

Manpower issues

In the Teso Sub-region, Atutur Hospital in Kumi District is located on a highway. It, however, lacks an ambulance. The facility, which was built in the 1960s, is on a drip. The hospital superintendent, Mr Simon Oluka, told this newspaper that the hospital receives many road carnage victims.

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“We have made several attempts to remind those in authority to provide an ambulance, but the requests have not yet been honoured,” he said.

Mr Nelson Mandeal Elungat, Kumi District chairperson, said despite Atutur being a highway hospital it is not equipped to handle eventualities.

“It also remains dilapidated, without access to national water,” he said.

Dr Peter Yeeka, the Bushenyi Health Centre IV officer-in-charge, said they are also incapacitated to handle emergency cases.

“We can’t handle them fully because we don’t have an emergency department and gadgets,” Dr Yeeka said, adding that cases are referred to “other hospitals like Kitagata hospital.”

According to Halson Kagure, the public relations officer of Mbarara Regional Referral Hospital, they are well equipped and prepared to handle any accidents.

“As a hospital, we have enough capacity to cater for all the people only that at times we are overwhelmed,” he said.

The Kamuli District General hospital medical superintendent, Dr Saidi Atuma, said the hospital receives an influx of accident patients.

“We have been forced to open a Special Casualty and Accident Unit on standby to receive the patients,” he said.

Mr Charles Galimaka, a social commentator at KBS Radio Kamuli, points out that most of the ambulances are grounded due to the high costs of maintenance and repairs.

“While the district hospital has opened up the casualty unit, personnel handling it are overstretched and perhaps not motivated,” he said.

Manpower challenges are also a big bottleneck at Aboke Health Centre IV in Kole District.

“We don’t have adequate capacity like items of supply of drugs and other medicines,” Dr Richard Ojede, the centre’s officer-in-charge revealed, adding, “We also lack infrastructure like the X-ray to do the screening for those who have had the fracture.”

Aboke Health Centre IV sits along Lira-Kampala Highway and Corner Mwolem-Gulu Highway.

“We have four doctors, but the challenge is the nurses are very few, we have two nurses working in the OPD and four in the wards,” Dr Ojede said, adding that the number of road accidents is increasing thanks to construction work along Lira-Kamdini Road.

They have gone from registering about five a month to as many as 11. Some of the accident blackspots are Corner Mwolem in Aboke Town Council and Apii.

 Training key

According to Masaka hospital principal administrator Charles Tumushime, the facility is well-equipped to handle emergencies. He added that regional referral hospitals with support from Korea Foundation for International Health care (KOFIH) developed a team of first responders who attained training in emergency care and can ably handle crash victims.

“The training the health workers improve their skills in handling and managing crush victims by giving them the necessary care that can help much in saving their lives,” he said

Records at Masaka regional referral hospital indicate that the facility receives at least 10 people admitted as a result of road crashes in a day. Ms Harriet Ijangolet, who runs the rule over the hospital’s call and dispatch centre, said that the Sub-region has four ambulances on standby.

Ms Ijangolet, however, said there is more needed to strengthen pre-hospital care to accident crash victims. This, she adds, can be done by training more first responders that can offer first aid to crash victims.

“We still have a challenge of lack of knowledge on what to do when people get to a traffic crash scene but with training offered to community members like the one we had by partners like KOFIH can be of great help,” she said.

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Masaka regional referral hospital is located along the busy Kampala-Mbarara Highway and Masaka-Mutukula Highway. It’s the first point of call for patients, including road crash victims. The hospital’s average daily outpatients stand at about 2000.

The record year for traffic crash deaths recorded in Masaka dates back to 2016 when 232 of them were tallied. The district has three major facilities where crash victims are always attended to as the first priority. These include Masaka regional hospital for the crashes that happen on Masaka-Kyotera-Mutukula Highway as well as Masaka-Mbarara Road; St Joseph Hospital Kitovu; and Villa Maria Hospital for those that happen along Masaka-Kampala Highway.

 Elsewhere, some district health officers and administrators of hospitals in the Kigezi Sub-region also expressed readiness in providing emergency health care services.

“We have asked all the health workers in the three hospitals that we have in Kabale District and others working in the lower health units to remain on duty to ensure that the required emergency services are offered,” Dr Gilbert Mateeka, the Kabale District Health Officer, said.

The Rubanda District Health Officer, Dr Abdon Birungi, says they have equipped all the health units operating near the Kabale-Kisoro-Rwanda-Congo Highway with all the necessary medicines and standby personnel to ensure that patients requiring emergency care, like first aid, are handled. This is before referring them to the Kabale Regional Referral Hospital for specialised treatment.

 “We have appointed supervisors to ensure that health workers do not abscond from duty, especially during the festive season. This has been done to ensure that emergency health care services are prioritised,” Dr Birungi said.

The Kisoro hospital medical superintendent, Dr Benon Rukunda said, although they have challenges of accommodation, they have equipment and personnel that can handle all the emergency cases reported at his facility.

In Yumbe District, Dr Ben Oboch Orionziga, the officer-in-charge of Yumbe Health Centre IV, said they have prepared themselves to handle such emergency cases.

“We have one ambulance that is dedicated to having quicker response free of charge. We also trained two nurses to handle the cases,” he said.

Dr Oboch, however, expressed worry that one ambulance may not be enough if the accident cases occur frequently.

Dr Franklin Idi, the Moyo District Health Officer, told this newspaper thus: “In Moyo District, all health facilities along the highway have responded to emergencies related to road accidents.”

In Buikwe, police said the growing potholes on the Nile-Njeru-Mabira Highway and lapping tree branches on the road are the major causes of fatal accidents.

Mr David Ssekamanya, a truck driver, said the potholes have developed right from the Nile in Njeru to Mabira Forest.

Ms Hellen Butoto, the Ssezibwa police spokesperson, confirmed that the aforementioned potholes and lack of sign posts along Njeru-Lugazi-Kampala Highway are the major triggers of accidents.

“We are monitoring movement of vehicles before and during the festive period in those particular areas and ready to respond to any eventuality on the highways,” she said.

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Accident victims along the highways are either rushed by police patrol car or police ambulance of the region to Kawolo Hospital or Jinja Regional Referral Hospital.

Black spots

Kampala Metropolitan

• Northern Bypass

• Lugogo on Jinja Road

• Entebbe Road

• Kajjansi closing at Kajjansi Town.

• Bata Bata area on Entebbe Road

Western route

• Mpanga Forest on Kampala-Masaka Road

• Kalandali Village on Kampala-Masaka Road in Mpigi District

• Kibukuttu swamp

• Nabusanke towards River Katonga

• Nabyewanga near Kyabadaaza.

Mityana District

• Nswanjere near the tree plantation

• Kikonde Tea Estate 

• Kampala-Mubende highway

• Mpamujugo Swamp

• Kassanda towards Myanzi

• Kabalanga a few miles to Mubende Township

• Kalembe, Mayinja-Abiri

• Kiyuni along the Mubende-Kakumiro road.

Western Region

• Kasunganyanja on Kasese-Fort Portal Road in Kabarole District

• Kihura area in Kyenjojo District

• Kanyandungu on Fort Portal-Kamwenge road

Eastern Region

• Kakira on Jinja-Iganga Road

• Railway crossing in Bukedea District

• Otuboi in Kaberamaido District

• Kamonkoli in Budaka District

• River Mpologoma Bridge in Namutumba District

• Bulyantente in Buikwe District.

• Mabira Forest in Mukono District.

Northern route

• Kafu River near the junction to Masindi District.

• Koro Village in Koro Sub-county, Gulu District on the Kafu-Gulu stretch 

• Lowiyo on Arua Road

List of hospitals on highways

Budaka Health Centre IV  - Mbale-Tirinyi Highway 
Mbale Regional Referral Hospital   -  Mbale-Tirinyi Highway
Kachorwa Hospital  -   Mbale-Kapchorwa Road
Mbale City Health Centre II   - Mbale-Tirinyi Highway
Tororo Hospital   -  Tororo-Mbale Highway
Nyalakot Health Centre II   - Tororo-Malaba
Nagongera Health Centre IV  -  Tororo-Busolwa Highway
Pakwach Health Centre IV  -  Pakwach-Olwiyo-Karuma Highway 
 Arua Regional Referral Hospital  -  Arua Highway 
Kibiito Health Centre IV   -  Fort Portal-Kasese Highway
Atutur hospital   -  Mbale-Soroti Highway 
Bushenyi Health Centre IV  -  Mbarara-Kasese Highway
Aboke Health Centre IV   -  Lira-Kampala Highway
Masaka hospital  -  Kampala-Kigali Highway
Kisoro hospital  -  Kisolo-Bunabena
Yumbe Health Centre IV  -  Moyo Road
Kawolo Hospital    -   Kampala-Jinja Highway

Compiled by Fred Wambede, Joseph Omollo, Felix Warom, Clement Aluma, Scovin Iceta, Robert Elema, Sheillar Mutetsi, Milton Bandiho, Simon Peter Emwamu, Alex Ashaba, Mudangha Kolyangha, Roert Muhereza, Emmanuel Arineitwe, Denis Edema, Philip Wafula, Sam Caleb Opio, & Bill Oketch.

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