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Wednesday, September 2, 2015

Uganda Boda Boda Epidemic

By Esther Nakkazi
It is raining and cold. Twenty-eight year old Samwiri Kyeyune, a Boda Boda rider in Kampala, Uganda is taking shelter at Crested Towers, seemingly shivering from the cold although he is dressed heavily.

He has rested his sunglasses on the dirtish, smelly, fading brown jacket that is slightly bigger than his size. It could be a winter jacket from anywhere in the world.

He is also wearing blue jeans and big black rubber soled shoes. He keeps a pair of gloves in his pockets and his helmet is resting on the bike, which is now parked in the rain.

Kyeyune’s Boda boda is one of the 200,000 operating in Kampala according to the Boda Boda Association but only 13,773 motorcycles have been lincenced by the Transport Licensing Board.

They take the name Boda boda, after bicycles and motorcycles that ferry passengers at the border towns between Uganda and Kenya. In Kampala, they are purely motorcycles.

To purchase his, four years ago, Kyeyune and his two siblings sold off an acre of their family land in Mukono near Kampala.

“I was tired of being poor and my wife was unhappy. When we sold off some of the family land, I decided to become a boda rider and make money,” says Kyeyune. Most boda boda riders are school dropouts and young, below 40 years. They are eager to make money and work for long hours.

He moved to Kampala with his wife, Janet, the family is now bigger with a sixth member, a two-year old son. He assures that his income has also increased by more than 80% to about 20,000 per day.

With a congested city, many Kampalans aiming to get to their appointments on time just jump on  Boda bodas, which weave through traffic jams easily.

“I usually park my car at my work place and move around town on a Boda boda because it is faster and it is a hassle to find car packing,” says Carol Nakku, a marketing agent with a radio station in Kampala.

Passengers like Carol sometimes in an effort to beat time urge the Boda boda riders to ‘fly’ yet they never wear helmets. Women are more reluctant than men passengers to wear helmets because like Carol says, it ‘spoils’ their neat hairstyles and they are a risk for disease. Hygiene is considered ahead of safety.

Boda Bodas deaths; Who is to blame?

Twenty-six year old, Michael Tebandeke was taking a turn off Jinja road to Namugongo when a vehicle knocked him and his two passengers off a Boda boda. He has now spent half a month at Mulago the National Teaching and Referral Hospital serving as the apex of medical care in Uganda and the teaching hospital for Makerere University.

Dr. Edward Naddumba, a senior consultant Orthopaedic Surgeon, says 80 percent of Boda boda accidents are due to human error followed by defective vehicles, environmental factors, poor roads, undisciplined road users and road designs.

Dr. Naddumba, is just one of the 28 Orthopaedic Surgeons against a population of 36 million. He says Boda bodas are increasingly the cause of trauma in Mulago.

Patients seen at the Accident and Emergency for Trauma centre are evaluated and those found to have major trauma are admitted to the Emergency ward. Boda bodas are responsible for about 75% of all trauma caused by Road Traffic Cases (RTCs) in Uganda.

Dr. Sam Okuonzi, a Member of Parliament says all over the country each referral hospital has a ‘boda boda’ ward. “They are not called trauma centres anymore which makes more meaning.”

Statistics at the Injury Control Center-Uganda based at Mulago shows that the Hospital receives 5-20 Boda boda related cases per day or 7280 cases a year. A 2011 traffic report shows that 570 Boda boda riders died or 15 die per day in Kampala.

The blame is on the narrow roads and a traffic mix with cows, dogs and cars all using them. Kiosks and markets on the roadsides also make it harder. Most roads have no signs to guide users and have potholes, which are dodged by cars and motorists, only to collide after skipping them.

David Muhwezi from the Uganda National Road Authority says they have tried to put up road signs but they are stolen so they are moving to plastic ones. To completely do away with this problem UNRA proposed a ‘shoot to kill on site' of road signs thieves. It has not helped much.

“Big vehicles do not respect boda boda riders,” says Matthias Okwi, a traffic police officer. Although traffic police have tried to educate riders there is too much political interference. “In 2010 we started  arresting defaulters but politicians started complaining saying police are hurting their people yet they could be unemployed,” said Okwi.

Asidri Paskali from the Boda Boda 2010 Association one of the 57 in the country says riders need education, training and enforcement but the biggest problem is the careless motorists who do not care about them.

Accidents due to Boda bodas:
Many of the Boda boda injuries are on the head, neck, face and involve the lower limbs as well they are usually open fractures.

“Both my legs were broken in the accident. There is no hope for me to walk again,” said Tebandeke in pain at Mulago. His wife says she prays for Tebandeke since he is the sole earner.

At the 'Boda boda ward' many accident victims have what looks like nails in their legs. It’s a move from a conservative form of treatment to the surgical treatment, which has cut on the time the accident victims spend at the congested ward.

“When we switched to the surgical method, patients are admitted for 14 instead of 33 days,” says Titus Bayeza the head of department, Orthopaedics, at Mulago Hospital.

The hospital has been struggling with big numbers and low resources. Space meant for 20 people now accommodates 60 people,” says Bayeza.

There is also a new trend in the accidents, says Dr. Michael Muhumuza, a consultant Neurosurgeon at the Trauma ward Mulago. The passengers (who sometimes are thieves) are killing the riders to steal their boda bodes.

As a result of the growing numbers, Boda boda injuries consume 62.5% or Ushs.1.5 billion of the Ush. 2.4 billion allocated to the directorate of surgery at Mulago per year says Dr. Naddumba who carried out the study ‘The Impact of Boda Boda Motor Crashes on the Budget for Clinical Services, at Mulago’ published in 2010.

Various donors though, most notably the SIGN organization provides intramedullary implants and the Health Volunteers Overseas also provides most of the external fixator implants. Average maintenance costs for a Boda boda accident patient is Ushs. 700,359 (USD 369) monthly, mostly young people aged 20-29 years according to the study.

Survival rate is low most victims become disabled. While most of the accident victims are also self-employed and their families suffer while they are recuperating from their injuries. Boda boda patients also spend 18% longer in hospital than other trauma patients

“A reduction in the number of trauma cases seen at Mulago hospital most of them from Boda boda accidents will free up space for the hospital to attend to other pressing matters,” said Professor Nelson K. Sewankambo - the Principal of Makerere University College of Health Sciences.

He said trauma has overwhelmed the orthopedics department and hence skewed teaching of residents who require exposure in areas of adult and paediatric orthopedics.

There is a mandatory use of helmets under the Helmet Law but compliance is very low. Although there is evidence that helmets can be highly effective in preventing serious head injuries on the road.
Correctly worn helmets reduced risk of death by 42% and risk of severe head injury by 69% but both riders and passengers don’t like them.

“We don’t wear them because they do not protect us…before you know it, it falls and breaks into small, tiny pieces; so what type of helmets are those? Ever since that happened, I don’t wear one anymore,” said a boda boda rider.

The Uganda National Bureau of Standards has gone to great heights to define a standard helmet also imposing stringent measures like pre-shipment inspection before importation. There are also plans to build a helmet laboratory for testing them.

But helmet wearing and public education programs combined with progressive helmet law enforcement are what could change the whole picture. At least Samwiri Kyeyune wears his helmet all the time.

Ends.
I wrote this for Gemini News based in Canada in 2013 but it has since been removed from the Internet. Since I had a raw copy so I upload it here on my blog. Uganda based journalist, Amy Fallon quoted from it on her blog- Bodabodababy http://bodabodababy.blogspot.com/2013_06_01_archive.html

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