This was written by volunteer GP, Dr Margaret, whilst working at BCH in March 2019.
For a while I have been thinking of writing about ‘trauma’ – the name medics use of the mess that happens as a result of accidents and injuries. There is no shortage of trauma on the ward where I work. In fact, road traffic accidents are the largest cause of admissions to the in-patient ward here in the last three months. (I count such things!)
The main means of motorised transport here is the boda-boda – the motorcycle taxi. Being a ‘Boda-Man’ is quite a status symbol – picture a young gun, going fast, wind in the face, taking risks, feeling the adrenaline, with maybe a bit of alcohol inside to fuel the fire. Many of the larger vehicles on the road treat bodas as errant creatures, with as much right to be on the road as a goat, and expect the poor boda drivers (usually with no helmets, and certainly with no leathers) to take avoiding action whilst the big vehicles plough on in the middle of the road. The roads are rutted and potholed. On two wheels, coming off is almost inevitable. Every week, there are boda-related injuries to patch up, from simple wounds and soft tissue injures, to nasty fractures and major head injuries.
The other vehicles prone to accident are lorries with open backs, on which tea is carried from small growers to the processing place at Kayonza. The growers stand in the back of the trucks, hanging on to the metal railings or sitting on the crops. And when the lorries are emptied, the drivers race back home as quick as possible, haring it along with men hanging on to the back. Trucks topple and crash, or break suddenly, throwing their passengers off the back with horrible consequences.
Last Friday was particularly terrible. A truck toppled into a bend. Its cargo was secondary school children, returning from a football tournament. All the youngsters were flung out of the truck onto the road or trapped underneath it. Miraculously no one died, and little by little, the 35 injured were transferred to the hospital for care. They arrived around midnight and my fabulous Ugandan colleagues set to work triaging the most badly injured and taking them to theatre for life-saving surgery – amputations and the like. Beds were found for all the others, and by morning, (which was the first I heard about it,) there was an air of calm busyness about the hospital as the work of the daylight hours began. There were feet and limbs to clean and wash and bandage. There were dozens of x-rays to perform and hundreds of painkillers to be administered. There are normally only two nurses on the ward. We had thirty extra patients. Wonderfully, nursing students stepped in to help, administering tetanus toxoid to all those with dirty wounds to prevent infection, and bandaging and bed-bathing all day.
And it so happened that the day was a public holiday (‘women’s day’ – a day for older men to stand and make political statements about their commitment to women’s equality.) Relatives of all the injured were on the doorstep of the ward, asking for news. By mid-afternoon these crowds were supplemented by onlookers and the curious. Every time we went in and out of the ward, we had to make our way through crowds.
It was exhausting. We learnt lots of lessons about managing mass casualty events.
Now, several days later, all but the most severely injured have gone home, none of the wounds have got infected and the injured have moved from shock to pain to boredom as they wait to be fit enough to be back on their feet and to go home.
I’m not a surgeon and I haven’t done much stitching in years. But I was glad to be involved in dealing with this event. It is a testament to a value driven institution that so many staff stepped in to help, and I found the sense of solidarity was very strong and carried us along.
What’s needed now is public health – work with boda drivers (like the ‘Better Boda’ project) to try and increase the safety of Boda drivers in their risky environment. Wearing helmets, using head lamps, not driving when drinking – all simple interventions that could make a significant difference. But beyond even that, there are deeper issues about how risk is experienced here. There is so much risk in most people’s lives here, and that largely because there is no financial safety net. There’s the risk of being unsure if there is enough money for the next meal or for the next set of schoolbooks, or how to cover the cost of an unexpected event. And there is illness, accident, injury, death in a life that is physically hard and exposed. And if life is full of risk, then why not drive a boda? – it will earn some money and offer status. If life is full of risk, and you are a school administrator, why not rent a truck rather than a bus for a trip – the cost of hiring a bus may make the trip impossible….
I think it will take far more than any medical management to address the rates of trauma here.