One line particularly caught by eye in the Mills, Rasheed, and Tollman chapter on Strengthening Health Systems:
“In the poorest societies basic preventive services should be introduced first—especially immunization, access to basic drugs, and management of the most severe threats to health such as emergency care for traffic injuries.”[i].
It brought me back to my time working in the bustling border town of Nimule, Southern Sudan, which is on the main Juba-Kampala road. In the span of only four months there were two major crashes of Juba-Kampala bus coaches, with many resulting fatalities and injuries. Nimule hospital was overwhelmed with patients. I often travelled on these buses going down to Kampala for the weekend and literally felt lucky when I survived each and every trip. Although the road from Juba to Nimule is under construction, the road from Nimule to Gulu, the next major town in Uganda, is currently unpaved. These buses would barrel along these bumpy roads at the highest speed possible, beeping vigorously as they went along and careening past an assortment of pedestrians, cyclists, motorcyclists, and even common animals such as goats. The bus was crowded to the max, with customers seated up front in improvised seats near the bus driver. I have been on trips starting off from Kampala that began with the driver leading a pre-trip prayer. Although not a religious person, I understood the instinct to pray before embarking on such journeys, although it did make me a little anxious about the speed they were intending to go!
With this in mind, I did some research on road traffic injuries in developing countries. Some facts that stood out from research done by Nantulya and Reich (2002) on the road accident epidemic in the developing world:
- Shocking numbers, such as 85% of all deaths resulting from road accidents and 90% of DALYs lost occur in developing countries.
- Those injured in developing countries are more likely to be pedestrians, passengers, and cyclists than drivers.
- When crashes occur, greater numbers of people are injured or die in developing countries, because the accidents more often involve buses, trucks, and mini-buses.
- Socioeconomic factors play a role in why people suffer greater effects. Poor people in developing countries are more likely to walk, cycle, or even knowingly travel in risky mini-buses, buses, or boda bodas (motorcycle taxis) because they have no alternative. They are often unable to pay for care when injured and, thus, do not go to the hospital.
- Hospitals in low income countries, however, are often not equipped with what is needed to treat these kinds of injuries, such as “oxygen, blood units, plaster of Paris, dressings, antiseptics, local and general anesthetics, intravenous fluids, Boyle’s anesthetic machine, and blood pressure machine.”[ii]
As more and more people in developing countries are getting cars and motorbikes and living in urban settings where these accidents are more frequent, it is important to make sure that the health systems are equipped to handle this unfortunately most common cause of disability and death.
[i] Mills, A., Rasheed, F., and Tollman, S. (2006). Strengthening health systems. In D. Jamison, J. Breman, A. Measham,G. Alleyne, M. Claeson, D. Evans, P. Jha, A. Mills and P. Musgrove, eds. Disease Control Priorities inDeveloping Countries. Washington: Oxford University Press and the World Bank.
[ii] Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002;324:1139-41.