People are dying daily from road traffic accidents, yet it’s not getting enough attention from the authorities. Dr Christopher Uyinmwen Otabor is an orthopaedic surgeon and the Special Assistant to the Senior Adviser to the President on Millennium Development Goals, he speaks with WINIFRED OGBEBO on the causes, and the management of accident victims.
What global action has been taken in respect to road traffic accident?
In 2011, the United Nations declared a decade of action against road traffic accident starting from 2011 to 2021 so we are presently in a decade of action against road traffic accident. I think that should draw the attention of government all over the world to this very important phenomenon in our day. The death from road traffic accident is the second most common cause of death of young people in our society and its second to infectious diseases like HIV and others. So you can see that it’s a huge burden on our society and if nothing serious is done about it, it has the tendency to ebb away our young vibrant people who are supposed to contribute immensely to the economic and social development of this country.
What are the causes?
The causes of road traffic accident can be broadly sub- divided. We have the human factor, the vehicular and the infrastructural factor. The human factor; talking about the man behind the wheels-so many things come to play and one of the issues to consider is distracted driving. A lot of drivers are distracted on the wheels and this could result to anything at any time. And he can be a source of devastation to not only himself but to others.
Other possible causes of distraction are use of cell phones while driving. Ill health also plays a vital role. Now, in this country, even babies can get drivers license and when you get it, that’s the end, you’re not checked anymore. People who are ill, who have mental illness, psychological illness, depression and epilepsy should not be allowed to drive because there could be an acute exacerbation or act during driving and that can lead to havoc on the road.
Travelling at night has also become a culture for some people and it is a terrible cause of carnage on the road because when you travel at night, you’re likely to fall asleep and when this happens, the driver could veer off the road, and off the track and collide with the innocent man on the other side. So night driving should be limited as much as possible.
Talking about the vehicular factor; there are a lot of rickety vehicles in the street of Nigeria. In Abuja, it’s fairly okay but in other cities, we have vehicles that are not road worthy.
Most of the tires are exported and I dare to say that over 90 per cent of the imported tires are expired tires because that was why they dropped them in the countries they are exporting them from. We bring them in the name of poverty but I think that is foolishness because they are bringing death into their country.
The last cause is the infrastructural factor, talking about roads. Our roads are bad. There’s no gainsaying that.
There are concerns about the management of victims of road traffic accidents in our hospitals. Why is this so?
The management of road traffic accident should actually start at the scene of the accident. In developed countries, we have what we call the paramedics. Those people who are trained soon after an accident occurs, a phone call is pulled across to the ambulance point; you have the paramedics and the traffic authorities present to clear the crowd and maintain decorum. It is a systematic approach especially when you have more than one casualty involved in the accident.
We have seen a situation where someone had an accident and had an incomplete spinal cord injury but because the people who were trying to extricate him did not know what to do, they completed the injury and the person is paralysed.
What is the ABC of resuscitation?
It is the basic thing any person can do if you’re found in an accident scene . For instance, if someone is found in an accident scene, the first thing is he goes unconscious because of the impact. The first thing you do is what we call the ABC because it’s as simple as the ABC.
A is the airways. You want to make sure that the fellow’s airways is open; the air passage. Probably the fellow was eating when the accident occurred and the food has gone in to block his airways. So you lift up the chin and you thrust the jaw forward and that helps to clear the airways. Or the tongue could fall back. Sometimes if the blood is in the mouth, you put your finger into the mouth and bring out the clots of blood so that you can clear out the airways for air to be able to pass through. That simple chin lift and thrusting the jaw forward can clear the airways for the fellow. If four minutes after an accident, oxygen does not get to the brain, the patient will be brain dead and there’s nothing you can do about it.
The person who is at the scene of an accident at that time, has a lot of responsibilities. It’s no use screaming and shouting around when the accident victim obviously needs help and it’s only knowledge that can help the person at that time. Lie the person down, lift up his chin, push the head upward and backward and that would make his tongue fall out of the way and the person can be breathing again.
The B is breathing. Make sure the person is breathing. Sometimes, after an accident, there’s what we call pneumothorax. The air fills the chest and that air is compressing the lungs. Sometimes we get a sharp object and puncture the chest wall so that that air that is causing tightness in the chest can come out. That needs some technical input; paramedics that are well-trained can do that as it’s not everyone that can do it. But if there’s a medical person on ground, you can puncture the chest wall with a biro and air would gush out. That can save the patient.
C is circulation. After an accident, there could be a deep cut. Blood vessels could be cut and you want to ensure that the person does not lose all his blood because if he loses blood to a certain level, he would fall into unconsciousness and if he continues, he dies. So you need to apply pressure to the part the bleeding is coming from. You can wrap it up with a cloth and elevate that part above the heart level so that gravity would prevent bleeding. You can use your hand to put pressure on that part that is bleeding and the bleeding will stop pending when an ambulance or help comes, then the doctor will take it up from there.
So those three basic things can help before the patient is taking to the hospital and the doctors can go on to advance trauma life support.
That’s what you can do at the scene of an accident then the patient is transferred carefully to the hospital. You don’t transfer accident victims on bus or pick up. You have to take him in a van with enough space at the back where the patient can lie down. If he’s unconscious, you lie him on the side, with one arm under his head so that incase secretions is coming out, it can fall out. We call it left lateral position. That can help the patient a lot.
You’re referring to a situation whereby accident victims are not attended to?
One of the commonest reasons is financing. Our health care financing system is poor unlike what is obtainable in developed countries. More than 2/3 of Nigerians don’t have insurance and most of the hospitals they go to need money to survive. So they always ask for money before they treat patient even though its not proper. There are also some basic things that ought to be done and the hospital does not have the facilities to do those things. They make the relations to do those things so you find that there is a gap. If the National Health Insurance Scheme comes of age and they spread the cost so that it can capture at least 50 per cent of Nigerians, am sure that would solve the problem of asking for money before treatment. But for now, we just have to do our best to see how we can go ahead and treat patient before they come to themselves and able to offset their bill.
However, some medical experts cannot manage some accident victims and that is why some who can afford it travel out of the country to seek treatment.
Talking about people travelling out of the country to seek for medical treatment, I think it has become a culture and a status symbol in our society because people pride themselves going to Germany, going to India and to the US for their treatment.
However, there are still a few cases that they actually need some expertise that we don’t have. But that’s probably less than five per cent of the total cases. We have very good orthopaedic surgeons in this country. We do many things; total hip replacement surgery, knee lengthening surgery and practically everything you want if you want to go there. Some of my patients have gone to India and come back and I clean up their mess. They are not super human. Nigerian doctors are better than them. It’s just that maybe the right environment and a proper investment in the infrastructure is not there. Most times Nigerians are carried away with big structure, ambience of the environment and they are not looking at the personnel. Our problem is that we don’t have investors in the tertiary care and in the hospital setting. I am calling on rich Nigerians to invest in medicare and if they do that, not only would the brain drain stop to a large extent, people from other West African countries and African countries would be coming also to Nigeria for treatment. When we go outside this country, Nigerian doctors are some of the best in the world.
Some patients patronize traditional bone setters rather than orthopaedic surgeons. Why is this so?
There are two factors responsible for that. The first is ignorance and secondly it’s poverty. More often than not, these people know that coming to a special orthopaedic surgeon is much better than the traditional bone setter because there is no basis for comparism. But they have looked at the cost involved and there is no doubt that it is more expensive to see an orthopaedic surgeon than to go to the traditional bone setter. But the truth is that on the long run, it is more expensive to go to the traditional bone setter because their results are trial and error, they dong get it right and at the end of the day, they still come back to the orthopaedic surgeon.
In orthodox orthopaedic care, when you treat 10 people or a 100 patients and 95 or 9 gets well, the remaining two or three who didn’t get well, is acceptable compared to treating a 100 patients and less than 10 gets well and the others have to manage their lives the way it is without full satisfaction or would have to revert back to orthopaedic surgeons to get it corrected.