School of hard knocks

A boda boda in a Kampala intersection

An ICU bed at Mulago

Crossing the street in Kampala is terrifying.   For the most part there are no lanes, stop signs, traffic lights, or speed limits, and the streets are riddled with giant potholes and swarming with boda bodas, which are motorcycle taxis.   The boda bodas are insane-- they weave through traffic and make reckless merges, and come flying out of nowhere when you are trying to cross. Needless to say, there are lots and lots of traffic accidents, many of them involving bodas. 

I rounded with the ICU team for two days during my last week and saw several unfortunate traffic trauma victims.  One young man had been crossing the street to get a chapati when he got "knocked" by a truck. (Knocked is an adorable way to say run over).  He happened to come in at the same time as another young man who also had a traffic accident but there was only one ventilator open so the ICU team had to choose whom to admit. The chapati seeker lost the coin toss, and stayed on the backup ventilator in the emergency room for several days, and was still there when I left.  The ICU attending estimated that about 75% of their patients at any given time were trauma patients.  Another statistic that I heard quoted frequently was that there were five boda boda deaths a day.  

In Liberia, the government just banned their motorcycle taxis, called pehn-pehns, in an attempt " to curb the ‘carnage and mayhem’ the pehn-pehn drivers cause," in the words of the police traffic chief.  In October, there were 1011 patients admitted to city hospitals in Monrovia for traffic related injuries.

When there are accidents in the street in Uganda, there is no good mechanism to get patients to the hospital.  Good Samaritans and police officers generally bring people in on the backs of bikes and in cars.  Ambulances are rare and the drivers are not trained paramedics so patients do not get any resuscitation or support prior to arriving at the hospital, if they make it to the hospital.   I met a surgeon named Peace who was trying to raise money to buy a used ambulance from Canada and had plans to train emergency responders to man it.  She was tired of receiving patients who had been "knocked" by boda bodas or taxis and came to the ED injured and without a story or early attention en route.

There was an op-ed in the New York Times recently that commented on the dearth of proper ambulances to deal with the traffic accidents in East Africa.  A follow-up letter to the editor argued that if roads were safer there would not be as many accidents in the first place.  I wondered often what it would take for that to happen, especially after particularly harrowing times crossing the street.  People take boda bodas because they get around the fastest-- when there are bad jams, private cars and buses along can stand still for hours.  There would need to be a metro, or buses plus roads that actually have traffic lights and lanes so that vehicles don't just cram themselves through the streets without any order.  There would need to be police to enforce rules like running red lights or speeding.  Of course it all requires money, but also attention and priority-- these are basic parts of a society, things the government ought to recognize as important and fix.  

Many people I talked to had the feeling that things like transportation, healthcare and education are not changing in Uganda any time soon, not with a president who has eradicated term limits and has been in power for twenty-odd years.   In the national Ugandan newspaper the Daily Monitor, the Former Minister of Ethics and Integrity, Miria Matembe, recently urged the educated youth of Uganda to demand better from their government.

“Youth, you have to wake up and take on the responsibility of stopping this government from stretching further. Because the more it stretches, the more you feel the pinch,” she said.

When I read this I had a hard time imagining young people rising up and organizing against the government, not because they are not motivated or aware or even unhappy with the status quo-- they are-- but because there is a deep current of respect for elders and a grim attitude of keeping one's chin up and soldiering on through hardship.

But I was wrong.  There's a limit, apparently.  Right now, the interns in Mulago and across Uganda are on strike because they haven't been paid since August.  As it is, their pay is meager and their hours are long and they get absolutely no vacation.  The senior house officers, the equivalent of senior residents, don't even get paid-- they pay tuition.  A university official had the audacity to explain to one of my friends that the gloves and supplies that the hospital provides and the experience of learning from patients is payment enough.  Right now, those unpaid senior house officers are manning the hospital while the interns are (appropriately) on strike to get their wages.  

I learned about the strike from my friend, and expressed worry for her and her patients.  She wrote back in agreement: "The patients are in trouble."