By Stephen Ssenkaaba
On a metallic spring bed inside Mulago Hospital’s orthopaedic ward, 26-yearold Michael Tebandeke rests his head; his lips gasping for breath.
His right leg, flung on the extreme side of the bed, is strapped with a white bandage. He rests the palm of his right hand on his bare chest, struggling to open his groggy eyes. His wife sits down on a mat, her round dark face dejected.
Two other young men -brothers to Tebandeke - stand near his bed, their eyes transfi xed on their ailing brother. Tebandeke is a boda boda rider. There is no prize for guessing what happened to him.
“It was 5:00am. He was drunk. I was carrying a passenger; then he rammed into us — head on.” Tebandeke woke up several hours later on a hospital bed. “That is the price you pay for riding a boda boda,” he says.
The tiny motorcycle taxis called “boda boda” have become an integral part of Uganda’s transport system.
Small, fast as an ostrich and conveniently able to negotiate complex corners, they are our answer to this country’s stressful traffic jam. But also, they have become agents of chaos in the country and a leading cause of accidents.
A study conducted by Dr. Edward Naddumba, a senior consultant orthopaedic surgeon at Mulago Hospital, and a team of senior orthopaedic surgeons, reveals that 75% of all trauma cases at the national referral hospital are as a result of boda boda accidents.
According to the Injury Control Centre, Uganda, Mulago Hospital alone receives five to 20 boda boda accident cases every day, resulting to 7,280 cases in year.
A five-year (2008-2012) injury and fatality trends report from Police indicates that 3,043 motorcyclists were injured in accidents last year, a significant increase from 1,795 cyclists injured in 2008.
The same report shows that passenger fatalities as a result of road traffic accidents increased from 3,951 in 2008 to 5,145 last year.
All these problems have been partly linked to the huge expansion of the boda boda industry without proper planning.
Because of poor registration, the actual number of boda boda bikes in the country is not known. But modest estimates indicate that there are over 300,000 boda bodas in Kampala alone.
Steven Kasiima, a senior commissioner of Police, attributes such growth to “vacuum created by unreliable public transport facilities, high public demand for alternative transport services and ease of acquisition of commercial motorcycles through credit facilities from private lenders and banks.”
But, the problems are far more complex than that. Unemployment/reactions With 62% of Uganda’s youth unable to find jobs, boda bodas have become a source of income for many idle youth.
“I would rather ride a boda boda than starve to death,” Sam Kibuuka, who pries the Port Bell route, said. Kibuuka, who left his carpenter’s job six years ago, adds: “I could hardly support my family.”
Today, he earns a daily income of sh20,000, whichcomes to sh560,000 monthly pay — two times more than a primary school teacher’s salary. “Though modest, this enables me to buy food for my family and pay for my children’s school fees,” he says.
The current circumstances have fuelled matters. You do not have to import a motorbike; they are now easily assembled in Ndeeba and other towns.
Many microfinance organisations and banks are readily providing loans for people to buy boda bodas. You do not have to register; you can change number plates as you wish. You can ride anyhow and anywhere. And when a policeman arrests you, a simple bribe will let you off the hook.
Victims of boda boda accidents at Mulago Hospital orthopaedic ward
No regulatory framework
The industry has thrived on such laxity. Mathias Okwir, the community liaisons officer, Kampala Metropolitan traffic, says it has not been easy to arrest errant boda boda riders because “there is no proper regulatory framework.”
Political interference has also not helped the matters. “Sometime back, we started a massive operation on errant boda bodas, but some powerful politicians with a stake in the boda boda business accused us of harassing the offenders.
We stopped,” Okwir, recently told a stakeholders meeting at Mulago Hospital.
These, added to lack of driving skills, poor infrastructure and lack of organised operation framework among boda boda riders has turned boda boda business into a real disaster with wide ranging ramifi cations.
Mulago national referral hospital’s budget and facilities have been overstretched by the influx of boda boda accidents cases. According to Prof. Nelson Sewankambo, the principal of Makerere
University College of Health Sciences, the hospital spends sh1.5b on treating boda boda patients every year. “When weighed against the annual budget allocation of about sh2.4b to the directorate of Surgery, this translates to 62.5%.”
Dr. Naddumba says boda boda patients spend 18% longer time in hospital than other trauma patients. “The average cost of managing a patient with boda boda injuries is sh700,359 over the eight-day (or more) hospital stay. Maintaining patients in the ward costs sh151,172,382, while the total theatre cost come to sh73, 642, 813.
This brings the total cost to sh224,815, 195.”
Considering that an average boda boda rider earns sh560,000, a month; that sh151,172,382 could treat multitudes of malaria patients and that sh224,815,195 could maintain a health centre III for some time, the impact of boda boda on healthcare is quite significant. It means that nearly all household income is spent on treatment for the victims; that hospital budgets are crippled and that healthcare priorities greatly have to change.
At the Orthopedic Ward 3A, surgeons struggle with multitudes of boda boda casualties. The ward today admits twice as many patients as its capacity. As a result, many patients are treated from the hopsital floor. “We are overwhelmed,” Michael Muhumuza, a consultant neurosurgeon, said.
Procedures have also been affected.
“Twenty years ago, we were treating child deformities like polio, club feet and other bone infections. Today, 90% of patients admitted are accident victims, majority of whom are boda boda accidents,” says Dr. Titus Beyeza, head of the Orthopaedic Department at Mulago Hospital. Beyeza says the orthopaedic ward has run out of space to admit other orthopaedic cases — “as all the beds are filled up with the emergency boda boda cases.”
Training of orthopedic surgeons now concentrates more on trauma surgery and less on other important fi elds of orthopedics. “In the end, we shall produce surgeons with good trauma surgery skills, but lacking in other aspects of the discipline,” Beyeza says.
Victims speak out
Livelihoods have been lost, families have broken up and dreams shattered. “When I got a boda boda accident, I lost my means of livelihood,” Michael Kawooya, a rider from Mityana spoke from his hospital bed in Mulago.
His wife also left her salon job to attend to her husband in hospital. “We left our two young children with my parents. They cannot go to school. We have spent all our savings on treatment.”
With most boda boda accidents affecting the youth aged 21-30 years, “the impact of boda boda accidents on Uganda’s most productive population will have far reaching effects on our economy, Dr. Sam Okuonzi, a health economist, says.
The Government continues to grapple with a massive problem about which they have done very little.
Plans have been announced by central government and the Kampala Capital City Authority to strengthen regulatory measures, register boda boda motorcyclists and improve road networks.
Two training schools have also been set up to train boda boda riders. But this is hardly sufficient. Without workable frameworks for these measures, the situation will remain problematic.