Commercial motorcycle accidents, leading cause of brain injury in Nigeria —Expert

Professor Amos Adeleye is a consultant neurosurgeon at the University College Hospital (UCH), Ibadan. In this interview by SADE OGUNTOLA, he speaks about the burden of commercial motorcycle riders, its implication on surgical practice in Nigeria and what needs to be done to mitigate the carnage. Excerpt:

WORLDWIDE, injury to the head or brain during road accidents is known to be the main cause of death from road accidents anywhere in the world.

When people die from accidents on the road by whatever cause-, vehicular, bicycle or train crash, they break limps and different parts of the body. They also bleed into the belly, the chest and outside. But majority should do well when they get proper medical care.

There are categories of accidents; there are those that die right there at the scene of the accident. There is virtually no medical remedy for such. Increasing road safety and accident prevention are the probable solution for this class of life-loss on the roads.  But among those who survive and get to a hospital, a very significant proportion eventually dies from brain injury.

Brain injury is a big chunk of the deaths from road accidents. Surviving from other injuries such as the limb is fairly higher than that from brain injury.

Once there is a brain injury, it creates a new scale of problems, including death. It means that since we cannot create accident situations that will spare the brain, then we must try and prevent these accidents from happening.

What are the common causes of brain injury?

So one must have an understanding of what is causing brain injury to try everything possible to prevent them from happening. All over the world, most of the brain injuries occur from road accidents. But in the western world falls at home now increasingly outstrip road accidents, especially in elderly people as the cause of brain injury.

In developing countries, Nigeria inclusive, the most frequent cause of brain injury remains road accidents mainly from motorcycles, and vehicles be it cars, buses and trucks.

Years back, of every 200 brain injuries from accidents, about 90 to 100 (70 Per cent) will be from vehicles, 10 to 15 from motorcycles, 1 or 2 from bicycles and maybe 2 or 3 from street brawls and maybe 2 from a gunshot injury, falls, or occupational accidents.

Gradually, we found that things began to shift. Now motorcycle accidents are becoming the most significant cause of loss of lives and limbs from road carnage. If we get 100 people who have brain Injury from road accidents, motor vehicles will just be 30 to 40 per cent and motorcycle will be like 60 to 70 per cent; it is a total reversal.

Certainly in my personal studies and many others, we have established that we have got a problem in our hands, motorcycles are just maiming people and crashing their heads.

Using a prospective database of head injuries from my practice in UCH, Ibadan, motorcycle crash accounted for 473 of 833 (57%) road traffic accidents.

The victims were young in age, they were on the average 33 years of age; males in 83 per cent and they were of low socioeconomic status. In more than 90 per cent of cases, they do not have money, which is the reason they will not be able to afford care.

The motorcycle accident involved the rider solely in 114 cases, these are crashing or banging into another motorcycle. And motorcycle-motorcycle crash in 69 per cent of all cases that involved motorcycles only.

The head injury was moderate or severe in 51 per cent of all the cases with 92 per cent of them losing consciousness, in coma or drowsy, evidence that something happened to their brain during the accident.

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Also, injury affecting other parts of the body,  such as the limbs in about 50 per cent and 24 per cent died.

In comparison with those who have motor vehicle-related accidents in this same group of patients, victims of motorcycle crash had a higher proportion of other injuries in the body, especially breakage of bones in the limbs and they also have an injury in the brain that often calls for immediate surgical operation.

What never ceases to freak me out is when I get to the accident and emergency room of our hospital and see victims of road traffic accident from head-on collision of two motorcycles.  Last week, I had two consecutive cases, both victims of the crash in the same ward.

Okada or commercial motorcycles are a big menace on African roads, and to the society.  Even when I was in Cotonou for a professional meeting, okadas were present too. The only difference is that they use helmets clearly more than we do in Nigeria. The use of helmet was apparent in only 2% of the patients in our own study. That is of every 100 cases of brain injury to passengers of motorcycle, only 2 were found to have head protection in the form of helmet on.

But there are debates on their economic benefits

It is said in Nigeria that if they are stopped, all of them will  lose their means of gainful livelihood and some may resort to armed robbery. But this is a problem that can be easily solved. They were doing something before okada riding came on board because it offers cheap and quick money.

But the classic story is that actually when they are involved in an accident and are brought into the hospital with a head injury, they are often virtually penniless, unable to afford the most basic of their health-care needs. A person with a head injury will require a brain scan to decide whether we need to operate him fast or not to save his life. By the time you are asking for a brain scan, they do not even have money to even do a test that costs N500.

A brain scan at UCH, Ibadan, being a Federal Government  subsidised hospital, costs between N32, 000 and N40, 000. Here is a man that we say should go do a simple N500 blood test and he is struggling to find the money to get it sorted out. How does he find N40, 000 for brain scan? And should the brain scan point to the need for emergency life-saving surgical operation, we would next be looking at financial costs to the tune of N400,000 more or less. This amount is actually terribly cheap for a brain surgery. This has got to be the cheapest cost for brain surgery anywhere in the world. In the western world, the financial cost would be millions.

Unfortunately, without the brain scan, it is only on rare occasions that we are able to do anything to address the specifics of the brain injury. The brain scan is to give a sense of direction we should take.

Since they cannot afford that scan, they are just there languishing. Many of them perish because their treatment got delayed; some survived but with lost limbs.

So with this so-called free money from the Okada riding, they get into trouble. So I do not buy the argument that if you stop them from doing that job they will be unemployed. That is not the only side of truth.

Every problem has a solution; certainly, social scientists can work this out. For example, a bus company can be established that will also absorb all of them to work as drivers, auto mechanics, painters, ticketing officers, office clerks, sweepers, and so on. It is an industry. They need to build the terminals, some of them are bricklayers, and they can be employed to do that. By the time we allow ourselves to think this through, we will find a solution or solutions.

Does it mean therefore that the ban of okada in Lagos was a good one?

Yes, I am a silent fan of that and I am praying that Lagos state government will succeed in wiping it out completely. Hopefully then, other states can take a cue from them and wipe this menace of okada riding out of the Nigerian space for good. There is no one that I know that is not a direct benefit of okada riding that does not agree that okadas should be off our roads. We do not need monotransports but mass transit.

One big luxury bus will take 100 okadas out of the way. This is safe, comfortable and more environmentally friendly, than even the small Micra taxis.

As neurosurgeons, are you overwhelmed by these crash victims with head injury?

Of course, we are terribly overwhelmed, but we are coping. If we take those cases out of the way, we will be free to do other things. They are an added burden for neurosurgeons in developing countries. But my main grouse is not my increased workload from the carnage they wreak on the road, but the precious lives they waste with such reckless abandon, and the limbs that get maimed.

Each person that dies turns a woman to a widow, children to fatherless and some parents to childless.  When a person dies, the loss is not to that person alone, the loss is unquantifiable in itself. Motorcycles are now a big source of loss of Nigerian brains, lives and limbs from road accidents.

NIGERIAN TRIBUNE