When 30-year-old Anthony Otyeka, a boda body rider in Gulu city left home for his day job, the result was an accident that almost left him for the dead.
On September 16, 2021, after an evening out with his friends and catching some drinks while chatting about the day, as was his routine, Otyeka lost control of his motorcycle and rammed into the road pavement. He hit his head on the tarmac and was seriously injured.
All he recalls is waking up from a coma the following day in Gulu Regional Referral Hospital emergency ward where he had been rushed for medical attention by well-wishers.
The Uganda Police annual crime report of 2022 recorded 20,394 crashes reported across the country out of which 3,901 were fatal, 10,776 were serious, and 5,717 were minor. The report shows a total of 1,404 of the fatal cases were motorcyclists.
Road crashes cause enormous suffering to those affected as victims as well as their families; they also place a huge burden on our national health system.
Otyeka says that at Gulu Regional Referral Hospital, medics did little to help him given the complex injury he had sustained. He was referred to St. Mary’s Hospital Lacor where the medics further referred him to Pope John’s Hospital Aber in Oyam district for specialized treatment.
After a CT scan, Otyeka sustained a cracked a section of his skull while a small part of his brain had a spot of blood stain. He was diagnosed with Traumatic Brain Injury (TBI). For three months, Otyeka was unable to speak coherently and lost nearly 50 percent of his memories as he underwent medical treatment.
He was discharged from the hospital after regaining his speech and advised to keep away from motorcycles for a while, three months later, Otyeka found himself back in the Boda Boda business. It’s a year now since the 31-year-old resumed riding a motorcycle after the crash. He says the healing process has been slow but lucky to be alive.
To date, he still struggles to speak coherently and has little memory of some of the places and people he knew. Otyeka says whereas he needs to undergo rehabilitation to regain his full body control and memory, he is constrained by the high costs. Apparently, he needs about UGX 250,000 ($70) to return for a brain CT scan in Oyam district and an additional UGX 100,000 ($26) for speech assessment at a private facility.
But that money isn’t available.
According to the Makerere University College of Health Sciences report, Road Traffic Injuries (RTIs) contribute to a relatively high disability prevalence rate of 12.4 percent of Ugandans with more than 500 people across the country in need of rehabilitation services.
It’s estimated that the government spent approximately 296.5 million Shillings daily on treating road crash victims in the financial year 2018/19.
Fr. Dr. Sam Okori, the Director of Aber Hospital says although the facility does CT scan for brain injuries and treatment, it doesn’t have the specialists to handle rehabilitation services for brain trauma. “For the most part, we do CT scans, if they need specialized services like speech therapy, we refer them to Mulago National Referral Hospital,” Dr. Okori said.
Otyeka is among dozens if not hundreds of road crash victims in the region who are still struggling to recover. Denis Lakwonyero Ocen, 49, a resident of Gulu City was equally involved in a motorcycle crash in Pader District on July 22 2011 that left him blind.
One evening, Lakwonyero who then worked with the Norwegian Refugee Council (NRC) was on his way to Agago District when he knocked and seriously injured a pedestrian crossing his path.
Although he didn’t sustain serious injuries, local residents who saw the event accused him of negligence and later beat him up before leaving him for dead.
He regained consciousness 65 days later after undergoing treatment in the intensive care units at various hospitals in Agago, Gulu, and Kampala with no sight. Lakwonyero says the incident has negatively impacted his life, having lost his well-paying job, two beautiful wives, and a number of friends who found no value in him because of his disability.
More than a decade after the incident, Lakwonyero who now represents persons with disabilities in Gulu District Council, says that he is yet to cope with his condition of being visually impaired. He says he still suffers from psychological trauma but lacks the finances for rehabilitation since its expensive.
Gulu Regional Referral Hospital rehabilitation center has been in operation since the early 1990s and has been offering rehabilitation services majorly to victims of the two-decade rebel Lord’s Resistance Army insurgency.
Francis Okeny, a physiotherapist at the facility, however, says the majority of their clients currently are road crash victims in need of physiotherapy, orthopaedic, and occupational therapy from across northern Uganda.
A Uganda survey shows that deaths among vulnerable road users — pedestrians, bicyclists, and motorcyclists — accounted for 94% in 2021, similar to the rate observed in 2020. Motorcyclists alone accounted for 51% of deaths in 2021. Males accounted for 82% and those aged 20 to 29 years accounted for 39% of fatalities in 2021.
Okeny says amidst the staffing gap and specialised equipment, the facility receives at least 30 clients daily seeking physiotherapy and occupational therapy.
The facility currently employs only three physiotherapists, eight Orthopaedic technologists, and two occupational therapists who offer services at the facility and outreaches to 15 districts in the Northern region.
Whereas, the majority of the services are free of charge, the orthopaedic department, however, charges between UGX 2 million ($532) to UGX 4 million ($1,065) for artificial limbs. However, as you can imagine the majority of the victims who need such services are unable to afford them and mostly tend to stay at home to avoid the high costs.
Statistics from the facility indicate at least 400 clients underwent different forms of rehabilitation last year alone, the majority being road crash victims in need of occupational therapy and physiotherapy, and orthopaedic technologies. According to the 2021 Police Crime Report, the Aswa River region, which comprises the nine districts in Acholi Sub-region registered a total of 628 road crashes out of which 173 were fatal, 330 serious, and 125 minor.
Agnes Ayaa, a trauma counsellor at Gulu Regional Referral Hospital Rehabilitation Center says in a bid to cut costs, the facility is currently conducting outreach activities to offer rehabilitation services in hard-to-reach areas.
She notes that whereas the majority of road crash victims heal from physical injuries, they tend to suffer the impact of the incident inform of trauma resulting from either loss of their limbs. Ayaa says trauma counselling helps the victims especially those with lost limbs to accept their condition and reintegrate into society.
Dr. Cyprian Opira, the Executive Director of St. Mary’s Hospital Lacor in Gulu City acknowledges that the cost of quality post-care treatment for road crash victims is high, adding that the majority of the vulnerable in the region can’t afford it.
For instance, Dr. Opira says the cost of carrying out internal fixation, a surgical procedure used to internally set and stabilise fractured bones is very high and can’t be afforded by many victims. To have such specialised surgery, one has to pay between UGX 2 million ($532) to UGX 3 million ($800).
Isaac Okot, a Speech and Language specialist at St. Philip Health Center in Gulu City equally admits the high costs of specialised rehabilitation have kept many road crash victims away from fully healing.
At the facility, Okot says they charge UGX 60,000 ($16) for speech therapy per session compared to UGX 150,000 ($40) in other facilities while for assessment, a client pays UGX 100,000 ($26).
“The cost attached to the rehabilitation of victims who suffered a traumatic brain injury is high because of few specialists and this price is double in Kampala. Most times, family members taking care of these people just give up on them and leave them to heal naturally, which isn’t possible,” he says.
He notes that the majority still find the price expensive since the visits may go beyond five months for full recovery. For instance, Okot says from 2020 to date, the facility received a total of 50 road crash victims in need of speech therapy.
He says out of the numbers, only two fully attended all the sessions and recovered, while ten attended for about four months and abandoned, adding that the rest never showed up after just a single session.