Nigeria Health Watch

Before the first impact: How your little actions can save lives on Nigerian roads

On Monday, February 10, 2014, Mr. Celestine Chima kissed his two children, seven-year-old Goodluck and five-year-old Goodness goodbye and stepped out of his residence in Owerri, the Imo state capital. Celestine was certain about two things; his destination, a small densely populated town called Nekede, approximately 20 minutes’ drive from his house and his mission which was to check progress at a hostel construction site he was supervising. He never made it to his destination.

The tricycle he boarded, its characteristic yellow colour identifying it as the popularly known ‘keke napep’ was involved in an accident along the Owerri-Aba road and he sustained a spinal cord injury that left him a quadriplegic. He lost the use of all his limbs and tasks as simple as waving goodbye to his family became impossible for Celestine. You can imagine the fate of Celestine, the education of his children, the hopes of his family.

Sadly, Celestine’s story is not unique as almost every Nigerian can recount a story or two of an acquaintance or family member that has been involved in a road traffic accident. Yet, as these accidents continue, we appear helpless. Beyond the tragedy of the incident is the helplessness in the common reaction when these unfortunate events happen. Most times, the focus is on the ‘evil’ person who orchestrated the accident, or we accept it as a divine occurrence that we are powerless to forestall. But, are we really powerless?

We often fail to ask the most important questions like; What was the state of the vehicle conveying passengers? What was the overall (physical, psychological, emotional) state of the driver? Was he driving above the speed limit? Was he distracted, using his mobile phone while driving? Did he have enough rest between his last trip and the unfortunate trip? Do relevant government agencies and stakeholders play their part to ensure drivers and passengers safety on the road? When these questions are asked and answered objectively, we will realise that nearly all accidents are preventable, even the ones attributed to bad roads. So, why are we not asking these questions. Why is no one taking responsibility?

Beyond the first impact

Without any form of health insurance, the long-term impact of road traffic accidents is predictable. In Celestine’s case, it was devastating. His business which was a sole proprietorship model automatically collapsed; he sold his machines and bus to pay for periodic home care when he couldn’t afford to remain in the hospital. A few months after the accident, his two children dropped out of school because he could no longer afford to pay their school fees. He was sustained by the goodwill of his family and friends. His case is not unique.

When Celestine developed a bed sore from being bed-ridden for a prolonged period, it took the intervention of a friend to purchase a water bed for quicker healing of the wound. At some point, he depended on the voluntary services of a physiotherapist to help restore the use of his limbs and a nurse to help change his catheter. He has had to relocate his family twice; first from a one-room store provided by one of his brothers, to a small village close to the city. His two kids have been enrolled in schools in the village and their school fees are paid by the benevolence of friends and family. Celestine is worried, uncertain on how long it will take before they give up on him.

Despite all these challenges, Celestine is very strong-willed and believes he will walk again even though he has been bedridden since February 2016, without any visits to the hospital for checks or even to a physiotherapist. He still can’t do anything for himself.

Breath alcohol test was carried out in parks. More than 53% reported drinking alcohol and 3.7% had concentrated levels, dangerous for driving. Photo source: Shell Petroleum Development Company of Nigeria

Situations such as Celestine’s have led experts to ask whether the Federal Ministry of Health (FMoH) should be more involved, and partner with other agencies to mitigate road traffic accidents. A key responsibility of the Ministry is to ensure that ‘the general population live healthy and longer lives’ and ‘prevention remains an important component of public health’.

Little actions that make a massive difference

We have, in the past, written extensively about road traffic accidents. One of these, struck a chord with the Community Health Department at the Shell Petroleum Development Company of Nigeria and influenced their decision to review an already existing intervention to target drivers in 2017.

Dr. Akinwumi Fajola, the Regional Community Health Manager of Shell said the company had a flagship program called ‘Health in Motion’. This involved providing healthcare services in host communities. They also developed a proactive approach within the Shell premises to ensure there were no incidences or fatalities from road traffic accidents. This is called Goal Zero.

The Shell team realised that drivers are often neglected during medical interventions, despite the fact that their work touches on almost every aspect of the economy. They decided to take Goal Zero (which had been achieved within the Shell fence) outside the fence using their ‘Health in Motion’ model. The team’s mission was to reduce risk-normalization, which means making risky behaviour the norm, outside the Shell fence.

Healthcare services and various health screens were carried out at two commercial motor parks and one tanker motor park. This move had a ripple effect as the screening highlighted a high prevalence of subtle unrecognised issues that contribute to road traffic accidents.

Out of the 731 drivers (commercial drivers and tanker drivers) screened, 47% had impaired vision while 17.6% had impaired hearing, in addition 40.7% (90) of commercial drivers and 34.8% (138) of tanker drivers had elevated blood pressure levels.

The screening exercise was conducted at the motor parks in the morning before the drivers commenced their daily operations and 3.7% of the drivers already had moderate to significant blood alcohol concentration levels. This implied that some drivers were already drunk as they prepared to transport passengers. Additional factors discovered during the focus group discussions were sleep deprivation, lack of rest, and consumption of locally brewed concoctions.

The next action was a partnership and interventions with the Federal Road Safety Commission, Nigerian Union of Road Transport Workers, Ministries of Works and Health, National Orientation Agency and other Civil Society Organizations to address these factors identified.

About a third of drivers who were screened had high blood pressure, with 3.4% undiagnosed cases had severe hypertension. Photo source: Shell Petroleum Development Company of Nigeria

Dr. Femi Oduneye, the Community Health Manager put the impact of these discoveries in proper perspective at the dissemination event organized by the company to drive discussions around driver’s safety. He likened crashes from road traffic accidents in Nigeria to a fully loaded Boeing 747 aircraft crashing every month. But because the accidents are widespread, with some happening in rural areas and not recorded, we are often oblivious of the impact. Dr. Fajola hopes findings from the intervention will inform policy direction to change the way driver’s health and road safety is perceived in Nigeria.

We should all be concerned

“Road safety is everyone’s business and we must all commit to it. It should be classified as an issue of public health importance,” Dr. Nneka Orji from the Federal Ministry of Health said during the dissemination event in Port Harcourt. This is a fact that cannot be ignored because various categories of drivers convey millions of people from one destination to another daily and do not use the roads in isolation. There is always an impact on other road users.

An instance of this is the unfortunate tanker explosion that claimed lives in Lagos State. While we question the rationality of transporting dangerous goods during the day instead of at night when there is minimal traffic, the state of the driver never finds its priority place in the long list of questions.

Comrade Eruemulor Moses, a tanker driver with the Nigeria Union of Petroleum and Natural Gas workers (NUPENG) said most of his colleagues drive all through the day, spend the night in clubs or brothels and continue work in the morning with very little rest. “This is very dangerous because drivers need to stay sharp and alert at every point while driving”, says Pastor Kalango, a pastor who has made safe driving his mission. Sleep deprivation has almost the same effect as taking alcohol.

Working with evidence to prevent more deaths

The results from the intervention provide clear evidence that there is a problem even though it not obvious. The major limitation here is that drivers, especially commercial drivers are always on the move so tracking them for these interventions especially during their peak hours may be difficult. This is where creativity comes in.

“Solving this problem isn’t about resources, but resourcefulness”, says Dr. Fajola, maintaining that the intervention can easily be replicated by smaller organizations or anyone willing to change the narrative on drivers and road safety.

Image credit: Nigeria Health Watch

The media can also play a major role in addressing this limitation, he said. A considerable number of drivers listen to their radios while driving and this can be leveraged to reach them with targeted messaging to promote behaviour change.

Evidence from the intervention shows that 75% of tanker drivers and 65% of commercial drivers had at least a secondary education. This implies that they should be able to understand basic messaging or awareness campaigns targeting them.

One of the recommendations by the Community Health team is for the Federal Ministry of Health to collaborate with Road Transport Unions to raise awareness on the burden of road traffic accidents and improve access of drivers to routine medical care.

While we commend Shell for the Health in Motion initiative and look forward to collaborations between government and other stakeholders to ensure that the general population live healthy and longer lives, we can also make a difference by doing the following:

Although these efforts seem trivial, we believe that they can help prevent road accidents and protect Nigerians from ending up in a situation like Celestine’s.

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