Nigeria Health Watch

From Okada to Keke

I was in Owerri recently and was not sure whether to laugh or cry. The ubiquitous “Okada” motorcycles that ferried (or flew) people around the city in my formative years were gone. One now had to walk relatively long distances to get to a major route. Once there, the easiest and cheapest form of transport  was now a tricycle knowed variously as “Keke NAPEP” or “Keke Marwa”. They basically have an engine that is slightly more powerful than a motorcycle’s, with 3 wheels and is able to carry anything from three to five passengers depending on their sizes and the dexterity of the driver. They were all over the place…literally everywhere!

The model of ownership is actually quite innovative – state governments import them in bulk and sell them to  people on an extremely low or no interest basis,  payable over a period of time. This is often taunted as a ‘poverty eradication’ programme created to empower the poor, jobless and underemployed. Keke operators are seen in most towns in Nigeria snaking through every available space, amid vehicles, violating traffic rules and risking the lives of their passengers. But they will never be as risky as the Okadas.

I ran into my friend and colleague Hilary, who was a thriving orthopaedic surgeon in Owerri. The last time I met Hilary he was emotionally distraught. While he admitted to not having the skills in epidemiology, he admitted that detailed studies were actually not needed to show the extent of morbidity and mortality caused by Okada drivers in Owerri. At the time, he invited me to spend a day with him while on-call at the centre where he worked – just to observe the number of patients brought in on any given day with “Okada” related trauma….and did they flow in. They came with all sorts of fractures – many too horrific to describe in detail here. With limited options in restorative surgeries and prosthetics, most of his time was now spent on amputations. When Malam Nasir El Rufai first banned Okadas from the FCT Abuja, most Nigerians thought it would be impossible to cope without them in most other cities. But now it is rare to find a major city in Nigeria where Okada’s are still allowed to ply their trade.

But to prevent the Okada problem from being replicated with the Kekes’, city planners must step up to their task of regulating the routes of Keke operators – else we may just shift our patients from the orthopaedic wards to the psychiatric wards as they recover from sitting half outside half inside the ever more popular Kekes. My friend Hilary the orthopaedic surgeon may be making a few Naira less, but he is sleeping a lot better these days….as a result of the banning of Okada and emergence of Keke! Naija!

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

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