Globally, over five million people die yearly from injuries. Road traffic injuries constitute a major cause of deaths compared to deaths from HIV/AIDS, Tuberculosis and Malaria combined. Are you shocked?
According to WHO Global Heath Estimates 2014, Road traffic accidents recorded the highest world injury death rate of 24% followed by unintentional injuries 18%, Suicide 16%, falls 14% and war 2%.
Again, a 2013 WHO report on global road safety showed that, 94% of all road traffic deaths and 90% of disability related to road injuries occur in low –and-middle-income countries causing temporary and permanent disability.
In Ghana, about Six (6) people die each day due to road traffic accidents caused mainly by drink-driving, excessive speeding and motor cyclists riding without crash helmets accounting for 60% of all traumas.
Between 1991 and 2019, road traffic accidents have killed 48,568 people and injured 352,797 rendering about 36% of the injured permanently disabled. Again, between 1991 and 2016, 6,899 children between 0 and 15 years died through road accidents.
Data from the Komfo Ankye, Korle Bu, Cape Coast and Tamale Teaching Hospitals show that, between June 1,2017 and May 31,2018, the hospitals recorded a total of 4,876 fracture cases as a result of road crashes.
Road traffic accidents remain the leading cause of death and disability in Ghana often involving the productive age group of 15-49 years.
In Ghana, the Greater Accra region records the highest number of road traffic related injuries while the Upper East has the highest OPD attendance per 1,000 population for road traffic related injuries.
The narrative is not merely about the figures but majority of these deceased were breadwinners who met their untimely death due to negligence on the part of reckless drivers or motorcyclists.
The deaths of these souls have left many families fatherless, motherless and even without children. Survivors of road traffic injuries often suffer amputation leading to permanent disability and sometimes loss of jobs or means of livelihood.
Pre-hospital delays, delay in treatment and inadequate intravenous(IV) fluids (liquid resuscitation) are the major deficiencies in Ghana’s trauma care system accounting for trauma deaths.
Injury prevention and improvements in trauma and fracture care are urgently required to reducing the burden of pediatric injury and fractures in Ghana and as well attain the Sustainable Development Goal 3.6 thus to reduce by halve deaths and injuries from road accidents by 2020.
But can Ghana achieve this goal as she continues to pay lip service to trauma care services?
Bone and joint related injuries associated to road accidents can be classified into dislocation and fracture (Closed and Opened).
Pain, deformity, swelling and inability to move one’s limb(s) are clear features of fracture.
While dislocation, resulting from two surfaces of a joint losing contact are easier to treat, closed fracture occurs when the skin overlying the fracture site is intact with no communication with the external environment and are often corrected with non-operative methods such as Plaster of Paris (POP), bandage, arm slings and traction devices.
But open fracture occurs when the site of the injury is breached and interacts with the external environment and is usually corrected with operative methods involving the use of plates, screws, external skeletal fixators, nails(rods) and wires which are often expensive.
Fracture complications such as severe bleeding or shock, limb gangrene, paralysis and loss of limb or life have dire consequences on the household of the affected person(s) and the economy of Ghana at large.
Needless amputations from post-fracture management usually associated with delays in proper treatment at health care facilities are avoidable.
According to Dr. Noel Tolgou Yempabe, Head of the Trauma Care Unit at the Tamale Teaching Hospital (TTH), road and domestic accidents accounted for the amputation of 36 children aged from 0-16 between 2015 and 2019.
Dr. Yempabe maintained that, amputation remains the last lifesaving option mostly common with referrals of fracture patients from bonesetters.
Trauma care systems: Bonesetters versus Orthodox treatment
Emergency care is an essential part of the health system and serves as the first point of contact for the injured or the critically ill (WHO, 2018).
But the high cost of accessing emergency health care services by trauma patients in middle and low income countries has compelled significant number of trauma patients to seek the services of bonesetters instead.
To the extent that, some fracture patients ‘run’ from hospitals to traditional bonesetters for treatment for fear of being amputated or their inability to afford hospital treatment is cause for worry.
But the use of concoctions, application of excessive pressure on fracture sites, unprofessional handling of fracture by bonesetters during treatment especially open fracture, has a higher propensity to amputation.
Unclean treatment environment and the application of herbs on open fractures by traditional bonesetters could worsen infections on fractures leading to amputation.
Head of Trauma and Orthopaedics at the Komfo Anokye Teaching hospital, Dr. Dominic Konadu-Yeboah, recognizes the role traditional bonesetters play in the treatment and management of fractures at the rural level but emphasizes the need to retrain, and better regulate the activities for safe fracture care.
He indicated that, though trauma care is generally covered by the National Health Insurance Scheme (NHIS), all materials needed for the treatment which are often expensive to afford by patients, must also be covered.
Dr. Konadu-Yeboah appealed that, implants for all trauma care should be free, “so that, anybody who gets a broken bone goes to the hospital and gets treatment for free because these injuries are not planned.”
The question that arises is, if the cost of fracture (open fracture) treatment at the hospitals is more expensive compared to that of bonesetters whose method usually results in amputation to save life, what can government do to change the narrative?
Perhaps, government needs to include comprehensive trauma treatment on the National Health Insurance Scheme (NHIS), subsidize the cost of orthopaedic implants for treatment and create trauma rehabilitation centres across the country.
Even though the Emergency and Trauma care department of hospitals are the preferred destination for fracture treatment, poor handling of motor accident injuries could account for deaths and amputation.
Again, the era of people only filming accident scenes with their phones and walking past them instead of learning to apply basic trauma management tips on injured persons to reduce complications and save life, is disturbing.
Leaving persons involved in motor accident injuries to their fate because we are all not health professionals is unfortunate; of course something can be done by lay-people to save injured persons.
Management of an injured person
At a road accident scene where persons are injured, ensure that, the environment is safe, remove all dangers before attending to them.
Kindly, call the person to check if the injured is awake and can talk and then call anyone around for help to transport the injured to the hospital.
In the case of a severely injured person, at least three (3) persons are required to properly lift the injured or unconscious person from wreckage.
Neck movements must be avoided and the injured person placed on a hardboard where possible, and the head must not be allowed to dangle. If you need to turn the person, do so by rolling or turning him or her in one piece like a piece of log.
Ensure that, the injured is breathing normally and lay him or her on the left side.
Handling a fractured body part
If a limb is broken, it must be splinted or straightened and held to a straight piece of object (cardboard, piece of wood,) using a bandage, a piece of cloth or headgear. Slightly raise the limb to relieve pain, reduce swelling and bleeding into the site of the fracture.
If there is severe visible bleeding from a broken limb, apply direct pressure using a clean cloth and raise the affected limb to control bleeding.
If available, apply ice pack (iced blocks in a polythene bag wrapped in towel or cloth) to the site of a fracture to reduce swelling and relieve pain.
When transporting the injured persons to the hospital, conscious victims should be laid flat with the head up. while unconscious or those bleeding from the mouth, vomiting or foaming from the mouth be laid on their left side.
Low-cost trauma interventions can have large returns but prevention is the most cost-effective way to reduce deaths and disabilities associated with road accidents.
Prevention is better than cure
Investment in the development of low-cost, high efficiency educational instruments and the promotion of rapid dissemination of knowledge on injury prevention to all parts of the country, through the use of mass media should be pursued vigorously by all stakeholders to minimize the impact of trauma in Ghana.
Safety of Children
Children’s behavior differs from adults and thus makes them vulnerable to injury because they live in a world over which they have little or no control.
Homes, workplaces and playgrounds must at all times be safe for children to avert possible injury.
At homes, parents must endeavor to use home safety devices such as guards above ground level, and kitchen gates and guard rails to restrain children from taking a dangerous tumble.
Parents or caregivers must ensure playgrounds have soft material like wood chips, sand or mulch under them and ensure that, the right reading playground signs and equipment are used depending on the ages of their children.
They should ensure guardrails are in good condition to help prevent falls and look out for things that can trip their children such as tree stumps or rocks.
At schools, teachers must ensure that, children wear protective gear during sports and recreation activities.
Finally, parents and caregivers must intensify supervision of their children at all times around fall hazards and playground equipment at home or out to play.
Drivers/Riders and Passengers’ Safety
Drivers/riders especially of commercial vehicles must ensure defensive driving/riding at all times, in other words “kill your speed before it kills you”.
Drivers/riders should ensure regular maintenance of their vehicles and motor bikes and checking on worn-off parts for immediate replacement to avoid unnecessary accidents.
Officials of the Motor Traffic and Transport Department (MTTD) of the Ghana Police Service must desist from alleged bribe-taking from offending drivers and strictly enforce laws and prosecute drivers involved in speeding beyond limits, those who engage in drink-driving and those who refuse to use seatbelts.
Motor riders and pillion riders should at all times wear recommended crash helmets when using the roads to avoid instant deaths when involved in accidents.
Female motor/pillion riders should avoid sitting with both legs on one side of a motor as this is dangerous.
The Ministry of Roads and Highways should identify and redesign roads at accident-prone areas and improve road markings and signage for the safety of pedestrians.
Pedestrians should avoid running across roads and instead use the Zebra crossing when crossing a road.
Passengers are strongly encouraged to speak against excessive speeding by recalcitrant drivers and where possible report such drivers to the nearest police checkpoint.
The Driver and Vehicle Licensing Authority and the Ghana Police Service should ensure that drivers of commercial vehicles strictly adhere to safety features such as exit points, seat belts for passengers, fire extinguishers, police escorts, first aid box among other thing.
Urgent Actions Needed by Stakeholders
The National Road Safety Authority is entreated to embark on continuous public education on the relevance of road safety through the mass media, community durbars, religious and public gatherings.
Transport operators should ensure their drivers undergo more refresher training on defensive driving and maintain two drivers when embarking on long distance journeys to avoid ‘sleep-driving’.
Government should use a percentage of the road fund to produce road safety text books and flyers to her citizens especially students at all levels of education on the need to avoid road accidents.
Government must commit to purchase more alcohol detecting devices for the MTTD to check drink-driving and ensure economic roads with potholes are timely patched to prevent accidents.
Again, the uneven distribution or posting of orthopedic doctors across the country has had dire impact on injury and fracture treatment or management and should be looked at.
For instance, data from the Ministry of Health and the Ghana Health Service show that, more orthopedic doctors get posted to Southern Ghana compared to Northern Ghana; this inequality must be addressed to win the fight.
The five regions of the North have less than 7 orthopaedic doctors with the Upper West and Upper East Regions having one doctor each.
Government should therefore train more orthopaedic doctors to salvage the situation particularly in Northern Ghana.
The Media; especially Radio and Television as part of our corporate social responsibility should develop road safety messages or build jingles for airing during our programs to encourage attitudinal change on our roads.
Ghanaian Pastors and Imams should integrate Road safety issues as part of their sermons during worship times for their members to change the narrative.
Our festivals could also be avenues for road safety education.
The implementation and strict adherence to the 3 E’s thus Engineering, Enforcement and Education is essential to reducing drastically, road accidents and injuries.
The cost of road safety education may be expensive but the needless deaths could prove more expensive.
Passengers must unanimously reject any vehicle with glaring evidence of being unworthy for our roads and demand for a change of vehicle or report to the police for the necessary action.
Injury constitutes a serious public health problem with significant social and economic cost. Injury prevention involves more than saying ‘Be Careful’; it is the responsibility of everyone in nipping the menace in the bud.
Ghana has already missed the SDG goal 3.6 which aimed at reducing by halve road traffic related injuries and deaths by 2020 but all is not lost, if government will dedicate resources and collaborate with key stakeholders to embark on nationwide education on road safety, we can do well.
Let us all actively play our roles whether health professionals, engineers, lawyers, media practitioners, teachers, police, household heads, religious bodies, government and non-government agencies to promote a nationwide education on injury prevention and road safety to end the needless road deaths in our beloved country Ghana.