I find it rather amusing and unbelievable that anyone can have a road traffic collision on Sunday afternoon in Abuja. I mean the roads are great to drive on and often quiet with little traffic. So, I am always amazed that people still have head-on collisions and fatal crashes on a day of rest! Monumentally stupid to be rushing around on a lazy Sunday!
The fact is that driving skills are abysmal and many people seem to lose their heads once behind the steering wheel. Now, with such accidents, some people also lose their necks. Spinal cord injury is all too common in Nigeria, that I am considering going around with a hard neck collar: so I can apply it on the next accident victim.
Prevention is cheaper
I got into a taxi cab to travel a short distance. I usually sit in front and with the seat belt fastened. On this day, the driver said, ‘Oga, no need for seat belt, na short distance we dey go’. I looked at him and asked him whether he thought I trusted his driving. He laughed, nodded his head in understanding and promptly put on his own seat belt. When I seat in front like this, I am also driving with the driver, watching the road and cautioning about care on the road and speed. It is the least you should do.
You know, in the past, farmers and palm wine tapers, falling off trees, were the people who sustained spinal injuries. Nowadays, road traffic accidents account for the majority. Many patients have been involved in accidents where the vehicle somersaults several times. The injuries occur often at the time of the accident or subsequently during extrication or transfer to hospital. Most patients present with partial or complete paralysis of the arms or legs or both. This includes loss of sexual function and loss of the ability to urinate or pass stool normally. This is because the spinal cord carries all the nerves that supply movement and sensation to the rest of the body. If the cord is severely damaged, the paralysis may be permanent.
A costly business
In the past, most patients with neck injuries in Nigeria were managed conservatively (without operation). This was because of the paucity of experts trained in managing such injuries, lack of specialised equipment and of course the cost of treatment. Even then, the cost of not operating is significant. The cost in managing a paralysed person includes the hospital bills, costs of a carer to look after the person, loss of income and long term rehabilitation costs. This could easily run into millions of Naira. There are also significant material and emotional costs.
Helpers do more harm
Ideally, treatment should start at the site of trauma. Safe and careful extrication, safe transportation and immobilisation in hard neck collar are crucial. It is known that following neck trauma, stabilization using a hard collar reduces movement of the neck. These patients cannot and should not be moved without adequate protection and care. I cringe when I see members of the public attending an accident and pulling the victim without due care. Please just call 122 to summon the Federal Road Safety Corp.
Spinal cord injury with paralysis is often associated with lifetime morbidity, so early active management is crucial. The initial care of patients with acute injury to the neck (cervical spine) is of paramount importance. The function of the nerve and spinal cord can be adversely affected by the excessive motion of the unstable spine.
Early diagnostic and clinical evaluations are important in determining the severity of the injury and making plans for subsequent management. Timely and appropriate imaging studies using x-rays, CT and MRI scans are essential to the cervical spine evaluation. Hospitals must be able to offer early neurological evaluation, investigation, diagnosis and surgical management to the majority of patients.
Management, manpower and resources
Because of the inadequacies of many of our hospitals and lack of equipment to perform the operations and rehabilitation, it has become very expensive to treat patients with this kind of condition. This is why many patients with spine problems get abandoned by their relatives because they could not afford the cost of treatment. Some families also take their patients home, where many of them later die.
Prolonged survival has resulted from a better understanding of the effects of spinal cord injury. All over the world, spinal injury centres have done much to increase the survival of and quality of life of cord injured patients. Rehabilitation is also very important whether the patient has been operated or not. The importance of the role of post-injury rehabilitation cannot be overemphasized.
No rehabilitation centres!
There is need to congregate these patients in spinal rehabilitation centres where dedicated experts and facilities exist for improving the outcome of treatment through physical and mental rehabilitation. The establishment of rehabilitation centres would go a long way in improving the social rehabilitation and survival of the patients. Some of my patients travelled abroad for rehabilitation. This cost on average about N20 million for 3 months of rehab. I am yet to see the benefit and that money is better spent on creating similar units here in Nigeria.
Know the facts
The high morbidity associated with spinal cord injury could be reduced through public enlightenment on road safety measures and personal awareness. Wear a seat belt, drive carefully and be cautious, wary of other road users. Do not let anyone drive you crazily (this includes public and private vehicles). You cannot be too careful. You cannot afford to have a spinal cord injury. It’s your neck so protect it by using your head!
Seriously, we need to establish or refurbish spinal and trauma centres that are equipped to function. Improved outcomes can be achieved with a careful approach and multidisciplinary integrated care including improvements in intensive care and effective rehabilitation centres.
Children are transported in pretty dangerous manners in cars on our roads. Many times, I see children unrestrained in cars and this is not right. There must a law against this and it must be actively enforced. This is child abuse and should be stopped. It is even worse when you see that the driver (mom or dad) is wearing a seat belt!
BASIC LIFE SUPPORT
Recently, I asked Chief Medical Directors, “Can your hospital save your life?” Do you have staff trained in basic life support skills: such that if YOU are taken to your own hospital, they will give the best and necessary care, to save your life? This is an important question and hopefully will push CMD’s to review their hospital’s delivery of vital life-saving services in emergencies. The same goes for all organizations involved in medical care and resuscitation. If needed, there is a course on basic life support and trauma care coming up in Abuja next week. This provides an opportunity to equip yourself and staff for life. Please call me for more information.
Dr Biodun Ogungbo MBBS, MSC, FRCS, FRCS (SN)