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.
Initial
care
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. Function of the nerve and spinal cord can be
adversely affected by excessive motion of the unstable spine.
Diagnosis
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 equipments 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.
Rehabilitation?
Prolonged survival has resulted from
better understanding of the effects of spinal cord injury. All over the world,
spinal injury centers 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 over emphasised.
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 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.
Protect
children
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 the 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. 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.
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