Tanzania tightens noose on motorcycle taxis to transform ailing sector

It is seven minutes to 4pm and the Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania is buzzing with activity as relatives of patients stream in to see their kin.

In this 10-bed trauma ward, we meet three young men: 19-year-old Rashid Bakari Rashid, 25-year-old Ali Muhidini, and 32-year-old Uzima Ali Bakari all lying supine in beds draped with mosquito nets.

Muhidini has spent the last three weeks on his hospital bed near the window. 

“There is a bit of breeze here,” he tells the Healthy Nation team as he narrates how he ended up here. “I was involved in an accident when a car that was behind me rammed into me. In the confusion, another car hit me in the chaos. I ended up with two broken legs. On the right, I suffered a broken thigh bone and shinbone while my left knee was shattered.’’

To correct the fracture, Muhidini’s left leg is strapped and suspended on a five litre weight. The method of strapping the patient’s affected lower limb and attaching weights (known as skin traction) limits movement and reduces the fracture to help decrease pain, spasms and swelling. It also restores and maintains straight alignment and length of bone following fractures.

The young man needs Tsh1 million (KSh50,000) to undergo surgery, money that he says he still does not have. Bakari Rashid was returning home from an errand on a boda boda when a car veered towards them, forcing the rider to also steer the bike to avoid a head-on collision. They ended up in a ditch.

He recounts: “My left leg hit a barrier on impact. I could not stand up on my own.’’ Bakari was rushed to a nearby hospital in Mwananyamala, Kinondoni District.

Tanzania tightens noose on motorcycle taxis to transform ailing sector

Tanzania tightens noose on motorcycle taxis to transform ailing sector

The experiences of the three men are the experiences of thousands of people in this country where, like in the rest of the region, motorcycle business is a sought-after economic activity, both in urban and rural Tanzania.

At Muhimbili Orthopaedic Institute, boda boda-related accidents account for the majority of road traffic injuries treated or admitted, and, therefore, a significant amount of resources, including personnel. For many Tanzanians, minor injuries suffered from motorcycle accidents are often ignored, with most people opting for over-the-counter painkillers. This is what Uzima Ali Bakari, 32, had been doing every time he had an accident. Until last year, when he suffered a more serious injury.

"My injuries were not serious. I only had a bruised knee and a few scrapes on my legs. The rider sustained severe head injuries. I did not go to the hospital.’’

Later, Ali started experiencing pain in his lower back down to his legs. He took painkillers to remedy the pain. The condition persisted and worsened. By December, bending or sitting was a nightmare for him. He could also not sleep.

"An MRI showed I had a problem on my spinal cord. The doctor explained to me that the pain was as a result of a degenerated disc in my spine.” Ali was later diagnosed with a condition known as lumbar spinal stenosis, according to Dr Kennedy Nchimbi, an orthopaedic and trauma specialist at the Muhimbili Orthopaedic Institute.

Upon further probing, Dr Nchimbi discovered that the patient’s current condition was as a result of his past untreated injuries.

Findings of research show that motorcycle riders face a higher risk of severe injury, morbidity, and mortality than other road users. For every kilometre travelled, motorcycle riders are 20 times more likely to die from a crash than other motorists. A more recent study returned a grimmer picture: about 71 per cent of all road traffic injuries in rural Tanzania involved a motorcycle. This was before a series of interventions were made.

A 2016 analysis of factors associated with road traffic collisions in Tanzania reported motorcycles to be the leading cause of traffic crashes, accounting for 53.4 per cent of accidents in six public hospitals. In fact, road traffic injuries were involved in 43.9 per cent of trauma cases and 66 per cent of traumatic brain injury patients who presented were at a hospital in Northwestern Tanzania, making road traffic injuries the most common cause of injury.

Explaining how accidents cost the Tanzania’s health sector, chief medical officer, Dr Aifelo Sichwale,  says 10 out of 100 patients treated at hospitals’ emergency departments are usually accident victims, with up to 77 per cent of these being victims of boda boda and auto rickshaw (tuktuk) accidents.

“About 71.3 per cent of road accident victims who end up in hospital are men. Most of them are aged between 19 and 37,” Dr Sichwale explains. In a survey conducted in 2020 involving five regional hospitals, it was found that road traffic injuries account for 60.3 per cent of hospitalisation.

At Muhimbili Orthopaedic Institute, between 10 and 15 (or 70 per cent) of the accident victims treated here are boda boda-related. ‘‘We treat patients who are brought from either from the scene of accidents or referred from satellite hospitals. This depends on the extent of their injuries.’’ This hospital attends to an average of 5,300 boda boda accident victims annually, or about 450 patients per month.

Most of these patients require surgery and prolonged hospitalisation, he says.

“A large percentage of these patients suffer injuries to the thighbone and leg bone (33 per cent), skull (30 per cent), back (12 per cent), pelvis (10 per cent), and other parts (15 per cent).’’

Dr Sichwale adds: ‘‘About 80 per cent of them need surgery and long hospital admission, which could cost up to Tsh800,000. For those with head and back injuries requiring admission to the intensive care unit, this costs between Tsh4million and Tsh12million.’’ The doctor notes that this cost is usually demanded upfront, overwhelming patients who lack medical insurance.

He adds: “The institution finds itself running on losses while trying to assist patients who may never clear their hospital bills.’’

With 77 per cent of these falling in the 19 -49 age bracket, Dr Sichwale laments that Tanzania is losing a large percentage of its workforce to boda boda accidents.

Dr Nchimbi explains that the ballpark cost of treating boda boda accident victims outstrips the subsidised cost. From a survey done at the facility to determine the cost of treating a fractured thighbone, doctors discovered that it’s anywhere between $1500 (Tsh3.4 million) and $2000 (Tsh4.6 million).”

Abdi Issango, the Zonal Traffic Officer in Dar-es-Salaam, says that while boda bodas have created employment and eased transport, they are also contributing to massive loss of the country’s young workforce. “Our biggest challenge is untrained riders and those without licenses to ferry people. There are also young men using boda bodas as a means to commit crimes. It is this category that violates traffic rules the most,” Issango notes.

To sanitise the sector, the Dar-es-Salaam traffic department is now sensitising riders by partnering with driving schools. These encourage riders to wear safety gear, for instance, to reduce the severity of injuries during accidents. The department has also enlisted community policing to talk about road safety.

“Beyond education, we enforce the law on violators. We arrest riders who do not stop at Zebra Crossings or those who do not wear helmets. We also arrest riders who are carrying more than one passenger, or carrying them without protective gear.’’

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