Steve Justus, MD–Trauma: The Hidden Epidemic

Sitting around the table, doctors from Weill Bugando Medical Centre, the second largest hospital in Tanzania, were discussing the barriers to effective trauma care at their institution. One of those barriers was the lack of an available emergency theatre. This results in an unacceptable delay in life saving intervention.

The question asked was: “Why?”

An insightful intern observed that an emergency theatre was set aside for caesarian sections. He stated that the hospital was required to report their maternity mortality statistics in detail to the Ministry of Health. The fact that maternity mortality is a high priority (and rightly so) for the Ministry is reflective of the priorities of international funders. No one could argue that maternal mortality should not be a priority.

During my first week in Tanzania, an orthopedic surgeon approached me about his dream for the hospital to become a trauma centre. His first step was to create a trauma registry.

In health statistics published by the World Health Organization for Tanzania, road traffic accidents are listed as one of the top ten causes of death, just behind syphilis.

Really? More people die from syphilis than road traffic trauma in Tanzania?

Paradoxically, it has been demonstrated that as a country makes economic progress, more people die from trauma. This can be understood by anyone driving on the tarmac roads of Tanzania, where speeding SUVs share the road with push carts, animals and children, or by anyone like myself, who has worked in a casualty ward observing mothers whispering quietly to their whimpering children with open wounds and deformed legs. These children lie patiently on stretchers between casualty beds, each containing two or more patients waiting their turn for medical attention.

Other published data from sub-Saharan Africa list trauma mortality in the top three to four causes alongside HIV, malaria and TB.

So what are the take home lessons? A couple of clichés will suffice. You can’t manage what you don’t measure. Follow the money.

The orthopedic surgeon was right on target when he suggested a trauma registry as a first step towards his dream of a trauma centre at Weill Bugando Medical Centre. Good data could establish the burden of trauma in Tanzania. Should this data establish what seems anecdotally true, then the need to address the high burden of death and disability from trauma will become apparent. Leaders within the Ministry of Health, the private sector and international non-governmental organizations must then step forward to address this need.

Dr. Steve Justus has spent 22 years as an emergency physician in North Carolina. In August 2008, he joined our efforts at Weill Bugando. His position in Tanzania is supported by a grant from the United States Government’s Agency for International Development (USAID).