Africa and the harms of progress

Today a car stops outside the clinic and a man is carried into the small ward and onto a bed. He is only just conscious and smells of alcohol. The story is that he has driven off the road into a tree. There are no obvious major injuries. I am concerned that he may have had a head injury, and tell them he needs to be taken to the nearest hospital an hour away, although i know that they will only be able to provide basic care. 

Then the police arrive in a pick up. In the back lies an obviously dead body of a young woman. She was unlucky enough to be in the way when this drunk man lost control of his car. My sympathy for my patient evaporates. He begins to wake up and complains of pain in his ribs which are likely to be broken. Because of a possible head injury I should not give him painkillers, which is good because I do not want to. This is the second fatal car crash ( I avoid the word accident because I don’t think it is really) in this small area in a week. Last time it was an overtaking car taking out an oncoming cyclist. 

I ask the staff at the clinic what is likely to happen in terms of punishment. The general answer is that the justice system does not really work and that he is likely to be able to pay people off quite easily to evade sanctions. Furthermore it seems that the common way to get a drivers licence here is just to pay for it with no instruction or testing!

Transport is a big problem for most people in Zambia. There are very few private cars and people take minibuses or cycle, or in many cases they walk long distances along the verge of roads that are only just wide enough for 2 vehicles, but not wide enough for 2 vehicles and a line of people walking along both sides. There are lots of rivers which cannot be crossed in the wet season and few bridges, 

which means long detours. 

So it seems particularly cruel that people with little access to cars themselves have to suffer the risk of injury and death from the small minority of car owners, some of whom are careless in the extreme, have never been taught to drive, and whose cars are often in poor shape. If an accident occurs, the ambulance service is non existent and the medical care very basic, so the risk of death or permanent disability is high, and if you are disabled there is no safety net to provide for you, apart from your family who probably simply cannot afford to. 

 As so often in Africa - the problem is easy to diagnose - but  hard to treat.