Burundi’s motorbike ban dilemma: To protect livelihoods or save lives?

BY JAMES KAHONGEH

There has been a certain sense of relief in the past few weeks for hundreds of Bujumbura residents who have either been injured or lost their kin through motorcycle accidents. When the Burundian government in March banned two and three-wheeler vehicles from accessing the city centre, operators were up in arms. One rider was shot dead in the vicious clash that ensured between the operators and the police.

Against the backdrop of the din of protests, however, thousands were celebrating.

Depending on who you talk to on the streets of Bujumbura, there are arguments for and against the embargo that has left public mobility extensively disrupted and livelihoods damaged or lost entirely.

Those like Nshimirimana Dyne are indifferent. The resident of Bujumbura’s Ngagara neighbourhood is a victim of an accident that left her with scarred knees and elbows for life.

Dyne, 29, remembers the day from hell with a mixture of cynicism and regret. ‘‘I was returning home from the market on a bicycle taxi. I had my sugarcane stock strapped at the back. A speeding motorcyclist hit us from behind. We lost balance and fell on the tarmac.’’

As many do after accidents, the rider fled the scene. With bloodied limbs but without money to go to hospital, the mother of four went home to nurse her injuries. ‘‘For days, I just lay at home, unable to provide for my children. Thankfully, I recovered in a week to return to work.’’

Few accident victims, though, return to their normal lives in the aftermath of motorcycle crashes. Some die. Many more are crippled for life. For those who end up in hospital, families sell assets to pay for their care.

The story of Dyne is that of thousands of Burundians who have either been maimed or killed in accidents by moto-taxi and boda bodas, called here ‘‘Bajaji’’ –borrowed from Indian multinational automaker Bajaj.

The World Bank lists Burundi as one of the 10 poorest countries in the world. Many youths have no jobs and resort to riding motorcycles to earn a living. But with minimal to no formal training for the majority of riders, and in a country with one of the world’s most dangerous roads, crippling injuries and death are always a mistake away. For passengers, taking a bike for a short trip is on many occasions to sign up for death.

Patrick Kalongo, a taxi driver, tells Healthy Nation that as many as 30 riders and pedestrians died in this city of 1.2 million people every week before the ban. ‘‘The riders are very careless. They are notorious for blocking other motorists and overloading.’’

Burundi’s Minister of Interior General Gervais Ndirakobuca in February said cyclists were responsible for the majority of road accidents that injured 2,000 people and claimed 1,300 lives in Bujumbura last year.

But what is the health burden of boda boda accidents in Burundi like? What is the toll to health facilities, communities, the government and the economy?

The World Health Organization (WHO) lists road traffic accidents as one of the major causes of ill-health and death in Burundi. In 2016, for instance, 54,700 people sustained serious injuries from road accidents. Whereas WHO’s estimated fatalities that year were 3,651, there was gross under-reporting by the government, with only 112 recorded deaths.

Here, two and three-wheel vehicles account for 25 per cent of all registered vehicles. But these also account for 13 per cent of all road traffic accidents in the country. This is higher than the regional average of 11 per cent.

In this country, 1,176 life years are affected due to disability from road crash injuries in every 100,000 people. Burundi has no known road safety targets. In fact, there is no age limit for imported four-wheel vehicles here, much less for motorcycles. Save for random inspections on roads, it is lawlessness for motorists and cyclists in this country.

But to understand the full extent of the impact of boda boda accidents, it is important first to know that the country’s healthcare is predominantly funded through donations. Expenditure on healthcare here accounts for a mere six per cent of the country’s Gross Domestic Product (GDP) of $3.26 billion.

Without donor support that Burundi so heavily relies on, most government operations, including healthcare, would run aground.

In the country of 11.6 million, about 70 per cent of the population lives in extreme poverty, according to the World Bank. In Burundi, 80 per cent of the people are employed in subsistence agriculture. With wide inequalities in access to healthcare, in spite of the needy population, majority of accident victims can scarcely afford to pay treatment fees. Many are therefore nursed at home.

The 2016 motorbike accident involving Burundi’s legendary drummer Antime Baranshakaje is a case in point. Barashankaje, 81, fractured his thigh in the accident that left him unable to walk and bedridden.

In the hospitals he visited, doctors advised him to undergo an operation. Such a procedure could only happen abroad and to do this, the traditional drummer had to pay BIF15 million ($5000 or Sh57,5000). This was a long shot for the elderly national hero. For many ordinary Burundians, raising this kind of money for treatment is unthinkable.

For more than two months, Baranhakaje lay at home in agony. He died the following year from illness and complications arising from the accident. The drummer’s experience illustrates the struggles most people here go through looking for treatment after motorbike tragedies.

Diane Cedric, a trader in the city, knows better than to take a boda boda ride. She had an accident in 2019 while going home from campus.

"I dislocated my left wrist and hurt my ribs. My parents could not take me to hospital. They took care of me at home for 10 days,’’ she recounts.

Now she wears long-sleeved dresses and tops to cover her scars. ‘‘They are very ugly. They make me uncomfortable,” she says.

Although the majority of accident victims such as Diane are successfully nursed at home, emergency and trauma facilities and bed occupancy in Bujumbura’s main health facilities of Buterere, Kamenge and Ngagara are dominated by cases of motorcycle accidents. Patients are admitted for anything; from fractured arms to broken ribs, concussions and other life-threatening injuries.

Findings of a survey done elsewhere in the region show that blunt injuries are the most common complications from motorcycle accidents. Those involving the head account for 60 per cent of all injuries. According to the survey done in the northern Tanzanian city of Mwanza, most boda boda accident victims are treated through surgery, with 86 per cent of them requiring wound dressing.

On average, patients are admitted in hospital for anywhere between a day and 120 days. Those who die (16 per cent of victims) are usually in hospital for an average of five days.

Yet for more than 10 years now, motorcycle accidents have been a major but neglected public health concern in Burundi, with minimal government interventions to curtail the worsening situation.

Since 2019, international humanitarian organisation Doctors Without Borders (MSF) has supported healthcare in Bujumbura by reimbursing hospitals the cost of treating victims of accidents. This allows patients to get care without charges. The withdrawal last year of MSF from Burundi, however, left many locals badly exposed.

On impact to the economy, road accidents cost Burundi $343 million or 11 per cent of its GDP annually. Sixty-five per cent of fatalities in road crashes are people in the economically productive age bracket of 15-65 years. For every woman injured, maimed or killed in a road crash, two men are.

In the last two decades, poverty, a population explosion and poor access to basic services such as healthcare have made the boda boda sector in Burundi a socioeconomic relief. But also a ticking time bomb.

In the last one decade, thousands of people, most of them from rural Burundi and with few economic prospects, have built their livelihoods around the boda boda economy. In the capital Bujumbura, half of the 1.2 million residents use these taxis to move to work, to school and to run errands.

Away from urban centres, motorcycles are the main mode of transport for green produce in the provinces. In the banana-growing areas, for instance, owning a bike is a big deal. Owners help to move Burundi’s staple food from farms to the market.

The boda bodas may be banned from accessing the capital for now, but in villages and towns such as Cibitoke, Muyinga and Gitega, they remain an important part of life, and with that a threat to health and life.

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