…Providing support on trauma care for proper emergency response
Trauma has become a silent epidemic in Nigeria, an epidemic that will only spread as the economy grows. It is commonplace for bystanders at the scenes of accidents to look on mouth agape, hands on the head, watching in concern as accident victims wriggle in pain, cry and bleed to death with no one offering first aid. Any emergency response given, if at all, ends up complicating or worsening victims’ conditions because many Nigerians lack proper basic first-aid knowledge.
Trauma management in our environment is poor. Nigerians, particularly, have a lot of assumptions about the right kind of first aid. People are willing to help but sometimes do not proffer the right kind of help. A country of more than 170 million people has no organized trauma response system and no formal training for paramedics. Injured people are often taken to the hospital in a car or minibus or draped across the motorcycle, sometimes several hours after the accident has occurred.
Even if the patient does reach a hospital or get medical care, it may not have the skilled staff or equipment needed. And the seriously injured probably bleed to death.
Trauma Care Foundation International is giving unprecedented attention to trauma management in Nigeria, attacking emergency care response holistically. Borne out of the desire to provide quality and affordable emergency response knowledge to Nigerians so as to provide timely first aid to accident victims, the foundation’s mandate is to improve the state of trauma care and emergency response services in Nigeria through health education, advocacy and community based programs.
Trauma Care International Foundation is a registered non-governmental organisation with a mandate to improve the state of trauma care and emergency response services through health education, advocacy and community-based programmes. Since incorporation in January 2012, the foundation has been at the vanguard of improving the health status and life expectancy of the Nigerian populace by promoting improvements in facility-based trauma care, providing support for national policies on trauma care and increasing local awareness on proper emergency response.
Although it started with the Child Safety Awareness Campaign, a first aid and basic safety measures training for children, the foundation has grown to managing six major programmes, including: Child Safety Awareness Campaign; Campaign for Improved Trauma and Emergency Response (CITER); Advanced Trauma Training Program (ATTP); Health for All Program (HFA); Voluntary Blood Donation Initiative (VBDI); and Basic Emergency Response Training (BERT).
Like every well-managed organisation, Trauma Care International Foundation has set objectives to help her realise her mandate. Some of these objectives are: generating awareness on how to provide first aid for emergencies (first responder care) in 10% of the Nigerian populace by 2020; creating a network of 10,000 voluntary blood donors by 2020; and significantly reducing delays in patient evacuation, transport and institution of prehospital care of trauma cases in Nigeria through public education and training.
The foundation has reached no fewer than 65,000 individuals including children, educators, grassroots community people, law enforcement agents and the general public.
Safety Record Newspaper’s Paul Mbagwu and John Ogunsemore were at the foundation’s office in Ikeja, Lagos to catch a glimpse of what makes the NGO tick. Excerpt.
A Nigerian Mustn’t Die At 40 Or 22 Years Because He Was In An Accident, Even If The Hospital Facility Isn’t Readily Enough – Dr Ena Tobor, Program Manager, Trauma Care Int’l Foundation
The idea behind Trauma Care
Trauma Care International Foundation is first and foremost a registered foundation. Why trauma care? We found out that emergency response is quite poor in this part of the world. For example, a six-year-old child abroad knows how to dial the emergency number. During our trainings, we ask the children what the emergency number, for Lagos State as an example, is and they say (the American) 911. That is to show that it is has been so programmed. If we don’t educate the younger generation, they may end up being like us at their age, without knowledge. That is why we go to schools and educate people, even the adults. We found out that a Nigerian mustn’t die at 40 or 22 years because he was in an accident. He doesn’t have to die, even if the hospital facility isn’t readily enough. We felt we should start with the nitty-gritty – first aid given at the time of the accident. From our research before we even kicked off, it was close to 5 per cent. Nothing was done. So you find somebody giving up in the hospital not because the hospital did not take him on time – there is traffic in Lagos, there is traffic everywhere – but because first aid wasn’t given. It is a lot of work really but we have just started. Although we have been able to impact close to 65,000 people, we are not done. There is still a lot. We felt like, ‘how can we come in and help Nigerians improve their knowledge on health and safety?’
How Trauma Care International Foundation was formed
Interestingly, we only started with schools because we felt the best way to start educating Nigerians was to start with children. We kitted up and had a few trainings. But we realised that we needed a voice and to amplify that voice and increase our capacity, we needed to register. We were just very interested medical professionals that wanted to cause a change. So we had to come up with a name and get the NGO registered. It was at the beginning just the Child Safety Awareness Campaign project, but as we increased we found out that even the adults did not know what we were talking about. Therefore, we had to open another chapter for adults, a different one for the law enforcement agents and so on. We were incorporated in July 2012 but, as I have said, we started trainings before then. We kicked off with one project but now we have six major projects.
Your background in emergency response
First and foremost, I am a medical doctor. I have taken health and safety courses and I am doing my Masters in Health Education and Promotion because I found out that a lot of people need health education. In one of our projects, we are going into communities and educating them, telling them they don’t necessarily have to be rich to eat good food.
Experience that led to taking to this line of work full-time
There’s a lot actually but I will share a few. During my house job, I did not know anything about NGOs. I noticed that, especially when I was on call during emergencies, a lot of the deaths were preventable and I did not like a patient dying on my watch. But the case came in so bad that there was no option. So I kept thinking about what I could do and pinned it down to lack of basic knowledge. For example, someone had a femoral fracture and died. How did he bleed to death internally? That means those that were taking him in did not know how to position him for the fracture to reduce bleeding. This (femur) is the biggest bone in the body and it is very bloody. Then I also had a man that came in, an Indian. He was unconscious and was in theatre. So I quickly came out to get a brief history from his dad. And his father said that they saw a lady who packed her car on the Third Mainland Bridge and the bonnet was open. She didn’t know what to do and they decided to help. The lady being a Nigerian stood in front of the bonnet while the man’s son stood on the side of the car and was looking into the bonnet. Suddenly, a car cleared him. When they described how they brought him to the hospital, I noticed that it severed his cervical spine. So, I was searching how to be of help in tackling this anomaly. Then I came in contact with the Chairperson and Executive Officer of Trauma Care International Foundation.
How did we start? She was not in country at the time. She just said: Doctor Tobor, you are going to Kaduna to train the children and adults there on CPR. Quickly, I gathered volunteers. We didn’t even have an office then. We got the response and it was amazing. People started calling us that there was an accident and they applied what they were taught by us and the victim survived. There was the case of a lady who CPR was applied on and she woke up. She is one of our volunteers now. We have one lady that called in to tell us about a father and his three children whose car flew from a bridge into the water and they drowned. All of them were brought out lifeless. People had started covering their faces on the road and she remembered a Trauma Care training she once attended. So she started CPR on them and they all woke up. A three-year-old girl was among them. Imagine if we did not teach that lady CPR. The wife would have been expecting a burial for a husband and three children. When I realised the impact of what we are doing, how one person can save a family, I knew I was in the right place.
Experience giving children First Aid training
Initially when we started, we were worried that the children might not understand what we were teaching them. I knew we had to start from the grassroots; we have to start with children. I did not have the privilege of being taught first aid. No one taught me about emergency number. I think it was my mum that taught me about how to cross the road, I was not taught in school. We started with kids as little as four years. I found out that they were really interested and I was amazed by the questions they asked after the class. That encouraged us. I found that all you need is just to demonstrate to these children and show them pictures. They can practice these things step by step and they don’t miss it. I thought they wouldn’t assimilate but they did.
On awareness generation for provision of First Aid (first responder care) to 10% Nigerian populace by 2020 objective
We have penetrated all the six geopolitical zones in the country. If I could draw a chart, I would be able to explain this better. We have covered 5 per cent in each geopolitical zone, which will add up to 1 in 40 Nigerians. So, we are on course.
One thing you have to realise is that we can’t just walk into (a place for training). To get just one training, it takes a week to get approval. What I mean is that we have to source for the programme, apply and write to get permission to come and train, and get a date which is convenient for them. A lot goes into just one training programme. That is why I said there is still a lot to cover. 2020 is three years from now and you might think we should have done at least a quarter. That is why I said there is still much to be done.
On objective of creating a network of 10,000 voluntary blood donors by 2020
We have done half of that already. We have networked over 5,000. For this year, our goal is to run it up to 10,000. We should be done before 2020.
On the objective to significantly reduce delays in patient evacuation, transport and institution of pre-hospital care of trauma cases in Nigeria through public education and training
Remember I said we started as a Child Safety Awareness campaign. But we found that first responders could also be FRSC, LASTMA, VIO and Police. These ones are on the road maybe during the road crash. I can confidently say now that as at 2015, the (Lagos State) Sector Commander (FRSC) said that road traffic crashes in Lagos State have reduced by 42 per cent and he tied it to the collaboration with Trauma Care. What we did was that we trained all the commands in Lagos. We trained the police force, NSCDC, Immigrations not just in Lagos state but we went to the East and Ogun state also. However, we found that because there are always new recruits. In partnership with FRSC Sector Commander for Lagos, Hyginus Omeje, we came up with a project; we’ll do what we call Post-Crash Care training. We will be doing that every quarter this year. By the time we are done, we expect an improvement in the evacuation of victims (of road crashes). He told me he was going through a picture that one of his staff showed him of how they moved a victim from the car into their vehicle and he was alarmed. He said he had to ask them if they did not go for Trauma Care’s training. The man told him (Omeje) that he was just recruited few months ago. So the idea came to him to inculcate the training into new recruits. Even the Nigerian Army and Airforce have invited us for such trainings. That objective is being covered just by training these first responders on Post-Crash Care.
On objective to increase availability of skilled care for victims of trauma-related incidents by training 1000 members of the medical and para-medical community on basic and advanced trauma life support by 2020
We have covered about 400 already. But it is not just in Lagos state, we have a network of doctors that we have connected in Warri (Delta state). And that is where the volunteer medical corps comes in. We have close to 600 members. I believe that will be exceeded because for that particular objective, we created what we call the Volunteer Medical Corps, which is medics all across – not just in Nigeria. We have over 500 from Nigeria alone. What we are doing is to train them on how to go about patient evacuations, even though they already have an idea of what it is about. Can they organise trainings in their own locations? We told them to organise trainings in their locations and let us know what they did. We gave them SOP (Standard Operating Procedure).
On objective to establish regional trauma care networks and audit systems by 2020
When we talk about audit systems, it is about what we have been able to do with the data we have. As regards, I may not be able to provide that information publicly. However, there are different projects with each having its own audit system. Child Safety Awareness has an audit system; even the voluntary blood donor drive. I can speak about that more because it deals with the Lagos State Blood Transfusion Services. With that we have been able to create that network of volunteer blood donors. With the audit system, we have been able to audit our blood drive over the past four years with Lagos State. We have picked over 600 donors and we have their data such that at every point in time if it comes in that they or their relations need blood, all they need to do is contact us and we network them. We are using that to create a system with the Lagos State Blood Transfusion Services. The same system is being fashioned out with the FRSC and other law enforcement agencies but they will be the one to elaborate on it if need be.
On voluntary blood donation
People need information and they don’t know how to go about it. What we do is just to advocate. When I go to corporate organisations – Unilever, for example – I encourage them to get their staff together to donate blood so that they can create a system such that when anyone of them or their relations need blood, they can get it just by a phone call. They can cut protocol, whatever the hospital, as long as it is within our system. That is what we have been able to do. As many people as interested, we get their names and call the Lagos State Transfusion Services. But for anyone to donate, we have to check. Some people look very healthy but they are not. By the time we check the PCV, his own blood level is very low and we recommend to such people what to take: multivitamins and what to eat to boost their blood levels. That is why I am into a Masters in Health Education. All the blood is taken by the Lagos State Blood Transfusion Services and given for free to the emergency centres within the Lagos metropolis. Suffice to say that we have branch out of Lagos. There is something like that in Calabar (Cross River State) and they were able to do the same. This is one of the audit systems I have been talking about, creating this system of networking everywhere.
The Basic Emergency Response Training (BERT) Initiative
The training is for law enforcement officials. We started in 2013, a year after incorporation. We have covered Lagos State; covered the East under Commander Akpabio. The training is for FRSC, Civil Defence, Immigrations, Army and Airforce although it started with FRSC.
About Health for All (HFA) campaign
This is targeted at the grassroots. Our staff members go out and identify slums that need to be reached. We get a resource person to facilitate easy penetration of the community and give them free medication and free doctor’s consultation. We also network them with a primary health centre so that they can follow up on treatment when necessary. We also teach them what combination of food to eat with little money that’ll benefit their body.
Keeping up with former trainees
It is not a one-off thing because we realise that there has to be review, even in schools. If not, maybe we would have passed Primary One and left primary school. But we go back for a review training at least a year after. That we do for every school. At the end of the year, we have what we call the annual Health and Safety fair during which we gather all the schools in the mainland. This is in collaboration with the Lagos State Safety Commission, Education Quality Assurance. We also have data which we don’t joke with. If not of the children who don’t have phone numbers and email addresses because of their age, we have that of the principals and teachers.
We have 7 permanent staff and a network of over 100 volunteers. I have found that you could achieve a lot with volunteers. For example, there is a call for training in Enugu and I don’t even have to go with all the staff because programmes are ongoing. So I just go with one camera person, then we train all their doctors. That very day before the training, I train their medical professionals on what to do. And that is how we recruit, network the medical professionals there.
The people behind Trauma Care International Foundation
We have a Board. Our Board is made up of medical directors, although I may not go into details. Our Board determines the input. What is the NGO going to portray for the year? What are our aims? All these decisions come in collaboration with the Board and the Chairperson.
We are funded by individuals and corporate organisations, some of whom we may not mention because they specifically asked not to be identified. We have gone to MTN, Cadbury, Nestle, Sundry Foods and they do this as part of their Corporate Social Responsibility. From time to time we have to intimate them with our plans and point out how they can come in. As you came in someone just called to say, ‘Doctor, I have someone that wants to sponsor.’ It is just like that.
A typical day at Trauma Care
A normal day in Trauma Care International Foundation kicks off at 7.30am. We have a review every two days. Every staff knows what is expected of them. They know the targets and logos for the month. We also produce articles and newsletters. They do that. If we have a programme, we rally together. Remember, one programme could take a week to put together. A week prior, we may receive a call on the Trauma Care line that, ‘Please come and train my school, my office people,’ and we schedule them. We receive a lot of such phone calls. We have a calendar which is very full.