Accident survivors whose legs were amputated say their stories would probably have been different but for doctors’ strike and unorthodox treatment at traditional bone-setting facilities. ANGELA ONWUZOO reports their struggle for survival amidst inability to pay for prosthetic aids
43-year-old Kazeem Ahmed will not forget March 6, 2019 in a hurry. It was a day the commercial bus driver who is also a bread pan manufacturer lost his right leg in a motor accident along the Lagos-Ibadan expressway.
The Kwara State indigene said life has been tough for him and his family since the incident, but has refused to give up, having been told by his doctor that he could walk again if he could procure a prosthetic leg.
The father-of-three who is currently on crutches says he desires to walk again through the aid of an artificial leg, but he can’t afford it.
Narrating his ordeal, Ahmed said, “I manufacture bread pans. I am also a commercial bus driver. Whenever there is low sales, I use my bus for commercial purposes.
“I ply Iyana Oworo-Mowe route. So, on the 6th of March 2019 when business was slow, I decided to operate my bus for commercial purpose.
“So, I carried passengers from Mowe to Iyana Oworo. While approaching Mountain of Fire and Miracles Ministries along the Lagos-Ibadan expressway, my vehicle developed a mechanical fault, I parked to find out what the problem was.
“When I opened the bonnet, an oncoming Sienna bus hit me from the back and broke my right leg.
“The accident happened around 1:00pm and the driver blamed it on brake failure. So, I was rushed to a hospital at Mowe for treatment.
“I received three pints of blood because, according to the doctor, I had lost a lot of blood and my packed cell volume was 10 percent.
“Later, the doctor told me that they would call an orthopaedic surgeon from Sagamu for a surgery on my leg. I was billed N400,000 for the operation.
“A week thereafter, the operation was carried out. I was told that after 41 days, the stiches would be removed and that I would start walking with the leg gradually with support of crutches.
Wound started smelling, oozing out pus
“But two weeks after the operation, the wound started smelling. It started bringing out pus. The doctor told me that I needed some injections.
“So, he placed me on an injection for one week. I spent N7,500 on each of the seven days. But after the seven days elapsed, I did not see any result.
“The wound was still smelling, with pus still oozing out of it. So, after managing my leg for two months with over N1m, the doctor told me that the leg had to be amputated.”
But Ahmed’s family objected to the doctor’s advice; they advised him to visit traditional bone setters.
Seven months in traditional bone setter’s home
“So, I was admitted at a traditional bone setter’s facility in Osun State. The man told me that he could handle it.
“He assured me that the leg would not be amputated. Unfortunately, after spending over seven months, there was no positive result. Instead, the leg became bad even after I had spent over N3m there.
“In fact, I was the one that discharged myself when I saw that nothing had changed and the wound was getting worse. The bone setter pleaded with me to be patient with him, but I was done.
From bone setter to Igbobi
“From there, I relocated to the National Orthopaedic Hospital, Igbobi, Lagos,” Ahmed said.
Continuing, he said, “At Igbobi, the doctors told me that I had 50-50 chance of walking again.
“They, however, gave me two options. The first was that they could manage the leg for five to six years but that it would cost me between N20m and N30m. The caveat: there was no guarantee of walking with the leg.
“The second option was that they would amputate the leg and I could walk with an artificial leg. I then chose the amputation of the leg because I did not have N20m or N30m to manage it; more so, there is no guarantee that I can walk with it again.
“My leg was amputated on July 28, 2020. I spent three weeks at Igbobi and the cost of the surgery was N215,000. Before I was discharged, the doctor told me to prepare to get a prosthesis to enable me walk independently.”
Prosthetic leg sells for N800,000
But if Ahmed thought that getting a prosthetic leg was a walk in the park, he soon knew better.
“When my wife checked the price of prosthetic leg at Igbobi, it was N800,000. I can’t afford it, though I really need the prosthetic leg to continue with my bread pan making business since I cannot drive anymore.
“Using crutches is really a burden to me and has a lot of limitations,” he cries.
He appealed to the government to subsidise the cost of prosthetic legs so that poor amputees can afford them and be able to move and live independently again.
A Professor of Orthopaedics and Trauma Surgery at the Ahmadu Bello University Teaching Hospital, Zaria, Mike Ogirima, told PUNCH HealthWise that survivors’ limbs are not just cut off for no reasons.
“There are some specific reasons why some accident victims do have to go for amputation,” he stated.
‘70-80 percent of amputation caused by traditional bone setters’
Prof. Ogirima, who is a past president of the Nigerian Medical Association, blamed most limb amputations on the activities of traditional bone setters.
According to Ogirima, traditional bone setters are responsible for between 70 and 80 percent of amputation cases.
The orthopaedic surgeon explained, “There are three indications why the limb may be amputated.
“Primarily, if the limb is so deadly that leaving it there will result in the death of the owner; or if the limb is dead or when it becomes a burden to the patient.
“For accident to cause amputation of the limb, maybe the injury to that lamb is massive that you cannot reconstruct it or blood supply to the limb has ceased.
“There is no reason why you should leave such a limb because it can cause death.
“But we have seen a lot of limbs and injuries that have been mismanaged by traditional bone setters.
“In fact, there are several studies done from the six geopolitical zones of the country showing that 70- 80 percent of amputations done in hospitals are due to negligence from traditional bone setters.
“That is negligence due to quackery on the part of traditional bone setters. They attend to injuries that are above their limit of operation.”
The professor noted that there are good prostheses that could help amputees move from one point to the other and also move on with their businesses to earn a living.
He said prostheses that function effectively and could compete with natural limbs were available in Nigeria but affordability was the problem, as some were above N1m.
Prosthetic legs and affordability
Prof. Ogirima said, “Prostheses are available but affordability depends on individual pocket. Affordability is a problem. The government should step in and subsidise treatment.
“The ones that function effectively and can even be used for sporting activities cost between N500,000 and N1m. The good ones are very expensive. Very functional types will help users earn a living and enhance their economic status. They can also operate machines with it.
“When these amputees have access to prostheses, they will be able to move from point A to point B. Life is movement and movement is life. A lot of them will be out of the road begging if they have prostheses.
“Again, use of prostheses have a super advantage over use of crutches. With prosthesis, you can run and compete in sporting activities, but you can’t do that with crutches.”
Another accident victim, Friday Avah, 44, who lost his leg 20 years ago, narrated his frustration, lamenting that survival has been difficult for him moving on crutches.
The betting agent said, “I had accident on May 23, 2000. Then, I was a commercial bus driver. The accident happened at Iyana Oworo bridge at night around 10:00PM. I was conveying passengers from Bariga to Oworo when my bus had a head-on collision with a Mercedes Benz.
“When the accident happened, I was rushed to Igbobi for treatment. I spent 18 months at Igbobi.
“But my leg was amputated because of doctors’ strike. I was on admission at Igbobi during the national doctors’ strike that lasted for over two weeks.
“By the time doctors resumed work to attend to me after the strike was called off, my leg had already rotten.
“Nevertheless, I thank God I am alive today. But I must say that it has not been easy living on crutches.”
‘Walking on crutches denied me life partner’
Continuing, the Delta State indigene said, “I wish I could afford a prosthetic leg which the doctor recommended to aid my movement. Walking on crutches has denied me a lot of things, including a life partner.
“The three ladies that I had approached for marriage turned me down. My mates are married with kids.
“Living on crutches carries a lot of stigma apart from having limitations in terms of movement.
“But I have vowed not to give up until succour comes my way; neither will I allow my condition turn me into a beggar.”
Common lament among the amputees
For 34-year-old fashion designer who simply identified himself as Tunde and other amputees our correspondent spoke with, their major problem is how to get artificial limbs to be able to walk independently again.
Sharing his experience with our correspondent, Tunde, a father-of-one, said, “I had accident in August 2020 at Apapa.
“I was going to work when a truck knocked me down and broke my leg to pieces. That led to the amputation of my leg.
“I spent three months at Igbobi, receiving treatment that cost me over N900,000 which I struggled to pay out-of-pocket.”
The Oyo State indigene added, “Walking with crutches is not easy at all. I am not comfortable with it.
“I was told to go for artificial leg. Where is the money? Raising N800,000 in this condition will certainly not be easy for me. I can’t afford it. It’s too expensive.”
‘Limb amputation saves life’
Experts say amputation is the removal of whole or part of a limb, often as a life-saving measure.
PUNCH HealthWise gathered that though there is no national data for amputation in Nigeria, road traffic accident remains the predominant causative factor and accounts for about 57 percent of amputations.
Evidence shows that rehabilitation of an amputee is a major problem in Nigeria because majority do not have access to or cannot afford the cost of the prosthesis, so they move around with crutches and some become beggars on the streets.
According to the World Health Organisation, road traffic injuries are among the leading causes of death and life-long disability globally.
WHO reports that about 1.24 million people die annually on the world’s roads, with 20–50 million sustaining injuries.
The UN health agency notes that globally, road traffic injuries are reported as the leading cause of death among young people aged 15–29 years; and are among the top three causes of mortality among people aged 15–44 years.
Increase in amputations driven by ignorance, poverty
President, Nigerian Orthopaedic Association, Prof. Kunle Olawepo, told PUNCH HealthWise that the increase in amputations were driven by lack of awareness and poverty.
Prof. Olawepo, who is a Consultant Surgeon at the University of Ilorin Teaching Hospital, Kwara State, said amputations are not from only road traffic crashes. He also listed complications of diabetes, cancer tumors, peripheral vascular disease, trauma, infection, burns, and traditional bone setters’ intervention as other causes.
Half of accident victims patronise traditional bone setters
Identifying road traffic accident as the number one cause of amputation among the listed causes, the professor said, “The truth is that, half of accident victims come to the hospital directly from the scene of the accident while half go to traditional bone setters.
“Two things are the major problem. First, is the level of education, though we also have professors in other disciplines who patronise traditional bone setters.
“Second, is poverty and penury. Some, when they are told about the cost of surgery, run away.”
On the cost of surgery, Olawepo said, “The cost of surgery varies and depends on the bone that was broken and how many they are.
“It could be as low as N20,000 and as high as N400,000. But people spend more going to traditional bone setters than paying for surgery that is required at the health facility.”
Prof. Olawepo stated that there are prostheses and orthotics that can be applied in lost parts of the body to replace the natural part, including below knee prosthesis and above knee prosthesis.
He noted that many people in Nigeria in need of prostheses could not afford them.
Some prostheses can be connected to the brain
“We have several types of prostheses. There are the types that are actually connected to the brain that the brain can control in a manner that if you want to bend your knees, you can bend them.
“Most of them are imported from China, India, United Kingdom and America.
“Affordability is an issue, not only for the man on the street who earns N30,000 minimum wage, but even for those who earn N100,000-N200,000 per month,” the surgeon said.
The NOA president decried the shortage of orthopaedic surgeons in the country.
Nigeria has only 500 orthopaedic surgeons
He said, “We have about 500 orthopaedic surgeons in Nigeria to cater for a population of over 200 million. You can see that the equation does not balance. And out these 500, about 100 to 150 have migrated out of the country.”
Mismanaged legs leads to amputation
Also speaking, Head, Department of Prosthetics/Orthotics, National Orthopaedic Hospital, Igbobi, Lagos, Adegbola Mayowa, said, “We see a lot of patients regularly and some of them whose legs have been damaged and mismanaged by traditional bone setters.
“Sometimes, it results into amputation and amputation can come in different forms.
“It could be above-the-knee or below-the-knee amputation. Amputation can happen in any part of the body. When you lose your limb, it does not mean you will not walk again.”
The HOD further said, “There are devices which we fabricate in O&P department that can replace limbs that had been lost; they help you to walk.
“We have local and semi-local prostheses that we manufacture here. But there are some of these prostheses that are imported into the country from Germany, America and Turkey.
“They are imported because we don’t have the raw materials to fabricate them here.
“Locally made prosthesis on the average, for amputation below the knee, is N250,000; while the imported type on the average is N500,000.
“For above-the-knee amputation, we don’t have locally made prosthesis. Reason being that it is too heavy. On the average, imported above-the-knee prosthesis is N800,000.”
Out of 10 referrals, only five get protheses
Mayowa noted that the demand for prosthesis is high but not all who are in dire need of it get it because of the cost.
“When we get 10 referral for prostheses, only five end up getting them as a result of the cost.
“Using prostheses is far better than crutches, because with prostheses, you can do more.
“Sometimes, if you are not told, you don’t get to know that someone is on prosthesis.
“Also, use of prosthesis reduces stigma. I will recommend any patient that had amputation for prosthesis to avoid stigma,” he said.
On the way forward, Prof. Ogirima recommended that more orthopaedic surgeons be trained to handle injuries either at the secondary or tertiary levels of healthcare.
At primary healthcare centres, he suggested, “We need to deploy medical officers who can see dangers inherent in an injured limb.
“We need to educate traditional bone setters on the need for early referral.”
For Prof. Olawepo, health insurance is key in making prostheses affordable for those whose limbs have been amputated, stressing the need for adequate care and support for those requiring extremity amputation through the strengthening of the National Health Insurance Scheme.
The NOA president said people should be sensitised to know where to go and access care when they have injuries.
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