# Notes from the Field: A New Approach to Prehospital Care for Trauma Patients in Tanzania July 26, 2023 - [ News ](/news-categories/news) ***As seen in MGH Global OB-GYN Newsletter*** Road traffic crashes are now the leading cause of death for young adults worldwide. Ninety percent of these deaths occur in low- and middle-income countries. In Tanzania, death from road traffic crashes is estimated to be roughly double the global rate. There is no public emergency medical services system, and the private ambulances that do exist are prohibitively expensive for average civilians. Consequently, most people are transported to health facilities by untrained laypeople. A central pillar of Médecins Sans Frontières/Doctors Without Borders' mission is the concept of [témoignage](https://www.doctorswithoutborders.org/latest/telling-it-it-why-we-speak-out) (testimony), which refers to the act of bearing witness to humanitarian or medical crises and the obligation for advocacy that follows. While working as an emergency medical technician at a large public emergency department in Dar es Salaam, Tanzania’s largest city, I bore witness to the brutal reality of trauma patients who suffered preventable disability and death from road traffic crashes because they weren’t able to reach the hospital in time. There were many challenging encounters, but one sticks out in my mind. In the middle of the night, a young woman was frantically rolled on a stretcher through the green double doors of the ED into the trauma bay. While riding one of the public transit motorcycle taxis with her husband, she had been hit by a private ambulance ferrying a young girl with cerebral malaria to the hospital. Her husband died on impact. Seeing she was still alive, the ambulance driver loaded her in the back with the other patient and brought them both to the ED. She had suffered a traumatic amputation of her right arm at the shoulder. No care was provided en route and she was actively hemorrhaging on arrival. The team worked quickly to control her bleeding and gain IV access. While I never learned the outcome, I do know that she lived long enough to make it to the operating room, thanks to rapid transport to the hospital and prompt attention in the ED. She was lucky. She only made it to an OR because she happened to be hit by an ambulance on its way to hospital. How many other trauma patients were dying in the streets from blood loss? Bearing witness wouldn’t be enough to change outcomes for road crash victims, so together with a motivated team of Tanzanian emergency physicians and a local prehospital care company, we set out to address the problem in a new way. We wondered, "What if the ubiquitous motorcycle taxi drivers themselves were trained to stop bleeding?" We started talking with them and found they were incredibly receptive and motivated to provide first aid. This led to the inception of a social program to train taxi drivers in a basic bleeding control course, which became known as the Okoa Maisha Initiative, meaning “Save a Life” in Swahili. Within a few months, we were hearing anecdotally that these taxi drivers-turned-first responders were saving lives. ![The basic bleeding control course is taught to bodaboda drivers across Dar es Salaam](/sites/g/files/omnuum6866/files/styles/hwp_1_1__720x720_scale/public/humanitarianinitiative/files/j.drake_okoa_maisha_initiative_1.png?itok=UhwxQLI1) Since then, the Okoa Maisha Initiative has continued to grow. A recently completed scientific evaluation of the program found that motorcycle taxi drivers can effectively learn and apply bleeding control interventions in the field to victims of road traffic crashes and transport injured patients to healthcare facilities. The Okoa Maisha Initiative team hopes to continue to expand the program until every motorcycle taxi driver in Dar es Salaam and other East African cities is trained in basic bleeding control, thereby ensuring that the power to save a life is never out of reach when it is needed most. ![The Okoa Maisha Initiative gains traction as a CGTN Africa news crew films a training session.](/sites/g/files/omnuum6866/files/styles/hwp_1_1__720x720_scale/public/humanitarianinitiative/files/j.drake_okoa_maisha_initiative_2.png?itok=BTOM-2PI) **References** 1. 2018 GWHO. Global status report on road safety 2018. 2. Vissoci JRN, Shogilev DJ, Krebs E, et al. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. Traffic Inj Prev. 2017;18(7):767-773. 3. Zimmerman K, Mzige AA, Kibatala PL, Museru LM, Guerrero A. Road traffic injury incidence and crash characteristics in Dar es Salaam: a population-based study. Accid Anal Prev. 2012;45:204-210. 4. Sawe HR, Milusheva S, Croke K, Karpe S, Mohammed M, Mfinanga JA. Burden of Road Traffic Injuries in Tanzania: One-Year Prospective Study of Consecutive Patients in 13 Multilevel Health Facilities. Emerg Med Int. 2021;2021:4272781. 5. Nicks BA, Sawe HR, Juma AM, Reynolds TA. The state of emergency medicine in the United Republic of Tanzania. African Journal of Emergency Medicine. 2012;2(3):97-102. **Author Bio** Joshua Drake is a fourth year MD/MPH dual degree candidate at Tufts University School of Medicine and an intern for the Emergency Health Systems Program. He has worked as an EMT at the Muhimbili Emergency Medicine Department in Dar es Salaam, Tanzania and as an Emergency Medical Services advisor and trainer at one of the few EMS companies in the region. In collaboration with Tanzanian emergency physicians, he designed and developed the “Okoa Maisha Save a Life Initiative” in Dar es Salaam, which trains public transportation drivers in aspects of basic first aid for people injured in road traffic accidents. After medical school, Josh plans to pursue a general surgery residency and to continue working with vulnerable populations, particularly those affected by disaster, war, and famine. Share on:- [ Facebook ](#) - [ Twitter ](#) - [ Linkedin ](#)