Spinal injuries in Africa: The 'good' of the Pistorius trial, smart new treatment, and making music through it all

Road traffic accidents are responsible for 70% of spinal cord injuries in Africa, the highest proportion in the world.

THIS week, a paralysed Polish man has been able to walk again after a pioneering surgery to repair his damaged spinal cord, using cells from his nasal cavity.

The treatment, a world first, gives hope to millions of people with spinal injuries, as until now, regeneration of the spine was thought to be impossible.

It’s the same week when South African athlete Oscar Pistorius received a five-year prison sentence for killing his girlfriend Reeva Steenkamp, and throughout the trial, his disability has been (opportunistically?) highlighted.

His lawyers called for a suspended sentence, arguing that prison conditions were not suitable for the double amputee because, for example, the showers lack handrails and he could slip and hurt himself. 

But judge Thokozile Masipa in her final remarks, Masipa dismissed the arguments, saying that his disability would not present the prison system with an “insurmountable challenge.”

The judge added that she felt that Pistorius’ vulnerability had been overemphasised in the evidence and that his “excellent coping strategies”—shown in his ability to compete with able-bodied athletes—had been overlooked.

Troubling numbers

The drama of the trial notwithstanding, one good thing the Pistorius trial has done is bring disability into mainstream attention. Every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury, according to the World Health Organisation (WHO). 

In Africa, it is estimated that between 21 and 34 people per million of the population suffer from traumatic spinal injury, the reported rate in Asia is between 7.8 and 20.5.

Africa’s dangerous roads are the main cause of spinal injury on the continent. According to WHO, road traffic accidents are responsible for 70% of spinal cord injuries in Africa, the highest proportion in the world. And the real cause of injury is poor evacuation and first-aid before reaching hospital. 

Ambulance transport is inadequate in most of Africa, so patients are often taken to hospital in buses, on carts, motorcycle taxis, or even on the back of an animal, which frequently causes further cord compression – most of the time, causing far more damage than the accident itself.

But in South Africa, violence is the biggest cause, accounting for 56% of spinal injury, while one study in Nigeria showed that the biggest cause in Plateau state – a major mining area – was collapsing tunnels in illegal mining.

Strange role of tuberculosis

But it’s not just accidents that cause paralysis in Africa. A third of non-traumatic spinal injury is caused, surprisingly, by tuberculosis – the bacteria which cause the disease that most commonly attacks the lungs, but can also infect other organs, including the spinal cord. 

Other causes of non-traumatic injury are congenital conditions, like spina bifida where the neural tube doesn’t develop properly while the baby is in the uterus, as well as other diseases like cancer.

Men are twice as likely as women to suffer from spinal injury. Many of the consequences of spinal injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical and social environment that excludes people with disabilities from participating in every day life.

WHO warns that people living with spinal injury are at a high risk for depression: Most people with spinal cord injury experience chronic pain, and an estimated 20-30% show clinically significant signs of depression. 

People with spinal cord injury also risk developing secondary conditions that can be debilitating and even life-threatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications.

Economic penalty

Spinal cord injury is also associated with lower rates of school enrollment and economic participation – particularly in many parts of Africa where disabled children are “hidden” away from the society out of shame. 

Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60%.

The outlook is so grim that people with spinal cord injury are two to five times more likely to die prematurely than the general population.

Africa has just a handful of specialised spinal rehabilitation centres. In 2012, the Kenya Paraplegic Organisation started a campaign dubbed “Bring Zack Back Home” to raise Ksh250 million ($2.8 million) to build a spinal injury rehabilitation centre in Kenya – the nearest one is located in South Africa – but so far just Ksh73 million ($818,000) has been raised, with about Ksh176 million ($2 million) outstanding.

Music fame from wheelchairs

But it isn’t all doom and gloom. In the DRC, a band of paraplegic musicians are causing waves both at home and abroad. The core members of Staff Benda Bilili are four musicians who suffered from polio as children. 

Three use wheelchairs, one is on crutches, and they burst into the international spotlight when a documentary film about the group was shown at the Cannes Film Festival in 2010.

Staff Benda Bilili’s first album “Tres Tres Fort” (“Very Very Strong”) was completed in 2009, to international acclaim.

The release was coupled with a European tour—the first time the members of the band had travelled abroad—that saw the group play to sellout venues across the continent.


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