Nigeria’s Golden Hour

As is my tradition, I planned on giving a hilarious recap of all the political, social, and of course, health news that happened in 2025. However, two things happened. One is a personal lack of enthusiasm on my part.  I looked through all my past writings for 2025 and combed the news for something uplifting, […]

As is my tradition, I planned on giving a hilarious recap of all the political, social, and of course, health news that happened in 2025. However, two things happened.

One is a personal lack of enthusiasm on my part.  I looked through all my past writings for 2025 and combed the news for something uplifting, witty or shocking, but all I encountered was more bad news, locally and internationally.

The second reason I chose not to recap 2025 is because when a world champion’s car rolled on the Lagos–Ibadan expressway and two lives were lost, the world watched and noted its ‘F’ ups (pardon my French). That footage of Anthony Joshua being helped out of a wrecked Lexus, dazed, in pain, fortunate to be alive, does more than shock us. It forces a single uncomfortable question onto the front pages and our conscience: what happens to the injured on Nigerian roads before they reach a hospital?

Initial reports from the scene blamed excessive speed and a wrongful overtaking manoeuvre for the crash. That is an important, actionable fact; reckless driving kills, and enforcement must be relentless. But the other persistent chorus, social media clips and international headlines suggesting that Nigeria’s emergency response was absent or incompetent, also matters because perception is fuelled by reality.

Some of the heat comes from Nigerians themselves, furious at what they see as chronic negligence; others are foreign news desks quick to paint the scene as proof that Nigeria is “backward.” The truth sits somewhere between these extremes: our emergency system has pockets of competence, but too many potholes.

For anyone who cares about saving lives, the obvious place to start is pre-hospital care. Lagos has one of the better models: the Lagos State Ambulance Service (LASAMBUS); and related emergency agencies have, over the years built a credible pre-hospital response with ambulance points and trained crews.

Lagos authorities report high response rates in recent years, a sign that when political will and funding align, outcomes improve. I am giving an example of Lagos because that is what I know. But Lagos is the exception, not the rule.

On paper, the Federal Road Safety Corps (FRSC) runs an Emergency Ambulance Service Scheme (EASS, or “Zebra”) designed to place ambulances along major highways and respond to crashes via the toll-free 122 number. There are also private providers and ad hoc inter-hospital services in Abuja, Port Harcourt and other cities, yet the map of actual, reliable coverage looks patchy: ambulances concentrated around cities, private providers who can be prohibitively expensive and rural highways where a victim’s fate depends on luck, the goodwill of passersby or the nearest commercial driver.

Truth is: you and I both know that this service does not exist. And if it does, it is functioning at less than 10 per cent capacity.

As a clinician who has worked in Nigerian hospitals and on public-health programmes, let me be blunt: the “golden hour” is a phrase; it is not magic. If an airway is compromised, or if bleeding is not controlled, or if a fractured pelvis is left to bleed on the roadside, the first 60 minutes determine life or death.

Ambulances are not just vans; they are mobile extensions of emergency medicine equipped, stocked and staffed by trained paramedics who know how to stabilise, triage and transfer. Where we lack that, whether because ambulances are not available or parked because they are not working, or lack of fuel, or because personnel are untrained, or because the public hotline is unheard of, the outcome is predictable – death.

In Nigeria, the golden hour is something we read in medical textbooks, ‘a myth’ or misnomer at best.

Which bloody golden hour when the nearest ambulance is hours away and you have to find the driver first, negotiate price and then find an accompanying HCW willing to travel to the site of the accident? Sometimes the ambulance arrives only to realise that there is no mobile oxygen concentrator in the vehicle or no IV fluids (Ah! We forgot to replace it!).

Calm down Fatima. Remember, this is a new year, and you promised to calm and forward thinking. *Taking a deep breath*

What lessons should we take from the Joshua crash? First, Nigeria needs to invest in pre-hospital systems as essential health infrastructure, not as charity. Lagos shows it can be done: political leadership, sustained funding and data-driven deployment moved ambulances where they were needed. Replicate that model along the Lagos–Ibadan corridor, the Benin–Asaba route and other high-risk roads. The FRSC’s Zebra scheme exists; it needs expansion, accountability and regular audits to ensure ambulances are truly available.

Second, professionalise the workforce. Training paramedics, emergency medical technicians and dispatch operators must be a national priority. Too many “ambulance” crews are volunteers with good intentions but limited skills. We must create accredited training pipelines and career paths so that emergency medical services are respected professions – not stopgaps.

Third, integrate public and private capacity. Nigeria’s private ambulance providers fill gaps but charge fees many cannot afford. A few days ago, a patient with suspected pulmonary embolism in Kano was transported to a cardiac centre in Lagos via an air ambulance. Cost? N65 million. Poor man for don tey for grave.

Contracts regulated public-private partnerships and emergency vouchers could ensure that a trauma victim’s ability to pay is not what determines access to life-saving care. A toll-free, well-publicised emergency number that routes calls intelligently supported by GPS and dispatch systems should be non-negotiable.

Fourth, strengthen hospitals that receive trauma. An ambulance that delivers an unstable patient to an under-resourced facility still leaves that patient at risk. We need designated trauma centres on major corridors, stocked with blood banks, operating theatres and staff ready for mass casualties. Centralised data on ambulance-to-hospital handovers will reveal where investments are most needed.

Finally, tackle the upstream causes: speed, poor vehicle maintenance and roadside hazards. Enforcement matters, so do safe road designs, shoulders, breakdown bays, barriers and lighting.

The FRSC’s message around speed is correct, but blaming victims or drivers alone without fixing road environments and response capacity is a half-measure. Also, collecting bribes on the road is not the entire mandate of the FRSC (just saying). Let the organisations do their work.

To those who point fingers at “de-marketing” or rush to defend the country’s honour: reform is not denial. Criticism spurs change. If an international headline states that a country failed and that claim has some basis in observed reality, our duty is to fix that failing, not to silence the critique.

Anthony Joshua’s survival is gratitude and relief for his family and fans. The two lives that were lost are the reminder that every crash is an audit of our health system. We can be better. We must be better. No matter how much money you have, I assure you that it will not help you during that golden hour. When your ribs are fractured and you are bleeding and breathless, how do you transfer money for ambulance?

If not for anything, let us do it for our selfish reasons.

Happy New year everyone!

PS: As 2026 has been christened the ‘year of taxation’, we pray that God gives us the heart and might to survive this daylight robbery and for the ‘revenue generated’ to be used for the good of the Nigerian masses; ameen.