DNA of a killer
Understanding road safety in India
Nearly 140,000 people in India died in road accidents last year. Several communicable diseases together do not take such a huge toll on human life. But the country does not see road safety as a health crisis, writes Kundan Pandey
KAILASH JHA, 46, a resident of Purnia in Bihar, has been immobile for almost six months now. In February, while returning home from a pilgrimage to Deoghar in Jharkhand, a truck hit the vehicle he was travelling in. When Jha regained consciousness two days later, he realised a spinal cord injury had left him bed-ridden.
The harrowing months since then have taken Jha to hospitals in Purnia, Patna, Siliguri and finally, Delhi. Doctors at Jai Prakash Narayan Apex Trauma Centre in New Delhi have placed a steel rod in his back. For more than 15 days, the trauma centre’s guest room has become the new home for Jha, his wife and two sons.
The family has already borrowed ` 4 lakh for the treatment and is set to fall into a debt trap. Jha’s younger son Roshan could not take his class XII board exams. Ashutosh, his elder son, had to drop out of his second year of graduation. “Doctors have left my father’s recovery upon god. I do not know how we will survive,” says Ashutosh.
In Patna, 74-year-old Bindeshwari Pandey, father of four daily wage workers in Delhi, lies in coma at the government-run Patna Medical College and Hospital (pmch). Pandey, resident of Pachgachia village in Bihar’s Motihari district, met with a road accident in July-end. His son Awadh has borrowed ` 70,000 from a moneylender to meet the medical expenses. “I have taken the money after mortgaging our farm land. I am not sure if I can repay,” he says with tears in his eyes.
The 16- katha (0.2-hectare) farm was a vital source of income for the family. “It was our lifeline. We took rice grown on this land to Delhi where prices are exorbitant,” he says. The accident threatens to snap the family’s ties with the village.The brothers have decided to shift Pandey to Delhi if he survives.
Recovery from road accidents often depends upon the survivor’s socioeconomic condition. K Venugopalan, professor of physics at Mohanlal Sukhadia University in Udaipur, has been wheelchair-bound after an accident at Nagarcoil, but he is luckier than Jha and Pandey.One of the four passengers of the ill-fated vehicle he was travelling in died while Venugopalan sustained multiple fractures. He spent two weeks in hospital. The bill came to a little over ` 4 lakh. “We luckily had a medical cover for ` 5 lakh.The bill was settled through insurance except non-medical expenses of about ` 20,000,” says his wife Lakshmi. Venugopalan, however, is not a typical road accident survivor in India.
TRAUMA ON THE ROAD
From Delhi to Patna to down south, hospitals are overflowing with road accident victims. Down To Earth (dte) found that deaths due to road accidents are much more than those caused by, say, communicable diseases.
The trauma centre of All India Institute of Medical Sciences (aiims) in Delhi, can handle only 15,000 cases a year. It received 60,000 patients in 2013. Data shows the number of patients has been rising by 10 per cent annually. Similarly, “In Nagpur, I have observed at least 10-15 per cent
rise in road accidents,” says Chirag Bhoj, head of the casualty department, Indira Gandhi Government Medical College and Hospital in Nagpur.On an average, the hospital gets 20 accident cases every 24 hours. Onefourth of them are serious.
According to National Crime Record Bureau (ncrb) figures, 137,432 people died in road accidents in 2013. This is about 40 per cent of the population of the Maldives. While communicable diseases (excluding hiv/aids) together killed 74,146 people, road accidents accounted for almost double that number (see ‘It’s a risky ride on the road’). The majority were two-wheeler riders and pedestrians. A total of 34,187 people were on two-wheelers which accounted for 24.9 per cent of the deaths. Similarly, 12,385 pedestrians lost their lives because of others’ mistakes. Besides the fatalities, 469,900 people sustained injuries in 443,001 road accidents reported in 2013.
According to an analysis by Delhi-based Centre for Science and Environment (cse), over the last two decades, while the total number of accidents and injuries show a small dip, fatalities have increased sharply.The proportion of fatal accidents in all road accidents has increased from 18 per cent in 2003 to 25 per cent in 2012.Road accident deaths account for more than one-third of total accidental deaths, including suicides and rail-related accidents.
Road injuries and deaths have seen a dramatic rise globally.The recent estimates of Global Burden of Disease (gbd) have changed the way health impacts of motorisation are understood by including deaths and illnesses from road accidents and air pollution within its ambit. gbd is an initiative involving the World Health Organization which tracks the number of productive years lost to diseases. Its report ranks road injuries as the world’s eighth leading
cause of death and the biggest killer of people between 15 and 24 years of age. If deaths due to road injuries and vehicular air pollution are combined, they exceed the tally from hiv/aids, tuberculosis or malaria.
“In a middle-class family, chances of a child going to hospital due to road accident is much higher than due to any serious disease like cancer,” says Dinesh Mohan, professor emeritus, iit-Delhi.
Yet, road accidents hardly get the attention they deserve. They evoke some interest only when the annual ncrb data is released or when a high-profile person is the victim. Rural development minister Gopinanth Munde died in a road accident in Delhi on June 3 this year. The debates that the case generated have fizzled out. Even the members of Parliament seem to have forgotten their colleague’s death.
An analysis of parliamentary questions to the Ministry of Road Transport and Highways between December 2009 and July 2014 show that of the total 4,090 questions on roads and highways, only 325 were on accidents (see ‘House not bothered’ on p26).
There are no innovative insurance schemes for accident victims. “Across the globe, the insurance sector actively works to help victims deal with the cost of accident. Unfortunately, in India this sector is dormant,” says Rohit Baluja, director of Institute of Road Traffic Education, which works on road safety.
Worse, India substantially underreports road injuries, says Rajendra Prasad, senior consultant neurosurgeon at Indraprastha Apollo Hospitals and director of Indian Head Injury Foundation. “If someone suffers a road injury when drunk, he may not report it to the police, ”he says.
A recent World Bank report “Transport for Health” states that in India the number of road injury deaths is more than double the official data. In China, the actual figure is four times.
Baluja says road accident investigation by the police is often arbitrary and unscientific. As a result, remedial measures are arbitrary, too. An expert committee report on road safety by the Planning Commission indicates that the actual number of injuries could be 15 to 20 times the number of deaths.
The trauma centre at AIIMS, Delhi, has a capacity to handle 15,000 cases in a year. In 2013, it received 60,000 patients