DNA of a killer

Un­der­stand­ing road safety in In­dia

Down to Earth - - FRONT PAGE - Re­search in­puts: An­u­mita Roy­chowd­hury, Priyanka Chan­dola, Vivek Chat­topad­hyay, Ru­chita Bansal

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

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