Cover Story (Spotlight Weekly)

Rolling On Wheels Of Misfortune

With the enforcement of the double-helmet rule from January 1, 2003, the number of head injuries has drastically been reduced, but motorcycle accidents continue to increase. The two-wheelers, a popular mode of transport among the middle- and lower-middle-class population, virtually rule the valley's roads. Conscious of the motorcycle-induced traffic anarchy, policy makers are scrambling to come up with ways of reducing accidents and fatalities. Considering the growing popularity of motorcycles despite their high risks, can the government's efforts work?

By KESHAB POUDEL

Sajan Shrestha, 20, a resident of Kalanki, was killed in a motorcycle accident a year ago while riding on the pillion. Following a month-long treatment in coma, Shrestha was declared dead. Had Shrestha worn a helmet, he might have survived.

A street in Kathmandu : Safety first

Medics at Bir Hospital, the TU Teaching Hospital, other hospitals and nursing homes regularly treat patients with blood oozing from skulls. Moreover, they have to respond to panicked family members trailing into the emergency rooms. Being a government referral hospital and centrally located, Bir Hospital receives the largest number of such patients. Everyday one can see the emergency room filled with injured motorcycle riders and their
distressed relatives. In the night, too, doctors and nurses attend to scores of people with broken wrists, mangled legs and head injuries, incurred in road accidents.

Following the introduction of the double-helmet system two months ago, doctors are happy to see a decline in patients with head injuries. "In the last two months, we have admitted only four cases of head injuries sustained in motorcycle accidents," says a doctor at the National Neurosurgical Referral Center at the Bir Hospital.

In 2001/2002, 92 people were killed and 200 were seriously injured in more than 1,000 small, medium and fatal accident-related cases. Of the dead, more than 35 were motorcyclists. Five dozen people incurred injuries. Of these, more than 50 percent were motorcycle riders under 25 years. And 95 percent were not wearing helmets.

In 2001/2002, an estimated 80,000 people were treated for different injuries at the emergency department of Bir Hospital. A third were injured in motorcycle-related accidents. Approximately half of these motorcyclists were young. An estimated 50-100 people are treated each year in the valley's major hospitals for injuries sustained while driving or riding motorcycle.

Costs of Injury

The costs of injury are always high. Head injuries entail long-term treatment with complications in rehabilitation. Survivors lose fitness and often have to depend on others.

Although no study has been done yet on the costs of injuries associated with motorcycle-related head injuries, they are estimated to exceed millions of rupees. "The management of injury is very expensive. Statistics show that males are more vulnerable and make up most of the victims. The more productive groups of people are more vulnerable," says senior surgeon and former director of Bir Hospital Dr. Ram Prasad Shrestha. (See box) "The victims of injury are deprived of income. Since treatment is expensive and time consuming, many victims from lower class families have to suffer. Disability damages overall earning capabilities."

Ever since motorcycles arrived on the roads of Kathmandu five decades ago, countless people have died after sustaining serious head injuries. Thanks to the initiative of Minister of Health Dr. Upendra Devkota, a renowned neuro-surgeon who has witnessed the bitter experiences of helpless patients, the government announced the double-helmet system for motorcycle riders from January 1.

The move was long overdue in a city where road accidents have surged. "The number of accidents and fatalities is high in Kathmandu valley. More than 2,000 minor and major accidents are recorded in the valley, with about 100 deaths and another 200 injuries," says Sunil Poudyal, an engineer at the Traffic Engineering and Safety Unit of the Department of Roads. (See box) "Our records show that the accidents occur at night and in places like intersections. Since very few vehicles are on the roads during those hours,
the speed goes up. The higher the speed, the higher the number of accidents."

Mandatory Helmet System

Motorcycle is one of the most accident-prone modes of transport. With the liberalization of the economy, Kathmandu valley has seen a surge in the number of motorcycles as well as accidents. Recognizing the safety role of helmets, the government several years ago made it mandatory for motorcycle drivers to wear them. However, it made them mandatory for pillion riders only two months ago.

Officials say the move has worked. "After the implementation of the double-helmet system, we have not recorded any death from head injuries. One motorcycle driver was killed when a truck hit him from behind. The good news is that many lives have been saved after the implementation of the rule," says Senior Superintendent of Police (SSP) Surendra Bahadur Pal, who heads the Valley Traffic Police Office.

Others argue that the double-helmet system alone cannot reduce accidents as long as traditional traffic norms continue. The problem in Kathmandu, they say, is the number of accidents. The new rule may reduce head injuries, but they would not be able to reduce accidents.

The experience of other countries and two-month experiment in Kathmandu valley have shown that in the event of a crash, wearing a helmet significantly reduces the risk of serious injuries to the head, and upper and mid face. Despite the strict regulations, some youngsters still prefer to drive without wearing a helmet.

According to a study by the Traffic Engineering and Safety Unit of the Department of Roads, motorcycles are one of the most accident-prone modes of transport. It is unsafe in terms of the number of accidents recorded. According to the study, motorcycles were involved in 66 percent of the total number of accidents and accounted for 38 percent of the fatalities.

The records of Bir Hospital and Tribhuvan University Teaching Hospital confirm this trend. Although almost all hospitals and nursing homes in the valley admit patients sustaining injuries in motorcycle accidents, Bir Hospital has the highest intake.

"We received 67,000 emergency cases last year. Of them, more than 40 percent were victims of accidents," says Dr. Saroj Krishna Shrestha, a senior orthopedic specialist. "Although Bir Hospital has a trauma department, it needs more specialized manpower."

Studies show that victims of motorcycle accidents are mostly aged between 18 and 26 years. Most are admitted in the emergency room for head injuries. The number of such patients, however, has declined. "In the last two months, we received just two patients," said a medical doctor working in the National Neuro-Surgical Department.

Till a decade ago, head injuries were not a visible and common problem in the valley. With the increase in the number of motorcycles, head injury is emerging as a major public health problem. It occurs most commonly in teenagers and young adults who would otherwise have been productive members of society.

"Nepal, too, sees a large number of deaths each year. Within South Asia, some 1.5 million deaths occur each year. There are various kinds of injuries. Road accidents are the basic cause of injuries in developed and developing countries. A large proportion of injuries, disabilities and deaths are caused by road accidents," says Dr. Shrestha, who is formulating a national injury safety strategy. "In countries like Nepal, pedestrians are the primary vulnerable victims of road accidents. In developed countries, vehicle users form the vulnerable group. In Nepal, the majority of the victims are not vehicle users," he says.

"Contingents of non-affluent and deprived people are vulnerable. In the present situation, the leading cause of injury is conflict. Whether inter-personal, inter-community, inter-group or political, we see thousands of people injured in conflicts each year."

Although it has become mandatory for riders to wear helmets, a small number of youths still violate the rule. "I don't want to wear this 'rice cooker' while traveling in the back - it's too much of a hassle," says a rider. With the capital's roads clogged and traffic rule violations growing, road accidents are expected to rise this year.

The cost of health care and other accident-related damage is mounting, as the government is yet to analyze the accumulated costs. The emergency services are packed with accident victims. There are few specialists available to treat the patient with trauma. This is a huge crisis that shows signs of growing.

Motorcycle Culture

Despite all the risks, people still choose motorcycles as the most popular means of transport. According to Department of Transport Management records, about 20,000 new motorcycles were added to the valley last year.

For many people, riding motorcycles is a compulsion. In a city where the public transport is unmanageable and overcrowded and cabs are unaffordable, motorcycle is a cheap and dependable mode of transport. "I cannot imagine life without motorcycles. The public transport takes an hour to cross less than six kilometers. If I had a dependable and manageable public transport system, I would not have needed to invest big money in a motorcycle," says Gajendra Mani Acharya, an avid rider from Bhaktapur.

"It is a status symbol in metropolitan society. This is also a fast changing pattern of urbanized culture," says Professor Rishikeshab Raj Regmi, department head of the Central Department of Sociology and Anthropology. "The use of motorcycles also helps individuals to work in two or three places."

For individuals like Acharya, the motorcycle helps to increase mobility and enhances efficiency. "A decade ago, I used to have dalbhat at 8 in the morning to reach my office at 10 am. Now I don't have to waste time."

The ascendancy of the motorcycle culture is the price of modernization, as newly-moneyed citizenry moves up to motorized transportation. But there's a strange twist to this familiar developing country's saga, as the policy makers are talking about the need to impose restrictions rather than improving public transport.

There is good news for officials and traffic police. Imports of motorcycles are gradually declining. Two years ago, the country imported about 3,000 motorcycles, which declined during the same period last year to 1,800. Motorcycle dealers expect that demand will further shrink to half.

Nothing symbolizes the country's massive economic and social shifts of the last decade better than the rise of two-wheeled vehicles. While cars remain a luxury, the number of motorcycles on the capital's road has soared from fewer than 30,000 in 1990 to nearly 175,000. Annual sales are estimated to top Rs.2 billion (US$ 200 million).

"The rise of the motorcycle culture is a new phenomenon of social change. Every society has to pass through various stages before moving to advanced stages," says a senior psychologist. "In the valley, the motorcycle symbolizes an element of status. Even urban people offer motorcycles as a gift to bride and groom."

Length of Roads and Number of Vehicles

According to the Department of Road, the three districts of Kathmandu valley have altogether 1,319 kilometers of roads. Kathmandu, Bhaktapur and Lalitpur have 804 km, 177 and 338 km respectively. Kathmandu district has 493 km of black-topped road. In Lalitpur, there are 139 km of earth road and 136 km of black-topped. The total road length in Bagmati zone is 2,503 km, of which 1,021 km is black-topped and 1,033 km earthen.

The average kilometer-per-day operation trend collected by Department of Roads shows that motorcycles occupy the top slot in Bagmati Zone. According to the statistics, average kilometers per day by motorcycle are 6,104,000 in Bagmati Zone, whereas the figure for buses is 134,511 kilometers. The car/jeep/van category secured the second position, with 2475,415 kilometers per day.

The Department of Transport Management registers about 70 motorcycles a day. In 1994, Kathmandu imported 8,653 motorcycles. That figure doubled in 1996, when the country imported 17,090 units. According to the department, it registered 38,522 motorcycles in fiscal year 2001/2002.

The numbers of motorcycle are several folds higher than other transports. According to available data, there are 170,000 motorcycles against 1,744 buses. Cars, jeeps and vans number more than 41,000. The valley has more than 200,000 vehicles of various modes.

In a two-lane street, one can see hundreds of motorcycles squeezing into various sides and corners, competing with four-wheelers and heavy transport.

Cause of Motorcycle Accidents

Most of the motorcycle accidents are avoidable and injuries and fatalities are preventable. Studies have shown that motorcyclists are responsible for most of the traffic-rule violations in valley. Simply following the traffic rules can prevent more than half of the motorcycle accidents.

The use of alcohol at the time of driving is the major reason for the accidents. More than 80 percent of motorcycle accidents are caused by overuse of alcohol. Although the law prohibits the use of alcohol while driving, there is rampant abuse. As Kathmandu valley has a large number of restaurants and pubs, most night drivers return under the influence of alcohol.

No one follows lane discipline and traffic signals. Motorcycle drivers overtake from every side of the roads. They do frequent U-turns. Most young drivers even do not hold the license and have no control over speed.

Even middle-aged people are seen carrying whole families on the motorcycle. Many people use it to fetch necessary things. Although the motorcycle is designed for two passengers, people carry up to four family members. As the tires of motorcycles are thin, there is always the possibility of accident in slips. There is a great risk of being hit by other vehicles from behind. Since motorcycles are based on two-wheels, it is technically more vulnerable. When riders are negligent, the rate of vulnerability goes up.

"Most of the accidents occur because of lack of knowledge about road handling. We must train the drivers in new driving schools with basic infrastructures and manpower. The road conditions are bad in the valley. Most of the roads are bumpy and there is no speed limit. It is up to the drivers to determine the speed. The average daytime vehicle speed of 20 km per hour goes up to 80 during the night when the traffic volume suddenly declines.

Technical Risk

Driving motorcycles is also technically and mechanically risky. Since there is no specific technical standard in the size and structures of the motorcycles, there is no system to reject the technically misfit motorcycles. Even the handle of motorcycles is not matched with the rectangle of the roads. There is also other defect in the motor bikes including in the chassis and other structures.

Although Transport Management Act 1992 clearly spells out the specific technical condition and structures of all kinds of vehicles, the Department of Transport Management does not have infrastructures to go through check.

A herd of bikers : Are they aware of road hazards ?

Many nations go through a motorcycle phase, but it's happened much faster in Nepal. Motorcycles now account for 70 percent of total vehicles in Kathmandu valley, the highest percentage in the region. The new mobility comes with a dark side. Only a half of the riders are perfect drivers. The valley's gravel and rough road network is jammed with children and teens riding at breakneck speed in heavy traffic. Adults use motorcycles as beasts of burden, dangerously overloading them with goods bound for local markets. Entire families go for rides, dad doing the driving, mom on the pillion seat holding a baby, while young daughter perches on the handlebars.

"We must fix load standard for the motorcycle and there must be speed limit. Now, you can see motorcyclists carrying everything from a rice bag to hume pipes and other materials in high speed," says Dr. Shrestha. "The time has come to strictly monitor misuse of motorcycles."

Unlike other parts of the world, the capital's current rate of motorcycle accidents and traffic congestion is still manageable, requiring some changes in the pattern of driving. When the double-helmet rule has reduced cases of head injuries, enforcement of speed limits and traffic rules and regulations will definitely make driving safer and more secure.

'Over 95 Percent Of Pillion Riders Are Wearing Helmets'

— SURENDRA BAHADUR PAL

Senior Superintendent of Police (SSP) SURENDRA BAHADUR PAL heads the Kathmandu Valley Traffic Police Office. SSP Pal, who has held the position for the last seven months, has introduced a set of rules and regulations aimed at reducing traffic accidents and casualties. Pal spoke to SPOTLIGHT on various aspects of traffic management. Excerpts:

Soon after taking charge of the traffic law enforcement office, you made it mandatory for pillion riders to wear helmets. What is the public response?

I have found a very positive response from a large segment of the public. Only a small number of people have opposed the decision. According to our records, more than 95 percent of pillion riders are wearing helmets. The remainder are also following the rules gradually. This is a good sign.

What impact have you seen in terms of casualty figures?

After the implementation of the double-helmet system, we have not recorded any death from head injuries. One motorcycle driver was killed when a truck hit him from behind. The good news is that many lives have been saved after the implementation of the rule.

On what basis are you making this claim?

If you go to Bir Hospital, TU Teaching Hospital and other hospitals, they can see their records. There is still negligence on the part of users, since they do not completely lock the helmet. We are launching an awareness program through FM radio stations on the importance of double helmets for traffic safety. We hope the situation will improve.

The increasing number of motorcycles seems to be creating more traffic-management problems. How do you look at this situation?

It is not possible to improve things through a single effort. We need coordination among concerned agencies. We are alerting the concerned authorities to the need to control the number of vehicles, including motorcycles. We are also demanding controls in terms of quality and quantity. If we do not take measures to control the number of vehicles, managing traffic in the valley will become more difficult.

How easier has it become to manage the traffic after the construction of traffic lights in almost a dozen intersections under Japanese cooperation?

It has helped us a lot, especially during rush hours. If we build lighting systems in other parts of the city, it will certainly smooth the traffic flow. There are 70 intersections where we immediately require traffic lights.

It is said there are flaws in the driving license distribution. Don't you think these are responsible for vehicle accidents?

Frankly speaking, we don't have proper driving schools. Most people learn to drive from their relatives or other drivers. They are not taught ways of handling vehicles and the roads. One should follow two procedures to issue the driving license: handling vehicles and maintaining road discipline. In the valley, most of the motorcycle drivers do not follow the lane discipline. Lane violation is one of the key reasons for motorcycle accidents. Drivers must have full knowledge about road and vehicles signs before they get the license. We don't have institutes that train drivers in that way.

On what basis does the government issue licenses?

The licenses are issued on the basis of vehicle handling, not road handling. We don't have adequate driving schools that can produce perfect drivers. There is no organization to teach the part of road handling.

How do you see the anarchy of motorcyclists on the road?

This is because of lack of knowledge about road handling. We want to see new driving schools with basic infrastructure and manpower to train drivers. We need to change the licensing system to make more reliable and efficient drivers.

'There Must Be A Limit On The Number Of Vehicles'

— SUNIL POUDYAL

SUNIL POUDYAL is an engineer at the Traffic Engineering and Safety Unit of the Department of Roads. Poudyal, who has been working in the unit for the last several years, spoke to SPOTLIGHT. Excerpts:

What is the ratio between motorcycles and other vehicles in the Kathmandu?

The number of motorcycles is far higher than other transports. According to our data, there are 170,000 motorbikes, against 1,744 buses. The numbers of cars, jeeps and vans are also increasing. There are more than 41,000 such vehicles in the valley.

How safe is motorcycle driving?

It is unsafe in terms of accidents. According to a study, motorcycles comprise 66 percent of total accidents and 38 percent of fatalities. This is a high figure.

What steps are you taking to reduce road accidents?

We have already taken a number of steps to minimize accidents. With the support from the Japanese government, we have improved 10 intersections of the valley.

Is the situation so bad because of technical or mechanical faults in the vehicles?

There are certain mechanical specifications, but we don't have a system to monitor compliance. Transport Management Act and Regulations have certain criteria, but they seem to be ignored while issuing permission to vehicles.

How to you see the state of road accidents?

The number of accidents and fatalities is high in Kathmandu valley. More than 2,000 minor and major accidents are recorded in the valley, with about 100 deaths and another 200 injuries. Our records show that the accidents occur at night and in places like intersections. Since very few vehicles are on the roads during those hours, the speed goes up. The higher the speed, the higher the number of accidents.

As an institution responsible for building infrastructures, what immediate steps do you suggest?

There must be limits on the number of vehicles and an increase the length of roads. The public transport system needs to be improved before restricting the import of vehicles. The three districts in the valley have almost 1,319 km of road. Of that, less than half is black topped.

How do you see the speed of vehicles?

Since most of the roads are narrow, there are always problems of congestion during rush hour when the average speed is between 25 and 35 kilometers per hour. The average speed varies from place to place.

How safe are two wheelers in the valley?

Motorcycles are very vulnerable in terms of mechanical structure, since they are open. In safety terms, motorcycle riders face a higher risk of injuries even without their fault. Motorcycles are responsible for most of the accidents in the valley, since they don't follow capacity measurements and other safety measures.

'We Are Poor In Terms Of Traffic Knowledge'

— Dr. RAM PRASAD SHRESTHA

President of Nepal Surgical Society Dr. RAM PRASAD SHRESTHA holds a senior position at the Ministry of Health. A former director of Bir Hospital, Dr. Shrestha, who has extensively studied injuries and casualties over the last several years, spoke to SPOTLIGHT on the subject. Excerpts:

How do you see the present state of injuries?

Injuries have already been identified as one of the leading causes of death and disability in the world. The situation is similar in Nepal. More than five million people die every year in the world due to injuries. Nepal, too, sees a large number of deaths. Within South Asia, some 1.5 million deaths occur each year. There are various kinds of injuries. Road accidents are the basic cause of injuries in developed and developing countries. A large proportion of injuries, disabilities and deaths are caused by road accidents. In countries like Nepal, pedestrians are the primarily vulnerable victims of road accidents. In developed countries, vehicle users form the vulnerable group. In Nepal, the majority of the victims are not vehicle users.

Who are the most vulnerable people?

Pedestrians, motorcyclists and bicyclists are the major victims of road accidents. Contingents of non-affluent and deprived people are vulnerable. In the present situation, the leading cause of injury is conflict. Whether inter-personal, inter-community, inter-group or political, we see thousands of people injured in conflicts each year.

What is the economic cost to the nation from such a high number of injuries?

The management of injury is very expensive. Statistics show males are more vulnerable and make up most of the victims. The more productive groups of people are more vulnerable. The victims of injury are deprived of income. Since treatment is expensive and time consuming, many victims from lower class families have to suffer. We need to adopt preventive measures along with treatment. The World Health Organization is taking the issue very seriously, highlighting injury prevention aspects. In our context, around 10 percent of deaths occur due to injury. The share of communicable diseases is decreasing because of preventive public health programs. But injuries are coming in bigger ways. Injuries are caused by modalities of transport, technology and industry. They are increasing tremendously. In Kathmandu valley, it is multi-fold. We have no option but to step up the prevention aspect. Disability damages overall earning capabilities.

What kind of prevention strategy is needed?

First of all, we need to prevent traffic accidents. According to a recent Bir Hospital study, more than 40 percent of motorcycle accidents are linked to alcohol consumption. If we make efforts to control alcohol consumption, we can reduce 40 percent of the accidents and injuries. We are not strictly following alcohol-testing requirements. Drivers who are drunk should be severely punished.

Are the increasing number motorcycles responsible for the rise in accidents?

In the last 10 years, the number of motorcycles has increased by several folds in the valley. The intersections are over-crowded. In some place, people having to wait long to cross the road. If we see the reckless driving of motorcycles, there is always a threat. There must be certain restrictions on importing motorcycles. Vehicles must be allowed in on the basis of the carrying capacity of the road. That is the prevention aspect. We must limit the number of vehicles. There must be certain rules to control driving as well as the number of vehicles. The recent decision of the government to make double helmets mandatory is right in terms of prevention. World literature has shown that wearing helmets reduces the possibility of head injuries by 60-70 percent. In motorcycles, more vulnerable are the pillion riders. The mandatory double-helmet system is a good step toward reducing injuries. We have also seen much criticism of the decision, but use of helmet definitely reduces the number of accidents and casualties. Full-size helmets are needed for both riders.

Do you have any acts on mandatory double-helmet system?

Although there was a provision in the act and regulations, nobody thought of implementing it. Thanks to initiative of the present health minister, Dr. Upendra Devkota, this provision has come into force. The provision for car seat-belts, too, existed, but was never implemented. It has to be applied vigorously. We don't have a clear-cut policy on injuries. Even the WHO mandates a national injury prevention policy. The Ministry of Health is seriously considering a draft document. All the line ministries will be involved in the framing of the document. We need policy-level documents for various sectors. We need a multi-ministry approach. It is a collaborative effort.

What will be the modalities for such a strategy?

The policy framework will be formed in multi-frame structural and multi-dimensional and multi-agency approach. This is has to be taken very seriously. In Thailand, they have a special institute for injury prevention. From the school level, everyone is taught about prevention matters. Their experience has shown that education reduces road accidents by 60 to70 percent. Road mapping is required to determine accident-prone areas. In Bangkok, these types of programs have reduced the rate of accidents. The programs include analyses of conditions and other aspects of the roads to decide what type of prevention aspects should be introduced. Road mapping should be introduced for prevention. The Japanese have supported the construction of lighting systems in key intersections.

How do you view traffic sense among the people?

Our traffic sense is very poor, as we don't know how to cross the road properly. I read somewhere that the Japanese are training Nepalese how to cross the roads. This shows how poor we are in terms of traffic knowledge. It seems the Japanese have far more difficulty in teaching Nepalese about crossing rules than in constructing the intersections. Education is essential. Our people are a happy-go-lucky type. We don't bother about how and where to cross the road. We are crossing the road from everywhere.