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Make Lanka a ‘Highway Code nation’
This is the concluding part of the inaugural address made by Professor A.H. Sheriffdeen FRCS, FRCSE as President of the Sri Lanka Medical Association last month on the spectre of motor accidents in Sri Lanka
Motor traffic injuries are predictable and can thus be prevented.
The WHO recommends a four-systems approach to be considered under speed control, good road design, traffic management and interventions in driver behaviour. Note the shift in emphasis of the onus of an accident from the driver to the authorities. Controlling driver-behaviour comes last on this list of priorities.

In our study just about every risk factor known to be responsible for motor traffic injuries was encountered. Excessive speed, alcohol, not wearing seat belts and helmets, using mobile phones while driving, fatigue, driver illness, young male drivers, poorly trained self-taught drivers, driving without valid licences, poorly maintained vehicles, unprotected vehicles, pedestrians not using pedestrian crossings, driving without lights after dusk and pedestrians wearing dark clothes after dusk.

Speed control
Most drivers, whatever the vehicle, enjoy driving at excessive speed. This is more so among 20 to 40-year-old males who in this study formed the largest group injured in the driver category. Whatever the disincentive, this category enjoys every form of high-risk behaviour.

The other group is the bus driver who has a mandate to earn the maximum in the shortest possible time. A little less than half the injured had been victims of a speeding bus, some even by swerving to avoid the speeding bus which probably drove away unscathed and probably oblivious to the fact that an accident and injury were caused by careless driving.

The solution that comes to most people's minds is high-tech speed detecting cameras and speed detecting guns. The evidence is that considering the investment, the return does not justify the expense.

Three solutions are suggested:
Buses and similar heavy vehicles should compulsorily be fitted with speed- limiting governors, which would necessarily limit their maximum speeds.

Limiting speeds to 40 km/h in urban areas and to 80 km/h on highways. Road signs at frequently placed intervals should be displayed on all roads. A remarkable phenomenon of Sri Lankan roads is the paucity of roadside signs indicating the speed limit. People would be surprised if they were to be told what the speed limit is on Magazine Road and Elvitigala Mawatha, by far the only highway that deserves to be called one in Sri Lanka. The local law enforcement officer must be given a mandate that it is entirely his responsibility to enforce this rule. Police patrol vehicles like distinctively coloured motorcycles are important disincentives for fast driving.

Engineers should be given the task of constructing "speed unfriendly" roads. eg. bumps, rumble strips and road narrowing when approaching major intersections. Barriers rather than double white lines should be used in the middle of the road to prevent overtaking at blind corners.

Driving licences
In the study conducted by our team 12% admitted to driving without valid licences, while 78% of the drivers had been self-taught. Driving should be considered a science. It cannot be learned by trial and error. It is an established fact that 90% of accidents occur due to human error. It must be made compulsory that all future applicants for driving licences should have followed a course at an authorized driving school. Apart from teaching the Highway Code, these schools should be provided with a manual containing the curriculum which would have a core of essentials for safe driving. It should include a section on the courtesies of safe and civilized driving. These would, as a few examples illustrate, help to develop a different culture of driving.

1. Slowing down at every pedestrian crossing whether there is a pedestrian on it or not and not tooting the horn and accelerating even when there is a pedestrian on the crossing.

2. Allowing a vehicle which is reversing into your path to do so and not tooting your horn and driving faster to beat him to it.

3. Slowing down and allowing a driver to cross your path rather than tooting the horn, speeding and staring menacingly at the driver. There are many more.
The evidence that higher fines and stronger punishments act as deterrents is not strong. Fines have been increased recently and we can await the outcome. Newspapers have carried stories that all efforts are being made to make it easier for fines to be paid.

We wonder whether the opposite should be tried i.e. to make the hassle of paying the fine itself a punishment. Moreover it was found in this study that only about half of the drivers or riders were familiar with the Highway Code. Offenders should be made to sit for the examination on the Highway Code that new applicants are required to sit.

Legislation should be enacted urgently to issue new driving licences with central computer records. As in Australia, UK and USA, a “points scheme" for different offences must be drawn up. Points will be accumulated for such offences and when they reach a certain value eg: 12 points, the licence would be suspended for a year.

These offences would include such dangerous driving practices like driving after alcohol, driving at excessive speed, driving through red lights etc. The focus is on "prevent accidents by punishing not punish after the accident".

Only two of the injured drivers in the study had been tested for alcohol. Here again prevention strategies are better than punishment after the event. It is a heartening sign to see police officers patrolling the roads late at night when drunken driving is commoner.

Seat belts are the greatest success story of injury prevention. Wearing seat belts minimises injury by 40 to 45%. In spite of this statistic only 4.7% in the study were wearing seat belts. It is time to make seat belts, from an optional status, to compulsory for both the driver and the front seat passenger.

Helmets worn by motorcycle riders and pillion riders reduce the risk of head injury by 20 to 45%. In our study 20%and 38% of these groups did not wear helmets. This obviously needs to be rectified.

The question of implementation of the law without fear or favour springs to most people's minds. Politicization of the bureaucracy including the Police Force would raise serious doubts in one's mind whether these plans can be implemented. This becomes a predicament when politicians with their back-up vehicles speed through roads without any consideration for the road-user. A recent news item highlighted how France's Minister of Justice was ticketed for speeding. If politicians need to get about in a hurry, special patrol cars should be sent in advance to create a lane without the present system of rude shouting and gesturing by officers in these back-up vehicles, at motorists using the road.

Driver fatigue and long hours of driving are further examples of the human factor in causing accidents, injuries and death. The frailty of human behaviour and perhaps vanity make most drivers deny that they are sleepy when driving although they probably are. Public awareness is essential. Drivers should be educated to take adequate rest before driving long distances. If one needs to drive in spite of this, our advice to drivers is to chew something; keeping chewing gum in the glove compartment should be encouraged.

Education
The importance of educating the public and potential drivers cannot be emphasised enough. However, education has to take place at various levels. The Highway Code should be taught at school level, in universities and to all categories in the government and private sector. We should be dubbed the "Highway Code nation".

In Australia there are mini-parks simulating roads and busy intersections where the culture of proper road behaviour is inculcated in young minds.

Pedestrians
The analysis of mortality rates for different categories of road users reveals that in 2002 and 2003, the largest of number of deaths was in the pedestrian group. Our study too shows that the largest category injured was pedestrians.

Adequate publicity should be given in all media on the real danger to the pedestrian. Fifty percent of those injured were after alcohol. One third were walking on the wrong side of the road i.e. with the flow of traffic. The majority wore dark clothes after dusk. The wearing of luminous arm-bands should be encouraged, more so for push cyclists and they should be made available freely at a reasonable price. Jay walking or walking outside the pedestrian crossing should be penalised. Pedestrians should be cautioned against standing on the middle of the road at night since visibility against the lights of oncoming cars is virtually nil.

A paradigm shift: Vision Zero
Education has shown to be effective with sustained advocacy. The Swedish model of Vision Zero (1997) recognizes the primacy of human well-being and human life, overriding one’s desire to get there quickly (mobility).
Safety: Minimise opportunities for error.
Change: Research and change provided by enforcers, co-operation by road users.
Ethics: Priority of human life and health over mobility.
Responsibility: Shared by providers and users.
I stood on this very stage on the occasion of the induction of the President of the College of Surgeons and spoke of the primacy of patient welfare being the first concept of the Physicians' Charter. Safety of the human Vs convenience and pleasure of the driver. This is a social responsibility that has to be ingrained in every driver's mindset before he gets behind the wheel of any type of vehicle. Respect for road rules, speed limits, pedestrian crossings etc will make roads safer for the human.

The responsibility for safety and for accidents has to be shared by providers and enforcers, not only users. An accident is a failure of the system. Humans are equated with errors -- from errors of judgment to errors of function. Every possible precaution should be taken to reduce or better eliminate the opportunity for errors. There should be a paradigm shift. The police officer in charge of a particular area should be entrusted with the responsibility of achieving the goal of a percentage reduction of accidents every month when compared to the figure recorded for that month the previous year. Incentives for achievers and reprimands for non-achievers should be worked out.

Scant regard is given in Sri Lanka to the role of the vehicle in the evolution of events that leads to an accident. Around 16.5% of the vehicles in which the injured were travelling in had serious defects and 14.8% of three-wheeler drivers had tampered with a safety mechanism in the handle lock that facilitated a smaller turning circle but increased the chances of the vehicle toppling over. Legislation has to be brought in for spot inspection of vehicles and for certification of road worthiness for older vehicles.

Preventive measures
There is in Sri Lanka, the Ceylon Association for the Prevention of Accidents and the National Road Safety Strategic Plan. They have outlined some of the issues I have also raised. These include: more traffic courts, independence of the Police Force, incentives for the traffic police, harsher punishments including suspension of driving licences including punishments to jay walkers, more devices to detect traffic offenders including Alcometers and elimination of alleged corruption in the Police Force.

Will it work? If implemented, yes.
Yet accidents happen and more accidents continue to happen. Newspaper headlines continue to scream out to the country the continuing carnage on our roads. The police are sceptical that this has any effect apart from just arousing curiosity and cursory interest.

Our study confirms what we already know. There are no startling revelations. Some would even say, "Here is a clear example of reinventing the wheel". However the study reveals one stark fact. That fact is that in spite of knowing the problem, in spite of doing what has already been done, the situation has not changed, the problem continues with all its terrible consequences. These consequences include the loss of 40,000 lives in the next 20 years and the lives of one million people affected, not to mention the enormous economic burden to the country.
As I mentioned earlier the effect of a tsunami on humans once every 20 years! We need to act now since the cost of this problem will add over Rs. 11.6 billion to our already strained economy.
Hence our recommendations include:

* Strong central control i.e. traffic police to be under the President or the Prime Minister.
* High status for traffic police.
* Empowerment of private sector and whole population. Participation in the exercise of safe driving and in helping authorities to enforce traffic rules.
* Institutionalized driver training and standard curriculum.
* Harsh punishment, legislation for driving licence disqualification on accumulated points.
* Highway Code re-testing for offenders.
* Developing a manual of core knowledge and courtesies of driving
* Discouraging motorcycles/three-wheelers
* Checking vehicle safety and roadworthiness.
* Legislation to revise speed limits.
* More speed limit signs displayed at frequent intervals.
* Re-location of pedestrian crossings away from bus halts.
* Encouraging luminous arm-bands for pedestrians and push cyclists.
* Each traffic policeman be given a mandate to reduce accidents in his area by a percentage each month compared to the number of accidents for that month in the previous year

If these recommendations are implemented, not only will there be a reduction in the number of accidents every year but the stage will be set for a different culture, of an orderly society. And no fear of the effect of a tsunami in 20 years from now!

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