This is the way our drivers drive

Globally, road traffic injuries are the ninth leading cause of death. In 2002, nearly 1.2 million people died as a result of road traffic injuries. The vast majority of these deaths (90%) occur in low-income and middle-income countries. The direct economic costs of road crashes are estimated at US$ 65 billion - exceeding the total annual amount received by those countries in development assistance. Sri Lanka has a high and a rising rate of road traffic accidents (RTA).

South Asia is predicted to record the largest increase in road traffic deaths, with a sharp increase by 144%, from 2000 to 2020. The WHO global burden of disease (GBD) project, estimates that by 2020 road traffic injuries will become the second leading cause of disability adjusted life years lost in the developing countries and the third leading cause of death. Road traffic deaths will increase on average by over 80% in low-income and middle-income countries, whilst declining by almost 30% in high-income countries.

Are we, living in low-income countries to sit and watch until this happens? No, at least we can start by looking into what factors may be contributory and preventable. Our study conducted over a period of 6 months in 2005 was for the purpose of identifying the prevalence of some known risk factors like the use of alcohol, helmets, seat belts and possession of a valid driving licence in the Kandy Police administrative area. The study covered the entire 24 hours of the day and all seven days of the week. All subjects were interviewed by a single examiner with the assistance of the police.

Blood alcohol concentrations were measured with a digital breathalyzer. We interviewed 758 subjects i.e. 656 (87%) drivers and 102 (13%) riders, of whom 742 (98%) were males. Of the 758 studied, 42 (5.5%) failed the alcohol breathalyzer test. Of the 42, 16 exceeded the maximum legal limit of blood alcohol concentration (0.08g/dl). There were 56 (7.4%) subjects without a valid driving licence. Of them 15 (9.0%), 9 (8.8%), 20 (7.3%) and 12 (5.5%), were identified from three- wheelers, motor bikes, light vehicles, and heavy goods vehicles respectively. Of the drivers of heavy and light vehicles (489), four hundred and thirty five (89%) were not wearing seat belts. Of the 102 riders studied, there were 4 (3.9%) subjects without helmets. Of the 98, who were wearing helmets, 7 (7.1%) subjects did not apply the protecting lock.

It appears that 1/20th of drivers are drunk at the wheel irrespective of the time of the day, a serious problem that needs urgent attention. This number appears to have doubled since 1998, where a similar study in Kandy area showed 2.5% of road users were under the influence of alcohol. Regrettably, the Police are ill equipped to make any major impact, as they are not equipped to breathalyse drivers as often as they like. This is an area where the hands of police need strengthening to enforce law.

The use of helmets has been shown to reduce fatal and serious head injuries by between 20% and 45% and to be the most successful approach to prevent injury among motorized two-wheeler riders. In our study many subjects were using helmets, but 7.3 % of them did not fasten the protective lock appropriately. The helmet is an effective measure against traumatic brain injury and more public education is required to improve the situation. The mandatory helmet law, with police enforcement is a demonstrable effective measure against road injuries.

Having any driver at all without a valid driving licence is a grave crime in a busy city such as Kandy. Our study showed a staggering 7% of the subjects, i.e. 1/13th of our drivers on the roads were not competent to drive or ride. They possessed no valid driving licences. It is observed that over 70,000 vehicles enter the Kandy city daily and these estimates to over 4900 drivers entering the Kandy city without a valid driving licence. This is clearly a lack of responsibility by law enforcing authorities. Is it fair to pose such a risk to the pedestrians of the Kandy city?

The use of seat belts, a world- proven effective measure against traffic injury is the least complied of all factors we studied. Only 3 people out of 20 chose to wear seat belts even when they had a seat belt fitted to their seats. Should the tax payer of this country fund health care for such people when injured? Why cannot policy makers ensure that seat belts are compulsory in this country when our accident rates exceed well beyond ten times over that in the developed world?

Motorcycles and scooters dominate the roads in Asia and Africa and they share the road with bicycles, human powered vehicles, pedestrians, and animals. The high-income countries do not experience such a heterogeneous mix of road users and this is one factor that contributes to road safety. It is quite possible that we enforce some rules to improve the road mix, by allowing only certain vehicles on busy roads. But who shall take this responsibility? On today's busy roads, can motor vehicles, three-wheelers, cycles, pedestrians and bullock carts move in harmony on the same road with no accident risk?

Most vehicles used in Asia are not as sophisticated as in developed countries. There isn't yet a mechanism in this country to make sure that the vehicles on the roads are rated safe. For each person who dies on the road in this country today, 11 are injured and most recover with residual disability. In addition there is no system to identify and rectify the major sources of error or design weaknesses that contributes to fatal crashes. Yes, we do have high-ways. These will become 'burul' ways with rain and ultimately 'wala' ways. The end result is a 'no' way that cannot be used by anyone. Instead of addressing the problem more scientifically, it is quite common for the politicians and responsible officers alike to blame the individual drivers and victims. The exchange of words or blaming the public is not the answer to improve the road accident menace.

We have shown some risk factors for RTA in Kandy police area that are blatantly ignored. Without immediate action to minimize at least those risk factors, there would be no hope for us in this country to improve our risk of road injury. The first challenge is to change the mindset of the politicians and law enforcing authorities that injuries are not an inescapable part of living and they are indeed predictable and therefore totally preventable.