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Tracey Koehlmoos: Road traffic accidents in developing countries – farewell to the colonel

2 Sep, 11 | by BMJ Group

Tracey KoehlmoosOn 11 June 2011, 44 schoolboys died when the truck they were travelling in flipped into a canal in Chittagong, Bangladesh. The boys were from three villages and were riding in an open truck on their way back from a football competition. I was haunted by the image of the devastated village parents, who no doubt had joyously sent their sons to a day of sports competition.

On 13 August 2011, eminent film maker Tareq Masud, and Mishuk Munir, ATN news chief executive officer (CEO), died along with three friends in a car crash outside of Dhaka. The loss of such talent is keenly felt by all in Bangladesh.

On 27 August 2011, my husband, Colonel Randall L. Koehlmoos, US Army, died in a road traffic accident in Jakarta, Indonesia. The irony of a soldier who has served in every major war and peace action for the past three decades meeting his demise on the streets of Jakarta is not wasted on me, even now in the depths of my grief. It highlights that we are all at risk and that this issue must be addressed before more lives are lost and more families suffer.

Although I write frequently about the boys, I have safeguarded my husband’s privacy with the exception of discussing our commitment to physical activity and the occasional détente over my refusal to provide a salt shaker on the table during family meals. I will tell you now that he was a consummate soldier-statesman who felt passionately about South and South East Asia: the issues, the languages, the culture, and the people.

In December 2010, I wrote about the scourge of road traffic accidents in developing countries. At that time I noted that it was predicted that by 2030, road traffic injuries will be the fifth leading cause of death globally. Already each year approximately 1.3 million people die due to road traffic accidents and an additional 20 to 50 million are injured or disabled in accidents. Despite being home to less than 50% of the world’s motor vehicles, low and middle income countries have 90% of the mortality burden for road traffic accidents.

There is no international organisation that looks at the complex issue of road traffic accidents at the same level as a UN agency like WHO, UNDP, UNESCO. Although road traffic accidents fall outside of the scope of health systems, road traffic injuries have an enormous impact on health systems, particularly in low income countries where systems of traffic law enforcement, urban planning, and justice may be less developed and where more of the population is vulnerable to these injuries because people are more likely to walk or ride in sub-standard vehicles (bicycles, rickshaws, motorcycles, three wheelers).

Reflecting on our 20 years together, I realise now that road traffic issues have always been a part of our daily lives. In Indonesia, we frequently witnessed men wearing helmets, women wearing helmets, and toddlers standing between them on the back of motorcycles weaving in and out of traffic.  Throughout the region we would see mothers carrying their babies in the back seat of a car, or toddlers jumping up and down on the front seat. One of our closest friends spent three months in a coma after a car wreck in Islamabad. Unique perhaps to Dhaka, Bangladesh, was the sheer population density combined with the speed and density of traffic. The beggars were ubiquitous and swarmed around the cars at every intersection often leading to injury or death.  In Nepal and elsewhere in the region my husband and I played the game of “How many people can you fit on a motorcycle?” The record was a family of eight and a goat witnessed in Pokhara.

In my original blog, I noted that the situation is grim, but certainly it is not hopeless. There are proven interventions that can lead to a reduction in the number of road traffic deaths and injuries. They include controlling traffic or reducing speed using speed bumps, introducing traffic circles or low-speed zones in urban areas, establishing and enforcing blood alcohol concentration limits, using helmets for both riders and passengers on motorcycles, using seatbelts, and infant seats and child booster seats. I will add now the issue of safe construction practices and good lighting on roads.

In the December 2010 blog, I ended by perhaps throwing my hands up, talking about competing priorities, and wondering what my role was in preventing traffic related injuries and deaths—and made a rather lame statement about telling the boys to use caution while crossing the street and always to wear their seatbelts. Clearly, I cannot abdicate responsibility any longer now that the colonel has died.

In the last two days I have learnt that 2011-20 will be the UN’s and WHO’s new decade of action for road safety. In the weeks ahead, when the fog caused by the colonel’s unexpected death starts to clear, I will figure out who these people and groups are—and how I can assist. Because even though my husband is dead I would like to look towards a global future in which other families will not lose their loved ones on the streets.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.

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  • Deborah Spillan

    Bravo! Tracey! You hit the nail right on the head! In the states it is a major problem as well!

  • Christine (Brenner) Bellin

    Well written Tracey! While it's been years since we've seen each other, and I never had the pleasure of meeting your husband, I'm still in awe at the suddeness of his passing.  I commend your strength, and know your boys can learn a great deal from it.  Stay strong my friend!

  • Sharlene5meisner

    Dear Tracey,
    Thank you for the eloquent expression and informative comments. In Cambodia we experience the same traffic about which you write. It is appalling to me to see babies on motorcycles. A teacher at our school just passed away from a motorcyle accident. Yes, he had his helmet on. It is alarming, and we all need to create more action to prevent this type of needless tragedy on our streets.
    Sharlene;)

  • http://e3intelligence.com/home/?p=131 Dr Suparna Das

    Dear Tracey

    My condolences on your bereavement. It takes a very strong person to write so eloquently about a subject that you clearly care about, especially when it has brought you such grief.

    Being a trauma doctor who was born and brought up in India but now lives in London, I too have been very seriously concerned about road safety in developing countries in recent years. I've had two near misses in my last couple of visits to India and despair about the lack of public education and road safety awareness in my native country. In 2009, India had the dubious distinction of being rated the global leader in road deaths by WHO. As per reports, 13 people die every hour on Indian roads – that equals a fatal jumbo jet crash every day! Yet no one takes any notice. You can read my blog post on it here http://e3intelligence.com/home

    I'm aware about 2011-20 being the UN/WHO decade for improving road safety. I would really like to help. When you get around to finding out who to contact, please can you let me know so that I too can join in the effort. You can email me at contact@suparnadas.com or contact me on Twitter @drsuparnadas:twitter

    Take care and thanks for a great post.

    Suparna

  • Bev

    Tracey, my husband and I extend our deepest sympathies to you and your sons for your loss.  You and I have never met; however, I am Karen's first cousin.  I was 7 years old when Randy was born, and I remember going to see him for the first time with my aunt Mary Ann, my sister, and a couple of my cousins.  I'm not sure why the memory remains with me as it does, but I'm thankful it for it.  God bless you and the boys.
    Bev

  • Anthony Papagiannis

    Dear Tracey,
    May I offer my sympathy for the passing of your husband, and my praise for your courage in voicing your concern about this global health problem at a time of personal grief and mourning. Only yesterday two young people lost their lives when they crashed their car on a tree at extreme speed after midnight in a main Athens avenue. It is a sad fact that safety is sorely neglected by drivers, who carry their toddlers unstrapped in the front passenger seat. All I can say is keep up the good work, and pray for sanity!

  • https://picasaweb.google.com/PAHO.research/InstituteForPeacePromotionAndInjuryViolencePrevention#5458151611344720850 Luis Gabriel Cuervo

    Two decades ago the local government of Bogota implemented a series of actions to reduce road traffic casualties. Sadly the evaluations were not released or published, yet they are worth of dissemination and testing elsewhere. One such novel approach was painting stars in the places where pedestrians became casualties of traffic. As a driver you felt compelled to slow down as you approached the areas with stars…and as a citizen, you felt compelled to demand action when conglomerates of stars were formed in areas that needed improvement of the infrastructure.
    The link illustrates how these stars looked like.
    https://picasaweb.google.com/P…  

    A good beginning is to change the name. Road traffic casualties are seldom accidents. In most cases they are the result of poor infrastructure or planning, carelessness or blatant recklessness.

    I salute Tracey's call to honor the Coronel calling for effective action.

  • http://www.rcgp.org.uk/default.aspx?page=841 Dr John Gillies

    Dear Tracey,
    My condolences on your great loss.I couldn't agree more with your blog.
    Working in rural Africa in the past and visiting over the past decade has made me aware that besides the risks of malaria, TB, HIV and all that goes with poverty, one of the greatest risk was the metalled road populated by drivers often high on alcohol or marijuana, hopelessly overloaded vehicles and complacent legislators and police.
    John

  • Gregg Hollomon

    Hi Tracy,

    I completely agree with your excellent comments and suggestions concerning road traffic and would like to offer you and your boys my deepest condolences for this tragedy. We will all miss Randy and it at times such as this that I wished I had gotten to be better acquainted as he seemed so passionate in acknowledging and understanding the issues of breaking the communication gap between the 'west and SE Asia. Our prayers go out to you and your family.

    Gregg Hollomon

  • Blueponyfarm

    My condolences ma'am. I am certain your husband was man of great integrity and honor, because no lesser man would deserve a lady such as you.

  • David Bishai

    Dear Tracey,

    My own journey into injury work began in personal tragedy too.  Someday soon I want to introduce you to my friend Rochel Sobel who runs Association for Safe International Road Travel.  The people in this field are very nice and there is plenty of systems level work to do.  We are all thinking of you.

    David

  • David Koehlmoos

    RIP dad, it is a shame he is gone. He will always be remembered as the great man he was.

  • Mari

    Tracey,  What  a well written, inspired article.  And to think you wrote it in the depths of your grief!  This is such a huge Public Health issue….Not only are the MVA deaths significant, but the morbidity that arises from sequelae from accidents as well.  Sometimes I think Nepal was better off when everyone had to walk every where and the only thing we had to worry about getting hit by…was a rickshaw…..Take care my friend,  Mari

  • David Koehlmoos

    I remember one time we were visiting the states during the holidays , it had rained so the roads in the countryside were slippery and we saw that some people had an accident, luckily there was an officer at the scene and no one was hurt. A down part in US motor safety is that people will always be against things, I saw on the news the a motorcyclist died protesting a helmet law.

  • Richard Smith

    I did have the privilege of meeting Randy several times, and he was very much the sort of person you'd want beside you in some sort of awful predicament.

    I have many memories of Randy, but two stick in my mind.

    Firstly, I was impressed with his deep love of South Asia. He spoke Urdu and loved the people, the places, the food. and the buzz of the continent. We met one time in Islamabad, and he was very unimpressed with the general understanding of Pakistan at all levels in the US.

    Secondly, he had a great, very dry sense of humour. One time he said to me: “Do you speak German?”
    “No,” I answered.
    “No need to thank us.” I must confess that it took me a while to get it. Perhaps the same goes for you.

  • Ihtisham

    Tracey, thank you for taking the time from your grieving and writing this article. I hope it finds wide dissemination and results in some concrete actions. Until there is some heavyweight attention to this matter, perhaps with associated carrots and sticks,  hapless third world passengers and drivers will continue to die. Our thoughts and prayers for you and your family.

  • Pwward

    I'm hesitant to point this out, considering your loss.  I don't think it's correct to describe bicycles, rickshaws and 3 wheelers as 'substandard vehicles'.  Most road deaths are caused by vehicles with 4 or more wheels weighing over a ton.  They are the source of the danger, not bicycles and the like.

    I hope as you explore this area in the future you come recognise what some have dubbed 'the arms race theory' of road safety.  The tendency of those in hoc with the car and lorry lobby to admonish more vulnerable road users for not adopting flimsy protective devices as mitigation against the monsters they build and market.  Also known as victim blaiming.

  • Skiwanuka

    Tracey and the boys, My heart goes out to you on your great loss. I cannot even begin to fathom the depths from which this article came. He was clearly a wonderful man and I am encouraged to note that he had a strong and wondeful woman by his side for 20 years! Be blessed. Be protected! Be comforted in your grief! Hugs (big clingy ones)

  • Merle Huerta

    I have no words that could adequately address the power behind your narrative. Perhaps from the well of your grief and pain, you will indeed effect change. So proud to know you, my friend.

  • Ulla Griffiths

    Dear Tracey,
    I’m terribly sorry to know about your loss. I’m thinking of you and your boys and wish you strenght in this difficult time and in the future. As others here, I commend you for being able to see above your own grief and debate about road safety. It is in no doubt one of the biggest public health problems we have and so much more need to be done. I recently went to a debate organised by Roadpeace http://www.roadpeace.org/ and I realised how todays traffic is imprisoning us all and also that it does not have to be that way. The roads can be changed if we have the will (and as always, the power!). All my thoughts, Ulla at LSTHM 

  • http://www.suparnadas.com Dr Suparna Das

    You are, indeed, correct in pointing out that trucks and SUVs kill more people than motorbikes/three-wheeler autorickshaws. Never heard of a bicycle or cycle rickshaw killing anyone but have heard of several cyclists being fatally run over instead. Those most at risk are pedestrians and small children. Ironically, Ratan Tata's inspiration for building the world's cheapest car in India – the Nano – came from a desire to protect low-income families who can only afford two-wheelers.

  • http://www.AmericanHighwayRoulette.com Dentongay

    Even in “developed” countries this is a big problem that gets little attention. In the U.S. we experienced more than 40,000 fatalities each year for the twenty years prior to 2009. It is the #1 cause of death for young people up to age 30. Nobody seems to believe that it can happen to them until it strikes someone in their circle of love. I've lost someone very close to me in an accident so I have an idea about how you feel. In order to try to make my friend's death meaningful, I've written about how we can reduce auto accidents and their consequences, but nobody wants to read it. I think many view accidents as caused by destiny or God but the fact is, auto accidents are caused by human behavior. I wish you success in your healing from the loss of your husband. Time will eventually make it easier. One thing that helped me was the realization that my friend, though no longer on this earth, was okay. My crying really was my own self pity surfacing. Still, I miss him 31 years later.

  • Reuma

    I am very sad hearing about your husband Colonel Randall L Koehlmoos who died in a road traffic accident in Jakarta .
    Dr Adiwirawan M Jakarta

  • Bev

    My husband and I attended your dad's “celebration of life” service in Nebraska yesterday.  There were a lot of people in attendance.  The service was very nice.  I learned so much about your dad, and what he had done during his military service.  I told your Grandpa Larry and Grandma Karen, “Randy's boys will be great men because of who their father was.”  Your Grandpa told me, “Randy and Tracy have done a great job raising their boys.”  Many people are praying for you and your family, David.

  • 17egourgonwong

    Hi David. I believe that he will always be remembered as a great man that he was. 
    From Erika.

  • Drmaryblack

    So sorry for your loss Tracey. Such a shock to lose your partner. To be able to write so coherently is a testament to you and to your marriage. I think the best partnerships leave us whole, so even in grief we wish to live as a tribute to what has been lost. At least I hope that is true.

  • Dawood Luqman, MAJ, US Army

    Mrs. Koehlmoos,  I am a South Asia FAO and had the occassion to meet your husband only once on a trip to the Embassy in Dhaka.  But I had heard of him long before that.  Everyone who knew him spoke well of him and the accolades are certainly fitting and well deserved.  I hope to follow in his footsteps and in the words of President Lincoln, continue to the great work he has thus far so nobally advanced.  I am truely sorry for your loss.

  • J. McAllister

    I knew Randy from our CENTCOM days in Multinational Logistics. I was greatly shocked and deeply saddened when I heard this news. Randy always seemed to pop back into CENTCOM for a visit when least expected. He was a professional Soldier with a great sense of duty and honor which he combined with a wonderful sense of humor. I am very sorry that I just now learned of this tragedy. 

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