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

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.