26 July-1 August 2013 #666

Road kill

Nepal’s most deadly epidemic is happening on its highways
Duncan Maru

FISHING OUT: Armymen try to pull out the bus that fell into the Madi River in Tanahu in July this year.
We were performing an ultrasound of a young boy with pericardial tuberculosis at Bayalpata Hospital in remote Achham district when we heard the jeeps pull up outside. The patients, bloodied and distressed started to pour in.

Soon, the district-level government hospital was filled with 20 patients. One had already died and our team got to work, suturing, casting, and giving fluids and banked blood. There were six fracture cases that were of such extent and complexity that we would refer them to Nepalganj Medical College, a 12-hour ride away.

Highway accidents have become an epidemic in Nepal and the roads of western Nepal are particularly dangerous. And as with nearly all diseases, the poor are the most vulnerable. In the 12 months ending April,more than 110 accidents have killed over 140 individuals in the far-west alone. Since then, a dozen more have died.

Furthermore, road traffic accidents ranked as the number one cause of disease burden among children between 5 and 14 years of age in Nepal. This is because pedestrians, passengers, and cyclists are most often the victims of road traffic accidents, rather than the drivers themselves.

Drunk driving is a major contributor, with most accidents taking place in the late afternoon and evening hours. Though fatal road traffic accidents are declining in the Kathmandu Valley due to the stricter drink-drive policies, it is still a problem in far-western Nepal. Nearly half of the drivers involved in accidents and brought to Manipal Teaching Hospital in Kohalpur showed evidence of alcohol consumption. In a separate hospital study of 870 traffic accident admissions, 17 per cent were found to be driving under the influence.

The Department of Roads and the Ministry of Physical Infrastructure and Transport have taken an active role to address traffic safety in the Public Roads Act (1975), Vehicle and Transportation Management Act (1993), Local Self-Governance Act (1999), and Roads Board Act (2002). Though Nepal is still greatly in need of enhancing core road policies, some progress is being made. In February the Department of Transport Management strengthened the written portion of the drivers’ licence examination in hopes of keeping unfit drivers off the roads. It also established a Vehicle Fitness Centre to repair and maintain public vehicles.

But the single most important initiative has been the no drinking and driving policy in 2011.A study has shown that the number of traffic accidents in 2012 decreased by 23 per cent compared to the previous year. In the far-west, a new system of time cards has been introduced to control speeding vehicles on the hilly roads of Doti, Achham, Bajura, Bajhang, Baitadi, and Dadeldhura after the devastating accident in Doti earlier this year.

More needs to be done, including:

• Restricting and regulating night buses

• Mandating seat belts on buses and controlling overcrowding

• Stricter legislation and enforcement of driving while intoxicated

• Increased funding for highway improvements

• Strengthening emergency response systems of hospitals through increased funding for training, emergency room supplies, and ambulance services

• Mandating proper and timely maintenance of private and public vehicles

• Stricter enforcement of driving licence rules

• Increased public campaigns on traffic safety

• Increased presence of traffic police on highways and local roads

• Setting and enforcing mandatory helmet use for cyclists, motorcyclists, and their passengers

There are economic costs to bus owners for many of these interventions and the costs of improvements to consumers—many of whom rely upon bus transportation for their own survival—could be substantial. The task of addressing the highway accident epidemic in Nepal is huge, but there is a real opportunity for saving lives with targeted policy interventions that are effectively implemented.

Duncan Maru, MD, PhD, is co-founder of Nyaya Health International. This paper was co-authored by Nirajan Khadka, Associate Director of Community Health with Nyaya Health Nepal, and Manaswi Sangruala.