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“There
ought to be a law that parents must die first.
When I
was lighting the funeral pyre of my son I thought, should it not
have been him lighting mine instead”
- A grief stricken father.
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“The
Hindu” an organization involved in providing information and
educating the people is indeed “living the values they espouse”.
Launching a year long safety campaign, the staff of the Hindu took a
pledge to wear helmets. Without such proactive measures head injuries
will continue to be a public health hazard. Unfortunately statistics
do not reflect the agony and misery faced by the individual family
when the breadwinner dies or is critically injured. It is also
forgotten that even a minor injury to the unprotected brain takes a serious
toll. For every death there are a hundred head injury victims working
at sub optimal efficiency.
Literature
worldwide, unequivocally states that additional protection to the
head with helmets, reduces the severity of any force, reaching the
brain. In industrialized countries death rates have decreased
by 18% due to use of helmets, seat belts, air bags, better
roads and speed limit control, while in developing countries the
death rate has increased by 13%. In India only 950
neurosurgeons are available to treat head injuries for 1150 million..
70% of head injuries are preventable as they occur due to negligence
and ignorance. 2600 crores (1% of the GDP of India) is the annual
loss due to road traffic accidents alone. With 11,000 new vehicles
being registered every day in India the two wheeler
population is growing 20 times more than the human population . A
head injury death occurs every four minutes making it the sixth
commonest cause of death. Millions of man-hours are also lost .
Reversing a very severe primary brain injury is
not possible, medically or surgically.
Use
of protective headgear is the simplest, quickest and most
effective method of reducing the number of severe head injuries.
Use of helmets, does not require funds or sophisticated technology.
Minor individual inconvenience, has to be sacrificed for the common
good. Freedom does not mean absolving responsibilities.
The reluctance to wear helmets is not because
there is any serious opposition to its use. It is
because of “this cannot happen to me” syndrome. A young
(71% of head trauma victims are motorcyclists in the age group of
20-39 years) healthy individual will never voluntarily accept
the fact that he/ she is at a risk for a serious head injury
and by the time this is realized, it is often too late It is
believed that use of helmets is not made compulsory due to
differences of opinion among the public. Ascertaining
public opinion speaks volumes for the statesmanship of the
authorities. Acting on them does not.
Even public opinion, depends on the design of the study, the size of
the sample etc. In one study 92% of non users said that they did not use helmets “ because
it is not compulsory ” 95% of the entire group were of the opinion
that making use of helmets compulsory was the simplest and best way
to ensure constant compliance.
Several
studies have shown that compliance is near perfect only when Big
Brother is watching all the time. Is it unreasonable for society
to expect that laws already enacted in public interest (Section 129
of the Motor Vehicles Act stipulates that all two wheeler users
shall wear protective head gear), will be enforced ?
In
1999 when the author was the Secretary of the Neurological
Society of India , the NSI impleaded itself as a co respondent in a
Public Interest Litigation filed in the high court of Madras (Special
Original Jurisdiction) In W. P. No.19587 OF 1999,
Though 7 years have passed the matter is still to come up for
hearing. One reads of courts suo moto taking cognizance of a
newspaper report – alas this does not seem to apply to writs dealing
with human lives. Many High Courts have ruled that use of helmets
should be compulsory. However some states including Tamilnadu believe
that compulsion should not be resorted to. 80% of the 9500 head
injuries treated by the author in Chennai during the last 30
years have been two-wheeler drivers or pillion riders. Only two deaths due to brain injuries
were encountered in the helmeted group compared, to the large number
of deaths amongst two wheeler drivers, with unprotected skulls.
A helmet bears the brunt of the impact
reducing the actual mechanical shearing forces reaching the
brain. The severity of brain damage is reduced. Irreversible brain
damage becomes potentially reversible. Severity of
head injury, death due to head injury, incidence of skull fracture,
occurrence of fits, duration of hospitalization and cost of treatment
is higher in the non helmeted group
Society is or should be
concerned whether a two-wheeler driver uses a helmet or not. In spite of large number of accidents, the chances of
sustaining a head injury is less than .01%. Naturally the desire to
use protective headgear is far less. How does one make a 2
wheeler user wear a helmet. Education ? , increasing
public awareness, ? Incentives ? Disincentives ? Compulsion ? Studies have
shown that when helmet use is voluntary, it is used by 40-50 %; when
it is compulsory it is almost 100 %; no other approach has
succeeded in raising helmet use to anything close to these levels. Public
laws are aimed at protecting human beings and society.
Can society exist without laws and enforcement.
Enforcement is one way to demonstrate that individuals are
cared and protected. (EEE) Education, Engineering
and Enforcement should be the strategy to reduce two-wheeler
deaths and injuries.
“Freedom and Democracy” is standing
in the way of enforcing an already existing law. The greatest
enemy of individual freedom is often the individual himself.
Individual inconvenience has to be sacrificed for the common good.
Freedom does not mean absolving responsibilities. No one objects to
the use of seat belts when a plane lands or takes off. This minor
inconvenience is accepted as a part of safety regulations. Any
parent, widow or children of a fatally head injured victim, the
insurance companies doling out crores of rupees, the medical
superintendents whose beds are always occupied with serious head
trauma, the disabled patient who is now a liability to
the family , the hundreds of survivors who are working at sub optimal
levels and the thousands with minor head trauma, responsible
for millions of man hours lost will testify to the consequences of a
head injury .
Not enforcing the law on the
grounds that individuals have a right not to wear a helmet is
taking a “forward”
step in a backward direction”. The pen is mightier than the scalpel.
With a signature, more lives in Tamil Nadu can be saved than even if
all the neurosurgeons in this state spend their entire life time
operating only on serious head injuries. Helicopter ambulances, state
of the art critical care head injury units and specially trained
neurosurgeons in every town can at best salvage a few more. An
ancient Talmudic saying goes thus “ He who saves one life says
the world entire” When a plane crashes once in two years, commissions
of enquiry .are set up. When a fatal head injury occurs every
four minutes and we have incontrovertible scientific evidence
that protection to the head would make an irreversible brain
injury reversible, the authorities are wary of even enforcing an
existing law. Making two wheeler
users wear helmets does not require funds or expertise. All that it
requires is a change in mind set.
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