KARACHI: Sixteen-year-old Rameez has been on a ventilator in an intensive care unit at the Jinnah Postgraduate Medical Centre’s neurosurgery ward for the past four days. The teenager along with his cousin was brought to hospital following a head-on collision of their motorbike with a car on the National Highway while they were on their way to Keenjhar Lake.

Both teenagers, who were riding the two-wheeler without helmets, received severe head and limb injuries in the accident.

“Sameer has regained consciousness after a brain surgery but doctors are not hopeful about Rameez’s condition. We are praying for a miracle,” said his uncle Fareed (names have been changed on the family’s request).

Once a bright schoolboy, Rameez is now ‘brain dead’, according to doctors who sought the family’s permission to turn off the ventilator but faced resistance.

“There is no sign in the body indicating that he would ever regain consciousness. Although we have made this clear to his family members, they insist that we continue to support him with the ventilator,” said head of the JPMC neurosurgery department Dr S. Raza Khairat.

The hospital, he said, was a public sector health facility with limited resources where patients received ventilator facility free of cost but it was not so in the private sector where patients had to bear medical expenses.

Last month there were 80 deaths at the neurosurgery ward. Of them, 65 were from severe brain injuries and 15 to 20 others from secondary complications. Most victims aged between 14 and 28 years.

In the ward, Rameez and his cousin are not the only ones who had common nature of accident. There are at least two more cases in which patients received injuries, including head injury, while riding a motorbike without crash helmets.

“Cases of injuries involving teenagers riding motorbikes have increased over the years. More than 70pc deaths at our ward are caused by preventable injuries, as motorcyclists can protect their head with the helmet,” Dr Khairat explained.

While the family of Rameez was still pinning hopes on the lost case, they could have prevented the accident by ensuring that he wear a helmet while riding motorbikes, he added.

Most of the head injury cases involving motorbikes are related to youngsters aged between 15 and 25, according to the head of the neurosurgery department.

12,056 accidents in six months

Within a period of six months, at least 12,056 road accidents have been reported at five hospitals namely the JPMC, Aga Khan University Hospital, Civil Hospital Karachi, Liaquat National Hospital and Abbasi Shaheed Hospital.

In these accidents, 528 people died, while there were 11,551 minor and 2,960 serious injuries reported from January to June 2014, according to the Road Traffic Injury Research and Prevention Centre which has been functioning at the JPMC.

Thirteen per cent people involved in the accidents were less than 15 years, while 36pc others were between 16 and 25 years.

“Rider/pillion rider group constitutes the highest number of road casualties, covering more than 63pc of the total casualty data followed by pedestrians (20pc).

“Only three per cent of people involved in motorbike accidents were wearing helmets. There were 234 fatal cases,” stated the data collected by the centre. (The data on helmet use was based on 9,382 casualty cases)

From the year 2007 to 2013, there has been an increase in road accidents involving rider/pillion rider. The number of fatal accidents involving motorbikes has also increased from 325 in 2007 to 551 in 2013, while 234 fatal cases have already been reported during the first half of the year.

Similarly, the ratio of fatal and serious cases has increased from 3,048 in 2007 to 4,242 in 2013.

“Fatal injuries often involve head injuries and 80 to 85pc of these injuries are related to youngsters who are not wearing helmets. Motorbike riders are the ones frequently found violating traffic signals that lead to accidents,” said Irfan Saleem Bhatti working as a road accident investigation officer at the centre.

Traffic police, however, denied that fatal road accidents especially those involving motorbikes had increased over the years. They said that in fact the cases had dropped.

“I don’t have relevant data with me right now but fatal cases have reduced. This has happened due to collaborative efforts including public awareness campaigns, correcting engineering faults on the roads and promoting use of helmets,” said SSP Traffic West Dr Qamar Rizvi, a spokesperson of the traffic police department.

Asked about the department’s sources of data collection, the officer said: “Our staff and the police department provide us with information. We don’t get the data directly from hospitals but that reaches us through the police from medico-legal officers at hospitals,” he explained.

Why protect the brain

“The brain is located in a closed, rigid cavity. Many parts of the brain are responsible for different functions and all human activities are controlled by the brain. Hence, it is important to protect the brain especially when someone is riding a motorbike,” said Dr Khairat.

Pre-hospital management and transportation, he said, was crucial in case of a brain injury. “The first hour is the golden hour, because proper patient management can save a life. If the patient’s airway gets blocked for any reason, for example vomiting or bleeding, the patient can die,” he pointed out.

In case of other injuries, he said, one usually got time to act but serious head injuries were often fatal. “You can’t wear a bullet-proof jacket to avoid a chest injury but you can wear a crash helmet to protect your brain,” he said.

Experts recommend the use of good quality helmets, as those made of poor material could break down in accidents causing injury to the brain. “People should buy fibreglass crash helmets that are a bit expensive but carry the warranty that they are unbreakable. They should also see that its strap is of good quality and can’t be easily broken. The third tip to buy a good quality helmet is to purchase it from a proper shop instead of a roadside stall,” said Tanveer Bukhari, a local manufacturer of helmets, who has been working with the centre to promote helmet use.

Rise in motorbike sales

According to media reports, the sale of motorcycles is on the rise in the city and over half a million motorcycles have been brought on roads over the past five years. “Since 2009, the excise and taxation department of Sindh has registered 1.342 million new motorbikes. More than half of them are meant for Karachi, as the rest were registered in other districts of the province,” a report stated.

With an increase in local production and subsequent drop in prices, two-wheelers, according to the report, have become a preferred mode of transport for people who have suffered the most amid the fast deteriorating public transport system.

“If this trend continues, there will only be chaos and congestion on roads and life will become more stressful and risky. Increasing environmental pollution and green house emissions are all linked to this issue. There are no two opinions that Karachi desperately needs a rapid transit system that might be linked to other modes of transport like the circular railway,” believed urban planner Farhan Anwar who heads Sustainable Initiatives.

Published in Dawn, September 7th, 2014