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Abstract
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We are all familiar with the organized chaos where there is enough order to achieve the goal in a complex situation. But what if those at the helm turn a blind eye toward affairs demanding urgent attention; it is a recipe for disaster in the making for posterity. Before 2004, the market volume for the two-wheelers in Pakistan was below 0.1 million annual units. Thanks to the government's open policy, new manufacturers with lower prices entered the market, giving a preferred solution for individual mobility. Effectively, purchasing a motorcycle and driving it on public roads has little to no legislative barriers enforced, and the market has achieved 2 million annual sales.[ 2 , 6 ]
Motor vehicle accident (MVA) is the leading cause of traumatic brain injury (TBI) worldwide.[ 2 ] This etiology has a unique feature; motorbikes are involved in most MVAs and are idiosyncratic demographically. In the Western world, motorcycle rights organizations are struggling to promote personal freedom over safety which, according to them, is a personal choice. Cultural, social, and economic factors heavily influence the type of vehicle driven and involved in the accident. In Western countries, motorcycles are mostly for recreational use, although it is one of the easiest ways of transportation. Motorbike usage in developing countries necessitated out of easy access. Southeast Asian countries have the highest use of motorbikes, with low- and low-middle-income countries accounting for nearly 85% of all road traffic deaths globally.[ 4 ] Pakistan, with its' population of 220 million, is the prototype of a developing country where motorbike use has exploded, and so has the magnitude of associated problems. It has led to a plethora of social and cultural changes in addition to the usual road safety concerns and the devastating issue of TBI. The transformation has its positives and negatives, although the overall influence has more downsides.[ 2 ]
In a tertiary national referral teaching hospital situated in Lahore, one of the densest cities in the world that caters to a nearly 22 million population, including the city itself and surrounding districts and villages, on average, we see approximately 1500 motorbike-associated MVA's annually in our Accident and Emergency (A&E) department referred to us for neurosurgical review. Of these, 340 (22.8%) are between the age of 10 and 20 and around 100-120 between 10 and 17 years (18 being the minimum age required to obtain a driver's license in Pakistan).[ 2 ] This number (1500) is, unfortunately, an underestimate and only one part of our department's annual TBI load due to several reasons. First, our department statistics are conservative as they do not account for those bike riders in A&E who were never referred for neurosurgical review. In addition, many secondary care and private hospitals receive a large number of head injury patients but do not have a neurosurgical department/cover to manage these patients appropriately. From an ongoing prospective study yet to be published, we investigated epidemiology, etiology, and reasons for underage motorbike driving, among other outcomes: secondary care hospitals account for approximately 25% and private hospitals for 15% of our TBI referrals where the victim was an underage motorbike driver. This figure also excluded all other etiology of TBI patients seen annually. Finally, the number of underage motorbike riders with mild and moderate TBI seen at the surrounding centers not referred to neurosurgery remains undocumented...
Language: en |