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Do Riders In A Video Game Need Helmets? March 27, 2006

Posted by scan man in Life in India, Medicine.

Thanks to Abs* and Philip K. Dick** for inspiring the title of this post.Traffic in India

*Abs is a friend from the US who visited India for the first time a few months ago. When asked what she thought about the traffic on Indian roads, she exclaimed "Traffic!! What Traffic? Its like a Video Game!!"

**I may not have done a good job of titling my post in the style of the author Philip K. Dick ('Do Androids Dream of Electric Sheep?', the book on which the movie Blade Runner is based). I wish the subject was something as abstract as an android exploring the meaning of life.

As a radiologist who has worked for some years in a Tertiary Referral Hospital which specializes in Trauma Care, I have seen more than what I consider my share of head injuries caused by vehicular accidents [RTA-HI in our referral forms: Road Traffic Accident – Head Injury]. A large percentage of the victims who I scanned have been riders or passengers on motorized two-wheelers who might have escaped unhurt if they had worn helmets.

My 'share' would seem microscopic if compared with the number of RTA-HI's that occur in our country. Like anything else that deals with India and her multitudes, the numbers would be mind-boggling.

India has the second largest road network in the world with over 3 million km of roads of which 46% are paved. These roads carry an estimated 60% of freight and 80% of passengers and they make a vital contribution to India’s economy. The road traffic contains an incredible mix of pedestrians, animal drawn vehicles, bicycles, motorcycles, cars, buses and trucks. On the whole the facilities for the large number of non-motorised road users are poor and the 40 million vehicles using the roads have a terrible toll on human life, killing over 80,000 people with over one third of a million victims requiring hospital treatment. These crashes not only cause considerable suffering and hardship but they also have a major impact on the country’s economy, costing an estimated Rs 300 billion or more than 3% of India’s GDP every year. (source)

Today one person dies every 6 minutes on Indian roads; by 2020 the rate is expected to be more than 1 every 3 minutes. According to the India Injury Report 2005, Injury is the third cause of mortality in India. The financial cost of road traffic injuries in direct and indirect socio economic losses amounts to Rs. 55000 crore (550 billion) or 3% of GDP. Trauma victims occupy 10-30% of India’s hospital beds (WHO SEARO January 2001) and trauma care systems can be improved in many ways. (source)

Given the abysmal status of public health record-keeping in many parts of our country, I believe that the numbers may be even more than what has been stated above.4 on a scooter
Mandatory helmet usage for riders of motorized two-wheelers is included in the Indian Motor Vehicles Act of 1988. However, implementation of the law has been left to the states. Only a few states have even attempted to implement the law. 7 on a moped

As can be seen from the pictures alongside, the authorities cannot control the number of people that are allowed to ride on a two-wheeler designed to carry two people. Forget about getting them to wear helmets.

(I got these pics from here and here)

This disregard for personal safety is pervasive throughout the country without regard to factors such as literacy, socio-economic background, etc. As proof, I would have to present myself as Exhibit A.

I confess. My behaviour on the road is less than exemplary. In fact, I have no right to be writing this because I don't wear a helmet when I use my motorized scooter. In my defense I have to state that I use it only to travel between my house and the hospital which are less than a kilometer apart and I don't go beyond 30 km per hour.

I conducted an informal survey, the results of which are more telling. There are ten other doctors in my hospital who use motorized two-wheelers (mopeds, scooters or motor cycles) for short commutes between home and hospital. None of them – old or young, men or women – use helmets. There are about twenty others who come to work at our hospital on two-wheelers. None of them use helmets.

We are healthcare workers. Most of us care for patients with horrendous head injuries which probably would have been less severe if helmets had been used. We supposedly know the preventive value of helmets.

Medice, cura te ipsum! – Physician, heal thyself!

Here is the plain language summary of a scientific review titled 'Helmets for preventing injury in motorcycle riders'.


Helmets shown to reduce motorcyclist head injury and death.

Motorcyclists are at high risk in traffic crashes, particularly for head injury. A review of trials concluded that helmets reduce the risk of head injury by around 72%. The risk of death is also reduced, although it is not possible to estimate a percentage figure for this reduction from the available evidence. It is likely that the protective effect of the helmet may depend on other factors, such as speed. There is, so far, insufficient evidence to compare the effectiveness of different types of helmet. Some studies have suggested that helmets may protect against facial injury and that they have no effect on neck injury, but more research is required for a conclusive answer. The review supports the view that helmet use should be actively encouraged worldwide for rider safety.

Perhaps we Indians with our profound belief in fate and karma do not feel the need for such preventive measures.

And of course there are those who argue about the existence of traffic rules, Indian style, which are beyond the comprehension of people who adhere to the western concepts of traffic rules.


The rationale could be less complicated….

'If you believe you are in a video game, you don't need a helmet'.




1. Moof - March 27, 2006

Excellent post, Dr. Scan Man! Excellent … and mind boggling.

Some of your statistics make my mind go blank when I try to concieve the numbers you’re talking about.

In the States, the majority of our traffic, especially during the winter months, is of the 4-wheel vehicle variety … however, in the summer months, two-wheelers of all sorts take to the roads in droves. Most states have helmet laws, although there are still quite a few hold-outs. Personally, I’ve never been a fan of State-mandated protective gear – helmets, seat belts … etc. … but that’s another rant for another place and time.

Reading your post, however, has given me a whole new perspective. Also – your “Rules of the Road” has convinced me that were I to come to India, I would not be driving a vehicle! ;o)

More seriously, you said: “Perhaps we Indians with our profound belief in fate and karma do not feel the need for such preventive measures.” Are you saying that most Indians would believe that if they were in an accident, it was fate? That it would have happened no matter what? In view of your post, I’d be interested in hearing the answer to that.

Thanks for a really enlightening read!

2. scan man - March 27, 2006

Moof: Thanks for your kind words.
Perhaps I generalized a bit when I said most Indians. I do believe that most Hindus would attribute an accident to fate. However, I also believe that belief in fate, especially blaming fate for adverse or untoward occurences is a general Indian trait. More cultural than religious. This becomes more pronounced in the case of accidents – man-made or natural. The fact that a person involved in an RTA could have escaped serious head injury if only he had worn a helmet would also be interpreted as a quirk of fate.'Vidhi' (விதி – Fate in Tamil) is I think the commonest excuse + consolation that is offered in the event of an untimely death in my part of the world.

3. Moof - March 27, 2006

Thank you for the reply! Such a good reply, however, has made me think of even more questions!

If belief in “Vidhi” is more of a cultural trait than a religious one, what do you think made it become so? Were the original roots in religion?

Is there any obvious conflict between the general Indian view of fate and “self determination”?

Sorry for all of the questions, but this is very interesting.

What are your own concepts where fate is concerned, if you would be willing to share them?

4. Abs - March 27, 2006

‘existence of traffic rules, Indian style, which are beyond the comprehension of people who adhere to the western concepts of traffic rules.’

yes, i think that sums it up quite nicely…while Indian style is apropo today – it might have to change in the coming years due to the increased number of motorized vehicles on the road in conjuction with the ever present bullock carts and people. I see the roads as four lanes the first being the bullock carts, the second the motorcycles or mopeds (i always think of italians saying ‘ciao!’ on these modes of transportation), the third being enclosed motorized vehicles (buses, cars, hybrids of both), and the fourth lane as ‘neutral territory’ where both directions of traffic set to go forth and overtake….depending on what direction you are traveling in the third and fourth lanes are really simply one lane.

Anyway…I digress. Bottom line, helmets are highly functional…I actually think I should wear one on an everyday basis walking to and from class. It gets pretty hairy here in Cleveland which is nothing compared to the video games of Indian streets.

….Then again…the system seems to work and there is a method to the madness.

My favorite was on an excursion to Pondicherry where we witnessed…Two men and Two goats peacefully putting along on ONE moped.

The goats weren’t wearing helmets.

5. It's me, T.J. - March 28, 2006

I don’t know if it would be safer to be a pedestrian or a driver.

Maybe being an observer from a 2nd or 3rd story window would be best.

The traffic rules… oh my goodness.

I had visions of myself driving over there and getting flattened. As I get older, I see myself getting slower and less in a hurry to get where I am going. Do you have older people that still drive around like that?

If I ever were to visit India… I will need to think long and hard on how I would travel around.

Would it be horribly disrespectful if I rode one of your cows?

I have this strong drive called ‘self-preservation’.


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