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Al-Ahram Weekly 1 - 7 July 1999 Issue No. 436 
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Published in Cairo by AL-AHRAM established in 1875 |
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Al-Ahram Weekly 1 - 7 July 1999 Issue No. 436
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| Published in Cairo by AL-AHRAM established in 1875 |
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Egypt Region International Economy Opinion Culture Profile Features Special Interview Travel Living Sports Time Out Chronicles People Cartoons Letters 
As the summer months loom ahead invitingly, droves of vacationers take to the open roads in search of sun and sea. Such excursions, however, can end in tragedy. A recent surge in highway fatalities has opened a Pandora's box of questions about rescue facilities and road planning. Are emergency centres adequate, or is prevention the best medicine? Gihan Shahine buckles up
On the last day of the feast, Nadia was driving back to Cairo with her husband and son after an enjoyable vacation in Hurghada. The morning sun gleamed on the narrow, winding highway, sandwiched between the sea on one side and high mountains on the other. The road is infamous for its "black spots" and hazardous curves.
Nadia was happily listening to music and chatting with her family about the trip when suddenly, around a sharp turn, a car came speeding towards them, then swerved into their lane and crashed into Nadia's car. The two cars were pulp. Nadia was seriously injured, while her son and husband faired a little better. The driver and passengers of the other car were killed instantly.
"Nadia and her family lay on the road unconscious," Nadia's sister Nahed Badr recounts sadly. "There was no telephone, emergency centre, ambulance or even a checkpoint anywhere. The nearest hospital was in Suez -- and that, of course, was not close enough."
'We should not wait until an accident happens and then blame destiny. Rather, we should develop a self-correcting system. We should start by studying all the black spots where accidents occur, as well as the reasons for those accidents, including driver mistakes and vehicle safety. It is only then that a comprehensive plan can be drafted to reduce fatalities.'
Milad Hanna
Fortunately, however, Nadia's son-in-law was in a car behind them and he immediately carried the family to the Suez Governorate General Hospital, where they received emergency aid. Nadia, who was bleeding profusely, received a transfusion. The doctor in charge quickly stitched up a deep cut on her face, but did not use surgical cosmetic procedures. Nadia's face was badly scarred.
"Nadia was saved at the eleventh hour, but the Suez hospital was not properly equipped to carry out serious operations," Badr explains. "My sister had to be rushed to Cairo, where better medical care could be provided. But the feast was not over, and there were hardly any doctors at the hospitals Nadia was taken to. My sister could have died. Finally, her son-in-law called a doctor, a relative of his who, with his colleagues, rushed to save her. She has been in and out of operating rooms since."
Nadia survived, but 17-year-old Ghada Afifi didn't. She was run over by a car on one of Hurghada's main roads and rushed to a hospital where "no medical care whatsoever was provided. She was left to bleed to death," her father told Al-Ahram Weekly. Her tragic death inspired her grieving father to build a hospital in 6 October City bearing his daughter's name.
Road accidents are the second most frequent cause of death in Third World countries. Recent statistics are alarming: in 1998, 23, 363 accidents took place on Egypt's roadways, claiming the lives of 5,000 people and injuring 22,000. Accidents also accounted for 23.5 per cent of all hospital fatalities, and 28 per cent of children deaths in hospitals. Accident specialists maintain that more than 50 per cent of casualties are in their mid-20s, and that one fifth of children between one and five years old who die in hospitals are the victims of accidents. Losses caused by traffic accidents are estimated at LE1 billion a year, including damaged vehicles, health care, hospital residency and lost working hours.
This year, a long spate of accidents killed more than 50 people and left hundreds injured. Many of these major accidents took place on Egypt's 7,000km of highway.
High accident mortality rates provide a sharp reminder of the urgent need for well-equipped emergency centres on Egypt's highways. "As opposed to developed countries, more people die in accidents in Egypt than are injured, which means that many deaths could have been prevented if proper rescue measures were provided;" remarks Dr Nabil Abdel-Meguid, a professor of surgery at Cairo University specialising in accident cases.
The first hour following an accident is crucial. "A life can be saved or lost, depending on the efficiency of medical care and rescue measures provided in that hour, and also on the way the first responders handle the wounded," Abdel-Meguid explains. "Any delay or deficiency in first aid measures can be fatal."
A study conducted at the Qasr Al-Aini hospital, however, shows that ambulances take an average of 45 minutes to reach an accident spot, unless the accident takes place right beside an emergency centre. Witnesses maintain that telephones are rarely available on highways and that, even when an emergency centre exists, nobody realises it, since signs are few and far between. People fear to carry the injured in their cars or even call the ambulance themselves because, under Egyptian law, witnesses may be made legally responsible for the accident. And, most often than not, emergency centres are poorly-equipped and desperately understaffed.
"More well-equipped emergency centres should be established at short intervals on highways," says Omar El-Ahmadi, dean of the Faculty of Pharmacy at Al-Azhar University. El-Ahmadi and his family once had an accident on the Cairo-Fayoum road. No emergency centre or telephone was available, but a passer-by volunteered to carry them to Giza Hospital, relatively far away. "The injuries were not serious but they could have become serious if left longer than that. No one can really feel how important rescue centres are unless one is lying helpless on the road," El-Ahmadi emphasises.
But should the government build more emergency centres or equip already existing ones? In 1995, the state launched an ambitious plan to build 60 fully-equipped emergency centres, akin to small hospitals, for every 100km of Egypt's highways. The plan was the brainchild of former Health Minister Dr Ali Abdel-Fattah. Only one of the hospitals was actually built (on the Ismailiya-Fayed road), and has not even been inaugurated yet. Apparently, the new ministry had different priorities.
"The project, if implemented, would have marked a fresh start in emergency services on highways," Abdel-Fattah told Al-Ahram Weekly. The plan, he added, was the result of extended investigations conducted by a committee of researchers from different fields, who studied every detail of the project, pinpointed "black spots" and defined locations for the new centres. All costs were to be covered by donations. "The project would have been especially beneficial in case of massive accidents in which the number of the injured would definitely go beyond the capability of any of the small emergency centres and ambulances currently available on highways. I still believe the government should consider resurrecting the plan," Abdel-Fattah maintains.
Many accident specialists, however, insist that Egypt does not need more new emergency centres, but rather more up-to-date concepts and better quality emergency services. In a recent article, the Weekly investigated Abdel-Fattah's four-year-old plan and showed how many critics at the time expressed their fear that the new centres would be destined to become as ill-equipped and deserted as the existing ones. Many experts also argued that it would be very impractical to allow professional doctors to leave their daily work in the cities and move to the desert "on the off chance an accident happens".
"Human resources should be our first priority", Abdel-Meguid insists. Many experts believe that the reason why many emergency centres are deserted is that doctors employed there take very low salaries and thus consider time spent at emergency clinics as wasted.
"Very few doctors are interested in the field," concurs Abdel-Meguid. "To encourage them, salaries and incentives should be earmarked for emergency doctors." But before that takes place, he quickly adds, there should be more focus on teaching emergency science in medical schools, making it an option for specialisation.
"Two emergency teams should receive continuous training to handle road accidents: one to extract the injured from the wreck and the other to provide medical assistance on the spot," Abdel-Meguid explains. An ambulance, he believes, should also work in communication with a "regulation centre," which would provide full data about all the hospitals in the area and the facilities available there.
Many experts agree on the importance of increasing public awareness of first-aid cases. "The first responder plays a crucial role in the life of the injured," says Dr Safwat Lutfi, professor of anaesthesiology at Cairo University and chairman of the Egyptian Society for Medical Ethics. "One mistake may lead to a life-long disability or to the death of the injured. During the '50s, we were taught first aid measures in schools. I think the Ministry of Education should adopt a similar programme."
Abdel-Meguid further suggests that two-day training workshops should be offered to the public. He also stresses the importance of encouraging voluntary efforts to upgrade emergency services, since "the government cannot do everything alone."
The government, however, has responded to the recent spate of accidents. Minister of Health Dr Ismail Sallam announced an ambitious plan to reduce accident fatalities and financial losses. The ministry has already updated 167 emergency centres on Egypt's highways, official sources say. A wireless network will be established to connect them with ambulances. Another 57 centres within Cairo have also been updated and provided with imported ambulances. The centres, which work around the clock, are staffed with three doctors each, according to official statements.
Three training programmes are currently being carried out in cooperation with foreign agencies to qualify doctors in emergency medicine. The ministry has also said it will make oxygen cylinders available for public rental and home delivery. Emergency helicopters will be soon provided in cooperation with the government of Norway to facilitate rescue measures, especially in isolated areas that ambulances cannot reach. The ministry is also studying the use of ambulance ferries to avoid rescue delays caused by traffic jams.
A regulation centre will be established in the Ministry of Health and furnished with a trained emergency team and a database including every hospital and emergency centre nationwide as well as a review of medical services available. In case of an emergency, ambulances can thus acquire immediate information about the most suitable hospital in the area. The centre will also coordinate a reserve of blood and medicine to be provided to hospitals for emergency cases.
Whether this ambitious plan will be doomed like its predecessors is a question yet to be answered. But at any rate, many believe prevention should take precedence over cure, and efforts should be directed to reducing accident rates by studying and tackling their reasons.
The study conducted at Qasr Al-Aini Hospital outlined four of the main reasons for road accidents: driving under the influence; speeding; faulty road planning, the absence of signs and poor lighting on highways; and the inadequacy of emergency services on highways.
Many officials admit that Egypt's highways are not up to international standards, despite government efforts to widen, pave and light highways, and despite a recent decision to ban large transport vehicles from travelling between nightfall and daybreak. "We should not wait until an accident happens and then blame destiny," says Milad Hanna, an expert in urban planning. "Rather, we should develop a self-correcting system. We should start by studying all the black spots where accidents occur, as well as the reasons for those accidents, including driver mistakes and vehicle safety. It is only then that a comprehensive plan can be drafted to reduce fatalities."
In a recent seminar on traffic problems, Ibrahim El-Demiri, vice-president of Ain Shams University and urban planning expert, conceded that "Egypt does not have highways in the proper sense of the word." A highway, El-Demiri explained, should not intersect with village roads, and should not feature crossing points for pedestrians or cattle. It should be situated outside the city. El-Demiri, like many other experts, believes the private sector should play a role. In the meantime, however, fastening your seat belt is all you can do.
Photos: Abdel-Aziz El-Nimr & Mohamed Mossaad
