DEATH is final, but for many who survive motorcycle crashes — most of them men in their twenties — the consequences are often a complex chain of interwoven challenges that leave them destitute and dependent on others for the rest of their lives.

A vivid picture of this reality was painted by experts at the recent Heads Up! Regional Think Tank organised by the JN Foundation, as they explored the consequential costs of the continued high volume of motorcycle crashes to health care, economies, families, and the victims themselves who never get to experience the best of their prime years because they were not wearing a helmet or protective gear.

The event, organised by the JN Foundation under the banner of the National Helmet Wearing Coalition which is a partnership with the FIA Foundation and the National Road Safety Council, was held at the AC Hotel in New Kingston and streamed via the JN Foundation’s
YouTube channel, where it is still available for viewing.

The injuries the thousands of victims of motorcycle crashes live with are varied and painful, according to Dr Rory Dixon — the chief medical officer at Sir John Golding Rehabilitation Centre in St Andrew, the only medical facility of its size and kind in Jamaica and in the English-speaking Caribbean.

The injuries or morbidities seen span spinal cord injuries to amputations of limbs. And, in the final analysis, only 10 per cent of those who survive and are rehabilitated return to earning an income.

“You’re looking at your typical male who is usually working, [he] has a motorcycle accident, and he is out of commission for a long period. You can just see the drain on the family and the community, in general,” said Dr Dixon.

The journey for most is a litany of agony, exacerbated by long periods of waiting and the development of other medical complications. Dr Dixon explained that often, it begins with a wait of about a week for transfer from a Type B or C hospital to a Type A facility for surgery. And from there, it takes them another one to three months to get into Sir John Golding Rehabilitation Centre.

“And that is because the bed space is very limited. Our capacity has not increased since 1954,” Dr Dixon said of the facility built to respond to the Jamaica’s first major outbreak of poliomyelitis. It is expected to receive some relief soon with the addition of a new wing that should house 30 more beds.

Then comes the conditions beyond their injuries. In just a few days in hospital, ulcerated bed sores are common, especially among those with spinal cord injuries. Dr Dixon revealed that in about 60 per cent of admissions, the young men develop bed sores, slowing their rehabilitation process, as wound care and possibly, plastic surgery, must be done. “Most persons with spinal cord injuries, they have no sensation. For us, we shift ourselves every so often when we sit, to take the pressure off our pressure areas, but persons with spinal cord injuries, the skin begins to break down within two hours of sustained pressure and, unless they are turned every two hours, which [is] standard, they end up with these massive ulcers which complicate their rehabilitation,” he explained.

These can extend the period of their hospital stay by up to a year.

Other complications such as contracture of the limbs and atrophy (wasting away) of the muscles due to their inactivity, pneumonia, urinary tract infections, and deep vein thrombosis (blood clots) can develop, too. Some even die before they can be rehabilitated.

“Rehabilitation is a multidisciplinary treatment. Persons have to be retrained how to take care of their bowel and bladder,” Dr Dixon explained, and assistive devices are as expensive as they are rare and difficult to tangibly access.

As commonplace and as low tech wheelchairs may seem, he pointed out that there is no system in place to present patients with one during the rehabilitation process.

As young men in their prime, the chronic debilitation they face can also be psychologically burdensome, as they are unable to earn and even obtain sexual gratification. They also participate in very little recreation, which can later contribute to the development of lifestyle diseases that further complicate and diminish their quality of life.

According to Dr Dixon, many are also eventually abandoned by family.

“So, there is a lot of support initially, and then after the person is admitted [and] they see the impact of what it is going to take long term, we find that the visits get less frequent, and after a while, when it’s almost time for the person to go back, we hear many things [such as] the caregiver has disappeared or migrated or they’ve lost the house because being the sole breadwinner, the [caregiver] was unable to pay the rent. So, this person [patient] ends up being in our care indefinitely,” he explained.

Meanwhile, the journey for survivors is even more complex when one considers that services, such as those offered by Sir John Golding Rehabilitation Centre, are not near areas where motorcycle crashes are concentrated, manager for public relations at the Jamaica Council for Persons with Disabilities (JCPD), Adrienne Pinnock, explained.

Most crashes and deaths occur in Westmoreland, where there is only a Type C hospital — the Savanna-la-Mar Public General Hospital.

“The western region of the island records a higher prevalence of accidents; however, the majority of social and rehabilitative services are concentrated in Kingston. The Jamaica Council for Persons with Disabilities also faces significant challenges in reaching individuals in rural areas. This limits the council’s capacity to effectively support the rehabilitation and reintegration of persons who have acquired disabilities,” she pointed out.

She noted, too, that without the access to supportive social care, severe psychological challenges can creep in, including depression, given not only the financial and social limitations the newly disabled young men face, but the social stigma attached to persons with disabilities.

“Despite public awareness efforts by the JCPD, stigma surrounding disability remains prevalent. As a result, individuals who acquire a disability and do not receive adequate support may face severe psychological challenges, including thoughts of suicide. These risks are heightened when rehabilitative services are either unavailable or not easily accessible at the critical point of disability onset,” she outlined.

Pinnock believes health and social services need to better share and use data to identify the need for services.

In the meantime, orthopaedic surgeon at St Ann’s Bay Hospital Dr Cary Fletcher said more than 80 per cent of crashes are preventable. In more than half of cases he’s seen, the young men were not wearing helmets or protective gear because they were only travelling “for a short distance”. In almost 100 per cent of cases where pillion passengers were involved, they wore none at all.

“This has been cited four times and authors in other countries have found the same thing, so I think this is one of the emphases to put in our public education messages. We need targeted messages. So, simply saying, ‘Helmets save lives,’ is not going to be sufficient,” he argued.

Training is also a necessity for motorcyclists, he added, pointing to his real-time studies done with victims who receive first respondent care at St Ann’s Bay Hospital, Dr Fletcher said only a quarter of riders had a licence and were insured.

“Those with a licence and insurance had a 57 per cent helmet compliance rate, which was almost double the overall helmet compliance rate of 29 per cent. This suggests that our helmet-wearing rates may improve if we get persons to acquire a licence and insurance,” he reasoned.

In 47 per cent of cases, the injuries he saw were due to collisions and 38 per cent of those were because of the young men losing control of the bikes they were riding due to speeding or errant overtaking.

“Had they been formally trained when you look at the [state] of the injury, most of them would not have crashed,” Dr Fletcher said.

Dr Cary Fletcher, orthopaedic surgeon, St Ann’s Bay Hospital, highlights data on the kinds of injuries suffered by motorcyclists during crashes as seen by the hospital, during a panel discussion exploring the social and economic impact of motorcycle crashes, at the recent Heads Up! Think Tank organised by the JN Foundation. The event was held at the AC Hotel in New Kingston. Listening is fellow panellist, Yelissa Mendoza Rodriguez, road safety traffic analyst at the National Institute of Traffic and Ground Safety Transportation in the Dominican Republic.