Image: Motorcycle taxis
Pedro Rey  /  AFP - Getty Images file
Motor vehicle crashes — not terrorism, crime, infectious disease or plane travel — are the number one killer of healthy Americans abroad, according to the U.S. State Department.
By
msnbc.com contributor
updated 10/21/2010 12:36:52 PM ET 2010-10-21T16:36:52

Sujal Parikh, a medical student at the University of Michigan, was killed on Oct. 12 when a motor-bike taxi he was riding on as a passenger was hit from the back by a vehicle  in Kampala, Uganda. Parikh, who was doing HIV/AIDS clinical research, and his colleagues were on their way home to dinner. They tried repeatedly to hail a taxi, but were unsuccessful. As a last resort, they jumped on boda-bodas, or motorbike-taxis, said Jerry Abraham, a friend from boarding school in Texas, where both men grew up. Parikh owned a helmet, but did not have it with him. He died from traumatic brain injury.

“I know the road safety statistics, but you forget that every number represents a story of human tragedy. Losing a friend to a road injury is a terrible reminder of the sense of urgency we must have to make roads safe,” said Abraham, a medical student and injury epidemiologist. “It’s an epidemic that’s growing so much faster than we can keep up with.”

“Sujal was an advocate for global heath. That was his passion. He was really making a difference,” said Abraham, who shared the details of the loss of his friend to increase awareness. Sujal, he said “would want to make sure this doesn’t happen to others.”

Traveling on many of the world’s roads can be deadly. Motor vehicle crashes — not terrorism, crime, infectious disease or plane travel — are the number one killer of healthy Americans abroad, according to the U.S. State Department.

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A new report warns that global road crashes, the leading cause of tourist death and serious injury worldwide, will continue to rise exponentially over the next two decades. “A deadly cocktail of killer roads, unsafe vehicles, dangerous driving and disoriented or carefree tourists means many dream holidays of a lifetime instead become life-ending nightmares,” reads the introduction to "Bad Trips: International tourism and road deaths in the developing world," released last month.

Few travelers prepared
“People have accepted that vaccines are important. But we need to do the same thing about all aspects of road safety,” said Bella Dinh-Zarr, the North American director of Make Roads Safe, a global initiative, and director of road safety for the FIA Foundation for the Automobile and Society, a nonprofit group based in London. Both groups produced the report.

Vote: Do you drive when you travel overseas?

More than 90 percent of the world’s overall road crashes occur in low- to middle-income countries, such as Kenya and Mexico, according to the World Health Organization. As a result of rapid development in many of these countries, there are more vehicles, but the infrastructure often cannot keep pace. Roads and vehicles, which often have no seatbelts, are frequently poorly maintained, and laws, enforcement and driver’s training are often weak.

“There is very little oversight,” said Bruce McIndoe, president of iJET Intelligent Risk Systems, a travel risk management company. Licensure of buses and vans, for example, “is incredibly horrific in many countries.”

His company discourages clients from driving in some countries, even in Western countries if it involves driving on the opposite side of the street than is customary, or when clients may be tired after long flights. “Driving is a highly risky activity, yet it’s largely under the radar for most people,” McIndoe said. “Why take that risk? Why do you want to fool around with the one thing you can control?”

Tourists, even as pedestrians, are particularly vulnerable because they are often more carefree on vacation and do not do things often done automatically at home, like wearing helmets and seatbelts.

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“We shouldn’t stop traveling. But we need to do our homework, we need to be prepared,” said Dinh-Zarr. She and other experts suggest not taking taxis that do not have seatbelts and to only take buses from an established company, to travel during the day, and to avoid crowded buses and trains.  When renting a car “most people ask for the fastest route. We really should be asking for the safest route.”

The “Bad Trips” report, she said, found that the international tourism industry provides little advice to alert tourists to country-specific road safety problems. In addition, Make Roads Safe conducted a study on travel guides, in collaboration with the Centers for Disease Control and Prevention.

“Most travel books don’t address road safety, and that’s a missed opportunity,” said Ann Dellinger, team leader for motor vehicles injury prevention team at the CDC’s injury center, but stressed that comprehensive analysis has not been completed.

Related: Staying safe on the high seas

How can travelers protect themselves?
Americans are traveling increasingly to countries where the chances of being killed or seriously injured may be from 20 to 40 times greater than in the U.S., according to the Association for Safe International Road Travel (ASIRT). But many crashes can be avoided, said Rochelle Sobel, ASIRT’s founder, if people become familiar in advance about local roads, laws and customs, which vary greatly.

For example, in some countries, stop signs and speed limits are not regularly acknowledged, and in many countries, particularly in rural areas, night driving is discouraged because headlights are often turned off, as drivers erroneously believe it saves the batteries, said Sobel, whose son Aron died in a 1995  bus crash in Turkey with 21 others, two weeks before he was to graduate from medical school.

ASIRT developed Road Travel Reports that detail road conditions, dangerous highways to avoid, driver behavior and police enforcement for more than 150 countries.

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It’s something Elena Kiang wishes she had known about before relatives traveled to China in 2008, when three family members died in a highway crash, including her mother, her aunt, and a cousin’s husband. Her sister and a cousin were also very seriously injured. Kiang said she believes that the crash could have been prevented and her family alive today if there has been better road conditions, regulations and enforcement. “The government failed,” she said.

The U.S. Department of State has country specific traffic safety and road condition information, updated about twice a year and accessed through a pull-down list. “We do everything we can to make it user friendly and specific,” said Andy Miller, a division chief at the Office of American Citizens Services. In the Republic of Korea, for example, motorcyclists sometimes drive on the sidewalks, and drivers of all types of vehicles do not always yield to pedestrians in marked crosswalks. Also, left-hand turns are usually prohibited except where a green arrow indicates otherwise, he said.

Students, young adults at particular risk
The inherent danger to tourists, combined with the risk-taking and invincible nature of young adults and students, can be a lethal combination, said Gary Rhodes, director for the Center for Global Education at UCLA’s Graduate School of Education and Information Studies. “Students are often looking for some type of adventure, but winging it in international travel can be very problematic,” he said.

The number of Americans studying abroad has increased four-fold during the past two decades, with greater numbers going to high risk countries, according to Open Doors 2009, a report published by the Institute of International Education.

“The majority of students go and have a great experience. They see the world and learn about themselves,” Rhodes said. “But that ounce of prevention is even more important when traveling abroad, and even more when traveling to the developing world.”

Charles Schewe, a professor at the University of Massachusetts and co-founder of  Sara’s Wish Foundation, in honor of his daughter, who as a study abroad student, died in 1996 in a crash in India on a bus that did not have seatbelts. The foundation has invented a portable seatbelt designed for travelers to take on trips, which is in development. “We believe that had Sara had a seatbelt, she would have survived,” Schewe said.

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Vote: Do you drive when you travel overseas?