- © 2008 Canadian Medical Association
Forty-two years after United States marines first landed on its beaches, there are signs of increasing economic prosperity in Da Nang, Vietnam. Behind the rows of brightly coloured fishing boats stand advertisements for banks and electronics companies. Bamboo scaffolding surrounds the shells of new high-rise office towers on the banks of the Han River. Road traffic is increasingly motorized, with streams of motorcycles and their helmetless drivers weaving constantly on the streets.
Accompanying that road traffic, though, are an increasing number of deaths and injuries.
Among the physicians in Da Nang most acutely aware of the burdens associated with these injuries, including the social consequences and emotional impact on families, are neurosurgeons at the Da Nang Hospital, the city's 950-bed tertiary-level public hospital.
After spending a month working as a resident on the neurosurgical service, the magnitude of the problem of road traffic-related neurotrauma became clear to me as well. The neurosurgical unit at the hospital has 102 beds but typically twice as many patients, most with brain injuries related to road traffic incidents.
The victims were of all ages: a 4-month-old girl who fell off her mother's lap and onto the road when the motorcycle on which they were traveling was clipped by a taxi; a 26-year-old man who had consumed too much alcohol to celebrate a Vietnam victory in the Asian Cup and crashed his motorcycle while riding home; a 67-year-old man who was hit by a motorcycle as he was crossing the street.
It was common for 2 to 5 neurosurgical procedures to be performed daily for the evacuation of subdural or epidural hematomas, decompression of cerebral contusions or treatment of skull fractures related to road traffic incidents.
Space in the trauma operating rooms on the ground floor close to the emergency department was at a premium. I was actually surprised to hear a baby crying as we were evacuating an epidural hematoma and turned to see that another patient had been wheeled into the room on a stretcher to have a cesarean section performed.
It's projected that it will take 35 years before low-income countries like Vietnam see a decline in the incidence of road traffic fatalities to the level now seen in developed nations. That is too long to wait.
Footnotes
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CMAJ invites contributions to Dispatches from the medical front, in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. Submissions, which must run a maximum 400 words, should be forwarded to: wayne.kondro{at}cma.ca