Hiding behind the mirage of development we see that Pakistan and Karachi, its biggest city, suffer a lot because of road traffic injuries. How often does it happen that we pick up a newspaper and don’t come across a headline that highlights the dangers of road traffic crashes? Will it be safe to say that a very low rate of investment in RTI’s (road traffic injuries) prevention accompanied by a high burden of RTI morbidity and mortality exists in Pakistan? Public efforts in RTI control are poorly-funded and hence this compares unfavorably with other conditions and with that of more developed nations where government efforts for traffic safety are well funded. Is it really deserving the low priority that it is getting?

Deaths from causes that were commonplace in the early 20th century – such as fatalities among workers in factories, mines, railroads and dockyards – are no longer accepted as inevitable today. Nowadays, many societies do not apply death penalty no matter how serious the crime is. A few years ago, about a hundred deaths caused by the spread of severe acute respiratory syndrome (Sars) mobilised international efforts to arrest the disease; and millions of demonstrators came out on the streets in many countries to protest against a war in their belief that nothing justifies the deaths of innocent individuals. So why is this attitude absent when it comes to road traffic? Recent estimates suggest that the RTIs result in one million fatalities worldwide every year. A vast majority of these deaths involve people who are less than 50 years old. Another 20 to 30 million people suffer injuries that need hospitalisation or expert medical treatment.

Given the current low level of investment, initial investments in transport safety, if chosen with care, could turn out to be extremely beneficial for public health and welfare. If cost effectiveness analyses of these interventions are able to document these high returns they could help to encourage widespread replication efforts. Evaluating the effectiveness of these initial investments in road safety in the developing countries should become a priority for the research community.

Let’s consider the following scenario:

According to the traffic engineering bureau, Karachi, between 1994 and 2000 one person was killed every 14 hours, one person injured every 11 hours and one pedestrian died every 25 hours in road accidents in Karachi. The same survey showed that one motorcycle was involved in accident every 41 hours, one motorcyclist was killed every 82 hours, one car was involved in accident every 37 hours, one minibus was involved in accident every 28 hours

What are our indigenous problems, besides not following traffic regulations? Let’s consider the obvious problems that are often ignored.

Non-homogeneity of traffic exists in Karachi and what is meant by that is, we have at least three or four different kinds of modes at the same time -- which is bicyclists, pedestrians -- two or three different kinds of non-motorised modes -- which is hand-pulled carts -- and within motorised modes we see more busses, trucks on urban streets than you see in the western world and three-wheeled scooter taxis, which you don’t have in the US at all. So, there’s a much wider mix of vehicles and people on the streets in India and Pakistan.

When a truck or a bus hits a pedestrian or bicyclist, and if the driver doesn’t run away from the scene of the accident, he gets lynched; and every second day a bus or a truck gets burnt because it has run over a pedestrian. If a child is hit by a bus or truck, it is set on fire by the crowd. This is ample evidence that the people do not take the existence of accidents as something acceptable. What people are saying by indulging in this violence on the streets is that it’s not acceptable. It’s not acceptable to have your kids killed on the street. The second evidence we have is that road bumps are coming all over the place, even on the intercity roads, so that if a child gets killed on an intercity highway -- and these are not limited access highways, these are open highways -- if a child gets killed on a highway in a village, the villagers go to the local politician, force the politician to get the engineer to get a road bump on the highway.

Roadside vendors have often been treated as illegal occupants of road space by the authorities. Traffic and transport planners too view their presence as unnecessary and an impediment to the efficient movement of pedestrians and motorised traffic. Every now and then, the city authorities launch a drive to evict or shift them to different locations. All these decisions are taken by officials who don’t use the services of these vendors. Given the heterogeneous structure of our society, the presence of roadside vendors is inevitable. Once we accept the fact that they provide legitimate services needed by road users, it is possible to design spaces for them on the road as an integral part of road development plans. Such designs can ensure efficient movement of vehicles and pedestrians without causing hardship to honest hardworking citizens – the vendors.

The rising cost of travelling by public transport within the city and long working hours force workers to live close to their workplaces. A violation of the law thus becomes a pre-condition for their survival. A large number of people living in these units are employed in the informal sector providing various services to the outer areas of the city. However, because of the lack of employment opportunities, people living in these areas have to commute long distances across the city in search of employment. Unlike the traffic in cities of high-income countries, bicycles, pedestrians and other non-motorised modes are present in significant numbers on the arterial roads and intercity highways. Their presence persists despite the fact that engineers designed these highway facilities for the uninterrupted flow of fast moving motorised vehicles.

How to solve these situations?

According to professors Dinesh Mohan and Geetum Tiwari, the traffic expert from IIT New Delhi, what needs to be understood is that some of the theoretical base of road traffic injury control counter measures may have international applicability, but many of the physical solutions may not. There is clearly a poverty of theory. For example, most road safety measures instituted in high-income countries have centred on automobile and automobile occupant. Road and intersection designs are largely based on cars, buses and truck movements. Motorcycles dominate the roads in less motorised countries like ours; human powered vehicles, pedestrian carrying loads and locally designed vehicles. No traffic flow models and computer programmes are able to account for this mix.

So whether you talk about costs or about safety, what is the consumer looking for? Now we have to think what kind of a mass transport system we can provide -- that is flexible and reliable.

A well functioning road infrastructure must satisfy the requirements of all road users.

Pedestrians, bicyclists and non-motorised rickshaws are the most critical elements in mixed traffic in Indian cities. It is this group of road users that needs the services of vendors the most. If infrastructure design does not meet their requirements then all modes of transport will operate in sub-optimal conditions. An efficient and safe road-traffic system must satisfy two design principles:

1) Arterial roads which have more than 30m right of way (ROW) must have physically segregated bicycle/non-motorised vehicle (NMV) paths, which cannot be used by motorised vehicles (especially motorised two-wheelers).

2) Average speeds on roads which have less than 30m ROW must be brought to 20-30kms/h with the help of traffic calming measures.

For the people who continuously park their car outside their homes, start owning 250sq-ft of government land, as they park outside on the street. This space is more than what the poor man occupies for “squatter settlements”. What is the cost of the 250sq-ft flat in the cheapest locality? Let’s say Rs2,000/month. Hence, every car owner who is using the street to park is getting a subsidy from the government.

Internal road safety audit and process:

1) Ensure that the safety director/officer has direct access to top management.

2) Designate one individual as the responsible person for safety authority for the system.

3) Identify the role of the safety director.

4) Include a mechanism for ensuring that all employees are accountable for safety.

5) Establish and review data bases to assist the continuous monitoring of the systems safety programme.

Pakistani women’s participation in the labour force continues to rise but instead of permanent, full-time employment they prefer to work at home or be self-employed in the informal sector. This growth of atypical forms of work reflects the flexible employment relations that is needed to allow enterprises to adjust or adapt to changing economic environments. Perhaps the “non standard” forms of work meets the needs of women workers. These women struggle against the many constraints and limitations imposed on them by society and the economy.

Dr Nasreen Ayub, associate professor at the women’s studies department of Karachi University, carried out a research on the topic of self-employed women of the certified informal sector in Karachi. The study was conducted on 265 respondents engaged in various types of works. It covered around 80 katchi abadis (squatter settlements) of Karachi and its suburbs.

These women confer significantly towards the economic development of society. They come from working class families whose men are also the breadwinners. but their financial contribution towards their family income has enabled them to enhance their own, and their families’, status.

The wages earned by some of the women in the following activities are broken down as follows:

In broom making they are paid Rs5 per dozen and they make about four dozen per day, hence they make about Rs20 per day. In bead necklace making they earn one rupee per necklace and make 12 necklaces a day, hence earning only Rs12 per day. For making papadum, they make Rs11 for every 500 pieces, and they make1500 a day, for which they earn Rs33 per day. For painting glass bangles, they get Rs5 per box of two dozen bangles and as they are able to paint 10 boxes of bangles a day, they make Rs50 day.

Let’s consider some of the case studies done by Dr Ayub. Nineteen-year-old Najma lives with her parents and an older sister in Old Golimar. Her father is a labourer and makes Rs800 while Najma stuffs toys with her mother. She earns Rs1,600 per month, and her sister who teaches in a school brings home Rs600 per month. So the aggregate earning of the family comes to about Rs3,000 per month.

They live in a pucca house with a tin roof built on 60 sq yards, it has electricity but no gas. The family has been able to acquire a TV, an iron, fans and a sewing machine with Najma’s proceeds. She started work when they were finding it hard to make ends meet.

Najma gets Rs30-60 per toy item. She works for 12 hours a day which is not so taxing as compared to other women. She is conscious of the fact that her toys are sold for a much higher price, but she needs what she gets and is laying the money aside for her older sister’s wedding.

Najma feels that her working for the economic support of her family has brought her respect and recognition among the relatives and friends. She is also proud that had it not been for her contribution her family would not have been able to enjoy certain material comforts.

Ruksana is 30 and has six children. Her husband is a tailor and earns Rs2,200 per month. They have a pucca house, with a tin roof, on 60 sq yards. Ruksana makes flower garlands and earns Rs2,100 per month. The children go to school and in their spare time they assist their mother.

Ruksana started working because her family was economically strained. Ever since she began earning she has bought several appliances like a TV, essential furniture, a sewing machine and a washing machine. She feels that she is economically more independent now and has a say in planning the expenditure.

She knows that her work is sold at a much higher price in the open market, but she knows there isn’t anything she can do about that. She thinks she is keeping better health since she began working, and the family can afford better food now. Ruksana says that other women belonging to the similar echelon should also work to alleviate the economic status of their family.

Gaitee, 58, is a widow with two sons who are married and living independently. She lives alone in a 40 sq yard pucca house with a tin roof. She has been living in this house (basically a room with a bathroom and no separate kitchen) for 20 years. The house has no gas so she cooks on a kerosene oil stove. She fetches water herself and buys her groceries also.

Gaitee does not possess a lot of domestic appliances. As a papadum maker, she earns about Rs280 a month. She has to support herself since her sons do not take care of her.

Despite this, Gaitee believes that ever since she began working, she has become independent and is also content. She disburses her earnings on herself and resides as she pleases without any intervention. She reflects that women should not feel helpless even if they are widowed or do not have sons, because at times even sons do not look after their parents, and hence if they are working, the women do in all probability feel far more self-reliant and secure.

Saeeda, 50, lost her husband 15 months ago and was at first in a quandary. She resides in a hutment and has a son who goes to school, as she wants him to get proper education. She has taken electricity from the neighbour and pays him monthly.

Saeeda stitches shalwar kameez suits for her livelihood and earns about Rs1,680 a month. She goes from house to house and collects orders, knowing full well that she is paid much less than what tailors make. She is not satisfied with her income because she cannot save anything for her son and says that she needs help from zakat donations. She is planning to work in collaboration with other women so that they can get larger orders and earn more.

Rukhsar, 30, lives in a room in her brother’s house. She has been married for nine years and has two sons and her husband knits carpets; he earns Rs60 per day. Rukhsar prepares the inside lining of leather caps and Rs50 per day.

It takes her approximately 12 hours of work every day. She spends her income on household items, providing for her children’s needs and meeting emergency expenditure. Rukhsar got her room painted and bought a sewing machine from her own income.

Bano Bibi, 38, has eight children and a husband who is chronically ill. Bano runs a vegetable shop outside her house. Her husband gets the vegetables from the main market and Bano sells them at the stall. They own a pucca house on 40 sq yards and cook on coal.

Bano takes immense pride in the fact that she is a source of subsistence for her family in these hard times when her husband cannot earn. She is educating some of her children since with her meagre income she cannot educate all of them.

In Dr Ayub’s research, it was ascertained that about 52 per cent of women out of the sampled population did their domestic work in addition to shouldering the economic burden of their families. In the case of self-employed women it was seen that 84 per cent had fixed timings for labour while 16 per cent had no fixed timings. Fifty per cent worked from morning till evening while 33 per cent toiled from morning till night and 16 per cent worked from morning till midnight. The study revealed that 51 per cent were satisfied with their work because the money acquired from it helped at home; 62 per cent were satisfied because their work was done from home.

When asked if they were ashamed of having to work, it was interesting to note that none were. In fact, 71 per cent thought that there is no shame in hard work while 39 per cent said it was better to work hard than to beg. Of the rest, 20 per cent said that there was no alternative to work, whereas 9 per cent worked to educate their children.

About 72 per cent of the sample population indicated that they acquired confidence and comfort from their work. Either because they could spend the money according to their own will or because they have attained more respect in the family. Whereas 28 per cent gained no confidence, either because the husband is too dominating or the elders in the family make all the significant decisions.

Self-employed women are generally not aware of the ways in which the market works, neither do they know the proper rate of wages others get for similar types of work. This is usually due to the middle-man or the contractor who deliberately doesn’t disclose these facts, so that he remains at an advantage and can exploit these women. As a result the women are cheated out of their righteous share of payment.

It is interesting to note that the women, mostly poor, are not willing to accept any financial help from zakat or other social welfare agencies. Though Dr Ayub also discovered that they did not know much about bank loans which they can take on easy terms for small enterprises.

The study confirmed that self-employed women lack formal training and perform their work on a trial and error basis, or from whatever training they got from their mothers at home. Adequate skill training could be provided at a community based level either through government efforts or social welfare efforts. Dr Ayub also suggests that some sort of an infrastructure could be created which would bring such women together. Maybe an association of self-employed women could be made which would at some level succour them at least in some way.

Until the second century, when the first team doctor, Galen, was appointed to the gladiators, the physician only became involved when there was an injury.

Today, in the United States of America, doctors wishing to specialise start with a primary residency program in family practice, internal medicine, emergency medicine, pediatrics, or physical medicine and rehabilitation, and then generally obtain one to two years of additional training through accredited fellowship (subspecialty) programs in sports medicine. Physicians who are board-certified in family practice, internal medicine, emergency medicine, or pediatrics are then eligible to take a subspecialty qualification examination in sports medicine.

Additional forums that add to the expertise of a sports medicine specialist include continuing education in sports medicine, and membership and participation in sports medicine societies. Sports medicine has been a recognized subspecialty of the American Board of Medical Specialties since 1989. Currently there are more than 70 sports medicine fellowships and approximately one thousand certified sports medicine specialists in the United States.

Sporting glory is something which most nations want to achieve. In the nearly 60 years of Pakistan’s existence, we have had our fair share of international sporting success. Arguably this is one field in which Pakistan has achieved more than in any other field! Pakistan’s success has been mainly in three sports – one individual and two team events, namely, hockey, squash and cricket – with some success in other individual events like snooker, wrestling, weight-lifting etc. at regional and international levels.

Pakistan has an enviable record of success in international hockey arena. We first participated in the 1948 London Olympics and were placed fourth on the table. We won an Olympic silver in 1956 and the crown itself at the 1960 Rome Olympics, repeating the feat in 1968 and 1984.

Moreover, we have had four world hockey championship titles (1971, 1978, 1982 and 1994) in addition to the seven Asian crowns – 1958, 1962, 1970, 1974, 1978, 1982 and 1990. Add to them the three Champions Trophy titles – 1978, 1980 and 1994 – and we can see beyond doubt that Pakistan was among the top few till mid-1990s.

Similarly in squash, the Khans from Pakistan have ruled the game single-handedly for a long time, starting with Hashim Khan’s British Open title in 1951 and then achieving the impossible – ten consecutive British Open titles from 1982 to 1991 by the one and only Jahangir Khan. Hashim Khan won the title seven times in all, while Jansher Khan did it six times and Azam Khan, four times. Not only that, Jahangir Khan won the World Open crown for eight times. But the glory years of Pakistan Squash also came to an end in the 1990s.

Pakistan’s cricketing success has been a bit more chequered. We played our debut Test match in 1952 and our first success came in only the second Test. In the shorter version of the game, who could forget the historic six on the last ball in Sharjah by Javed Miandad in 1986. The 1992 World Cup success, of course, was the stuff dreams are made of, but that also represents our last hurrah on the world stage. Since then we have not been able to stamp our authority like we used to do on global sports. Things are much better in cricket than what they have been like in hockey and squash, but in absolute terms it may be argued with some justification that we have receded in cricket as well since the 1990s.

It is interesting that most of the nation’s sporting achievements were secured when the country was getting over the initial troubles after Partition and we had very little in the way of infrastructure, training and facilities for our sportsmen. Perhaps it was shear determination and the will to succeed that helped our sportsmen bring all those laurels. But that is also a reflection on the way I which international sporting activities were conducted then and the manner in which they are managed now. Our sportsmen made it big till the world remained amateurish in approaching sports. Once the world moved forward and went for scientific approaches and professional training regimes to achieve sporting excellence, we failed to follow suit and the result is that we have stopped winning as consistently as we used to do. In fact, we have stopped winning for most part.

In the modern world, competitive sports demand high level of fitness that can only be acquired through a punishing training regime. Modern athletes push the boundaries of physical tolerance of their bodies to its limits to gain the competitive edge. This is due to the fact that unlike previously now success or otherwise is measured in hundredth of a second. A change of minimal percentage point in performance is enough to make a telling difference; the difference between winning a gold medal or nothing. This level of competitiveness by its very nature exposes them to injuries.