Broken Femurs and Cracked Backs: An Ethnography of Thai Motorcycle Safety

Introduction

We arrived in Thailand last Thursday to visit our daughter Kirsten who teaches English in a Thai school. Within a half hour of arrival we were informed that she had just had an accident. She was driving her scooter near a Thai market in the small city of Phrae, when a “white car” backed out in front of her. She hit the brakes, skidded out, and fell into an on-coming truck whose wheels gave her back a big whack. At about the same time, the people picking us up at the airport sent her a text saying we had arrived successfully at an airport in the next province. She texted a “thumbs up” back to them from the back of the ambulance indicating that she was pleased we had arrived safely. She didn’t think that a brief text about a motorcycle accident was appropriate in such a circumstance—thus the thumbs up.

At this point she began her ethnographic participant investigation of the Thai insurance, medical, and legal system. More about the ethnography of this situation in a minute!

But first a word from our sponsor: Motorcycle Safety.

Motorcycle Safety I: Artificial Femurs in Tanzania

     Motorcycles are really dangerous. But they are also ubiquitous in the middle income countries like Thailand where people have enough money for a motorcycle, want to send their kids across to town for school, don’t like to walk, and car ownership is not affordable.

    Which brings up a trip to the operating theater I made last April when visiting Tanzania, a country poorer than Thailand, but which has also had a boom in motorcycle purchases as the economy has improved. The director of the Tanzanian hospital took us on a tour of the facility. It was a large facility in a rural area of Kilimanjaro Region on a dirt road. But they were able to do many things, including delivering lots of babies (we visited the new-born ward), treat topical diseases  and the other things a rural hospital on the sides of Mount Kilimanjaro needed to do.  They even had a college where nurses and medical aides are trained. At one point, our tour guide asked if we wanted to see the operating room. Sure why not? I’ve seen a couple of operating rooms before on t.v. and even occasionally in person—it is a table with lots of cool machines and lighting.

     So he took us to the operating room. But he didn’t take us in the actual room itself, because it was being used at the moment. So he invited us to have a look at the viewing window (this is a teaching hospital after all). And there we watched a surgeon operate on a broken leg. We could only see the leg—the rest of the patient, who was sedated with a spinal block, was covered All I could see was disembodied leg. But into this banged-up leg the doctor had inserted a manual “screwdriver” (actually a brace and bit), with which he was carefully screwing something into a bone via a hole in the leg. This wasn’t like the type of operation I’ve seen on t.v. where there are bright lights beeping machines, and fancy machines. Just a very focused surgeon with scalpels and screwdrivers. No whirring machines either. A bit more than what we had bargained for on our “tour!”

        Next stop was the storeroom, where we were shown the collection of metal femurs they kept there—i.e. a metal rod which includes a hip joint, and a  “For motorcycle accidents” it was explained. They had several sizes in the store, in anticipation of the motorcycle accidents that are increasing in number as the Tanzanian economy develops and people buy motorcycles. Indeed, in every Tanzanian town there is a new industry going back less than ten years—the motorcycle taxi service (buda buda in Swahili). Young men hiring out the back seat of their motorcycles to passengers. And such motorcycles were the raison d’être for the store of metal femurs kept there. The hospital was anticipating motorcycle accidents—and broken femurs.

Back to the Thai Hospital

Now back to Kirsten, who was hit by the truck here in Thailand. She had finished teaching her English evening class, and was riding to the market to meet her friend for dinner when the white car backed out of the parking place in front of her. She hit the brakes, and skidded out, tumbling into the on-coming traffic. The fall was not too bad as she was going slowly. But when she looked up, she saw a truck coming toward her head. As a reflex, she apparently went into a fetal position, so that the truck hit her on her back. Pow! Or ouch!  The next thing she knew she was thinking about whether her toes and fingers would still move.  Taking a gulp she wiggled them–the did!

The truck had Thai university students on the back who screamed. Other people started running toward the accident, and nervous laughter began—who would talk to the farang lying on the ground? Others took photos. Someone called the ambulance. Kirsten found an English-speaking Thai woman, and asked her to find her friend in the market a few hundred feet away. The Thai asked if she could borrow her motorcycle, and Kirsten, lying on the ground, told her it was ok The woman returned in a few minutes later with my daughter’s farang friend. An ambulance came too, and loaded my daughter onto the gurney. The friend was told to slowly and carefully follow the ambulance to the hospital. But of course the ambulance went quickly to the hospital, causing the friend to drive—quickly.

At the Emergency Room, Kirsten was x-rayed, and a quick diagnosis made that Kirsten was o.k.—she was sore from muscle bruises and cracks in in three lumbar vertebra (the pointy part of the vertebra, not the actual spinal column itself).  Fortunately there was not damage to the spinal column itself, which is why she could still wiggle her toes.. Because Kirsten has Thai accident insurance, she was quickly x-rayed and placed in a single room to spend the night—the hospital knew they were getting paid. The doctor finally arrived, and reported that the x-ray of the spine was normal, and that she could be discharged. Kirsten, explained though that she could not walk, much less climb the four floors to her apartment. Told this, the doctor changed his recommendation—she would need to spend the night in the hospital, and see the orthopedist.

The orthopedist came by the next day, and took another look at the x-rays. It seemed that that the truck tire had broken and/or cracked three of the spurs on Kirsten’s lumbar, which explained well why she was having so much pain while walking. However, no surgery would be necessary. New prescription? More pain meds, a week of taking it really slow, and a corset for a month. Oh, and she should have been wearing a motorcycle helmet, too.

Motorcycle Safety II: Motorcycle Culture in Phrae, Thailand

Up to 26,000 people are killed in road accidents every year in Thailand, which puts the country in the 6th spot in terms of road casualties. Of those killed, up to 70 or 80 per cent are motorcyclists or their passengers. Source

Kirsten is part of a large group of American and European young people teaching English in Thailand. Besides having a lot of motorcycles, Thailand also has a great thirst for English education, and is willing to hire twenty-something foreigners (farangs) like Kirsten to come teach in primary and secondary schools. Many of the people taking these jobs are thirsting for adventure. Adventures in Thailand naturally include motorcycles, which cost only about $40 per month to rent, and make mobility possibility possible, as they do for the streets full of Thai motorcyclists.. The rentals come with insurance for the bike to protect the owner, but not for the medical costs to protect the renter—accident insurance costs Kirsten another $30 per month, and covers medical expenses, and loss of income in the event of an accident. What they don’t come with is motorcycle training, experience driving on the left side of the road, or what appear to foreigners to be chaotic Thai driving culture. The result? Every one of Kirsten’s foreign English teacher-friends had fallen off their bikes, often during the first weeks on the road with a range of bruises and “road rash” the result.

     What is this Thai driving culture? Children start riding as passengers at birth, and start standing/sitting on them by age two. They begin driving motrocycles themselves as teenagers, and will drive their motorcycle to high school. Most college students have their own motorcycles, as do many high school students.  They usually drive on the left side of the road, but not always, especially if there is not a convenient place to turn right to a destination.

      Roads in northern Thailand are designed for an earlier age which involved foot traffic, slow ox-carts, cattle, water buffaloes, and elephants as recently as 30 year ago. Even city roads are often windy, narrow, and parking practices are irregular–line of sight is often block. Street vendors are an attraction of Thailand, but they also obstruct view since they are often literally in the street. Finally, there of course is a close relationship between drinking and accidents in Thailand, as elsewhere. Thailand has its own brands of whiskey and beer which are drunk in both moderation and excess. 

     Motorcycles helmets are required in Thailand at least since 1996, but the law is often ignored, despite police checkpoints. Kirsten has been stopped several times at the police checkpoints, and always had a helmet with her, though not necessarily on her head, so no ticket. But she always wears a helmet when going to her school as an example to her students, while complaining that to wear a helmet she has to take her hair down, which is hot in the tropical weather, so sometimes she carries it attached to the helmet carrier. Anyway she was not wearing her helmet at the time of her evening accident.

       Kirsten is not unusual in Thailand either,.  last year, just 43 per cent of motorcyclists and their passengers nationwide wore helmets, down from 46 per cent a year earlier. Source.  The informal rule in Phrae is that the helmets are worn during the day when the police are activity—and focused particularly on the time that the schools begin, and are dismissed. The motorcycle traffic of the high school students is heaviest at this time—and they do receive tickets if they do not have a helmet.

Conclusion: Kirsten’s Hospital Bills

So what has happened to Kirsten? She spent two nights in the hospital, and thankfully does not have to take advantage of the screwdrivers, nuts, bolts, artificial femurs, and so forth which I hope that the Phrae surgeons have to fix the many motorcycle accidents of Phrae. The corset holds in place the three lumbar vertabra that were cracked/damaged by the truck’s wheel against her back, and which makes walking painful. She does not require surgery—just a slow and awkward recovery period so that the bones can knit back together while being protected by the corset. Her biggest regret I think, is that she cannot get back to her first graders too soon, as they have the habit of affectionately jumping on her unexpectedly. She expects to return more quickly to her older students who do not do this.

For this she spent three nights in the hospital for which her insurance policy will pay compensation to her of about $30 per day. Because she was paying the accident insurance, her total out of pocket co-pays came to about $75. The biggest item was her corset, which was billed to her at $33. The bill I saw from the second hospital where she spent two knights, had visits from two doctors, an x-ray, and painkillers had a total bill of about $250, most of which was billed directly to the insurance company.

Kirsten was also interviewed by the police who had a finding of “no fault” for the three drivers involved in the accident, a conclusion that she has no quarrel with. As for the photos taken of her lying in the street, we have not seen them, and they have presumably been posted to Facebook, but  not by anybody who tagged her–so we have not seen them.

Overall Conclusion: The Value of Ethnography Itself?

So what is the overall conclusion of this blog? Well, motorcycles are dangerous! You should also come visit a place like Thailand, to visit, study, travel, or any other reason. The people do things differently than they do in Europe or North America, but there is also a richness and kindness evident in every day interactions.

But you probably already knew that motorcycles are dangerous, and Thailand is a great destination–so why read this far?  Of course motorcycles in Thailand are dangerous, but also necessary in every day life for the vast majority, including faring teachers, who cannot own cars. And if you are new to Thailand, remember you probably have not been standing on these beasts since you were two years old, driving since your were thirteen, nor have the experience of multiple accidents and fatalities among your friends and age mates. Which means, learn to ride motorcycles slowly, be aware of your environment, always wear a helmet, and always remember first Kirsten, and then surgeon with the screwdrivers I saw in Tanzania.

Not much of a conclusion, really, but does ethnography really have to always have conclusions? Or safety sermons? After all, ethnography is also about telling stories—which I think is the real point of this blog after all. Tell stories because they are interesting, engaging, and important. Or perhaps to just say “thank you” to a type of world which his different than your own.