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CAPE TOWN, South Africa — “There is the cause of the accident, those cold ones,” a bystander told me at a horrific traffic accident in Cape Town, South Africa. He then pointed to a pile of Castle lager bottles next to two police officers.
Ten feet away an arm extended from beneath a rolled over white Mazda sedan. The driver was trapped under the vehicle for over an hour, vital signs declining by the minute, before he was finally freed by the jaws-of-life. Four passengers had already been pulled from the mangled wreck. Family members of the victims rushed between patients to identify loved ones.
I was with Carly Smith, a senior paramedic with ER24, a private ambulance company, on an overnight shift. Though we would respond to six road traffic accidents—one pedestrian knocked down by a motorcycle, two fender-benders and three overturned vehicles—during our ten hours together, Smith said that “Cape Town is in a bit of a chill out this week,” due to the death of Nelson Mandela. In other words, this was not a busy night.
During the holiday season here, road traffic accidents are in the spotlight. Local news outlets run death counts. The public is told to be safe and not drink and drive. But this is a problem that lasts all year. South Africa has the second highest road traffic fatality rate in Africa, the continent with the world’s most dangerous roads, according to a World Health Organization (WHO) report on road safety.
Dr. Unice Vorster, an emergency room doctor at Groote Schuur, the public hospital where the trapped patient was eventually sent, says that most of the road traffic injuries that she treats are alcohol-related. But, driving under the influence is not typically prosecuted. Dr. Vorster says that blood alcohol tests are taken at the hospital and that in the crush of cases, they often don’t get done.
The WHO report shows that Africa as a whole has poor enforcement of drinking and driving laws. South Africa received particularly poor marks despite estimates that 55 percent of all road deaths there involved alcohol. In beer-swilling, but apparently law-abiding Germany, it is just 11 percent.
South Africa has long had a troubled relationship with alcohol. Under its “tot” system, vineyard laborers were paid part of their wages in alcohol. The country’s mine owners used similar compensation schemes for their workers. Though now banned, these practices left a legacy of heavy alcohol consumption and attending health consequences. The Institute for Health Metrics and Evaluation reports that alcohol is the nation’s leading health risk factor, leading to increased rates of everything from HIV/AIDS to mental illness to interpersonal violence.
A few hours after chatting with Dr. Vorster, another call for a roll over came in, this time on a stretch of highway near downtown known as “hospital bend,” both for the fact that it curves around the grounds of Groote Schuur hospital and that it is a frequent site of accidents.
When we arrive on scene, the driver is out of the car and bloodied, but alert. He explained that he had seen something in the road, swerved and pulled the handbrake. Next thing he knew he was upside down and kicking out the back window of his hatchback. After finishing his story, he paused for a moment and then confessed: “I had a few drinks.”