Paving the Way for Safer Streets in Madagascar

Every day, inhabitants of Madagascar's capital city, Antananarivo, risk their lives as they traverse its overcrowded streets on foot, by bicycle or by car. The city, originally built to accommodate half a million residents, has ballooned to 4.8 million. Last year, more than five people a week were killed on the city's streets; about 20 people a day, many with serious brain injuries, were sent to the city's sole trauma hospital. The culprit? Automobile crashes, most involving pedestrians.

For Madagascar native Catherine Christie, a Bloomberg School MPH student and fourth-year medical student at the University of California, San Francisco, the opportunity to raise awareness of this burgeoning public health crisis in Madagascar's capital city seemed tailor-made. Christie grew up in rural Madagascar, where she lived until she was 16, and most of her family members remain there. "This means that my family and friends—and fellow citizens—are in danger," she says.

For 10 days in January, Christie got a firsthand look at just how endangered their lives are, when she executed an ambitious, multi-pronged field study that included extensive data collection and advocacy efforts. "She did more in 10 days than most people do in 10 months," says Susan Baker, MPH, a Health Policy and Management professor and Christie's faculty advisor.

During her stint on the streets of Antananarivo, Christie rushed from one automobile crash to another with beeper in hand. Often, she followed the injured to the Centre Hospitalier Universitaire Joseph Ravoahagy, where she participated in clinical consultations and, alongside surgeons, performed surgery on brain-injured patients.

In the hospital and on the streets, Christie made several revealing observations. She learned that pedestrians, who account for 55 percent to 70 percent of all fatal road traffic injuries in Antananarivo, must navigate overcrowded roads and sidewalks regularly used as parking spaces. Via an observational study of over 700 motor vehicles in Antananarivo, she also learned that only 8 percent of drivers wear seat belts.

For the injured, the journey to treatment and recovery is beset with obstacles. With just one ambulance in the entire city, transportation for victims comes slowly. The lucky ones who do reach the hospital find it understaffed. Lacking MRI equipment, surgeons must rely on clinical signs before deciding where to open up a brain-injured patient's brain to relieve pressure and swelling.

Christie shared her findings with Madagascar's Minister of Health, and on January 16, the country's first seat belt law was passed. The trauma hospital's first CT scan has been promised. The shock of the high volume of injuries and deaths has at least been recognized.

"My hope," says Christie, "is that the system will better protect its citizens."