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Sin Casco (without a helmet)
  1. Samuel Gerson
  1. Correspondence to New York Presbyterian Hospital, 610 West 173 Street Apt 6B New York 10032, New York, USA


This photograph depicts a typical scene on a city road in the Dominican Republic (DR) – another bright, sunny day on a congested stretch of pavement in the capital, Santo Domingo. From a vantage point by the street, an observer becomes vertiginous watching the endless, dizzying parade of vehicles streaming by. Two lanes evaporate into three or four, as drivers jockey for the leading position. Merengue music blasts out of a nearby grocery store, adding to the deafening cacophony of broken mufflers and blaring horns. Live electrical wires sag down between crumbling cement poles, at times reaching dangerously close to the top of passing cargo trucks. Suddenly, a motorcycle darts through the centre of the image, carrying three men – none wearing helmets or protective gear. Weaving in and out of oncoming traffic, they quickly disappear down the road behind a cloud of thick exhaust. While safe for the moment, this scenario too often ends tragically for these riders, in a pile of twisted metal and broken bones. In 2004 the WHO released the world report on road traffic injury prevention identifying roadway mortality as a major global health problem that claims an estimated 3000 lives daily. Ninety percent of these deaths occur in developing countries. In the DR, road traffic injuries are the top cause of death among males of working age. According to police records, motorcycle accidents account for the majority of these fatalities, most involving multiple un-helmeted passengers. Images like this inspired a group of New York-based physicians working in a Dominican neighbourhood – where the burden of trauma is felt emotionally and economically among friends and relatives of victims from their native country – to launch an initiative aimed at helmet use and roadway injury prevention in the DR.

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