Friday, 13 November 2015

Transport Policy - Don't Forget Travel Sickness

There has, quite rightly, been much attention paid by many people recently to 'unseen illness' - mental illness, cancer, sarcoidosis, etc., etc. - the many, many conditions that are not immediately visible to others. They vary in severity, of course, but can sometimes be underestimated in terms of the impact that they have on the way a person is feeling simply because they are 'invisible'. Some of them can even occasionally be dismissed in a kind of 'get over it' attitude, and I think it's right to repeat the oft repeated, 'you wouldn't say that to someone with a broken leg'.

One condition that rarely gets mentioned, or considered as something that is in any way 'serious', is the issue of travel sickness, or motion sickness. It's often something experienced in childhood and 'grown out of', of course, but many adults also suffer, and it is a very real problem for people in their daily lives. It's often 'unseen', unless people actually get to the point of turning visibly green or vomiting, which most sufferers prefer to take action to avoid if they can. There are a variety of medications and 'remedies' out there, but many people find them to be less than universally successful, certainly in doing anything more than being a 'coping strategy' that somewhat mitigates the worst effects (something to 'hold back the flow', so to speak, but not any kind of 'cure' for the feeling of nausea itself). It never seems to be considered as a factor to be taken into account when looking at transport policy, but it's such a common problem, and such a serious and debilitating condition for sufferers, that I think it should be.

So what are we talking about here? Well essentially it's a form of 'sensory disconnect' - one part of the body's mechanisms not agreeing with another part as to what is going on. At its core it's about visual input seemingly disagreeing with the balance and movement information coming from the inner ear. It's speculated that it might have evolved as a defence mechanism against poisoning - a likely symptom of that being visual hallucination, leading to the brain receiving different signals, leading to it deciding that it needs to eject whatever substance is causing the problem before it gets any worse. That seems reasonable enough to me, though I claim no expertise in such things - to put it bluntly, humans originally evolved to survive eating things, not to travel at high speed.

Let's personalise this - as you might have guessed, it's something I have suffered very badly with over the years, which is why I'm so aware of it. Initially I was quite bad in childhood, then it reduced for a while through my twenties, and then it returned later on and continues to this day. It manifests itself in a number of ways, as it does with many people - most of the issue is related to travel and transport, although it also causes issues with watching TV and film stuff with extended spinning or non-steady camera work, including cameras attached to people. The film 'Gravity', for example, won awards for its effects, but included scenes that were sheer torture for me (and I had to close my eyes at several points, so missed some of those award-winning effects). Commentator Brian Moore probably nailed it more than he realised when he referred to the 'ref cams' now being used for international rugby games as 'Vomit Cam' - I can cope for short bursts, but extended shots from that kind of thing are no fun at all.

Three times I have spent an hour or more lying horizontal on a bench in theme parks as a result of being persuaded to go on to some particular ride or other. These scenarios are mostly the fault of my kids, and my daughter in particular, who had a tendency to tell me that I'll 'be fine' and 'it's not too bad' when she wanted me to go on something with her. Once was from a 'pirate ship' ride, on the 'half-swing' setting considered suitable for smaller children, once from a 'simulator' ride, and once from a coaster. I'm actually not too bad on milder coasters normally, because it's a short stint with plenty of fresh air blowing in my face, but this particular one completely flattened me (the reason I mention my (then teenage) daughter, and hold her so responsible for it, is that when we came off she told me 'Oh yeah, Mum felt sick on this one too', knowing full well that her mother has a far 'stronger stomach' for such things than me!). In all these cases I was apparently green for some time, and certainly not back to full functionality for a couple of hours.

And that is something that non-sufferers often don't appreciate - the fact that the problem doesn't instantly cure itself when the motion stops. The body doesn't suddenly say 'Oh, that's OK now, then' - it takes a good while to realise that the 'poison' isn't an issue any more. That results in the old 'it's only 20 minutes on the train, and then you'll be fine' suggestion - that's just not how it works for many of us. That 'just' 20 minutes sets off a reaction that can sometimes last for hours.

So what makes it better when travelling? Well, the simple answer is driving - not even just going by car (people who know me know that I rarely agree to be a passenger for any length of journey, and will always prefer to drive), but actually driving. I know many people who feel the same - although there can still be a problem, it is usually nowhere near as severe and much easier to control. Again I claim no scientific expertise in the issue, but from my experience I suspect that there are several reasons for this. Firstly, driving forces you to focus constantly on an exterior horizon, which is a help with keeping the different sensory inputs consistent with one another. Secondly, the fact that you are actually in control of the means of travel means that you not only have additional inputs to help the brain interpret the signals properly (you can 'feel' what is happening through the wheel, and so on), but that you are anticipating movements to a much greater degree (because you are controlling them), which allows the brain a little more time to cope. Thirdly, in many cases the driver ends up by default in control of things like the temperature and air flow in the car - that is of critical importance to the whole issue. It's not a 'cure all', though - my girlfriend is certainly well used to the periods on journeys when I am silent, have the window open, take regular small sips of cold water and am sucking a mint. She's well aware, thankfully, that my unwillingness to speak is not because 'I'm in a mood' or anything! It's not a problem for driving standards - quite the opposite, in fact, because it forces me to concentrate utterly on what I am doing.

Now you may be getting a hint here about some of the things I'm talking about when it comes to transport policy. A big one is the push for public transport. Of course, it is much greener, and that's very important. It also helps to reduce the need for road building and maintenance, and all of the other things that come with the simple fact of there being less cars on the road. I think we should spare a thought, though, for those for whom public transport is genuinely not a viable option at the moment, unless you want them to arrive at their destination green and self-pebble-dashed, and incapable of doing anything at all for hours afterwards (which would hardly seem fair on them).

Yes of course we have to encourage more and better public transport, but we also have to consider what 'better' really means. A huge issue for travel sickness sufferers, and one that I've almost never heard mentioned in the whole debate, is the design of modern public transport vehicles. We seem to be obsessed with not only making them faster and more efficient, but also making them 'comfortable' in a sense generally accepted by many, perhaps most, people for whom motion sickness is a distant issue that seems to have little or no relevance or importance. For them, 'comfortable' seems to mean nice and warm, sealed from nasty drafts, and so on. Let me tell you - for us sufferers, there's nothing worse. I, for example, can quite easily cope with travelling in a vintage railway carriage, with open windows, lots of airflow coming from the direction of travel, cold, draughty, and so on. Yes, it's much slower and less efficient in its streamlining, and you can't use such carriages at modern ultra-high speeds, but I'd much rather spend an hour getting somewhere on that than spend 20 minutes in a relatively modern sealed and heated carriage. I'll be in a far better state when I get to where I'm going. Exactly the same applies to buses - if it's cold, there's air blowing on my face, and so on, as it used to be with those 'nasty old rattly' types of bus, it's barely an issue at all, at least on relatively short journeys - modern buses, though, are invariably utter torture, especially when packed with people and noisy with chatter (that adds to stress levels, too, which certainly doesn't help).

Don't even get me started on heated longer-distance coaches, with tiny little air vents above that might turn on if you are lucky, and might provide a whisper of air if the driver has thought to turn the relevant system on at the front! Have you ever spend large chunks of a coach journey in the usually pretty rank toilet (often the coolest place anyway!), trying to prevent yourself from continually repeating the outward flow as best you can? Believe me, it's no picnic at all, and the more modern a vehicle is, the worse it is. I can also tell you that train toilets are no more pleasant. And then there's aircraft, with their modern insistence on improving efficiency by reducing air circulation and cleaning. And bendy-buses - they are absolutely hideous things to travel on, no matter which bit you are sitting in.

We must be able to design transport vehicles in a much better way, with these issues in mind. Of course, some people might complain about them being cold and draughty, but ultimately they can put a jumper on - surely better for some to have to wear a coat than for others to have to wear the contents of their own stomach! Indeed, in a train scenario it might be possibly to have specified 'cold' and 'warm' carriages - obviously we can't have open windows at 100 MPH plus, but we can have a decent rate of vented and/or forced cold air flow in the relevant direction, to help the sense of motion sickness sufferers cope with the potential disconnect (cold air flow, in the correct direction, is a huge factor). There may be other things we can consider too (suspension systems, and so on - I couldn't put my finger on why, but more modern suspension systems, where you don't 'feel the bumps on the road' so much, seems to me to make things far worse, and sideways rolling is another big contributory factor), but the main thing is that we need to take the issue seriously and consider it as something important. At the moment we clearly aren't doing that at all, or not anywhere near seriously enough to design stuff that works for many motion sickness sufferers.

If we want to be getting the many people like me out of our cars and on to public transport, we have to make public transport far more usable for us than it currently is. Currently, it really is just not an option for many people - when we wonder why some people are still glued to driving along in their own cars (not even doing car sharing), we have to recognise that that is likely to be a significant issue for quite a number of them. We can't simply pretend that the problem isn't a serious one, or a significant one worthy of consideration in transport policy in terms  - it's really quite common, and a very big issue for those who suffer.

Last year I had to travel to a conference in Glasgow, from South Wales. Almost without exception, my friends and colleagues were taking various modes of public transport (some train, some coach, some plane - the practical differences between those modes for me are negligible). Needless to say, I was driving myself. There are, of course, certain other advantages to my chosen mode of transport - the minute I got out of the hotel to make the return journey, I was in 'my own space', with my own music, my own control of conditions, my own schedule, and even the ability to smoke (not having smoking at all on public transport is another issue for some people, but that's a somewhat different subject). I was driving for one reason, though, and one reason alone - it was, quite simply, the only way I could get there without vomiting, though it took me considerably longer to get there than many others (and of course I'd be quite happy to have a reduced journey time, if I could, and getting there without the fatigue of having driven all day). Though I guess I'm quite a serious sufferer, I know I'm certainly not unique, and there are many, many more people who suffer less severely for whom it can still be a significant consideration.

This has real implications for policy-making, and it is something that needs to be considered. When we're looking at designing policy, systems and vehicles, we have to be asking ourselves whether they are the best that they can be to allow the maximum number of people to use them. We also have to ask ourselves what alternatives there are for people who are not able to use them. That consideration becomes important again as the increasing probability arises of 'driver-less cars' a driver-less car makes you a passenger, but being a passenger really isn't an appropriate option for some people. There will always have to be some recognition of the fact that some things are not appropriate for everyone. We really can't ban car driving, or begin to price it out of practical existence, without putting people who suffer from a fairly common and potentially very debilitating condition at a severe disadvantage in life (and viable travel is an inevitably important aspect of opportunity in the modern world). It might not be a visible condition, but it is certainly a condition that we have to take seriously - without doing so, we run a real risk of actually discriminating in practical ways against people, on the grounds of a fairly common health condition.

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