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Doctor Komang Krisna was about to leave when work he heard the tell-tale sound of sirens. Seconds later an ambulance came tearing into the hospital's driveway. Inside was an Australian tourist just out of his teens – the latest in a stream of motorbike-accident victims in the Indonesian resort island of Bali.

“I've seen many head injuries but nothing like this,” says the orthopaedic surgeon who's worked at the emergency room at BIMC Hospital in the Nusa Dua tourist district for four years.

“His head and face were open from where he'd hit the ground and there was a bone sticking out of his left thigh. We rushed him into the surgery. I operated on him simultaneously with a neurosurgeon and plastic surgeon all night to save his life.”

Dr Krisna, who owns a BMW R1250GS and Harley Davidson Road Glide CVD, has many similar stories about tourists coming off scooters, which can be hired by anyone, with or without a valid license, for as little as $2 a day on the Indonesian island.

“Another time, a man was brought in by locals who found him lying unconscious on the road. His neck was broken. He never walked again. We also get lots of foot injuries because in Bali people usually ride around in sandals that offer no protection. I've seen feet dangling off legs by the skin and lots of missing toes. Hand injuries are also common.”

Shockingly, 80 per cent of Krisna's patients are motorbike-accident victims and, he claims, about three-quarters of them are Australians.

The unhappy trifecta 

Road accidents are the third most common causes of Australian deaths overseas after natural causes and illness, according to the Department of Foreign Affairs. Last year, the country with the highest number of Australians hospitalised was another Southeast Asian country where many tourists rent scooters - Thailand, with 178 cases. Indonesia was in second place with 144 cases – nearly all of them in Bali. That is one crash victim every two and a half days.

“We continue to be concerned about the number of motorbike accidents involving Australians overseas,” said a spokesperson for the department, which can help liaise with local hospitals and family members back home but doesn't pay for its citizens' hospital bills overseas.

“We encourage all Australians to consider carefully the risk of motorbike travel overseas, have a valid international driving permit, Australian motorbike driving license, wear a helmet, follow the local road rules and take out comprehensive medical insurance,” the spokesperson said.

The patient with the broken leg and hole in his head at the start of this story had bought medical insurance before leaving home. But he wasn't wearing a helmet and was unlicensed, so his insurance was void. Krisna says his parents had to pay bills totalling $75,000 before he could leave the hospital.

The number of Australian tourists who find themselves in the same situation in Bali beggars belief, says Phil Sylvestor, travel safety expert with World Nomads, a travel insurance company in Sydney.

“We recently surveyed motorcycle-related claims by Australians in Bali,” he says.

“We found two-thirds were denied because one, they had no license; two, no helmet; three, were intoxicated; and four, what we call the unhappy trifecta – all three combined. These people all had to pay their medical expenses out of their own pocket.

“Flip-flops and a Bintang singlet are not motorcycle-appropriate safety clothes, and if you don’t ride a motorcycle at home, the backstreets of Kuta are not the place to learn.”

Sylvestor adds: “And be wary of the cheap novelty helmets in Bali. A World War II-style helmet might look cool but the brain injury from a helmet that’s not up to the minimum safety standard is no joke.”

Nuts and bolts of the problem

So why are so many Australians who never ride motorbikes at home willing to do so in Bali, where the road conditions are more challenging?

Mostly because it's a cheap and quick. There is no public transportation in Bali and the traffic is highly congested. At peak hour, the 5km drive between the popular tourist hubs of Seminyak and Canggu can take an hour in a car. On a motorbike, it's 15 minutes.

Graft also encourages tourists to ride unlicensed Bali. According to Indonesian law, a person caught driving unlicensed will have their vehicle's registrations papers and keys confiscated until a fine of 2.5m rupiahs ($272) is paid at a Regional Financial Services Authority Office.

But according to many foreigners who've been stopped by police while riding motorbikes in Bali, cash bribes are usually solicited instead.

“If you don't have a proper license, you are a Gofundme in process,” commented Lorraine Lawson during a discussion on unlicensed driving on the Bali Expats Facebook page.

“ATM on wheels,” added Rob Dutchy.

If there is some logic in riding a motorbike unlicensed in Bali, there is none for riding without a helmet, which are always provided at no extra cost by those who rent motorbikes. Many foreigners can even be seen riding around with helmets strapped to the back of their motorbikes.

Members of the Bali Expat group attempted to explain this behaviour.

“I always try to wear a helmet but sometimes they literally don’t fit my head with my hair,” wrote Deandra Dela-Amina Whyte.

Barbara Nicholson said, “My partner says it’s too hot.”

“It feels better than riding with one, especially at slow speeds,” wrote Steve Dowler.

But many more said it's about freedom.

“My guess is because everywhere is full of rules,” wrote Seftan Cousins-Thomas.

“If you want rules, go back to Australia,” says Leo Oktovrios.

But road rules also exist in Bali. And those who ignore them, warns Phil Sylvestor, should “cross their fingers and hope nothing bad happens.”