“Prevention has always been better than cure”
My observation of patterns that play out in the developed world and then slowly slither to the rest of us, is the pattern of implementing public health initiatives. It almost seems that once the problem of infectious disease is managed, the focus expands to the prevention of diseases and health systems strengthening.
South of the Sahara, the focus has remained infectious diseases, as evidenced by the continued imbalance of infectious disease research vs “everything else” research. It’s like we’re stuck here, and the world has moved on. And between parents, community structures, government, manufacturers, lawmakers, law enforcement, and politicians – we’re still figuring out who’s responsibility this is.
According to WHO, around 2000 children die from preventable injuries every day. Approximately 80% of child injuries occur in and around the home. The incidents of these injuries vary in different countries and cultures. According to American Association of Poison Control Centers’s 2015 annual report, there are over 1 million instances of substance exposures in children who are younger than 6 years of age. These instances are also higher in children in developing countries as compared to developed nations.
In my everyday clinical context, these statistics manifest in the very steady stream of patients with caustic ingestion-related oesophageal injuries. The patients frequent our wards, operating theatres, and social work departments.
The usual suspect is an oven cleaner and ingesting this causes catastrophic oesophageal injury, derailing the life of the family forever. The substance is usually kept in an unlabeled or mislabeled container, which is easily accessed and easily opened. These patients are admitted and depending on the severity of the injury – this admission can include intensive care, multiple trips to the operating theatre, the need for tube feeding, associated airway injuries requiring life support, and even death due to oesophageal perforation and resultant infection. Aside from the physical insult and its implications, these injuries have far-reaching economic, social, and mental consequences, as well as altering the family dynamic. All of this, in an already stressful context.
Hand sanitiser has joined the list of “items of questionable safety” in our everyday lives. Patients have presented to us with airway injuries from inhaling or ingesting hand sanitiser. One of these patients required intubation and respiratory support. The other jarring reality is that these injuries happened at school.
There are extensive regulations around the content of hand sanitisers. Judging how quickly, relatively unknown companies were producing this much-needed component of the armamentarium, I cannot imagine that there was the robust implementation of these regulations.
The list of potential threats to children continues to get longer, as none of these threats is neutralised. The list includes button batteries, swimming pools, unrestrained children in cars, massive, motorised gates (which are not on motors) but lean against walls, fall and crush children, dogs, candles and boiling hot water in containers on floors and illegal electricity cables.
The concept of the environment has been diminished to describe the natural environment, and our behaviours that are threatening the existence of it, but the word environment encompasses all the space we live in. The proximity of the menace and the gravity of the consequence should be jolting – but it isn’t until something happens, and the regret is paralysing.
At Red Cross Children’s hospital in Cape Town, South Africa, we are fortunate enough to be affiliated with a non-profit organization with on-site premises. This organization is called Childsafe and focuses on injury prevention through research, education and recommendations to legislation. All this was initiated by a clinician, Professor Sid Cywes, a paediatric surgeon who championed this cause and generated its initial momentum.
There have been countless stories of inspiration and world-changing action originating at the frontline. Children need champions at multiple points in society, launching a multipronged attack. Injury prevention is a quantum shift in perspective – from mere survival to ensuring the quality of life. It is a shift we must make. The alternative is too costly.