Accidents are preventable Drowning, the silent killer:


By Vidyajyothi Dr. Wijaya Godakumbura

The writer is a Consultant Surgeon who has received four international and three Sri Lankan awards for two decades of work on burn prevention. This is the fifth installment of a series of articles based on his Sinhala book 'Protect Your Child from Injury'. It contains sections taken from several WHO, World Bank and UNICEF publications and his own observations. It has been approved as a library book for schools.

For most children, water that is found in a stream, lake, waterfall and the sea, or that collects in the compound after rains is a toy. Is it possible that their attachment to water is the result of spending the first nine months of their life in the water in the mother's womb? The irony is that now we can not live even for three minutes submerged in water . Though serene in many areas except in rough seas and waterefalls, water takes the lives of 400,000 people every year globally. The majority who drown are children, i.e. 175,000, and young adults.

Drowning is the second leading cause of injury deaths in the world after road accidents. Over 90% of these deaths occur in low and middle income countries. In children under the age of 5 years, it is actually the leading cause. As our country is surrounded by sea and have many streams, wells and lakes, drowning is a common type of injury. The annual death toll for Sri Lanka is around 1050. It is several times the number dying of Dengue, but there is little agitation or work done on drowning prevention in our country. Please note that 'Life saving' that is referred to in news items is not drowning prevention, but only a facet of it.

'The Silent killer'

We know that in most potentially fatal accidents such as major road accidents and severe burns the victim shouts due to pain and the fear of imminent death, but it does not happen in drowning. This is because he tries to conserve all his energy and the diminishing amount of oxygen in the lungs to keep his head above water. So, one has to know that a person in water is in difficulty through other means. They are-

Waving the hands

Moving the heads and legs irregularly

Lying still with face down, or

Only the head is visible with open mouth

A very sad feature of this scourge is the fact that some drown while trying to save another from drowning. When seeing a friend in water in difficulty, others jump in to water on impulse to save him. On April 2004, five youths drowned in the 'Meedum ella' falls in Deniyaya. One had fallen in to water from a height and the other four had jumped to save him. The unfortunate result was that one death became five. All of them had also consumed alcohol earlier. The lesson to learn is that one should not jump in to water unless one can swim. Instead, a long pole or a rope should be used to get him out of water. Around 63% of those who drown are males, and this male preponderance is due to their natural risk taking behaviour, resentment of parental advice and alcohol consumption.

Consumption of alcohol:

Alcohol affects balance, coordination and judgment, and its activity rises when the person is in the sun. It has been found that 25% - 50% of young people who drown in pools, streams and the sea have consumed alcohol. Those who consume alcohol can drown even in one foot of water in canals and paddy fields. Everybody seems to know that driving after consuming alcohol can cause road accidents, but few are aware that alcohol can also promote drowning. In many places, the pool and the bar exist side by side!

The World Report on Child Injury Prevention published by the WHO and UNICEF in 2008 has this to say. "Drowning is a public health issue calling for worldwide attention. It is more serious than what the present statistics reveal. This problem, which has not received much attention till now deserves priority. High income countries like Australia and America have achieved a dramatic reduction of death rates in drowning. Their experiences would help other countries to do likewise". Many countries are now paying attention to this scourge. In 2010, the International Drowning Research Centre was established in Bangladesh. A World Conference on Drowning Prevention was held in Vietnam in 2011 where this writer got an opportunity to make a presentation. Another conference would be held later this year in Germany.

Sites of drowning:

These differ from country to county. A Sri Lanakan newspaper once reported that four children drowned by falling in o unprotected wells in February 2010. It is possible that the number of children who died during the last 20 year in this manner exceeds 600. This is a common accident in Sri Lanka, but sadly it does not seem to receive any attention except as a news item with no follow up by Police and Health Authorities to ensure that the owner puts up a protective wall around it. The Code of Criminal Procedure Act requires "wells to be fenced in such a manner as to prevent danger arising to the public". How come people are fined for allowing mosquito breeding, but not for allowing drowning? The majority of children who drown in unprotected wells are school children. Teachers should therefore pay special attention to this problem and collect data on such wells from their own pupils and send them to the local Police and the MOH. We normally get exited after the event. Action should be taken before the next tragedy occurs.

 (Part II will appear tomorrow)

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