An epidemic of trauma is killing South Africans and draining health resources at a rate second only to AIDS. And violence and alcohol are the main culprits.

Trauma – unnatural deaths due to external and preventable causes  is thought to be the second biggest killer of people under 50 in South Africa.

South Africa also holds the dubious distinction of having the third highest number of deaths from trauma of any country in the world.

But the structures and budget to make trauma a priority public health issue within the Department of Health are still not in place, says Dr Frank Plani, Vice-President of the South African Trauma Society.

“Approximately 60 000 people die from trauma in South Africa each year. And a staggering 2,5 to 3 million people get treated for injuries annually in South Africa,” says Dr Margie Peden of the Medical Research Council.

The drain on public health resources is enormous. Trauma patients require intensive hospital care and expensive and multiple orthopaedic or surgical procedures.

The Medical Research Council has estimated the cost of traffic collisions at R45 million per day. The cost of interpersonal violence is about three times this amount.

According to Dr Andrew Nicol, Head of Groote Schuur’s trauma unit in Cape Town, more than half of all the surgery conducted at Groote Schuur is trauma-related. Surgery on the victims of gun-shot injury, in particular, has become commonplace.

“In the early 80s, gunshot injuries were rare. Now, it’s 60% of trauma surgery,” says Nicol.

And the cases seen at Groote Schuur are just the tip of the iceberg. In the Western Cape, it is estimated that one in every ten people undergoes medical treatment for trauma each year, says Nicol.

But if public hospitals like Groote Schuur are being swamped by an epidemic of trauma, the answer to the problem is not more money for treatment and surgery.

What we need, say the experts, is prevention rather than cure. This is especially with regard to violence, which is the leading cause of trauma in eight out of nine provinces.

“Violence is not just a criminal justice problem. It should be seen as a public health problem. Yet few government resources are put into trauma prevention,” says Nicol.

Until trauma is seen as a public health disease by the Department of Health, resources for monitoring, prevention and education will remain inadequate, agrees Plani.

There is no directorate dedicated to the prevention of physical trauma in the South African Department of Health. The prevention of interpersonal violence, as well as the prevention of substance abuse, falls to the Mental Health and Substance-Abuse Directorate within the Department of Health.

In countries like the United States, where trauma is considered to be a priority public health concern, violence, alcohol, and drug abuse are seen as educational issues from primary school level upwards.

According to Dr Zodidi Tshotsho, Deputy-Director of the Mental Health and Substance-abuse Directorate, pilot projects to promote conflict-management skills in school pupils have now started in three provinces in collaboration with the Department of Education.

But it is easier to give people information and skills than to modify their environment. Alex Butchart from the UNISA Institute for Social and Health Sciences argues that social violence and alcohol-abuse will only diminish if education is accompanied by socio-economic development.

“Education alone won’t do a great deal since the main risk factors are structural  lack of housing, electricity, employment. By itself, education is a waste of time,” says Butchart.

Butchart’s point is born out by the fact that the highest levels of homicide are seen in countries with the lowest Gross National Product. He says that more murders result from social violence between acquaintances who are often drunk, than from premeditated criminal violence.

MRC research conducted in 1999 shows that a staggering 71% of victims of violence and 50% of patients injured in traffic collisions had positive alcohol levels.

Alcohol plays a major role – not just in interpersonal violence  but in all forms of trauma, including accidents and drownings, in South Africa. According to Nicol, 60% of all trauma patients seen at Groote Schuur are under the influence of alcohol.

“I believe that alcohol on a wider scale is a lot more dangerous to many more people than cigarettes,” says Prof Deon Knobel, Head of the Department of Forensic Medicine at UCT.

“Tobacco is evil, but it doesn’t cause murders, road deaths, family violence and all the other problems associated with alcohol,” agrees Frank Kahn, head of the Central Drug Authority (CDA).

Passing laws to ban tobacco is hypocritical if alcohol manufactures are given free rein to promote their products, Kahn is reported by the Cape Times to have said recently (2 Nov 2000).

Kahn also said that the CDA would advise the government to stop “dragging its heels” when it came to tackling the country’s widespread alcohol problems.

Ironically, the good news is that excessive levels of trauma in South Africa have meant that trauma surgeons trained in South Africa’s public hospitals are among the best in the world. -Health-e News.