The need for public health interventions to prevent head and other
injuries
Dr. Hemamal Jayawardena
HEALTH STANDARDS: The standards of health in Sri Lanka
measured by any conventional guideline is very satisfactory. The rates
of infant mortality at 14 per 1000 live births, and an expectation of
life at birth of 73 years are indicators any developing county can be
proud of. However, the existence of high levels of malnutrition, in
spite of being a socialist democratic State and an increased incidents
of traumatic injuries, both of which are easily preventable is
disappointing.
The government's initiatives and attempts to avert malnutrition such
as through school health programmes is commendable. All governments that
come to power within the next 10-15 years should keep their obligation
towards prevention of malnutrition among children and should continue
with efficient and effective nutritional programmes for children. State
support should always go into such programmes, especially as 25% of our
population live below the poverty line.
Leaving nutrition to be taken care of by existing promrammes, today I
focus on the need for Sri Lanka to have a comprehensive multi-sectoral
public health programme towards preventing of injuries. I also take this
opportunity to inform the public on some aspects of injuries that are
most damaging - head injuries.
Traumatic injuries were the leading causes of hospitalization in Sri
Lanka in 2002. They are usually the result of intentional and non
intentional violence. Non intentional injuries are mostly accidental and
road traffic accidents, burns, industrial accidents, falls from heights,
sports injuries, war injuries and electrical injuries are some common
examples. Intentional injuries follow assault, attempted homicide and
attempted suicide.
While the public health directorate of the central Ministry of Health
should take the leadership in the comprehensive multi-sectoral public
health programme, there should be close links with other partners.
These include the Provincial Ministries of Health, World Health
Organization, accident and emergency services, the judicial medical
services, the traffic police, schools, NGOs involved in law and society
as well as the legislature. The role of legislators with vision and
intelligence is especially important (e.g. to implement a obligatory
bicycle helmet law) for any public health strategy.
Leading five causes of Hospitalization in 2002.
Causes of Hospitalization Rate (%)
1. Traumatic injuries 14.5
2. Diseases of the respiratory system excluding diseases of upper
respiratory tract, pneumonia and influenza 9.7
3. Viral diseases 6.4
4. Symptoms, signs and abnormal clinical and laboratory findings 6.3
5. Diseases of the gastro-intestinal tract 5.5
Source: Samarage, Ministry of Health
Most of the deaths following injuries are due to trauma on the head.
Fractures of the skull and crushing of the brain as well as bleeding
inside the confined space within the skull causing compression of the
brain often cause death. There are times when a person dies due to
aspiration of blood while he or she is concussed following head injury.
As with many health problems, the best way to protect oneself from
head injuries is to prevent them from happening in the first place.
The public can do many things to minimize head injuries. Wearing a
seat belt when driving or travelling in a motor vehicle, buckling
children in safety seats and stop driving after consuming alcohol or
other medicines that cause drowsiness are effective.
Some of the deadly head injuries I have investigated as a
practitioner of forensic medicine, have been of push bicyclists. Many of
them could have saved their lives if they wore a helmet. But we have no
culture in Sri Lanka of cyclists wearing helmets. I do not think that
there are many manufacturers or importers of cyclist helmets (which are
much lighter than motor cycle helmets) in Sri Lanka. it is up to the
legislators to introduce this practice by making cycle helmet as well as
to give incentives to local manufacturers.
Many people sustain injuries by falls at home, office or public
places. Using a long grabbing tool to reach objects on high shelves,
rather than climbing on unstable chairs, installing handrails on
stairways, using safety gates at the top and bottom of staircases when
young children are around, removing tripping hazards such as small rugs
and loose electrical cords out of the way, putting grab bars in
bathrooms where elders bathe, getting your eyes checked and wearing
correct glasses if necessary, are simple ways of avoiding falls.
If a person you know has knocked his or her head somewhere and has no
pain or other complaints, it is often not a case to worry.
However, if there is persistent headaches or neck pain, trouble with
such mental tasks as remembering, concentrating, or decision making,
slow thinking, speaking, acting or reading, getting lost or easily
confused, mood changes, feeling light-headed, dizzy, or losing balance,
having an urge to vomit, having an increased sensitivity to lights,
sounds, or distractions, having blurred vision or ringing in the ears,
it is advisable to see a doctor.
(The writer is Attorney-at-Law, Fellow, Harvard School of Public
Health, Boston.) |