|It's important to teach children how to swim: Picture shows swimming sessions in Bangladesh (courtesy WHO)
Drowning is the second leading cause of accidental deaths in the world, next to road accidents. Out of the 3.55 million annual global deaths from accidents, drowning accounts for 390,000 and over 90% of these deaths occur in low and middle income countries.
A child drowns every minute in the world, and drowning is the main cause of death from accidents in children under 5. “Drowning is a public health issue calling for worldwide attention”, state the WHO and UNICEF. “This relatively neglected injury problem should be given much higher priority."
Drowning is generally considered to be a ‘silent death’ for a person who is about to drown is unable to shout for help because he tries to save all his energy and the decreasing amount of oxygen in the lungs to keep his head above water. When water enters his air passage, he cannot shout anyway. Therefore the onlookers have a bigger responsibility than in the case of other injuries.
In low and middle income countries, most drowning deaths occur in natural bodies of water like streams, tanks and the sea while in rich countries many deaths occur in swimming pools.
An infant can drown in just two inches of water in a basin when left unattended. A toddler who crawls towards an unprotected well sees his own reflection in the water and may try to touch it; what happens next is easy to imagine. Having a well in your compound increases the risks of a child drowning sevenfold. According to four recent news items, four children had fallen into unprotected wells in February last year and three died. More than 800 children would have died in that fashion during the last 20 years, but enough action has not been taken to prevent such tragedies. The Code of Criminal Procedure Act requires wells to be fenced “to prevent danger to the public”, and failure to do so is punishable in a court of law. The police and the MOHs should take action.
There is a higher incidence of drowning among young men in open bodies of water due to their natural ‘risk-taking behaviour’ and alcohol consumption. Alcohol influences balance, coordination and judgment, and its effects are heightened by exposure to heat and sun. Alcohol accounts for many drowning deaths though most people do not seem to know that.
Deadly rip currents:
Unknown to most people who go to the beach, deadly rip currents occur causing many drowning deaths. After the waves break, the massive amount of water that is carried by them has to return to the sea. When it meets the next wave, this water then flows sideways through the surf until it finds an exit back to the sea. The resulting rip current is narrow and located in deeper areas between sandbars. Some refer to them as ‘rivers in the sea’. Unlike the waves, these areas appear calm and give the illusion that they are the safer areas. This lures the bathers to these areas and it is like ‘stepping on to a fast moving treadmill’. They can carry a person 200 feet offshore in one minute. Even a person standing waist deep close to the shore would not be safe. It is impossible to swim against them, and the swimmer would get exhausted and drown. Fortunately the rips do not push a person under water. The thing to do is to swim sideways, and a wave may then bring him back to the surf. Everyone who goes to the beach should be aware of them.
A significant number of Sri Lankans drown in the sea. Recently while at Hikkaduwa beach, I was dismayed to note that there were neither life savers, nor rescue equipment, nor notices to indicate safe and unsafe places for bathing. It must be so in other beaches too except in a few popular beaches like Mount Lavinia and Negombo. The local authorities should make a note of it.
The global incidence of ‘near drowning’ is between two - three million a year. When persons who are about to drown are saved, the outcome varies. Those who are alert on admission to hospital usually recover. If they are confused or comatose, 30% of them die and 15% end up with severe neurological deficiencies.
Those who receive immediate first aid, i.e. the Kiss of life (Cardio Pulmonary Resuscitation - CPR) from bystanders before trained people arrive do better. So the message is - we all should know how to give CPR. It would be great if TV channels demonstrate the steps. Without such first aid, subsequent ‘advanced life support’ in a hospital can be of no use as what arrives in the hospital may be a dead body!
Another important lesson is “do not to jump into the water to save a friend unless you can swim”. Those who can swim should of course, attempt to bring a drowning person out of water. One should approach the person from behind and twist the arm behind his body to prevent him clinging to one’s neck, and bring him to the land with his head raised above the water. Those who cannot swim should throw a rope or use a stick- such items should be kept near popular bathing spots. Ropes attached to floating devices at one end and to a drum that could be turned with a handle at the other end are much better. They are the equivalent of life jackets that seafaring vessels and planes carry.
Swimming and water safety education protect children from drowning and prepare them for safe aquatic recreational activities. As even skilled swimmers can drown, supervision at all levels is important. Parents who take children to swimming pools and other open bodies of water should supervise them very closely. How often do fathers sip beer and mothers chat with friends while their small kids are playing in a swimming pool? It is good to give the kids floating devices too.
Prevention of drowning should be based on the following principles-
Prevent the unexpected fall into water, such as into unprotected wells, from dilapidated bridges and from overloaded boats, ferries etc.
Avoid drowning in instances when boats and ferries capsize by wearing life jackets
Protect those who intentionally get into water, by warning them about unsafe bathing spots and alcohol use, and through rescue equipment.
Rescue those who get into difficulty while in water.
After rescuing them, give first aid when indicated and send them to hospital.
The following specific strategies that are used in other countries for drowning prevention should be used in Sri Lanka-
1. Remove the hazards
Draining unnecessary accumulation of water in bath tubs, barrels etc
Prohibit bathing in unsafe areas
2. Create barriers
Fence off swimming pools, wells and ditches
3. Protect those at risk
Educating parents about supervision
Teaching the public how to rescue others
Keep rescue equipment in beaches
Wear life jackets when travelling in boats
4. Increase community awareness
Legislating against drinking near bodies of water
Identifying the hazards
Developing safety plans for floods and tsunamis
Using safety flags in beaches
5 Counter the damage
Cardio Pulmonary Resuscitation (CPR) training. If the person has stopped breathing, immediate first aid by bystanders in the form of mouth to mouth respiration (‘kiss of life’) is critically important.
Swimming training: It is now universally accepted that the ability to swim helps to avoid drowning. Many countries are paying special attention to swimming training. In Vietnam portable fibreglass pools are used while in Bangladesh innovative methods, such as bamboo fencing in ponds, are used. In schools with swimming pools, authorities should ensure that every single child gets proper swimming training before leaving school.
However attractive a large body of water like a lake or a river is, always remember to take care. No alcohol before that dip in the sea, river or pool, and no jumping into water on impulse to save a friend if you can't swim!
The writer is a surgeon who is a member of the National Committee for Prevention of Injuries. He made a presentation at the World Conference on Drowning Prevention held in Danang, Vietnam recently. Those interested in forming a NGO to prevent drowning are welcome to contact the writer. (firstname.lastname@example.org)