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Southern Africa report
  1. David Bass
  1. Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch 7700, South Africa

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One aspects of paediatric trauma medicine that really appealed to me when I entered this field just over 10 years ago, was the challenge of non-operative management of blunt injuries. Like most colleagues, I certainly have no deep aversion to the blood spattered, adrenaline rich milieu of emergency surgery, but when working in adult trauma units, I had found the endless routine of operating on victims of gunshots and knife attacks both predictable and depressing. At Red Cross Children's Hospital, my happy experience has been to deal mostly with blunt injuries, usually the result of falls or traffic collisions, and where clinical diagnostic ability and the art of multidisciplinary management are more important than speed or manual dexterity. In recent weeks and in spite of government efforts to control handgun ownership (as outlined in my last report), I have had no choice but to dust off my scalpel, don the bloodproof apparel known as “universal precautions”, and spend long hours in the operating room repairing the ugly damage caused by flying bullets—always uglier when it lacerates the flesh of young children. In preparation for this summer holiday season, I have restocked my unit with large bore chest drain catheters, high flow intravenous infusion sets, instrument packs for resuscitative thoracotomy, and an autotransfusion device—all of which I thought I'd left behind years ago at the adult hospitals where knife and gunshot wounds are pretty much stock-in-trade. With heavy hearts, my staff and I roll out the red carpet for a new problem in the field of childhood injury—while prevention initiatives still struggle to make an impression on the old ones.

The official South African figures for road traffic injury in 1997 are horrifying: 517 669 collisions, 22 757 serious injuries, and 5146 deaths. Against this doom and gloom, the “Arrive Alive” traffic safety campaign launched countrywide throughout South Africa two months ago looks to be one that means business. In the course of regular weekend “blitzes” in the Western Cape alone, 87 000 motorists have been fined for a variety of misdemeanours, and the number fined for driving under the influence of alcohol (total = 887) has dropped dramatically. Although 9508 fines were handed out in the same period for failure to wear seatbelts, there has not been a single conviction for failure to restrain children, most likely because South African laws governing use of child restraints are too anaemic to be worth enforcing. CAPFSA hopes to make a worthwhile contribution to child passenger safety in 1998 by launching a long overdue child restraint loan scheme based in Cape Town. In reaching this point, our sincere thanks go out to all our sister organisations who inundated us with invaluable literature accumulated in the course of setting up similar schemes in their own centres.

Lastly, Victor Nel and colleagues at the University of South Africa are to be congratulated for convening the successful SAFECOMM6 meeting at Eldorado Park in October 1997. The African continent in particular was well represented in terms of delegates and subject matter, as befits a meeting entitled “Consolidating communities against violence”.

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