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Thoughts from Southern Africa
  1. David Bass
  1. Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch 7700, South Africa (Tel: +27-21-658 5199, fax: +27-21-689 1287, e-mail: daveb{at}

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    What are the elements which are truly indispensable to the philosophy and practice of child safety? Research? Academic debate? Funding, perhaps? If our window on the world is framed by a higher education in health related disciplines, the contents of peer review journals, the occasional scientific meeting and an unfailing adherence to Haddon's matrix, then the above mentioned elements will most probably rate highly among our list of priorities. If so, we may be guilty of two assumptions—firstly, that academic health care is immortal, and secondly, that the concept and practice of injury prevention will survive as long as the towers of learning remain intact. In Africa today, both assumptions are groundless.

    With utmost respect to the wide spectrum of disciplines that contribute to the promulgation and execution of safety programmes throughout the world, it is more than coincidence that many of the pioneers in this field were (some still are) prominent figures in clinical medicine: Hugh Jackson, Alastair McKellar, Sid Cywes, and J Alex Haller are just some who immediately come to mind. Clinicians faced with the unpleasant duty of dealing with the casualties of an unsafe society will predictably strive for a change to the status quo, as the four personalities quoted above did with distinction. In the developed world, there are many committed health care professionals who have followed and will follow this path with the necessary zeal and selflessness (because child safety offers unique rewards, but it certainly does not pay the rent!). In Africa, the changing pattern of medical training and practice as well as the collapse of vital infrastructures (law enforcement and municipal services in particular) are unlikely to foster such enthusiasm for injury prevention when the energy required on the one hand, and the financial rewards on the other, are vastly disproportional to one another.

    It is sad to think that the survival of injury prevention on the African continent may soon depend on it being adopted by one of those agencies based in the First World, but for the efforts of whom vaccination programmes, food relief, and basic health education would also be non-existent.