• By Dartington SRU
  • Posted on Tuesday 16th February, 2010

Where a creche may halt a hidden "epidemic"

Some perpetual threats to child well-being are so fundamental that they seem to symbolize the wider range of difficulties encountered by a young prevention science as it seeks to make itself universally useful.In Australia a long hot summer is coming to an end, having claimed over 70 lives since Christmas Eve as a result of drowning accidents.The Sydney Morning Herald regards the death toll in rivers, lakes, swimming pools and surf as a significant national tragedy. But it is very ready to acknowledge how minor it must seem to neighboring countries in the tsunami zone.The Herald goes on to cite alarming UNICEF-funded research published by The Alliance for Safe Children which suggests that as many as 350,000 children drown in Asia every year irrespective of any natural disaster.The Alliance describes the losses as a hidden epidemic – for the want of any useful epidemiology: "It shows," writes Herald correspondent Justin Scarr, "that in a developing country a child who drowns rarely makes it to hospital, almost never gets rescued and is likely loved but farewelled long before government or the UN gets to know. And, in the world of foreign aid and public health, numbers count."He goes on to describe the cultural and environmental differences that apply depending on where along the borders of the Indian ocean children live. Australian life savers might assume that people drown while taking unnecessary risks, swimming where they shouldn't, or ignoring warnings, lifeguards, whistles, signs and other enforcements. But in rural Asia, drowning is an everyday hazard. "Families have houses that are surrounded by open waterways, rice paddies, fish ponds for food not fun, wells, troughs for the livestock that live in their compounds, and streams that turn into torrents with the rains that come frequently.""There are very few backyard pools in Asia," Scarr says. "Thousands and thousands of children don't get the chance to learn how to protect themselves in water. Children are drowning in everything from rivers, lakes and ponds to wells and even cooking pots."The story coincides with an announcement by Royal Life Saving and the Australian Government's Agency for International Development, AusAID, that it is to establish the region's first international drowning research center in Bangladesh. The Australian government is contributing $756,000 over three years.Scarr is Royal Life Saving's Chief Operating Officer. With partners in Bangladesh, Vietnam and Thailand, his charity is testing survival swimming lessons. They are delivered in rural villages where – critically – there are no pools, and by local lifesavers working in the absence of any swimming club. "There is little point telling parents in Asia to watch their children when culture and circumstance has them on hips or the floor while mum, grandma, or sister is busy, cooking, cleaning, tending to cattle, reaping rice and everything else their day entails," Scarr explains."While stronger infrastructure, more stable households and improved health systems may eventually change some of this, we have introduced other safety strategies."So in Bangladesh, effective drowning prevention has turned to be closely connected with improvements in day care. Or it might be argued that improvements in day care are having a significant, predictable effect on deaths by drowning. "Establishing a creche or day care center in the village, as well as home safety programs such as putting infants and one-year-olds in playpens, is making a huge difference," Scarr says. "Research found that young children most frequently drown between the busy hours of 9am and 1pm. So by creating a small system of child care in each village, we are not only protecting children during the high risk hours, but also give a local woman a job, a family an income, children an education and all those mothers of the 'terrible twos' some more time."Perhaps the most frightening experience that I have had while in Bangladesh was a social autopsy into the drowning of a seven-year-old girl. A social autopsy is a cold term that is essentially a small coronial-style investigation but delivered in the context of the child's village. "Mother, father, siblings and the girl's friends were all interviewed by a trained facilitator in front of the village of several hundreds of people. After many minutes of screams, and muffled cries, the mood changes to resolve and community leaders begin to commit to change things: swimming lessons, fencing, better supervision, rescue and resuscitation training. It all sounds very familiar."See also from 2007: For a prevention strategy, why look further than the poolside fence?

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