Trauma Time

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Last day of cardiology call; starting trauma surgery tomorrow.

An article about South Africa's hosting of the 2010 World Cup made me think about the context of penetrating trauma. Johannesberg in particular is an infamous center for trauma research, and one of the most dangerous places in the world, prompting all the concerns about tourists visiting.

Looking around, it certainly seems that the risk of getting shot or stabbed is, ahem, not quite equal. The rates where I train are in the neighborhood of 20 per 100,000 or so, putting us outside the top 25 most dangerous cities in the US in favor of places like Detroit and Compton; on a country averaged rate, though, it puts us between Puerto Rico and Kasakhstan, which is not great. With a stated death rate from intentional trauma of 20, we get more than a gunshot wound a day on average (they do tend to come in groups).

Of course, it gets worse; South Africa has a rate of 38 per 100,000, as high as almost 50 in the last decade. Iraq wins--or loses, whichever. But that's an active war zone; the one that makes me wonder in this list is Jamaica, which people run off to all the time. Imagine if Apple tourism started selling getaway packages to Iraq.

These statistics face the same problems as any public health measure. Any country with a functioning public health system will do a better job of tracking statistics, and the statistics in Sierra Leone or Somalia are likely not quite reliable, whereas ours should be quite reliable. I'm guessing the rates in countries like Somalia, Angola, or Colombia are unreliable to say the least. I'm not sure how a country with no infrastructure deals with such a trauma load, except as depicted in the pictures linked above from Somalia.

According to the Boston Globe article with the photo above, Somalia has lost 17,000 civilians to trauma in the last 2.5 years, or 6,800 a year; if the population is counted right, that's a death rate of 680 a year from penetrating trauma. 680! Makes that picture above seem a bit more poignant. Makes me think I'll take trauma more seriously. Makes me happy I'm not in Somalia. Makes me just overall confused about the state of the world and what we're missing on a daily basis if we don't go looking for it. Imagine the apocolypse we would be filling our airwaves with if our penetrating trauma death rate was thirty times greater than it is now. And yet, it's happening. Just not here.

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