A FEW years back, I paid a visit to the Spinal Rehab Unit at Natalspruit Hospital in Gauteng. I had an uncle whose spinal injury had made him a quadriplegic, so I felt a personal interest in their work.
I was struck by the youth and wonderfully muscular bodies of many of the men working out on parallel bars, and I asked the physiotherapist in charge what the commonest cause of spinal injury was.
Her answer echoed earlier research done at Natalspruit, which had found that “Gunshot injuries were the commonest (36%), followed by injuries related to motor vehicle accidents (MVA) (25%), stab wounds (20%)...”. (Epidemiology of spinal cord injuries: a reflection of changes in South African society, Hart C, Williams E Paraplegia. 1994 Nov;32(11):709-14.)
Most of the patients in the unit were between the ages of 20 and 30, and these young men had a poor prognosis: the unit would rehabilitate them, bring them to a state of fitness and functioning that should promise a productive life, but once released back into the community, they had a high chance of dying within a few years.
This reflects the lack of access to care after release, and the poverty within the community; my uncle lived 40 productive years after his injury.
In the early 2000s, D Allard and V Burch wrote: “Firearms, the leading external cause of non-natural deaths in South Africa (SA), claim approximately 15 000 lives annually.
"Up to 127 000 firearm-injured victims seek state health care assistance per annum. The fiscal burden of treating these injuries is not known.” (The cost of treating serious abdominal firearm-related injuries in South Africa, D Allard and VC Burch).
I wondered what is the cost to society of a gunshot injury. Allard and Burch looked at “all patients who underwent emergency surgery for a firearm-related abdominal injury, during the six-month period 01 October 2002 to 30 April 2003...”
On average, each gunshot wound treated in a state hospital cost more than R10 200, a figure which back then was thirteen times the annual per capita spend on health by the state. (And of course, this relates only to injuries to the abdomen. My guess is that such injuries would be messy and reasonably complicated to treat.)
But that doesn’t include the domino costs of ongoing medical treatment, work-loss costs and public services rendered to patients after the initial treatment.
In 1997, a study looked at the total costs of gunshot injuries in the USA, what you might call cost-to-nation. (Costs of gunshot and cut/stab wounds in the United States, Miller TR, Cohen MA, Accid Anal Prev. May 1997.)
It found a vast difference between the consequences of gunshot and stab wounds: “In 1992, gunshots killed 37 776 Americans; cut/stab wounds killed 4095. Another 134 000 gunshot survivors and 3 100 000 cut/stab wound survivors received medical treatment.
"Annually, gunshot wounds cost an estimated US$126 billion. Cut/stab wounds cost another US$51 billion”.
Interesting to note that South Africans die of gunshots at a much higher rate than Americans – compare 15 000 deaths in a population of just under 50 million with 37 000 in a population of just under 300 million at that time.
“Treatment costs for GSWs (gunshot wounds)are higher than those for SWs (stab wounds) and are rising more rapidly, with an increasing amount of public funds going to meet these costs.
"Considerable savings to society would accrue from any effort that decreased firearm injuries, even if the same level of violence persisted using other weapons,” wrote C Mock et al in 1994 (Comparison of the costs of acute treatment for gunshot and stab wounds, Journal of Trauma, April 1994).
By August 2011, about 2.9 million firearms were registered to around 1.5 million civilians at South Africa’s Central Firearms Registry. (The figures were down quite significantly from 17 years earlier, when 2.4 million civilians owned 3.5 million licensed firearms.)
And who knows how many unlicensed firearms there are? Some sources guess as many as four million.
Interestingly, since the Firearms Control Act was promulgated in 2000, there have been significant reductions in deaths from gunshot: in 2002, 29% of unnatural deaths in South Africa were from gunshots, topping the table, while 14.5% were from stab wounds.
By 2008, the latest year for which these data were available, the situation had reversed: 13.6% of deaths were the result of stab wounds, while gunshots accounted for just 10.8%.
And the number of women who died by being shot by their intimate partners – an idea which is very much top-of-mind at present – had halved.
If that’s the result of control over licensed guns, what would be the impact of a serious, concerted effort to control all guns?
To do this, of course, we’d have to transform our police force; we’d also have to look hard at how to reduce alcohol abuse (about 57% of gun homicides involve alcohol); and we’d have to engage civil society as an integral part of the campaign.
But think of how many millions of rand we could save our public health service if we reduced the level of gunshot injuries by half again. How much money could we free up for other urgent needs?
And, with the anguish of a grieving family very much in mind, how much pain and suffering could we prevent?
*Mandi Smallhorne is a versatile journalist and editor.
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