One Bullet Story: Zambia

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One Bullet Story One Bullet Story series series The Socio-economic Impacts of The Socio-economic Impacts of Firearm Violence in Firearm Violence in Lusaka, Zambia Lusaka, Zambia THERE IS NO CHEAP BULLET THERE IS NO CHEAP BULLET

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Copyright IPPNW 2007

Transcript of One Bullet Story: Zambia

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One Bullet Story One Bullet Story seriesseries

The Socio-economic Impacts The Socio-economic Impacts of Firearm Violence in of Firearm Violence in

Lusaka, ZambiaLusaka, Zambia

““THERE IS NO CHEAP BULLETTHERE IS NO CHEAP BULLET””

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Presented by:Presented by:

Dr Robert E MtongaDr Robert E Mtonga

International Physicians for International Physicians for thethe

Prevention Of Nuclear War, Prevention Of Nuclear War, IPPNW/ZambiaIPPNW/Zambia

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MAP OF ZAMBIAMAP OF ZAMBIA

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MAP OF AFRICA SHOWING MAP OF AFRICA SHOWING ZAMBIA`S LOCATIONZAMBIA`S LOCATION

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Firearms-related violence is Firearms-related violence is not considered as a public not considered as a public health issue in the same way health issue in the same way HIV/AIDS, Malaria, HIV/AIDS, Malaria, Tuberculosis, malnutrition, Tuberculosis, malnutrition, among others are. among others are.

In Zambia, this scourge is In Zambia, this scourge is discussed as a security and discussed as a security and criminal justice issue.criminal justice issue.

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The following “One The following “One Bullet Stories” of Bullet Stories” of gunshot victims at a gunshot victims at a Lusaka hospital Lusaka hospital prove that small prove that small arms arms areare a public a public health threat in health threat in Zambia.Zambia.

The medical The medical community needs to community needs to become involved to become involved to help stop the help stop the injuries and deaths.injuries and deaths.

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Surgical visits to the University Surgical visits to the University Teaching Hospital in LusakaTeaching Hospital in Lusaka

The UTH has five general surgical wards &The UTH has five general surgical wards &

7 surgical subspecialties. 7 surgical subspecialties. Cases profiled give a flavour and extent of Cases profiled give a flavour and extent of

the problem (1998-2002).the problem (1998-2002). UTH sees about 1/3 of gunshot incidents UTH sees about 1/3 of gunshot incidents

Lusaka.Lusaka. Some cases are not admitted to the wards.Some cases are not admitted to the wards. Other gunshot injuries seen in private Other gunshot injuries seen in private

health units.health units.

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SOME ILLUSTRATIVE CASESSOME ILLUSTRATIVE CASESCase#1Case#1

Male/13 Years, sustained gun shot Male/13 Years, sustained gun shot wounds to the face. wounds to the face.

AK47 used in felony-from DRC (police)AK47 used in felony-from DRC (police) Reconstructive surgery, a tracheotomy, Reconstructive surgery, a tracheotomy,

gastrostomy, 3 units of blood, intensive gastrostomy, 3 units of blood, intensive care unit ventilatory support.care unit ventilatory support.

Spent 14 days in hospital.Spent 14 days in hospital. Needed 16 weeks follow-up.Needed 16 weeks follow-up. Cost health care system US$ 3000.Cost health care system US$ 3000.

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Case # 2Case # 2 Male/33, sustained multiple bowelMale/33, sustained multiple bowel perforations from gun shot injuries.perforations from gun shot injuries.

Needed a laparotomy to repair the Needed a laparotomy to repair the bowels.bowels.

Developed complications along the way.Developed complications along the way.

Discharged from hospital after 27 days.Discharged from hospital after 27 days.

Cost the health system around US Cost the health system around US $2000.$2000.

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Case #3Case #3

Male 7/years, with skull bullet Male 7/years, with skull bullet injuries, sustaining brain herniation.injuries, sustaining brain herniation.

Took over 3 hours theatre time, Took over 3 hours theatre time, resuscitation, removal of damaged resuscitation, removal of damaged bone and skin chips. Bandaged and bone and skin chips. Bandaged and taken to the intensive care unit.taken to the intensive care unit.

Died same day.Died same day.

Cost hospital US $1000.Cost hospital US $1000.

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Case #4Case #4

Female/13 years, with multiple Female/13 years, with multiple intra-abdominal gun shot intra-abdominal gun shot injuries.injuries.

Need laparotomy to repair the Need laparotomy to repair the large bowels and kidney.large bowels and kidney.

Died one day later from Died one day later from haemorrhaging.haemorrhaging.

Cost hospital US $1200. Cost hospital US $1200.

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Case # 5Case # 5

Male/19, shot in the abdomen, Male/19, shot in the abdomen, sustained injuries to the urinary sustained injuries to the urinary bladder, liver, stomach and large colon.bladder, liver, stomach and large colon.

Needed a laparotomy to repair the Needed a laparotomy to repair the damaged organs, lasting over 2 hours, damaged organs, lasting over 2 hours, stayed 7 days in hospital.stayed 7 days in hospital.

This visit cost the hospital about This visit cost the hospital about US$ 1500,excluding secondary costs US$ 1500,excluding secondary costs

such visits from relatives and friends, such visits from relatives and friends, lost productivity, psychological trauma lost productivity, psychological trauma etc.etc.

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Case #6Case #6

Female/2 years 6 months old, Female/2 years 6 months old, shot in the knee with damage to shot in the knee with damage to the vasculature.the vasculature.

Needed exploration of the wound Needed exploration of the wound and ligation of the bleeders.and ligation of the bleeders.

Spent 8 days in hospital.Spent 8 days in hospital.Cost the health care system Cost the health care system

about US$ 700.about US$ 700.

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Contextual Issues Contextual Issues

Huge Burden of Preventable Diseases and DeathHuge Burden of Preventable Diseases and Death High incidence and prevalence of HIV/AIDS with High incidence and prevalence of HIV/AIDS with

opportunistic infections such as TB, diarrhoeal opportunistic infections such as TB, diarrhoeal diseases etc.diseases etc.

High malaria incidence & resistance of Plasmodium High malaria incidence & resistance of Plasmodium to the cheaper drug chloroquine.to the cheaper drug chloroquine.

Rising cases of Non-communicable diseases.Rising cases of Non-communicable diseases. Inadequate resources to finance health service Inadequate resources to finance health service

provision. This gives rise to: provision. This gives rise to: Erratic supply of drugs and other supplies.Erratic supply of drugs and other supplies. Dilapidated infrastructure and equipmentDilapidated infrastructure and equipment

Lack of health facilities to undertake specialised Lack of health facilities to undertake specialised treatment in the country.treatment in the country.

High attrition rates among the core health workers in High attrition rates among the core health workers in the public sector.the public sector.

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The Resource EnvelopeThe Resource Envelope

The WHO Commission on Macroeconomics has The WHO Commission on Macroeconomics has estimated that Zambia needs a per capita estimated that Zambia needs a per capita expenditure of $33 in order to deliver the expenditure of $33 in order to deliver the Basic Health Care Package. Basic Health Care Package.

From 2000 to 2004, the per capita expenditure From 2000 to 2004, the per capita expenditure on health has only averaged $18 inclusive of on health has only averaged $18 inclusive of public & and private expenditure.public & and private expenditure.

Provision of public health services at primary Provision of public health services at primary & secondary level require at least $12 per & secondary level require at least $12 per capita.capita.

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The Resource EnvelopeThe Resource Envelope

This is exclusive of the following costsThis is exclusive of the following costs Tertiary level careTertiary level care Co-artem as the first line drug for malaria;Co-artem as the first line drug for malaria; HIV/AIDS interventions (VCT, PMTCT, ART)HIV/AIDS interventions (VCT, PMTCT, ART) Residual indoor spraying for malaria;Residual indoor spraying for malaria; DPT+ Hib vaccinesDPT+ Hib vaccines

Currently these are supported throughCurrently these are supported through Global FundsGlobal Funds Multilateral organizationsMultilateral organizations PepfarPepfar

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One Bullet is Too CostlyOne Bullet is Too Costly

The costs of direct health costs are The costs of direct health costs are truly enormous.truly enormous.

Zambia’s health budget is USD Zambia’s health budget is USD $18/person/year$18/person/year

The costs of gun violence are varied:The costs of gun violence are varied:* * Physical costsPhysical costs - disability, - disability,

eyesight loss. eyesight loss. * * Social costsSocial costs, i.e. dependence, , i.e. dependence,

identity crisis arising from changed identity crisis arising from changed statusstatus

* * Economic costsEconomic costs - arising from - arising from medical costs, mental health costs medical costs, mental health costs quality of life costs among other quality of life costs among other things.things.

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FURTHER COSTSFURTHER COSTS

Hiring of security agents for Hiring of security agents for protection of persons and protection of persons and property arising from fear of property arising from fear of being attacked by armed being attacked by armed elements.elements.

Erection of perimeter walls around Erection of perimeter walls around premises.premises.

Creation of a culture of violence.Creation of a culture of violence.Scaring off investors.Scaring off investors.Increased policing costs.Increased policing costs.

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ONE CONCLUSIONONE CONCLUSION

Medical community - Get Involved! Medical community - Get Involved!

Help:Help: Stop One Bullet From Being Fired. Stop One Bullet From Being Fired. Join The Call For An Arms Trade Treaty.Join The Call For An Arms Trade Treaty. Support The Implementation Of The Support The Implementation Of The

SADC Protocol.SADC Protocol. Support Stricter National Gun Laws.Support Stricter National Gun Laws. Educate Colleagues About The Urgent Educate Colleagues About The Urgent

Need To Stop Gun ViolenceNeed To Stop Gun Violence..