Road traffic accidents may potentially lose their top spot as the leading cause of accidental death in Sri Lanka – with death by drowning taking its place.
Minister of Youth and Sports of Sri Lanka Namal Rajapaksa stated at a recent event that “drowning is the leading cause of accidental death” in Sri Lanka and went on to share that it would be advisable for people to learn how to swim.
However, Ministry of Health Directorate of Non-Communicable Diseases Consultant Community Physician and National Programme Manager (Injury Prevention and Management) Samitha Siritunga shared that while drowning was certainly one of the leading causes of accidental death, it was unlikely to surpass deaths caused by motor traffic accidents, adding that the past two years were abnormal indicators considering that they were outliers due to the pandemic and island-wide lockdowns.
He shared however that introducing a water safety culture was crucial in the country, further stating that there was a necessity to educate the public on water safety, while also establishing barriers and improving swimming skills, and other elements like rescue and resuscitation training, etc.
WHO World Congress on Drowning defines drowning as “the process of experiencing respiratory impairment from submersion/ immersion in liquid”. Deaths following drowning number around 372,000 per year worldwide and drowning is considered a serious and neglected public health issue.
State of drowning in Sri Lanka
The Department of Forensic Medicine, Faculty of Medicine, University of Kelaniya, in a research conducted on deaths following drowning in Sri Lanka, shared that there had been “no significant efforts taken to prevent drowning in comparison to the preventative mechanisms adopted for Non-Communicable Diseases”.
The research further provided that, while most drowning victims belonged to the age group of 21-60 years, the majority of deaths, at 37.3%, were within the ages of 11-30 years. They also identified that among the biggest possible contributory factors for drowning, environmental factors scored 41% and alcohol consumption 20%.
The research stated that people in Sri Lanka, especially those from small villages, had access to natural water pools or irrigation tanks which they used for their daily needs, including entertainment. Most people have their own well which may be protected or unprotected. In some villages, people cross water canals on wooden blocks without adequate protection or use a wooden stage (paruwa) for transport along waterways. Due to heavy rain in the central hill country, water levels may suddenly rise in the lower regions without warning.
Even though some beaches have warning signs with graded risk, irrigation tanks do not have the same. Sometimes without knowing the actual depths, children and adults drown being poor swimmers, especially in irrigation tanks and at sea. Lifeguards are available only on a few beaches. One conclusion is that drowning is not only a public health issue but also a socioeconomic development challenge.
Once someone starts to drown, the outcome is often fatal. Unlike other injuries, survival in the case of drowning is determined almost exclusively at the scene of the incident and depends on two highly-variable factors – one is how quickly the person is removed from the water and the other is how swiftly proper resuscitation is performed.
The research also indicates that an overwhelming majority of drownings happen in low and middle-income countries where people have close daily contact with water for work, transport and agriculture.
Measures for prevention
A regional assessment on drowning prevention released by the World Health Organisation (WHO) warns that climate change, to which the Asia Pacific region is particularly vulnerable, places already-vulnerable communities and individuals at increased drowning risk. More frequent and extreme weather events can lead to more regular and intense floods, increasing populations’ exposure to potentially hazardous interactions with water.
The assessment also further provided that non-fatal drowning – where individuals are rescued and/or resuscitated – also results in a substantial number of hospitalisations, and can cause severe brain damage that may result in long-term disabilities such as memory problems, learning disabilities and permanent loss of basic function.
WHO Regional Director for South-East Asia Dr. Poonam Khetrapal Singh stated in the assessment that while many lives were lost each year, drowning remained a largely unrecognised threat to health and well-being. Therefore, it is imperative that governments focus on the development of national water safety plans and policies and implement tested and low-cost water safety interventions to prevent drowning and save lives. “No child or adult should lose their life to drowning,” he said.
Considering these many assessments, in 2019, the Sri Lanka Tourism Development Authority’s Domestic Tourism and Community Relations division implemented a drowning prevention and lifesaving programme to protect tourists. Run in conjunction with the Sri Lanka Coast Guard Department, three lifesaving units at Bentota, Mirissa and Hikkaduwa have been upgraded, with jet skis provided to each.
Dr. Siritunga also drew attention to the national action plan for the prevention of drowning drafted in 2015 which was a national model for water safety and drowning prevention. He said that this model was based on internationally-accepted injury prevention models and drowning prevention strategies. However this was merely draft and he shared that since then, a more inclusive multispectral safety plan had been developed in collaboration with a number of entities including Sri Lanka Life Saving, the national body for life saving and water safety-related activities in Sri Lanka, the Sri Lanka Navy, Coast Guard, and many others.
He stated that this safety plan was originally intended to be released in 2021, however due to Covid-related delays, they had completed the document only now and would be officially launching it in March.
There are a lot of ways to die
Dr. Siritunga also shared that when it comes to leading causes of death, there were intentional and unintentional deaths and while suicide was the leading cause of intentional deaths when it came to unintentional deaths, there were a number of non-exhaustive contributing factors.
He shared that in this upcoming action plan, they had covered the major problem areas of road traffic accidents, drowning, and home-based injuries. “People are most vulnerable when they are at home; 50% of recorded hospital injury-related treatments are caused by home accidents, including falls, electrocution, poisoning animal bites, etc.,” he said. “There is also a major focus on children and the elderly because those two categories would need to cover schools, playgrounds, daycare centres, care homes, elderly homes, and others.”
Addressing the effects of drowning, Dr. Siritunga said that human behaviour had been identified as a key risk factor for the occurrence of drowning. Confirming the findings of the WHO regional assessment, he added that in the process of experiencing respiratory impairment from submersion, other than deaths, lack of oxygen to the brain after a non-fatal drowning could lead to long-term disabilities ranging from memory problems and learning disabilities to complete loss of basic function.
He also noted that in the present experience, with the relaxation of Covid-19 related regulations, uncontrolled increase in human activity may be causing an increased risk of drowning. This is furthermore a reason to implement the finalised action plan at its earliest.
What can we do?
A review of the draft national water safety and drowning prevention model concluded that while drowning prevention had been on the injury prevention agenda in high-income countries for many years, many low and middle-income countries like Sri Lanka were working towards drowning prevention and seeking support from those in government, private sector and community settings.
The review proposed that in order to reduce accidental deaths by drowning, Sri Lanka can adopt certain steps, which includes providing internationally-recognised lifesaving training to Sri Lankan personnel across various industries, including tourism, swimming, lifesaving, and the armed forces; the expansion of lifesaving services utilising armed forces personnel previously involved in the civil conflict; and partnerships developed with Government, industries and non-profit organisations, just to name a few.