What’s New in Emergencies, Trauma, and Shock – Camel, Cattle, Borewell, or Sewer Injuries: Time for Public Health Contextualization of Injury Prevention : Journal of Emergencies, Trauma, and Shock

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What’s New in Emergencies, Trauma, and Shock – Camel, Cattle, Borewell, or Sewer Injuries

Time for Public Health Contextualization of Injury Prevention

Raina, Sunil Kumar

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Journal of Emergencies, Trauma, and Shock 15(4):p 155-156, Oct–Dec 2022. | DOI: 10.4103/jets.jets_147_22
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Public health on this planet seems to have evolved primarily through observation and the answers to most of our public health concerns have largely been dealt with using the principle of trial and error. Contextualization of health was an expected outcome of scientific observations and this has more profoundly been found in addressing the complex needs of public health. Observation based science leading public health continued till the Universalist views built on a superstructure of one size fits all globalization, largely derived from neoeconomic theories did not establish a direction to methods and methodologies of conduct and execution of observation putting “local context with global impact” into shadows.

Convinced of the durability and invincibility of its science-economic framework extending to health, public health injury science has largely focused on injuries resulting from road traffic crashes, falls, drowning, burns, poisoning, and acts of violence against oneself or others, among other causes. The reasons for large-scale focus, although could also be attributed to the data which supports these as the leading cause of death. As per the reports, for people aged 5–29 years, 3 of the top 5 causes of death are injury related, namely, road traffic injuries, homicide, and suicide while drowning is the sixth-leading cause of death for children aged 5–14 years. Falls, on the other hand, account for over 684,000 deaths each year and are a growing and underrecognized public health issue.[1]

Beyond these, well-defined injury entities, there are injuries which go unrecognized either because these are not high in volume or proportionately less fatal and therefore are generally considered less important for inclusion in large-scale datasets. Millions of people worldwide suffer nonfatal injuries each year, which besides leading to emergency and acute care visits, hospitalizations, or treatment by primary care practitioners, may result in temporary or permanent disability and the need for long-term physical and mental health care and rehabilitation.[1] However, what may go unnoticed is that exposure to any form of trauma, howsoever small, particularly in childhood, can increase the risk of mental illness and suicide; smoking, alcohol, and substance abuse; chronic diseases such as heart disease, diabetes, and cancer; and social problems such as poverty, crime, and violence. Precisely for these reasons and for preventing fatalities due to these, avoiding any form of physical injury should be a priority, more so in people more vulnerable than others, because of the conditions in which they are born, grow, work, live, and age.

But to address this priority, contextualization is the key as prevention efforts become easier if the understanding of cause and impact is localized.

A mention of injuries caused by large animals in literature is not uncommon. However, there is not much literature on camel-related injuries. One such study highlights the role of preventive measures in decreasing the incidence of camel-related head injuries.[2] This study has investigated the role of helmets in preventing head injury of camel caregivers. One of the reasons for not finding many a mention of such kinds of injuries may be their differential distribution, being restricted to a few population groups, and in those particularly to those engaged in a specific kind of work. Therefore, much like some other unrecognized work-related injuries, the use of prevention strategies among camel caregivers should be made compulsory. The thought process and the action implementation should be local.

Injuries similar to camel-related are found in other population pockets worldwide. Some purely work related and others are more due to an absence of prevention strategy in place. Cattle-related injuries, although a significant cause of severe morbidity and mortality, again are underreported. However, with injury patterns similar to high-velocity road traffic collisions, it is important that treating clinicians need to be alert to the possible outcomes of cattle-related injuries.[3]

The fact that injuries are unevenly distributed with prevalence more among the less advantaged means that the risk for injuries is unevenly distributed. This uneven distribution of risk makes injuries preventable. Risk factors arising out of living in a particular way, working in special situations, traveling hazardously, or even going to school in precarious conditions demand a focus on prevention efforts in the community settings as also access to quality emergency trauma care and rehabilitation services. However, most earnest efforts need to be made in preventing injuries wherein need of resources for prevention is not huge and the benefits are immediate. While the use of helmets among camel workers is one such intervention, others such as injuries among sewer workers or injuries in open borewells, might just need a change of thought process.

In sewer-related events, a total of 340 deaths were reported in 5 years extending into the middle of 2020 among manual cleaners of sewers and septic tanks across different parts of India. A hazardous job, the record of fatalities may not be telling the entire story of how these events may have unfolded. Much worse, borewell injuries, due to open borewells resulted in a total of 40 child deaths since 2009.[4]

The actual number of incidents may be more since many incidents go unreported, but with 27 million borewells, several of which are dried up and no longer in use, a situation when the pipe and the iron cast are removed, leaving behind an open hole, an injury is just waiting to happen.[5]

Probably, it is time injury prevention acquires a focus long overdue with the development of frameworks contextualized to localities through the involvement of local stakeholders.


1. Injuries and Violence –World Health Organization (WHO) Available from: https://www.who.int[SingleRight-PointingAngleQuotationMark]Newsroom[SingleRight-PointingAngleQuotationMark]Fact-sheets[SingleRight-PointingAngleQuotationMark]Detail Last accessed on 2022 Nov 22
2. Hefny AF, Hefny MA, Al-Ali MA, Mousa HM Camel-related head injury in a high-income developing country. J Emerg Trauma Shock 2022;15:162–6.
3. Rhind JH, Quinn D, Cosbey L, Mobley D, Britton I, Lim J Cattle-related trauma:A 5-year retrospective review in a adult major trauma center. J Emerg Trauma Shock 2021;14:86–91.
4. 340 Sewer Cleaning Deaths in Past 5 Years:Government Available from: https://www.thehindu.com[SingleRight-PointingAngleQuotationMark]News[SingleRight-PointingAngleQuotationMark]India Last accessed on 2022 Nov 22
5. G-Chart for Predicting Bore-Well Accidents Available from: https://analyticsin-diamag.com[SingleRight-PointingAngleQuotationMark]g-chart-predicting-bore Last accessed on 2022 Nov 22
© 2022 Journal of Emergencies, Trauma, and Shock | Published by Wolters Kluwer – Medknow