We traveled to Turkey in the Fall of 2012 and made a 5 day stop at the Turkish-Syrian border not far from the ancient city of Antioch. We were to bring in medical supplies, assist, and learn from medical providers taking care of wounded Syrians. The now two-year-old Syrian revolution has created an extensive grassroots network of activists from within Syria, its neighboring countries, and the West. Our journey began with one activist, Dr. Ahmed, a veterinarian by trade. Due to the war and his medical skills, he subsequently took on the role of medic, nurse, doctor, and supply coordinator for wounded civilians and soldiers near the Turkish border. At any given time, Dr. Ahmed cared for 10-15 postoperative patients in his single bedroom apartment. Most were rebel fighters, but some were soldiers from the Assad regime, testament to his belief in medical care as a human right.
Recent estimates as of January 2013 have put the Syrian death toll at 60,000 to 70,000 lives lost. We did not know what to expect when we arrived at the rehabilitation camp, a few kilometers from the Syrian border. As we drove through the town, Dr. Ahmed pointed out landmarks including a small waterfall at the foot of one of the Syrian mountains. Many Syrians came by daily to view, touch, and drink the water that cascaded from Syria.
We spent 5 days and nights in the camp, taking care of patients in wheelchairs and casts, patients with single and multiple limb amputations, paraplegics, quadriplegics, and a few women who lost their eyes. We helped in the makeshift urgent care, determining if new patients could stay at the camp for continued care or be transferred to a local hospital by ambulance. As we spent time with these brave men and women, we heard their stories of pain, loss of loved ones, but hope. And sadly, as we cared for their wounds, we began to realize that we had seen many of these injuries and mental traumas before, not from other international medical missions, but from a part of the world closer to home: our own domestic war zones. Our training during medical school and residency in U.S. trauma centers had prepared us for what we witnessed and experienced almost half a world away.
Anyone who has worked in a level-one trauma center wedged in the watersheds of several inner cities has seen wounds produced by multiple mechanisms of violence. Per the Center for Disease Control (CDC), injuries and violence are the number one cause of American deaths in the first half of life. This does not include the millions of Americans who are injured and survive to be faced with long term medical, psychological, and social consequences. As an example, two adolescent brothers were brought into Andrew’s hospital late one summer night. One was fortunate enough to be shot in the leg with a “flesh wound” while the other was shot in the chest and died within 30 minutes. The brother who survived suffered from post traumatic stress disorder and major depressive episode and required significant amounts of counseling. What effect this violence will have on this 17 year old boy, his family and future, we cannot know. Multiply this story by 30,000 Americans who die by guns every year , and it is not surprising why gun violence has been labeled a public health crisis by President Obama himself. Sadly, it has required several mass shootings covered by a sensationalized news-media conglomerate to grab the nation’s collective attention.
Since returning home from Syria to a raging debate regarding gun control, we are concerned about why this dialogue is occurring only now. Gun violence represented by the recent highly publicized mass shootings is nothing new for America’s metropolitan and inner city neighborhoods, the hardest hit segments of our population. A review of recent literature revealed several disturbing trends that may explain why we, as Americans, know so very little about our fellow citizens who are shot to death every day.
In their recent JAMA article, Silencing the Science on Gun Research, Kellermann et al. discuss an ambitious effort by pro-gun members of congress to eliminate the National Center for Injury Prevention and Control, a branch of the CDC. In 1996, $2.6 million in funding were removed from the CDC’s budget, a figure that corresponded with the amount of money spent the year prior on firearm injury research. The long term effect has been a sharp decline in firearm injury research. The authors note that “even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.” Less research going into this area translates into fewer elucidated opportunities where counselors, social workers, health care providers, and policy makers can step in and intervene to prevent gun-related deaths.
By stark contrast, alcohol-related research has received continual support, and to good effect. Through funding from the National Institutes of Health (NIH), several studies have identified opportunities for screening and early intervention, translating into reduced drinking and alcohol related traffic accidents among college students and underaged individuals. Additionally, multiple NIH-funded studies performed throughout the past 30 years have proven that raising the minimum legal drinking age to 21 reduces both drinking and alcohol-related vehicular accidents among persons under age 21, a policy change which is estimated to prevent about 1,000 traffic deaths each year.
Instead of support, the Florida Bill HB115 (2011), as one example, was enacted to restrict physicians from asking patients about firearm ownership and intentionally entering this information into medical records. The bill has been defended as a guardian of patient privacy and protection from harassment. However, it is baffling that health care providers can freely inquire about smoking, drinking, and drug use, all of which are personal items of information with direct and indirect implications on personal and public health, but questions on gun ownership are deemed an invasion of privacy, which somehow nonsensically outweighs its potentially lethal consequences. Similar bills have been proposed in 7 other states.
Furthermore, a brief provision in the Affordable Care Act that received little attention until a Washington Post article was published in late December 2012, limits the ability of physicians and insurers to collect information on patient gun use. The cumulative effect of the lack of federal funding for research and infringements on health care providers’ abilities to discuss firearm safety is creating a disturbing challenge to treat firearms as a public health crisis.
As healthcare providers, we have a responsibility to care for and protect the wellbeing of our fellow members of society. In light of this public health crisis and the challenges that pro-gun policy makers have put in our way, we must combine our efforts to help reduce gun-related violence in America. Below are some suggestions proposed by Doctors for America that we should be aware of when considering the areas in which to act:
- Support gun violence prevention research: Over the past two decades the number of deaths due to car accidents has decreased by 31%, deaths due to fires by 38% and deaths due to drowning by 52%, part of this decline came from research geared towards finding interventions that work .
- Promote gun safety education by health care professionals.
- Support increased mental health access: This is only part of the answer; according to the American Psychiatric Association Access to Firearm Arms by People with Mental Illness (2009), 4-5% of violence is attributable to mental illness. However, individuals with mental illnesses receiving regular treatment are less likely to commit violent acts than those who do not receive treatment.
We also encourage you to become more informed and contact your Congressional representatives via http://www.drsforamerica.org/take-action/gun-violence-prevention.
