“And so, we are appealing to you all; we need your help so that this boy can swallow again. They have been begging on the streets for a while now but the money isn’t up yet. Ketewa biara nsua” a voice shouted persistently.
Walking back to my seat at church, I kept wondering. This is the sixth-week since my church is taking money to help pay for surgeries for children who accidentally swallowed one form of chemical or the other. I am told there are more children lined up for their turn to receive their widow’s mite from the congregation.
It gets worrying because most of these children have had to abandon school and beg on the streets because their parents cannot afford the surgeries that will make them better again. And in some cases, their parents have to recruit paid ‘marketers’ who are good orators in appealing to the public for money.
The story often goes like “his/her parents were outside and he went in to ingest a mouthful of ‘parazone’ or caustic soda”. Yes, children are generally curious and adventurous and will always find themselves at risk of several home accidents. In fact, the statistics are alarmingly increasing and it is even feared to escalate as parents become busier with work and other commitments. Children who become victims of these home accidents are further subjected to interventions that worsen their plight. “Ama, bring the red oil from the kitchen and let us force some down his throat”. And this child will after a while vomit-the parents will be relieved and everyone will go back to their businesses.
But a couple of weeks down the line, the child will gradually be refusing food and eventually start drooling saliva from the mouth – he/she cannot swallow again. You may be wondering what might have gone wrong. Let me tell you.
Most of the household bleaches are alkaline (some are very strong alkaline). On exposure to the skin or any body tissue in undiluted form, they can cause serious corrosion or burns to these surfaces. So, when children accidentally ingest them, there is a high chance their throat and swallowing pipe (oesophagus) can be burnt. Now after getting into the stomach, the alkaline here from the bleach is going to react with the strong acid in the stomach. This reaction can produce extreme heat as a by-product. So, imagine what will happen to an innocent child whose throat and oesophagus have been burnt with bleach and given red oil to vomit.
He is going to vomit the heated product of the bleach and acid reaction up his throat again and get burnt twice – first from the initial corrosive bleach, and second from the heated product of the reaction between the bleach and the acid in the stomach. After these events, the body will take some time to heal from the damage with resultant scar tissue formation. This often leads to narrowing and sometimes total blockage of the swallowing pipe. Caustic soda is notorious for causing swallowing pipe narrowing – even after spitting everything out after one has introduced a drop of it into the mouth.
A similar but different thing happens with children who ingest kerosene – they are given red oil to vomit. The danger with this is that it exposes the victim to more danger. Kerosene and all the other hydrocarbons (petrol, diesel etc) are light dense (will settle on solutions) and highly volatile (can evaporate). Making victims vomit after ingestion will increase the volatility of the kerosene. In this way, the kerosene might evaporate and end up in the lungs to cause inflammation and irritation with subsequent breathing difficulties.
The kerosene, when left alone in the stomach depending on the quantity ingested, will cause little or no harm to the victim. The biggest danger again here is that vomiting to a large extent is a poorly controlled exercise. The volume of vomitus and the intensity of throw-ups cannot be predicted. Owing to this, the vomitus can accidentally get in the airways and cause sudden death or severe illness.
Children who have ingested one form of chemical or another can be identified by sometimes the smell of the chemical on them. Some may complain of pain in the throat or abdomen with obvious burns to their lips. There may be chest tightness, difficulty in breathing and or nausea with vomiting and in some extreme cases of poisoning, unconsciousness. The proper immediate interventions that can be provided include the following but never inducing the victim to vomit. First of all, make sure that the victim and you are not in any imminent dangers – naked flames to the fuels, slippery floors from spillages and vomitus etc. Second, be sure the victim is responsive; being unresponsive means the poisoning is severe.
At this point, you need all the help you can get to call out to neighbours or even strangers for help – no matter how minor the incident may be. And then check if the victims have their airway opened and breathing. You can assist with opening the airway and breathing if you have been taught how to making sure that the heart is continuously beating. Again, try to identify the type of poison ingested or you can carry the bottle with you to the hospital. Also make an effort to establish when the poison was ingested, how much was ingested and do not give anything by mouth at this point – drinking too much water can cause problems.
Wipe any vomitus from the victim with plenty of clean running water, change soiled clothing, and keep them dry and warm. You can use protective material like rubber or polythene bags to cover your hands while handling people exposed to poisonous chemicals like weedicides. Quickly arrange for transportation to the hospital and keep victims lying on their side till you arrive at the hospital.
You can learn more First Aid interventions from the Ghana Red Cross Society or Iran Clinic (a member of the Iranian Red Crescent Society).
By Richmond Larweh
The author is a Clinician and a First Aid Instructor. He has undertaken several extensive trainings for First Aid Instructors and First Aid volunteers in Ghana.