By Judy Wolf
When you think of Africa, these images come to mind: great herds of migrating wildebeest, hunters such as lions and hyena attacking their prey, and huge waterfalls feeding rivers that host giant hippos as they bask in the sun.
But all too often, an African physician sees another picture — a lifeless child who, according to the caregiver or parent, just happened to accidentally fall onto the floor. But if this physician has been trained to recognize the unique set of diagnostic clues of abusive head trauma, or shaken baby syndrome, he would know that the parent’s story was a lie.
Shaken baby syndrome is one of the world’s least recognized types of child abuse. In the United States, physicians are typically trained to recognize it, although there is a continued effort to achieve national awareness of SBS throughout the medical profession as well as within our society. Long-term consequences of the abuse, if the child survives, include cerebral palsy, learning disabilities and developmental delays.
A 2010 UNICEF survey on violence against children in Kenya revealed that 66 percent of girls and 73 percent of boys reported experiencing some type of physical abuse by age 18. This limited survey data did not mention SBS specifically nor identify SBS as a form of child abuse, but it clearly demonstrated that child abuse is a serious problem in Kenya.
In fact, “the shaking of young children is a surprisingly common act in a wide variety of countries and cultures,” writes Desmond K. Runyan, M.D., of the University of Colorado in “The Challenges of Assessing the Incidence of Inflicted Traumatic Brain Injury: A World Perspective.”
In Sacramento County, Dr. Angela Rosas, medical director of the Sutter BEAR Program and child abuse consultant for Sutter Health Sacramento Sierra Region, instituted a shaken baby syndrome prevention program to educate new parents about this form of child abuse.
With this intervention, the rate of infant deaths declined from 12 per year to zero or one for the following three years. When program funding stopped, the numbers of deaths began to rise. This convincing evidence led to reinstatement of the program.
So why did Rotary go to East Africa? As chair of the Rotary Club of Davis’ Child Abuse Prevention Program, I was contacted by Vickie Winkler, R.N., executive director of Health Education Africa Resource Team (HEART), based in Nairobi, Kenya, requesting that a team of child abuse experts come to Kenya to do training on SBS diagnosis and prevention in hospitals and university schools of medicine.
As this idea grew in concept, my club and I applied for a Rotary International Vocational Training Global Grant for funds to send a team of five to Kenya to teach physicians, medical students and nurses how to identify SBS. The grant for $49,750 was approved with cash contributions from Rotary Clubs in Davis (noon and sunset), Woodland (Luna Vista and Sunrise) and Fairfield-Suisun.
The team — Rosas; Nancy Cabelus, R.N., an expert on child sexual abuse; Kalyca Seabrook, family resource specialist with the Yolo County Children’s Alliance, Kay Resler, a past president of the Rotary Club of Davis; and I — left for Kenya on April 6.
The team visited nine hospitals and three schools of medicine in Nairobi, Eldoret, Kisii and Mombasa. Presentations were given to hundreds of Kenyan medical providers, students and nurses. When participants were asked if they had ever heard of shaken baby syndrome, only a few hands went up. However, the majority had seen the classic symptoms of SBS in their practices — subdural hematoma, retinal hemorrhages, brain swelling, rib fractures and other patterned injures and fractures.
By the end of the presentations and demonstrations using simulation baby dolls, most nurses and doctors agreed that they had seen such cases of trauma in their practice and/or had shaken a baby to quiet them. Some even reported that they believed that shaking a baby was the right thing to do when a child was crying inconsolably, but now through this training understood the devastating effects of SBS.
One of the highlights of our visit in Nairobi was the team’s visit to the Kenyatta University Children’s Cancer Ward. It was an overwhelming experience to see these young children, some of whom have been in the hospital for six years, dressed in old, tattered clothes, with dirty faces and urine on the floor that wasn’t cleaned up.
Yet, the nurses are doing an amazing job of caring for the children with the barest of resources available to them. The children were so excited to play with team members — each smiling and laughing as though they didn’t have a care in the world. It was very difficult, but so well worth it.
In addition, the team visited a Women’s Equality and Empowerment Program in Mombasa. The team talked with some of the participants — women who have AIDS who were abandoned by their husbands. The team provided health assessments, listened to their concerns, provided groceries and gave training on SBS with demonstrations using simulator dolls. The women each told the team about their backgrounds and the projects they were working on and the new skills they are learning.
Finally, the team was part of a remarkable community effort to build a mud home for a woman with AIDS and her daughter who had become estranged from her family because she had AIDS. Through the persistent help of HEART, the woman’s younger brothers welcomed her back into the family and gave her a piece of the family land on which to build a home. A new pit latrine also was built and funded by the Rotary International Vocational Training Global Grant.
What do we do next? The good news is that the training was received with great enthusiasm by the leaders of each institution we visited in Kenya. They were excited about including the demonstration dolls and CD-ROM training in the teaching curriculum for all medical students, and expressed a strong sense of commitment to achieve national awareness and education throughout their medical institutions and schools of medicine.
It also became clear that there is a need to put a comprehensive public awareness program in place to educate Kenyans on the effects of shaken baby syndrome and how it can be prevented. This will be done by placing SBS prevention posters in as many public places as possible throughout the country, such as hospitals, clinics, stores and banks. The club and I will continue to follow up with public health leaders in Kenya to ensure that the training program is continuing.
While Africa is a beautiful continent, some of its children have no one to protect them or care for them properly. They have no safety net. They live in a place where child safety services are not equipped to protect children at any level. While Kenya is beginning to awaken to the epidemic of child abuse, much still needs to be done.
We all know that children are our most important asset. They are our future. Unfortunately, according to the World Health Organization, 53,000 children die from neglect or abuse each year around the globe. In the United States, five to six children die each day from abuse. In 2012, there were 81,764 confirmed cases of abuse in California. Without our help, there will be more deaths and children growing up damaged who will continue the cycle of abuse.
Call your local child abuse prevention center, support your local Rotary clubs that are working to prevent child abuse or contact your local nonprofits — such as the Yolo Crisis Nursery and the Sexual Assault and Domestic Violence Center of Yolo County — and offer your help.
The children need our help … won’t you join the fight in any way you can?
— Judy Wolf is a Davis resident and chairwoman of the Rotary Club of Davis’ Child Abuse Prevention Program.