Sadiyya Sheik
Sadiyya Sheik

Think dry

What is it about the festive season that makes people want to kill themselves and each other? Strange question, I know, but I spent the night of the 25th and early hours of the 26th December with the drunks and depressives at hospital in the casualty department.

I could probably count on one hand the number of patients that were not intoxicated and on that same hand the number that were at hospital for some reason other than a stab wound or motor vehicle accident. The only variety was in the type of weapon used (knives are more popular than bottle pieces) and the site of injury (although a stab to the chest is often accompanied by one to the head.) If you have a warped sense of humour, you might see the comedy in the case of a patient with a stab wound that was on his way to hospital when he was involved in a motor vehicle accident. He was also intoxicated. I don’t know, I’m just saying it might be funny to some people.

Suffice to say, we spent the night in aprons and gloves, trying to decipher random slurs, dodging projectile vomit and, of course, stitching. We literally ran out of sterile suturing instruments at various points during the night while the queue of patients needing stitches snaked along a blood-splattered corridor.

I can’t help but wonder how different the night would have been, say, if we introduced an alcohol ban around the festive season. Of course, I say this from the point of view of someone who does not drink so I might be just a tad biased, but hear me out.

It is more than common knowledge that the consumption of alcohol, in various concentrations and quantities depending on the consumer, causes loss of inhibition and impediment in a range of sensory and motor skills. The combination is deadly. Why then do we stock our hospitals in anticipation of carnage, litter the roads with policemen and paramedics and claim zero tolerance while watching the daily updates on “how many people died on our roads today”.  Is the “Drive Dry” campaign really effective? How many times do we need to see the unsuspecting “victim” of alcohol veer off the road and into oncoming traffic before the “it won’t happen to me” reality sinks in?

Is it just me or does it seem like we’re doing everything but the most obvious? We’ve identified the root of the problem, why don’t we tackle that?

  • Mandy

    Alcohol is an amazing social barometer. There are people who know how much they can tolerate, pace themselves and go home in a taxi or with a friend who hasn’t been drinking. Then there are people who drown their livers and out of machismo or lack of options drive home. Unfortunately the former are often injured by the latter.

    I go out often to major clubs in Durban and to date have never encountered a road block. In spite of the fact there have been two deaths outside one club in particular, the police don’t seem to be doing anything.

    So no, Drive Dry is not going to work, it is not policed well enough and there are few options available to those who want to go out and drink. Lets face it, the majority of 18-23 year olds are not going to spend their last R50 on a taxi home, they are going to use it to buy another couple of drinks.

  • Mark Robertson

    You raise a very good point – however I doubt banning alcohol, tobacco or any other substance will change people’s self destructive behaviour. Most responsible people can enjoy a few drinks without any behaviour change at all. It’s also one of life’s strange paradoxes that the poor generally are addicted to those things that make them poor. Take smoking for example. Professionals and graduates hardly ever smoke. But every bergie and street child I see, who doesn’t even have the money for a loaf of bread, is puffing away on a R20 per pack cigarette which damages his health, costs him money and stinks. Banning alcohol will just mean the law-abiding will adhere and the rest will find someway to get it anyway – look at Prohibition in the USA. Somehow people have to take responsibility for their own lives – and at the end of the day, it’s up to them. However I salute you for your hard work and the nightmare you have gone through trying to repair the appalling damage people do to themselves.

  • Mark Robertson

    Your blog also raises a very good question about the future National Health System. My greatest fear is that this scheme will frankly ‘reward’ those who neglect their own responsibilities to staying healthy (your guy with the stab would who then crashed his car while drunk) , and will penalise those who look after themselves. It’s a classic ‘perverse incentive’ – we are all FORCED to pay a premium (based on our income nogal which is also very dubious) and then rather than rewarding those who never need a doctor (I don’t think I have seen one in over 5 years), we reward those who are permanently sick by paying out claim after claim after claim with other peoples’ money. Unfortunately my view is the only way to make people look after themselves is to have a heavy ‘excess’ people must pay themselves like an insurance policy so people have an incentive not to claim. I also think the state has no right to force me to join a cross-subsidisation scheme – by having no medical expenses and paying out of my own pocket I am actually forcing the cost of health care DOWN by not creating a demand for over-servicing. This actually helps those who can’t afford healthcare. I fear the system will probably be a complete disaster and will result in even higher costs and poorer service for everyone. Your thoughts as a doctor welcome.

  • Julian

    With respect, I’d like to see any government ban alcohol use over the holidays. Ain’t gonna happen. It’s unworkable. What people need to do is be more responsible about their drinking.

  • W

    When does banning substances or activities begin to infringe human rights???

    How many people die of diabetes? Obesity related illnesses?

    We know the source of the problem. So why not ban fatty foods?

    I can control my drinking and my eating, so why should I suffer because others break the law and do not control themselves?!

  • Gerry

    @Mark Robertson: You are the sanest respondent to any blog I’ve read on here. Well said sir!
    Can I buy you a beer?

  • Robin Grant

    At its most basic form, drinking alcohol is a form of self medication. How people drink in a society is indicative of the state of health of the society. Drinking is merely a symptom of societies ills. treating the symptom (which is common practice in allophonic medicine) will not change why people are drinking in the first place.

  • Robin Grant

    My spell checker got the better of me – (which is common practice in allophonic medicine) – should read – (which is common practice in allopathic medicine)

  • Stephen Browne

    Yet more proof that our currents views on substance abuse are completely and utterly skewed. There is no sense of perspective or reason when it comes to how we attempt to control what/how much people may and may not use. We laugh at our drunken ways every weekend, excuse our friends who drive under the influence (they’re just tipsy, and they have ‘experience’ driving drunk), and encourage our kids to do likewise. I dare any researcher to go to a large parking lot outside any central clubbing area and take a census of the people leaving in their cars – get a real sense of how many idiots are out there. Don’t even get me started on cigarettes …

  • OneFlew

    Mark Robertson, your question is a political and actuarial one rather than a medical one.

    All insurance schemes, whether run privately or by the state, rely on cross subsidy. That is the nature of insurance.

    In countries where a national scheme is established, this is done on an across the board basis. In other words, they do not allow “adverse selection” (where the low risks opt out, thereby driving up costs for higher risks). This is partly an insurance question and partly an equity one but partly also a paternalistic one. People who opt out do not necessarily do so for sound reasons and are also not exempt from dread diseases; the state disallows such opting out. Leaving people to die in the streets because they took stupid life decisions is not politically attractive. (As you may know, many employers, particularly where there isn’t a national health scheme of any quality, such as in SA, do the same.)

    In most countries these things are paid for through the tax system and most tax systems are progressive. This means that you do pay more if you earn more.

    Admittedly your slope is steeper in SA and there are more poor people and the scheme may correspondingly be more difficult to fund. This is, however, a question of practical economics and not one of philosophical principle.

    Some people, in pursuit of a rationalisation of their biases, argue like hard rightwingers when their “real” argument is an easier one: it won’t work.

  • Mark Kerruish

    Christmas Day 2009 in Claremont, Cape Town. The police station (during the day shift – 6 to 6) doesn’t get a single complaint, let alone an actual crime. I’m willing to bet a lot of alcohol was consumed the night before and during the day in that area.

    Compare this with the writer’s experience and I think we are moving into cultural and class responses to alcohol consumption.

  • X Cepting

    It must be very demoralising to be in an emergency room over the festive season. Case of: “But I’ve just stitched you up, how did you…”
    But banning alcohol definitely is not going to work. Before the draconian anti-smoking laws turned moderate considerate smokers into arch criminals I rarely saw young kids smoke. Now? I rarely see kids who don’t smoke, or drink for that matter. Our society now seems to foster a respect for lawlessness and being a “gangsta” has become the most desired job prospect, closely followed by becoming president. Therefore I agree most of all with you, Robin Grant. we will never cure the alcohol problem if we do not first cure the reason for the abuse. It is not just alcohol but drugs, food, sex, loud noise and excessive driving speed (almost anything one can think of) which is abused, to take the mind of a miserable unproductive existence. Alcohol abuse does not change who a person is, it merely leaves them with less inhibitions. A substance which some of us can responsibly use to take the edge of a busy day and enjoy a relaxing evening with friends and family at home. That is the essence of the problem, I think. Responsibility has been replaced with a hollow sense of entitlement. Need with want. If we can repair that, I hazard a guess the abuse will disappear.

  • Larry Goodfella

    Genetic disposition to alcoholism is very prevalent in non-caucasian ethnic groups. Europeans have been consuming alcohol for thousands of years and they can generally be found to be immune to the type of rampaging psychosis inducing drunkedness that aflict those of other groups that have only discovered the joys of violent inebriation since colonial times.

    Just like the common cold ravaged the indigenous populations of the America’s and Australia, so has the bottle of brandy been the greatest scourge.

  • Sadiyya Sheik

    “How many people die of diabetes? Obesity related illnesses?

    We know the source of the problem. So why not ban fatty foods?

    I can control my drinking and my eating, so why should I suffer because others break the law and do not control themselves?! ”

    @W:I understand this sentiment entirely and I dont mean to say that the solution is as simple as banning alcohol around the festive season. Im sure you will agree however that alcohol and fatty foods is not the best comparison to make here. Alcohol is considerably more dangerous in the sense that an intoxicated person is not the only person affected by their choice to drink in excess: Families, pedestrians, other drivers…
    As far as fatty foods go, the person eating the food is the only one affected (with some exceptions.)

  • Mark Kerruish

    Larry Goodfella, I’d like you to cite any reputable journal to back your “genetic” assertion.

  • Larry Goodfella

    @ Mark Kerruish

    I am sure that there is some study out there, but I have not the time or inclination. My ‘generalisation’ comes from experience and common sense.
    I may be wrong, of course, but you cannot dispute my assertions either.

  • Mark Robertson

    “Genetic disposition to alcoholism is very prevalent in non-caucasian ethnic groups.” Unfortunately this is not scientifically correct – have a look at any of the medical research on alcoholism. The only significant racial differences in alcohol metabolising (not the same thing as abuse) is that Asian people have a slower rate of alcohol metabolism in the liver and hence tend to get drunk more easily for the same bodyweight. Regarding alcoholism, there are no racial differences.