Marauding mango trees and other African hazards....

(This is Geoff posting on Charlotte's computer)

Ask most people about dangers in Africa (I'm sure I've covered this topic previously) and I'm sure they'll list lions, elephants, hippos, snakes, spiders and all the usuals. Some may even say road traffic accidents (pretty high on the local causes of death). I doubt many would pick up the two major causes of paediatric trauma seen at St Francis' - mango trees and ox carts.

It seems that falling from mango trees is a rite of passage amongst the youth of Zambia. It has now reached the point that when a child comes into our OPD in a sling I just say "mango tree....?"and the parent nods and smiles. Today (an emergency OPD day only) I have seen four broken wrists, a fractured elbow and a bruised back, all from falling out of mango trees. I also operated on 4 other children admitted over the weekend with fractures from mango trees (most upper limb again, one girl also had a femoral fracture). Some of the children are as young as 5. Most of them seem to bounce to a greater or lesser extent - where you would expect serious injuries from falling from up to 10 feet, they often just have isolated limb fractures. Which is good, because I expect they are back up the tree as soon as they can (I bet some of them in their plaster casts).

Interestingly, the mangos are not yet near ripe, they seem to enjoy eating them when they are quite hard and incredibly tart. It is suspected (as already mentioned) that the recent spate of sigmoid volvuluses is down to eating large amounts of unripe mangos. It is difficult to blame though, when the only fruit readily available is mango and people are both hungry, and keen for a sweet snack. I have however created a new acronym to use in OPD - MTRI - "mango tree related incident".

Having covered the many dangers of the mango tree, I should also point out the more obvious danger of moving ox carts. Cattle are everywhere (they regularly walk outside our house) and are a major source of transportation for people away from the main road to bring their produce to market. Children however do seem to make a habit of tumbling from them. It seems to be just enough to break an arm, or if they get stuck on a wheel to break a leg.

This all makes the more exciting recent crocodile bite a little more exotic!