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Crowd Justice for Trauma in LMICs?

Author: S. Ariane Christie, MD

Date of Publication: Thursday, March 23rd, 2017

“Crowd” or “popular” justice refers to judgment determined and administered directly by the people. Persons caught or suspected of committing crimes are punished by bystanders in situ and may be beaten or even killed. Although exceptionally disturbing, in many places, crowd justice is viewed as a means of deterring crime and enacting retribution.

In Cameroon, crowd justice is practiced widely for crimes such as theft and is a common cause of intentional injury. During our work in Cameroon, I’ve come to realize that crowd judgment also plays an important role in the pre-hospital response to injury and other emergencies.

Prior to going to medical school I had the formative and distressing experience of witnessing a serious bus accident in Tanzania, and remembered the feeling of helplessness that I had in that situation.

After graduating as a physician in the United States, I have on several occasions acted as the first responder after witnessing an injury or other emergency. Therefore, when I learned I was going to have the opportunity to conduct research on injury in Cameroon, I felt relieved that I would at least be more prepared if any emergent situation should arise.

As might be predicted given the known high rates of trauma in LMIC, I unfortunately see injuries occur on a weekly basis—often as a result of road traffic injuries (RTI). However, I have never had the opportunity to provide first aid to any trauma victim outside the hospital in Cameroon. After each injury I’ve witnessed, bystanders have quickly assembled to extricate the hurt individual from the scene. Any causes for delay, including my attempts at examining the injured person, are swiftly deflected by the group.

Admittedly, my first reaction to this phenomenon was concern that the actions of the crowd might inadvertently worsen the severity of the injuries. I’ve watched with horror as unconscious trauma victims were jerked up by their arms and placed in taxis with no seeming regard for C-spine precautions.

However, the reality of RTI in Cameroon is that the risk of further injury is a present and looming threat for both the victim and everybody else at the scene, and clearing an accident efficiently is understandably prioritized as a matter of public safety. Additionally, in the context of a healthcare system that is strictly fee-for-service and has minimal pre-hospital care infrastructure, crowd response often functions in designating a representative (typically the party at fault) to oversee pre-hospital transport and, perhaps most critically, pressures them to pay for emergency care.

Consequently, while trauma management by crowd responders probably does result in inadvertent morbidity, it also probably saves lives by facilitating expedient secondary risk reduction and coordinating and mobilizing access to treatment.

Cbs Team In Tombel

The picture above is of S. Ariane Christie, MD (the author of this post, located in the bottom right corner of the picture) and the rest of her Community-Based Survey team in Tombel, Cameroon. You can read more about the Community-Based Survey here.

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