'This is a pandemic in South Africa': Doctor on food poisoning cases

A surge of poisoning cases and ease with which toxins can be bought or accessed by children is a major cause of concern, says Dr Simon Fraser, a medical professional completing his community service at Tshepong Hospital in Klerksdorp.

“I think it needs to be stressed that this is literally a pandemic in South Africa. I can guarantee that there is a child or young person right now as you read this who is in a public or private hospital in South Africa with organophosphate [pesticide] poisoning,” he said in an interview with TimesLIVE.

Fraser spoke about poisoning cases after the deaths of five children who consumed snacks that they allegedly bought from a local tuck shop in Naledi, Soweto. The case followed that of three children aged between one and four who died of suspected food poisoning in Mdantsane NU2, Eastern Cape. 

Fraser said while poisoning is a leading cause of toxin-induced deaths in South Africa it is mostly accidental in small children and often intentional among teenagers.

“Organophosphates are a leading cause of toxin-induced deaths in South Africa. Exposure in small children is most commonly accidental. In older age groups — adolescents and into young adults — it is unfortunately increasingly common as a form of intentional poisoning such as suicide or intentional poisoning of another person,” said Fraser

Between April 26 and May 5, four pupils from Eqinisweni Secondary School in Ivory Park took their own lives by consuming poison.

Fraser says examples of organophosphates include insecticides like malathion and halipirimi, which is a black granular pepper-like powder commonly found in townships as a pesticide.

“The first symptoms are typically gastrointestinal, such as nausea, vomiting and stomach cramping ... In the emergency department, we often see patients presenting with late signs, usually with every imaginable body fluid pouring from the various orifices in the body,” he said.

“In the emergency department we often see patients presenting with late signs, usually with every imaginable body fluid pouring from the various orifices in the body. Though revolting to think about, this is a helpful memory aid for the recognition of organophosphate poisoning: if the patient is ‘wet and slimy’ in every imaginable fluid, you have to consider organophosphates, or their sister group, the carbamates.”

Fraser says the treatment is complex and requires immediate medical attention.

“The initial management of a suspected organophosphate poisoning is related to symptomatic treatment and relief of immediately life-threatening symptoms ... I need to stress that treatment of organophosphate poisoning is time-consuming, difficult and unpleasant — more especially for the patient than the healthcare provider.”

He emphasises the importance of prompt action and outlines the treatment process.

“Children can change condition very quickly, and due to their much smaller body size are more likely to have rapid onset of more severe symptoms. Treatment comprises protecting the patient’s airway from excessive bronchial secretions and bronchospasm ... Atropine has the general effect of ‘drying up’ the body’s secretions, so we give it in incrementally increasing doses until we have reached a dose where the effect is the cessation of signs and symptoms related to the poison,” he said.

Prevention strategies are crucial. Fraser advises: “If keeping poisons around is necessary, ensure they are stored far out of reach in clearly labelled and closed containers.”

He stresses the importance of educating older children about the dangers of hazardous substances: “In older children, education is important: not to explore or fiddle with possible sources such as rat traps or poisons.”

South African Depression and Anxiety Group (SADAG) project manager Roshni Parbhoo-Seetha said their research indicates that rat poison is among the most accessible and frequently used methods for self-harm.

“One of the concerns flagged were the number of suicide attempts happening at or before school starts. Rat poison is one of our biggest ones and what we are finding is that schools themselves don't know what to do in a crisis. Three weeks ago, we had two pupils who had taken rat poison in the morning and their friends had taken them to the sick room, but the school didn't know how to deal with it,” Parbhoo-Seetha said.

“In terms of rat poison, we found that it’s cheap. For R10 you can walk to the corner shop and just buy it. You don’t have to be a certain age, you can be anyone and it’s sitting there and easily accessible.”

To access support services, visit www.sadag.org or call the toll-free 24-hour suicide crisis helpline at 0800-567-567 or SMS 31393 and a counsellor will call back to help.

TimesLIVE