Aloha mai kako, and welcome to Deep Dive into Water Safety, a podcast produced on the

island of Kauai by Kauai Community Radio. KKCR is a listener supported, volunteer-powered,

non-commercial radio station serving our island community. To learn more about our work and

to Kokua, visit kkcr.org on the web. Deep Dive into Water Safety is rooted in Kauai's deep

relationship with the ocean, its power, its beauty, and the kuleana we all share to stay safe

and to protect one another. It is presented by your host Margaret Wright. Margaret is a long-time

water person and board member with the Kauai Lifeguard Association. Mahalo for listening. Let's dive in.

Today we are taking our conversation beyond Hawaii into the global landscape of drowning prevention.

Drowning is often misunderstood. It's not just an accident. It's a public health issue that

disproportionately affects those with the least access to resources, education, and safe environments.

Our guest today brings a critical voice to that conversation. Dr Colleen Saunders is an epidemiologist,

a researcher based at the University of Cape Town and a leader in drowning prevention through

life-saving South Africa. Today we will be discussing a powerful concept, leave no one behind.

What does that mean in the context of drowning prevention?

Who are we missing? And how do we translate global research into real world impact in places like

Kauai? Dr Saunders, welcome to Deep Dive into Water Safety. I'm so glad you joined us.

I'm so excited to be here. This is wonderful. Good. So in your paper, leave no one behind,

which I have here, an African perspective on the first World Health Organization Global Status

Report on Drowning Prevention. Yes. You described drowning as an neglected public health crisis.

Why has drowning remained invisible compared to other global health issues in your opinion?

I think there's a few reasons. You touched on it a little just now in your intro as well.

And I think historically, drowning has been viewed very much as a series of accidents,

right, of individual accidents, and not holistically as a kind of consolidated issue,

a public health preventable issue. And so people tend to look at the individual

accidents or what are considered accidents and pick out the things from that particular story,

but miss the point that all of the, there's a whole lot of factors that contribute to these things

in a system, and they are actually preventable. I think the other main issue, historically,

is that drowning's really been undercounted. So we haven't realized how big an issue it is because

there's been undercounting with non-fatal drowning. We still don't really have a handle on the

burden of non-fatal drowning. There's still a lot of under-reporting of drowning deaths in certain

areas, particularly in rural settings. And we, even in the current conversation, we haven't

really started to bring in the issue of flood related and transport related drownings. Those

are kind of counted as something else in the bigger picture. So I still think there is this

under-recognition of the burden, although we now recognize that there's an under-recognition,

if that in sense, but, you know, and that is starting to help us understand how big of an issue

it is, but that has emerged quite recently. And then in places like South Africa, we have

the other challenge is that we, for one to be a better word, are competing against many other

issues. So when you try to tackle an issue like drowning, you're competing for attention and

resources with big issues like trauma and violence and road traffic and HIV. So it's quite tricky

to motivate for resources into drowning prevention in the face of these other big burdens.

You sound, it sounds just like we're talking about the United States, and even the issues we face

here in Hawaii, which is amazing to me. You just, you state, and we could, you could give a little

background to South Africa, possibly in your conversation for those of us who are out in the

middle of Pacific Ocean, or people are listening other places, kind of about the geography,

the Indian Ocean, the Atlantic Ocean, but we can get into that. But we're going to, I want to ask

you this, you state that progress in drowning prevention has not been equitable with Africa lagging

behind global trends. Why does equity actually look like, what does it look like in drowning

prevention? Because we have that issue here, the equity of the indigenous population not getting

access to things. Yeah, I think there's a broad issue there in their statements, and then there's

I think the challenges around at a community level or even a country level. But you know, on a global

scale, we've seen, so the global status report on drowning prevention that was published in 2025,

now, 2024, sorry, we that showed that global drowning rates are declining, right? There was a

38% decline in global drowning rates, but that was, it was only a 3% decline in drowning rates,

mortality rates in Africa or in the African region. And so the African region was lagging very far

behind. And I think it's probably even more pronounced because we have quite a large limitation

in the data and the surveillance data from the African region. So I think it's probably still

even undercanted and we don't have a good understanding of the burden. But then, so I think there's

the slack inequity in the efforts, well, maybe not the efforts, but there's certainly a

disparity in the decline that we see globally and within certain regions, particularly

low middle income regions or local income countries. And then on a country level, there's, I mean,

I think you hit the nail on the head, we had a little chat before we started around

the similarities, perhaps between Hawaii and a place like South Africa, we were an upper middle

income country. But we have one of the highest inequity indexes in the world. I think we kind

of swap places with Brazil at the top of the list for inequity every couple years. And so we have

this challenge of like large areas that have that are well-resourced and then large portions of

our population that are under-resourced. And it plays out in the access to things like

learning to swim in the drowning prevention space. It plays out in access to learning to swim

in access to swimming pools, just kind of a culture around swimming even sometimes.

It plays out in access to water sports. And I think you describe yourself as a water person,

right? And there is a culture of being a water person that comes with access to pools,

access to these water sports that build the comfort around being in the water as well. And that is

not something that is experienced by everybody in our population. And it's certainly experienced

by a small part of the population, I think. So things like that, I think that kind of come from

this issue of access, which is definitely not equitable across our community.

So let's just talk about data because we have talked here about drowning,

just in some sort of who will come back on our show because he talked a lot about CPR and what

parents should know that they should all know a CPR class, which is breaths and compressions

if they're around water. He did a very good job of taking that down to a level that most people

could understand. So he's going to come back on because he's doing some training in California

for first responders. But we talked about data and we talked about the fact that drowning is not

a very sexy topic. And that, you know, we're now understanding, and I'm sure you knew because

you're a researcher epidemiologist and the data and the definition's been out there. But drowning

and nonfatal drowning are two different things, but they're still drowning, right? So if we had a

report here in Hawaii on a holiday day, how many drownings we had in a year, maybe it's a thousand

because of nonfatal drownings, right? And we're not keeping track of the data particularly well.

We're starting to look at that. But what do you know that the true burden of drownings likely

far higher than reported? How dangerous, in your opinion, is to build policy on incomplete data?

And what is the minimum data system every country should have to start making real progress?

Because we don't have that here. We don't have, we're trying to get to that point where we have

an actual data set so we can make good policy decisions. But it's the ability to collect that

data not just on fatal drownings, but on nonfatal drownings.

Sure. I mean, I think there's a few questions in there. And I have to say, I get really

excited when we start talking about data because it's happening going into I will.

But it's, you know, I think you, so you asked the question and this might not answer it specifically,

but you asked the question, what's the kind of minimum data I think that's needed for policy,

right? Or what's the danger of acting on incomplete data?

Right. And it's so interesting. I am, as you said, an epidemiologist and I kind of,

I think we need all the data, right? So we need to know everything before we act. That's my,

I'm a scientist, a researcher, my brain, we're slowly, I want all the information before I start

something. And then I happen to have a conversation with a policy maker here in South Africa, we're

trying to, to move forward on some national policy. And he said to me, well, what does the data say?

And I said, well, we don't really have enough, you know, but we know this and we know that and we

know this. And it was little bits. And he's like, well, that's enough. We can do something. And so I

think it's interesting. So I think that there's a couple of answers to that question. I think for an

epidemiologist, there will never be enough data. We want to understand everything to the minutest

detail. But at some point, you have to start acting, right? We can't always just say we need more

research. We need more research. We have to start trying to do something. So I think, I think the

danger probably lies in not recognizing that you don't understand everything. But if you can

recognize what you do know, which is perhaps a burden. And you, and you may be recognized that

that is excluding a nonfatal burden, or you, if you understand what you have, you can start to act

on it, even if you don't have enough detail or information. And so, you know, the, the, you say,

that, well, I think you were speaking specifically probably around Hawaii, around the nonfatal

drowning data issue. I mean, that's, I think that's largely a global issue. There's so little data

on nonfatal drowning because it is really tricky to try and capture. And I think in Sydney, for me,

in many places, in Africa and definitely in South Africa, we still try to get a handle on fatal

drowning data and make sure that we have that big picture. But trying to track nonfatal,

even though we have this really good understanding of what that is now, it's still a big challenge.

So I think the answer to your question is we can never have enough data, right? But at some

point, we've got to start. Well, we, we see the same challenges. I mean, the World Health

Organization came out with their information of which you're, you're mirroring in South Africa

that children are at risk. And they're the biggest risk here, one to 15. It's the highest risk for

drowning. And the indigenous population here only represents 23% or so of the population of Hawaii,

but represent 37% of the drowning. So, and we found that information out from a young man named

Clark, who's from New Zealand, and is now living here from Hawaii and did research

for the water safety plan and found that disparity, which is really, really great information. And

so we're trying to move forward with programs that address that. So you emphasize that children

bear the greatest burden. What are the most effective interventions? We are not scaling fast enough.

And if a country could only do one thing tomorrow to reduce child drowning, what should it be?

Oh, sure. Thank you for throwing me a hot potato, yeah. But I mean,

so, you know, as you rightly say, so children do have the highest mortality rates consistently,

I think, maybe with a few exceptions in certain settings. But, you know, the and children under

five in particular have very high mortality rates from drowning. And I think this has a lot to do

with, so I have two young children, my eldest is six and my youngest is four. So it kind of has

some recent lived experience in this. But children are just, they, I think their exposure is driven

by opportunity. And I guess their exposure to the hazards around them. And they're naturally

curious. As soon as they get mobile, they, you know, they want to explore their environment to

run them. And they're completely dependent on adults to keep that environment safe and to help

them navigate it safely as well. So I think that, and this kind of covers a group of interventions,

but I think the biggest thing that we can do is make sure that we are putting them in a safe

environment and keeping them in a safe environment. And there's, there's layers to that. So,

you know, things like being in early education centers or daycares, things keeping them safe,

supervised, making sure that they can't get access to water bodies without us knowing.

Keeping them safe is really the sounds obvious. But keeping them out of an unsafe environment

is really the thing that we need to do. We can't change who they are and we don't want to,

because they, they have to explore their world and start to understand it. But we need to make

sure that the boundaries are there so that they can do so safely. Yeah, we've had two things here.

The Department of Health put out a message that said,

eyes up, phones down. Yeah. And the idea being it pools and always having a watcher

and at the beach having somebody watch and being present to watch kids while they're

around bodies of water. Those are things that they've been trying to message here.

The other thing, I want to, if you don't mind, I want to jump in there. I think one of,

so I 100% agree with that message. But I think one of the things that we forget about,

and particularly in this young age group, is that, you know, if we're doing our job as parents

and caregivers, we are watching them. And it's the challenge often comes as when we don't expect

them to be around water, right? So when they were in, for example, the living room,

and we quickly stepped out to go and answer the phone or something. And then suddenly they get

out and they get access to a pool or a bucket or, you know, we take a phone call or answer the door

quickly while they're in the bath. Maybe that's not unexpected access. But I think we have to

broaden the look at supervision and safe environments to outside of when we expect them to be in the

water. Often the, I think the safety, the creating a safe environment is putting layers in place

so that when we aren't around, that environment is still safe. It doesn't depend entirely on our

attention and supervision at all times. Layers in place, I've heard that said by a lot of people

on drowning prevention, water experts, can you tell me a little bit more what you mean by layers

in place? Yeah, I think it's, you know, we're all fallible. I am in the space. I've been a

lifeguard for 20 years. I'm a water baby. My job, my day job is research in drowning and drowning

prevention. And I still struggle at home with my kids. I still find that when I'm around the pool

with them, they are lapses and I suddenly catch myself and we forget to put the pool cover on

or things like that. I think so we are all fallible. And we all, and these situations where you

think a child is safe because they're in a particular place and then they surprise you or they

move quicker than you think or they get asked somewhere where you didn't know that they could.

Those things happen. And so I think that part of keeping children safe is making sure that they

are multiple layers to protection. So what that means is, yes, supervision. It's critically important.

And maybe we can talk a little bit about what supervision is as well. But, you know, I think supervision

is really important. But making sure that when and if there are these lapses or errors, that there

are other layers of safety in place. So particularly things like, you know, if you have water bodies

on or close to your home, making sure that they can't get access to those without you. So whether

it's pool covers, pool fences, puns and other water bodies are a challenge as well.

You know, this doesn't, it looks different in different places. If you think of places like

Bangladesh where water is all around the home, it's, you know, it's quite difficult to put up a fence,

but they're looking at creative ways of doing that. But the point is to have these layers of

safety. And I also think exposure to kind of water. Well, I don't want to call it swimming, but

exposure to being in the water and starting to learn the principles of swimming and floating and

things like that. That is another layer that maybe comes a little bit later than the age group we're

talking about. But that is another layer, learning how to swim, learning how to float, making sure

that there's restricted access to these water bodies, you know, keeping supervision as much as

possible. Emptying, you know, we had a drought here in Cape Town. It looks like we might be

hitting into another one, but we had some water restrictions a couple years ago, quite serious

water restrictions. And everybody was keeping buckets of water around their homes and catching all

their shower water and things and using it to flush the toilets. And so a lot of people had buckets

of rainwater and shower water and all sorts of things all around the home. And anecdotally,

we had a little surge in drowning incidents in and around the home because people forget about those

as sources of risk as well. And so, you know, the layers of protection is more than just supervision.

It's making sure that when you forget about something, there are also other barriers in place.

The shower door is closed or those, they can't get access to those buckets of water.

That's really what I mean by layers. That's really very good. I would say also that

you wrote this article and I'm going to get back to what we're talking about. But

why did you write this article? And how did you get involved in drowning prevention?

Let's rate about the, I have two sitting in front of me. So, I have fatal drowning in

Western capes out after I see that one. But I'm talking about the current one or you could talk

about both of them. But the one is leave no one behind an African perspective on the first

World Health Organization Global Status Report on Drowning Prevention. You could talk about

either one, but they're very, very good. And just I would just like more.

Yeah, so I think your question maybe was around how I got involved and then and then where they

came from, both of those. Well, I grew up in a small town on the east coast of South Africa,

all these London. And we lived in a little beach town. And I started doing, I don't know if you

guys have nippers there. I don't, I think so it's like junior lifeguards when you're little.

We have two-year lifeguards, which you have bippers. We call them nippers, yes.

So I did nippers when I was a kid and then we moved to Cape Town and I spent about 20 years as a

volunteer lifeguard at Big Bay here in Cape Town. And so I've always, I think life savings in my

blood have always had an interest in life saving. But I never really thought it was always my hobby.

And when I finished my PhD, I was kind of struggling a little bit with where I wanted to go and what

I wanted to, how I wanted to establish my, my own work. I felt the work that I was in was a

little bit saturated. And at that time, I ended up just doing some kind of analyses of media

reports and things on the side for life saving South Africa. And that ended up kind of pushing me

into the space and realizing that actually there was so little research on drowning and drowning

prevention in South Africa that I started dabbling in it on the side. And then at some point,

that became my part of my, my day job and my research focus. So I think it's always been in my

blood, but now I get to do it during my day job as well. That sounds very similar to a lot of

people living in lifeguards and they become doctors and they become researchers. I think there's

a few stories around like that for sure. Yeah. And then the, so the, the Western Cape study,

that was, it was really interesting. And actually that I kind of got pulled into a working group

trying to unpack. There was a particular season, a summer season in the Western Cape, which is a

province of South Africa, a coastal province. But there was a spike in, in drowning incidents and

a couple of kind of organizations and the disaster management in particular, but together

and said we needed to just understand what's going on and, and try and come up with a strategy

for preventing drowning in the province. And we tried to, so I got pulled into that from a

life saving perspective. I was with the life saving organization. But as we were trying to unpack

that, you realize this, we don't have the data. We actually don't really, no one's really

interrogated the data. And that's where that study came from, that Western Cape study. So we took

seven years of fatal drowning data and tried to look at the patterns to, to help inform a strategy

for drowning prevention for the province. And what did you find? What did you find out from that study?

Sorry, we found, as you rightly pointed out, the children were at greatest risk. So I think about

40% of the drowning, the faith, this was just fatal drowning incidents were children. And we definitely

saw the highest rates in children under five. But we also saw these kind of high rates in young adult

men in our 20 to 35 years old or so. And what was interesting is that, so the rates kind of spiked in

that age group, but it was particularly in the men. So that that particular age group had the

highest ratios of male to female in terms of the fatalities. I think between 11 and 14 male deaths

per female. So there were these kind of two really stand-out groups for us, these young children

who drowned in and around the home close to the home. And then this group of older, like these

young adult men who tended to drown, you know, further like larger bodies of water away from the

home. So that jumped out and then we saw some patterns around holidays and things as well and

seasonality. And all of those helped to to inform the strategy that we developed.

So you have all this data, you've done this research. How is that moving forward with any kind of

policy? And the second question, because I don't want to forget this, do you have the South Africa

a water safety plan, which has been recommended by the and then was recommended by the United States

water safety plan, which they did that every state should do one. Does South Africa have one?

So the West and Cape province has one. We did as part of that study, we did. So that's a subnational

kind of strategy for the province, but that one in itself is about 10 years old now.

I'll go back to your your question with Iran. How do we you have? I didn't mean interrupt you,

but you know what our safety plan that's 10 years old, we're sitting over here thinking

for all because we have one. But so maybe let me answer that question first and then I'll go

back to your first one. But so we do so we have this provincial kind of subnational one.

But what we found, as I said, it's about 10 years old. I think we launched it in 2017 or so

to just 10 years. But one of the big challenges, and I suspect I don't know if this holds for the US

similarly, but you know we have these three three tiers of government. So we have national

government, then our provincial government and then a little bit more of a local kind of

municipal district level government. But there is a bit of attention between the provincial

government and the responsibilities there and the responsibilities of national governments.

And so often, you know, just a lot of the things that we recommended in that provincial strategy

became really hard to implement because what they actually needed was an action at national level.

And and I had a student last year, well the last two years that did some work, she did some

qualitative interviews trying to understand different like actors and the policy environment

and their perceptions around drowning. And and almost all of them came back to like well,

these things roll downhill. So like you have to have national policy and and guidance to get the

buy-in at a sub-national level. And and then once that instruction is in place, then

kind of thing is can happen at a local level as well. So to answer your question in a long-winded way,

we don't have a national strategy. We we have a big red dot on our country page in the global status

report. But I think there are a sufficient number of people that are that are not advocating

hard for it. And one of the things that the status report the global status report did was I think

because there's now a big red dot on our on our country page. It has it has spurred some interest

at a national government level to try and look at how we can develop a national strategy. So the

the conversation that I have with policy makers around data and it was exactly around us is we start

we have started to have the conversations around developing a national strategy in a process

and we've had some buy-in from national government. But we're in the early stages. So we don't have one

yet, but watch the space hopefully within the next year or two. They will be one. And I think that's

really needed to drive action at both provincial level and then at local level.

They are exactly right. And it sounds like a conversation we have here all the time here in Hawaii.

We have legislation now to create a department of water safety so that everything's coordinated under

one umbrella, the messaging, the data collection, everything. And hopefully that will pass.

We have something very specific. We're not taught we have not talked about anything

specific about your activities recreationally and how the geography of South Africa is with the

Indian Ocean and the Atlantic Ocean. We have a couple minutes we can talk about that. And then

your surf-life Africa and then National Sea Rescue Institute which is very interesting to me also.

But the issue here is that we know that we can do certain things in the legislation around

something for free diving which is an activity that is very culturally aligned here in Hawaii.

So there's some legislation about putting specific warnings on labeling to say these are

considerations that you should be careful when you buy this just reminders. If we get that kind

of thing on particular free diving equipment which is not made here but made internationally maybe

in China that could have maybe global implications according to that. We also have an issue and we haven't

talked about is water safety in our schools has been a big issue. We used to have it all the time.

And as you said swimming isn't the first thing. It's water competency or survival being able to

float. Those things are important. We have talked about that a lot here. And we're trying to get

back that back into the schools at least as part of the PE understanding rip currents understanding

the ocean right and bodies of water and how to survive in them. And it's been difficult to get

it back in the schools. Do you I've kind of run around that conversation a lot. Do you have anything

in your school system that talks about water safety? Oh this is such a difficult it's really a hot

topic here. And it's one of the biggest challenges that we have I think. Exactly. We have a lot of

so you spoke about life saving South Africa. You spoke about the National Seer Rescue Institute.

There's a couple of other organizations. There's a wonderful local organization called the Dasty

Sunshine Foundation here as well. But there are a lot of kind of these charity-based community-based

programs which try to bring water safety awareness and education into the formal education system.

So the problem is that those are add-ins and so what it is is you know it's a package or a program

that these organizations have developed and they are all wonderful all of them. But then there's

no formal incorporation of that into the curriculum. So in our curriculum, our basic education

curriculum we have a subject called life orientation which is kind of all sorts of exactly what it is

what it says I suppose is you know all sorts of things that you need in life right and what

shouldn't you have and taught us how to do our taxes or anything but but there are some component

or elements of water safety awareness in that curriculum and so often these programs are brought

in to address that particular part of the curriculum but they kind of come in once a year or maybe

even a couple of times a year but what we're really trying to advocate for and this is really

difficult because everybody every issue in South Africa wants a piece of the curriculum right

everybody wants some of their they want you know violence prevention road safety everybody wants

to be in the curriculum and so it is it's really challenging to get the water safety and awareness

that the kind of theoretical understanding and knowledge into the curriculum and then on top of that

is you know this issue of access that we spoke about earlier as well so my kids

both do swimming swimming lessons so my daughter is in grade one and she has once a week at her

school she has a swimming and learn to swim lesson and then they have after school swimming etc etc

because they have a pool on the premises but you know that's probably I don't know I'm going

to thumbs up here because I don't have the numbers but maybe that's 20 to 30% of the population has

that kind of access and there are many many schools who don't even have the basic kind of facilities

for for their curriculum let alone all the extramurals and things as well so you know I think

there are so many opportunities within our education system to try and build exactly as you said

learn to swim and the water competency as well into the you know that they kind of leave the

basic education system with those skills but in order to do that we we have to try and develop

systems that can address this issue of access so whether it's you know it doesn't always have

to be a pool at a school but it needs to be a program that allows access to a pool close by

but and that is one of the things that are the this organization that I spoke about the Darsi

Sunshine Foundation they've done really well they've partnered with private swimming schools

to get children from schools that don't have access and actually take them to these small

private swimming schools and they go there once or twice a week I think and they get swimming lessons

what's the name they're really trying to oh I'm sorry it's called Darsi Darsi Sunshine Foundation

and I think it's the founder of Christie Doyle is actually a Scottish woman but the organization is

based here in South Africa and in Scotland I think but yeah so getting into the education system

universal challenges well we're surrounded by water out here so it seems to me people have said

we're the epicenter of water safety there's no reason why it shouldn't be here but your South

Africa and not everybody is on the coast so you have inlets and rivers and things like that

give us a little brief geography lesson one of South Africa and the ocean the Indian Ocean the

Atlantic Ocean what are your challenges there so I mean so and I think this is this really speaks

to your point earlier about this issue of why drowning has been kind of under recognized before as

well I will get to South Africa now but because I think we also quite narrowly associate drowning with

you know kids and swimming pools people at the beaches we're in reality so we have we have a

really long coastline if I tell you the number that's in the top of my head I'll be lying because

I can't remember exactly but we have a really long coastline and there are vast stretches of it that are

unprotected in terms of life-saving services so we have a lot of like really remote coastline as well

we do have a really well-established voluntary life-saving service across the country so that's

along the coast as well as inland on like particularly some of the big dams in our inland

provinces we have quite a big area in our country but there are you know the life-saving

services are certainly they're localized to the urban centres so the big cities along the

the the big and medium-sized cities along the coast and they are kind of these vast stretches of

coastline in between that have no life-saving services and you you touched a little on the kind of

the two sides of the country right I'm on the west coast um we have quite brutal cold winters so

our our life-saving services stop uh kind of very soon Easter weekend we normally run up to

um whereas along the east coast uh so Durbin um East London port Elizabeth they uh will run a

bit longer and Durbin I think runs here around because it's really beautiful they all year around

um so we have these vastly different contexts even just within the life-saving community but

the the context of drowning is they are it's so difficult to describe because

South Africa is this we we have these kind of really hot pockets of high income kind of environments

we're drowning looks a certain way and it looks like maybe beaches and swimming pools and

and things and then we have um you know vast expanses we're drowning looks very different and it's

associated with like water infrastructure so things like you know irrigation ditches and canals

and flood waters so uh the the east coast uh has experienced a lot of really devastating floods

um and we know from other work that about 75% of fatalities and floods are drowning deaths

um but they're often not counted as drowning deaths um and so we've seen these devastating floods

particularly on the east and side of the country and those are things that we don't always

associate with drowning right but it's really hard to address the issue of someone swimming

between the flags on a beach and Cape Town and in the same breath be addressing the the you know

people that are kind of getting their homes washed away down down a river um in flood and so we

struggle with this like wide range of contexts of drowning inland coastal um urban rural

high income low income uh the the the the contexts are so different across the whole country

um that i think that's probably one of our challenges is is everybody has a particular area of

interest um and so they kind of advocate and um you know try really hard to to resource a particular

area of drowning prevention whereas i think we need something national to to really try and help us

pull this all together and say hang on we're working in in one space actually and we need to

try and tackle the system ethically uh i don't think i could have said that better or what has been

said on this show is that's exactly the case and what you're describing is really kind of a

microcosm here right we just had major flooding i don't know if you saw that in the news here in Hawaii

yes i did see that a few weeks ago yeah yeah it's just a Wahoo Maui the big island kawaii was

we were really lucky not to get anything in 2018 we had horrible flooding here on the North Shore

but as you know climate change and everything is helping helping to make these things be a lot worse

than they've been and the elevation of the sea levels we're seeing a lot of issues around flooding

that we were never seeing before so you're right and and we're all trying to attack a different

problem we were lucky here because we have this water safety plan that people are actually looking

at here in Hawaii and the governor said if you read it and take it to heart you could save lives so

it's really kind of a working water safety plan and in that retention ponds as you described

is a big issue here and we were able to get a law passed to put barriers around retention

ponds because one of the authors of this water safety plan lost a child to that she could swim

but her friend couldn't and she went into safer and there was no barrier on this water

on this retention pond so you're right there's different ways that people can drown it's not

just the ocean or a swimming pool. Sure yeah and I think that's something that's often

misunderstood and I even find myself occasionally particularly in conversations like this where I'm

talking with other people from the life saving space you fall back even though I fully appreciate

the broad nature of water hazards I often fall back to what I know and what I know is the beach

right and the pool and and the environments that I live and recreate in and so I think it's

you know we have to consciously be bringing those other issues to people's attention and our own

and making sure that we aren't you know lifeguards are an important kind of system element for safety

both at the coast and inland and we can't forget about that but they aren't going to address the

issue of flood related drowning so we have to make sure that we're we're kind of unpack all elements

of this issue right it's an evolving kind of world crisis and the more people we have on here the more

we learn about what we're doing right and maybe where we could learn more and hopefully we can

help you in that regard so in years surf like Africa is that pretty much the same kind of

organization that's in the UK and and in Australia and New Zealand yeah so we so I think you're

talking about life saving South Africa yes so that is our our national life saving kind of authority

it's our national organization it's a public benefit organization so it's non-profit

but it's really it's the standard holder for for the life saving kind of qualification in the

country um so it's responsible for most of the training and and certification and as I say the

standards are around life saving services so even though it's a voluntary organization often it's

our voluntary trained lifeguards that end up working in the the paid for services around the

country as well so you're saying on Durban on the Indian Ocean side would that be correct

that's right yeah so it's it's more mellow conditions is oh no definitely not okay so where's

Jeffrey's Bay I'm getting the Jeffries Bay is a little kind of southeast um so as you start

coming down the east coast around the bottom but Durban so Durban's big surf um it's quite a wide

kind of open coastline um so big so big groups when the storms come they have lots of rivers as well

so lots of river miles that create quite interesting conditions there as well um but shocky

um and but warm water so it's really that's it's warm water and beautiful weather year round so

that's why the the lifeguard services on that side will come around and then the the waste coast

is a so it's book Atlantic it's cold water um very cold water um and the conditions you know

the so the coastline's quite different it's sort of made up of like a collection of I want to say

Bay is almost um and so each of those have very much their own characteristics around the surf

and and swallow and water temperature and things um but it can get pretty in winter we when our big

storms come through um the conditions can get really rough um for sure a little bit different to

the the Durban side but uh yeah pretty rough so the lifeguards are not working after this month

there is that what you were saying or yeah typically most of the waste and care services will

finish Easter weekend so we have Easter weekends always a pretty big weekend here um but then it's

starting to it I mean I say it's starting to get towards winter now but we didn't we're in the

middle of a bit of a heat wave uh at the moment um but yeah we're starting to move down to

to colder temperatures and and get towards winter so we have an issue with tourists okay

70 percent of drownings happen with visitors and its snorkeling is their main issue I don't

know if you have snorkeling if snorkeling is an issue there or if there are other reasons and

if tourism is a big um economic value to you and South Africa on the beaches on the coast as a

opposed to inland in in the park yeah absolutely so um I mean tourism is a big uh kind of

element of our economy here so um so really really important to us we have we have big numbers

of of tourists from all over the world as well and I think our um our currency helps so sometimes

it's a relatively affordable holiday to get to us as well yeah so snorkeling so we I mean

particularly the west coast which is the colder water snorkeling's not I mean people certainly

people dive but um it's not uh I wouldn't call it like a big industry here it's a little bit cold

up kind of east coast urban and as you move up towards uh most and big diving is definitely a big

industry there and probably snorthing to some extent the waters warmer there's a lot more to see

there I I don't think that uh kind of snorkeling and diving related drowning is a huge issue

I'm not saying that we don't have any so I mean there's definitely been a a number of stories but

I don't think it's emerging as a particular risk group but what I will say is that like visitors

it's really difficult the um I think there's some really good work that's come out of Australia

around visitors so Stacey Wilcox pigeon and Wilcoon have done some work around

visitors and there's even within when we talk about tourists even within that there are these

groups these different kinds of tourists and visitors and and the the patterns that we see

are different within those so you know uh particularly what they call overseas tourists is a bit of

an older group often they're maybe almost retired or retired um and so they come with a different set

of risk factors right so they often drowning in that group is often associated with underlying

medical conditions but then you get a younger group of visitors and um tourists that are maybe

kind of doing working holidays and they often that can sometimes be associated with riskier

behavior and maybe some bad choices and um uh you know like a in holiday vibe if that makes sense

so I think even within this broader group of tourists there are uh kind of different patterns

as you break it down into to different groups but as a whole I think it's recognised as a

visitors to it an area and here we like in Cape Town and Durban they are very popular local

visitor spots as well right so a lot of the inland population comes down to either Cape Town or

to Durban for the holidays the Big December holidays so we have overseas tourists but then we also

have local tourists as that makes sense um yeah and so the you know I think the the challenge there is

that often the holidays you relax you let your guard down a little you probably do things that you

wouldn't ordinate you know you you kind of do riskier um things that you wouldn't do ordinarily

there's often a bit of alcohol involved uh unfortunately South Africa that has quite a heavy

kind of alcohol culture around holidays and and recreation and often as well you are

interacting with activities like snorkeling um but you know we also have like the standard pedal

boarding surfing um etc that you are maybe not familiar with so maybe you haven't really but

you're just trying it because you're on holiday right and you aren't you don't have a good

understanding of what the risks are and what the conditions are and what you should be taking and

not taking etc so I think it's a combination of these unfamiliar activities unfamiliar locations

where you aren't you can't read the conditions well because you don't know them even if you're a

water person if you go to a different place sometimes it takes you a while to figure out how to read

the space right um that's a really good thing yeah read the space so that is what messaging are you

doing in South Africa around water safety because we're doing messaging but as the mayor said

we got to change our messaging because it doesn't seem to be really so this is a this is actually

quite an interesting conversation because it's I mean this is a conversation we have internally

all the time between different stakeholders is like well you're saying this and we're saying that

but it's all these things are important but how do we not dilute the message right so I mean we

have I think across the board we have a lot of messaging around supervision of children um so that

is a big one for us um trying to promote this idea of of you know it's an adult responsibility to

keep the young kids safe um and what supervision is because supervision you can't be supervising if

you're sitting with a phone or you've had a couple of drinks um alcoholic drinks um so you have

to be close by you have to be sober you have to be paying attention um so big one around supervision

we so certainly in our life saving space we um and I think this is slightly different to the US but

we have the flag system so the red and yellow flags the the safe bathing areas so we really tried

to push the message of swimming between the flags yeah we don't have that here we don't have that

yeah so um and which is difficult because you know we don't have enough um patroled

beaches really to accommodate everybody who wants to come to the beach we have these large

structures of unpatrolled beach um many people want to go to areas of the beach that are quiet

and remote um because they want a certain drink um or you know they they don't want to be kind of

harassed by lifebards getting them to swim between the flags so um I think it's it's it's certainly

a message that we think is really really important but it is difficult because we also appreciate

that not everybody can get to a beach where there is a lifebards service um that's patrol and

add the big message I think is around alcohol particularly in our big um some a season you know

around public holidays and even this Easter weekend coming up now um we have a big problem with

with alcohol on the beach and around water bodies and rivers and dams so um that that Sydney is part

of our big messaging strategy as well what do you do in unguarded beaches when somebody gets in

trouble and how what kind of system do you have that can uh alert lifeguards or um

yeah it's difficult they are so there are some stretches so there's a couple of reasons why

beaches might not be patrolled right and it's it's a difficult conversation because if it is a

dangerous beach and it's not a very good swimming beach and they are rips and then we don't want to

put lifeguards there because then you're saying we'll come and swim here right it's fine

so there are certain stretches of beach that are unpatrolled because they are inherently unsafe

for swimming and then obviously there's all the signage and things but people still um people will

choose to go to the beach where it's where it's closest and and easiest the so some of those

beaches that are in the urban centres the um the National Sea Rescue Institute here in South Africa

they have this really great initiative that it's it's a recent um kind of advancement

but they have started putting up cameras um that are actively monitored so in their emergency

centre um and particularly along the stretches where they are unpatrolled and so they are able to

they i mean their their view of the resolution on them is amazing and they're able to kind of

identify risky spots on a particular day because of rips and things and then they will actually

monitor them and they are able to when they see someone in trouble activate nearby services

so whether it's a sea rescue service or a lifeguarding service that's close by um all they might

try and you know get law enforcement or something down to to move people along to a different

beach but that is at the moment very much restricted to a handful of of beaches particularly

around Cape Town and the reality is that for large stretches of the coastline if something happens

to someone um in those spaces um you know if it's not witnessed that's uh it's going to be a while

before someone is alerted to it and and something happens um if it's witnessed there we do have

some emergency numbers that you can activate the local sea rescue stations or we have in certain

uh kind of open centers we have these coastal rescue groups which is a collection of local life

guards and sea rescue and uh you know maybe other rescue services and EMS and things that can be

activated right and they're quite localized but yeah there's it it really is uh quite a problem

and a lot of our our well actually I would say almost all our coastal drowning happens in these

spaces the outside of duty hours and duty um patroled areas so these cameras they're they're not

AI driven they're just no they're actually there's a person sitting there a couple of people um kind

of monitoring them and watching them um and I've seen it it's really it's quite amazing um but

I think there's there's quite a lot of work coming from different parts of the world around AI

recognition um I've seen some I don't know whether it's New Zealand or Australia that are doing some

work around rock fishes and cameras at certain hotspots that can detect when someone falls in the

water and sort of sends an alert um I do think it's that is probably one of the areas um for the

with good potential for for drowning prevention utility yes I see that is probably just what you

said so in areas where there's no nobody able to guard it it's a risky area it's got bad conditions

I think that makes a lot of sense so I think the development of AI in that direction um I hope we'll

have some promise um doctor Saunders so you've written these articles and this one was in the

African Journal of Emergency Medicine yeah are people reading that and taking to

art like doctor like our governor green said I mean that's the million dollar question right and

actually I think this is an announcement question from Alia that you you you raise and then we got

sidetracked a little yeah but is like how do we get evidence to to action um I you know that

it's difficult so I think I think there are various ways of communicating so I don't think that

the policy makers in my environmental reading that article um I think maybe you know what that

that article in particular speaks to maybe a particular interest group or people that are

really interested in this space maybe maybe academics maybe clinicians risky services etc but

I think it it highlights what we're trying to do there is is highlight that particular issue

to groups that aren't already um uh necessarily interest or not not not not interested but it's not

on their radar right we're trying to get it on a uh a broader like radar but do I think my

president or whoever the minister of health is really and that's probably not um and so I think

that that those are useful and they're academic and they're thought leadership pieces but the policy

action comes from interactions and this is it's really a difficult space when you're a scientist

epidemiologist and you kind of want to play with data all day it's really difficult to put

just off into these suggestions we have to try and speak the policy language and try and

reframe your issue um into you know the the issues that people are interested in and are willing

to resource as well so I do think we have to take the the drowning message and advocate for it

outside of our usual um places and spheres of influence um which is not always comfortable

right um and often it's a very different language to that which we are used to speaking as well

so whether you work in an academic community or a academic community or a serious university

community you you use different terms you speak differently right but when you start moving

into policy environments you have to speak a different language and you have to really

be very clear on what your message is and what it is that your what your ask is as well

that's true then if you're on this particular show were you just talking to me an average person

and people listening trying to understand the issue around drowning to hear it from different

perspectives and hear it over and over again to you go yes we have a problem and people will say

here to me all the time we have a problem right we take drowning as inevitable not as preventable

yeah you mentioned that in the very beginning um talking about it's a series of actions

that happened that that we can prevent but we're not doing that and I go back to what my

tipton said in his interview with me which was you know the value of statistical life right the

year of life lost and I wasn't really paying attention to that and then when you start looking

at that everybody in policy making is going to get to a point where they go how much is this

going to cost right but even in the world health organization they're talking about for every nine

dollars US dollars invested I mean you get I mean for every one dollar nine one yeah exactly and

yet I see this these studies in Australian study that use the value of statistical life

200,000 in 3000 estimated the annual cost of fatal drowning at 1.24 billion Australian dollars

um you know I don't understand this in the US in patient cost for the fatal drowning can

average 96,000 dollars in India out of pocket expenses 340 per incident the major Australian study

explicitly included search ambulance and and costs of of the burden of of now I'm not trying

what am I trying to say of well I think what you're trying to get to there maybe is the so it's always

such a struggle with me and it's not my area of expertise around cost effectiveness and right and

but but I think it's this it's the they are economic losses to an economy right when a a person

dies prematurely and and those can be direct because of their that particular kind of loss of

the income that they will generate and the taxes and whatever whatever that as the average person

in that country and because drowning is this an issue of young people so either children

or this young economically active group particularly these kind of young men the economic loss associated

with a drowning death is much higher than maybe something like you know diseases or things that

happen later in life but they are also so they are those particular costs but then they are also

all these other costs that are sometimes included and sometimes not included right and and this is

one of the challenges with non-fatal drowning as well is that we often aren't we haven't really

been able to quantify well the economic cost to an individual but also to an economy a country

around the care and the loss of productivity and the loss of productivity of the family around

a person that has suffered a non-fatal drowning with you know particular consequences so they are

particular medical consequences that come along with a non-fatal drowning and these can be

severe or they can be not that severe but severe injury can really mean it can mean divorce

in a family it can mean loss of productivity for the family as well as the individual so that

there's there are costs to the actual care and that can look different whether it's a private

health care system or a state health care system you know there are costs to the rehab

to you know providing with like specialised education etc and so often those are the things I

think that we aren't including when we consider the the cost-benefit ratio of drowning prevention

initiatives because they are really really difficult to quantify and this issue of the value of

a statistical life it's such a horrible concept but unfortunately it is it is a stats concept

economist concept that because it gives us a grounding for which we can start to compare

different interventions and so so even though it is essentially placing a value on a person's

life I don't think anybody's probably comfortable with that because really how can you do that but

what it does is if we say that this is what we're willing to kind of put a stake in the ground and

say this is the value of a statistical life what we can then compare is different interventions

and how cost-effective they are and and how they can mitigate those those losses that is so well

said thank you for helping me out but I think when we start making policy and as you said we need

an overall systems approach to drown absolutely and that's where we're at and that comes with

understanding what it's going to cost right and that's all yeah I guess it always comes down to

how much how much is again a cost and and and and then what am I going to get for that it's not only

the cost it's the return on investment that's really important and that's why I think that report

from the WHO was so yes because it really shows that how much you know a small investment in

particularly I think it was daycare and learn to swim yes it makes such a massive impact

you know from an economics perspective even I that's so well said and I think everybody who's

going in front of legislature should be repeating those stats over and over again right so people

understand that a little bit of an investment is a huge return for the whole community and as you

said non-fatal drownings in this small community people drown kind of regularly but there's a lot

of non-fatal things that as you said affect the community affect the family it you know it's

kind of a trauma situation that we kind of live well we'll leave it at that but if you had the

attention of global leaders for one minute what would you tell them about drowning oh wow

so this seems like a really obvious thing I think in when I'm speaking in this environment but I

think it's something that I have knocked my head against a few times that maybe we take it for

granted but I think the biggest thing that I would say is that drowning is not inevitable it is

preventable and so with the right systems and layers of protection in place drowning incidents

are preventable they are not an inevitable kind of part of of life or living in a you know a city

et cetera et cetera so I I think that if I really had one point that I wanted to try and convince

people with power it's that drowning is preventable and that investments in prevention are really

important and they they have a good return on investment that's well so do you have any more

research plant we're actually busy at the moment so it's a really exciting project because I get

to to put my toes in the sand occasionally around this but we I am busy working with colleagues

from the University of Plymouth in the UK and the South African Weirder Services it's a project

that's funded by the Meets office in the UK around rip current forecasts so we're kind of towards the

end second going into our last year of the project to develop a rip current forecast for the

South African coastline so I'm really excited that's we're hoping to launch the forecast in April see

so that's what we're working on and now we're at the tail end of trying to wrap up all the

impact assessments and things could you give me like a little insight into that and maybe come

back doctor Sanders and talk about what you think that is a big issue maybe I'd probably I'd

probably direct you to one of my colleagues because you're going to ask me all the questions about

the physics which I don't answer but yeah essentially it's we're using so kind of the there's a

marine forecasting unit at the South African Weirder Services which you know so they have access to

all the whatever it is that wave heights and wind and you know all those different marine

forecasts and so we've worked with partners in the UK the I think it's the coastal marine

applied research unit at the University of Plymouth and they have developed a rip current forecast

which takes into account so these these factors these kind of changing factors but also the

morphology and geography of individual beaches and develop these algorithms that really predict

a rip current hazard so a hazard rating in sort of three day batches so so there is currently one

for around six beaches in Cape Town and then this project was looking to try and expand that

through to Port Elizabeth and to Durban as well and it's quite challenging because the coastline

is so different so I spoke earlier about the you know quite different morphology of the beaches

along the two coastlines but yeah it really and so part of this current part of the project has

been to use things like to try and automate this categorization of the beaches as well so

use things like satellite imaging etc to help make it a little bit you know that we can actually

do it for the whole coastline and not manually for each beach but it's really exciting it seems to be

working well and we're hoping to to get it launched soon and see how how it's welcomed by the

community oh well I want to hear more about that when it comes out that's I think that's great

yeah and then and there's a few other projects in the pipeline as well so I've got a couple of

students working on different things we we don't have very good so you spoke about the Western

Cape Study but we actually haven't got a really good black robust epidemiological analysis

of drowning at a country level yeah so at a national level so busy working with the South African

Medical Research Council on analyzing some of their injury data so hopefully that should come

out soon some data around essentially a replication of that Western Cape Study but at a national level

yes and then I've got the students as well working one of the big challenges I wouldn't say

big but it's certainly it's substantial we have a a fair amount of drowning that's associated with

baptisms and religious ceremonies here in South Africa so we I think like your culture we have a

like a very interesting relationship with water so you know the water is kind of built into who we are

and and our engagements water is often the place that we go to when we have something special to

either celebrate or or recognize and and so many of our communities you know baptism in a very

important element of their their religion or their culture and so we're trying to understand

some of the decision making around where to go and what's important and what we could do to support

water safety in those in those instances without intruding on the you know the moment and so we

obviously you know it's difficult to to tell people to take to go and do this in the middle

of the bathing area in between the flags right so we really want to try and understand how we can

support that and and but do it in a very sensitive way that we still honor the actual ceremony so

that's really exciting I'm really keen to get that off the ground and and start to see what

emerges there that should be a good piece of research based on cultural issues around water safety

that should be where your country and is and one last thing is there any legislation pending

at the national level uh not at national level so as I said we we're in the early stages of trying

to get a project off to you know develop a national strategy right in the Western Cape we spent

a lot of time over the last two years hashing out and I really mean hashing out

to be quite an arduous process um legislation around pool safety so you know residential pool safety

so essentially it's a piece of legislation that says you must have a cover or a fence

um and that's been really tricky to get to the point where it was kind of acceptable by the parties

involved and as so it's there but now needs to be um essentially enacted um and we're we're

hitting some sounding blocks there um so there's there's some legislation in the works but uh it

it may be as we spoke about it yeah a little bit contingent on national policy

well it's been an interesting conversation and I hope you can come back because

what you've written about is very good and very insightful and hopefully it moves the needle

in South Africa around water safety you know what stands out to me is that drowning people

intervention is not just about the water it's about the access education and reaching people

who are too often overlooked and you've talked about that in South Africa and even in our small

state of 1.4 million versus I think what 60 million in South Africa yeah but here in Hawaii we are

part of that global conversation and we're trying to understand how we can do things better

uh whether you're a resident or a visitor here the message is the same your safety starts before

you enter the water and the message that Dr. Saunders says to all of us that is drowning is not

inevitable it's preventable I think it's a great line Dr. Saunders and I really appreciate you

coming on because I'm going to remember that and I think that's something that people think about a

lot and I appreciate your time I I really do today thank you so much thank you so much for having

me I've had a wonderful conversation with you it's really been very enjoyable thank you deep dive

into water safety has been a podcast production of Kawaii Community Radio you can support our work

at kkcr.org the musical selection for this program is Olaali by the Haku Keki off of the album

Children of the Sea used by permission from Nakamakai