THEA COETZER
Concerns for Children Injured in Road Accidents
It appears from work done on claims for victims, that the prevention of accidents to young, particularly very young children, is not receiving adequate attention.
My work in assessments of children injured in accidents leads me to believe that the following frequently play a causative role
One would want some research done into the profiles of all road accident victims, but particularly children, as they are the most vulnerable and at risk and cannot speak for themselves. I feel that the problems of children living in poverty, in marginalized communities and in sub economic housing situations are inadequately addressed. This is of course true generally, but in particular when it comes to accidental injury.
An information system capturing the profiles of road accident victims set up by the Road Accident Fund (RAF) will give indications of where attention must be focussed in terms of improved prevention of childhood accidental injury.
Future attempts to do use "disability percentage approaches" or "sets of international impairment measures" in order to streamline claims, cut costs, and avoid high individualized claims, must be deemed inappropriate and should be discouraged.
The best option remains to assess every individual by experts in their fields of practice, to fairly determine the extent of the losses incurred by that individual. For example, the loss of a limb in one individual may mean totally different long term losses from that of another; much depends on the specific circumstances of the individual. The rights of even the most disenfranchised or marginalised person is best protected in this way and eventually the fairest settlement is thus expedited.
It may well be an option for the Road Accident Fund to appoint or have on their staff a resident or in-house team of expert medical and rehabilitation evaluators of to triage each case at the outset and so map the desirable course of a claim to save costs.
Putting limitations on claims for General Damages may be one way of capping some portions of the claim.
Assessments of impaired children by experts, following a road accident injury claim, often result in numerous recommendations concerning their future well being.
Regrettably, many recommendations seldom come to fruition.
The current system of support to children that are the victims of road accidents falls short in the following:
Children from indigent communities that are seriously injured, are admitted to state hospitals where the essential emergency and medical intervention is provided and once the child is "out of medical danger" is often discharged without the necessary rehabilitation, intervention, provision of the correct assistive devices and guidance provided to parents.
As a rehabilitation specialist I perceive considerable pressure on state hospitals to save and cut costs. What are (often falsely) deemed less essential services are greatly undermined through staff cut backs and service limitations, at the expense of injured people. Physiotherapy, occupational therapy, speech and language therapy, psychological services, social work intervention, domiciliary services and even psychiatric help, typically come under considerable pressure due to lack of staff and resources and can consequently not be utilised correctly. This means that children are not given the full course of rehabilitation, are not pointed in the right direction in their communities for care and ongoing services and may well develop secondary participation limitations, which could have been prevented with good rehab and follow-up care. Families often have to "muddle along" on their own until the childs claim gets processed.
It is then not unusual to find that the message of helplessness sets in rather than a message of possible self actualisation, despite limitations/disability of participation limitation; (the very work rehabilitation specialists are trained to do.)
There has to be some form of contract between the RAF (Dept Transport) and Medical Services (Dept of Health) that ensures that all Road Accident victims receive the type of care an individual that uses so called Private or Medical Aid Supported Care would get prior to settlement of the claim and once an undertaking is given.
Numerous children that are injured in road accidents require some for of educational support.
Main stream school no longer provide adaptation classes for children with special needs. Such children are supposed to receive support through so called ELSEN itinerant teachers. Many schools in less well off communities simply dont have such teachers, or ELSEN teachers are stretched beyond capacity. Children with serious traumatic brain injury typically remain in the main stream in large classes. They simply "fall between the cracks" and get promoted from grade to grade and finally tend to become drop outs, that are further marginalised by society.
Special schools are also under pressure and can only really serve children and families in the urban or peri-urban areas. Children with disabilities from rural areas and the platteland remain marginalised.
There has to be some form of contract between the RAF (Dept of Transport) and the Education Department that will ensure that all children with special needs, resulting form injury in a road accident, will receive individualised, facilitated educational care and support for as long as they require it.
The Department of Education must be encouraged to set up satellite or small special schools in rural areas and in the platteland to overcome the problem of children that cannot cope with main stream schooling in their communities. Hostel facilities in urban areas at existing schools need to be revised.
Regrettably young adults with impairments and activity limitations that are capable of working (even if only part time) receive inadequate ongoing rehabilitation. Facilities for work rehabilitation are extremely limited, even in urban areas. The recent closure of Re-Able, a rehabilitation workshop in Cape Town for people with activity limitations is an example that the government is not serious about work rehabilitation. Private work rehabilitation is not affordable to all.
Workplaces with people who cannot enter the competitive open labour market are over subscribed to, or are being down-sized. Sheltered Workshops (Service Products) are no longer options to available for people with limited productivity for this reason.
It is absolutely vital that work rehabilitation centres are set up to enable people with activity limitations to return to some form of work, even if this is limited. There must be a stronger collaboration between the Dept of Health, Dept of Manpower and Dept of Labour to set this in motion. Securing small government contracts for such workshops are deemed vital. Perhaps the Dept of Transport can bring some pressure to bear on these departments in bettering the outcomes for the injured victims of road accidents!
4 Use of the so called UNDERTAKING to pay for all future medical needs or accident related educational expenses and assistive devices after claims settlement
Unsophisticated parents have difficulty in accessing the undertaking from the RAF, at the expense of their injured children. This is even more complicated if a percentage is apportioned to such claims.
Access to rehabilitation services is often non existent to people who need them most. Private rehabilitation services are often the only options and these are completely outside their communities and too expensive to even contemplate as an option for most.
A card system functioning like a medical insurance claim card from the RAF, whereby medical expenses are deducted may be one way of addressing the problem. The fees and tariffs for medical and rehabilitation services should follow the fee guidelines as set out by the Board of Health Funders. The professional associations of all medical specialists and rehabilitation professionals should be approached to establish reasonable fees and tariffs for services.
A transport system (akin to Dial a Ride in urban areas) that is run by the Dept of Transport for RAF claimants to provide access to difficult to reach services could be an option to solve the problem of accessibility.
A no-fault system that eliminates percentages seems more desirable; for all children (not limited to certain age categories).
Thea Coetzer (Mrs)
Neurodevelopmental Occupational Therapist
Phone: 021 68 66056
Fax: 021 68 99795
E-mail: [email protected]