For most of us when we think about gun violence we think about two scenarios- those who die and those who survive. We don’t really think about the sequelae of gun shot wounds and the effect they can have long term.
Life after a gunshot (or multiple) can be a drastic and disabling change for many. When I tried finding reference material for the long term complications it was a bit difficult and there were a lot of medical articles I didn’t have access to.
Here I speak to some of the possible long term complications, this article in no way encompasses all the long term effects of gun shot wounds.
What does a gunshot do to your body?
It really depends on the bullet, you have those that simply go straight through on a more predictable path and those that fragment and explode inside the body.
In general, when someone is shot by a bullet, the energy that the bullet has dissipates to the surrounding tissue and creates a cavity, this cavity then collapses and causes damage to the structures surrounding it.
For the bullets that remain unchanged as they enter the body, this is the main mechanism they use to cause damage, so they aren’t as bad as the ones that break into fragments. Those bullets not only have high energy but they also cause ripping and tearing of structures in the body.
It’s hard to predict the path of a bullet, since it can change its course inside the body.
Overall, what happens after being shot really depends on the type of bullet, and the path of the bullet.
Watch BBC’s video ‘What happens when you’re shot?’
While doing my reading I came across an article in The New York Times called ‘What Bullets Do to Bodies’ by Leana Wen, and it is an op- ed that compared two similar young male patients with similar injuries but done with different bullets. I think it encapsulates just how much of a difference the bullet can make. Read it here.
Life after gunshots.
There will be persons who make a full and complete recovery without any real physical challenges, there will be those who become completely dependent on others for care and there will be those who are in-between.
Being shot in the head, spinal cord, chest or abdomen will be some of the worst to recover from statistically, while those in the limbs would be easier… but nothing in life is hard and fast.
The long term effects of gun violence can affect physical and mental health.
How can it affect physical health?
This depends almost completely on the injury. We will be focusing on long term effects and complications.
The Nervous System
Persons can have neurological damage. This means they can have damage to the parts of the body that allow us to move, feel, think and so on.
Damage to the brain can cause cognitive dysfunction, which can affect a persons ability to communicate, go back to work or school or function at the mental level that they used to.
Persons can also become paralysed from damage to the spinal cord, and this can be as drastic as quadriplegia where they’re unable to move their upper and lower limbs (hands and feet).
This can cause persons to become dependent on their family and friends. They are at risk of having bed sores that can lead to terrible and life threatening infections and can put them at risk for amputations.
Damage to the spinal cord can also cause loss of bladder and bowel function, so some persons may have to have in a urinary catheter to collect the urine from the bladder and/ or use diapers.
Damage to other nerves that supply individual parts of the body (called peripheral nerves) can cause paralysis of a group of muscles or might make them weak. Someone who is shot in the shoulder may have difficulty using the hand on that side because of damage to those nerves.
Damage to nerves can also result in chronic pain, which is called neuropathic pain. This is one of the most difficult types of pain to treat.
The abdomen is colloquially called the “stomach”. Injury to this area has the potential to damage several structures.
The intestines can be injured which can result in having to take out parts, leaving the patient with a stoma, which is basically when you bring part of the intestine out unto the skin of the abdomen, you would put a bag over it which would collect the contents of the intestine.
This is one of the most common results of abdominal injury, some persons will have to use this bag to collect their faeces for life or some may have it reversed and able to defecate normally.
Other organs like your liver, kidney and spleen can be damaged which can lead to removal of either the entire organ or parts of it. If the spleen is removed, persons are more at risk for certain infections and will need vaccinations to help prevent those infections.
There is a lot more than can happen, damage to bones can cause amputations and persons might need multiple operations to correct the damage done.
One of the studies I saw spoke to the psychological effects of injury. You can read ‘Physical and psychological outcomes 8 months after serious gunshot injury.’ here.
Gunshot wounds will affect most persons mentally, from having post traumatic stress disorder (PTSD), depression, feelings of guilt to avoidance behaviours.
In order to treat these, it is paramount to get professional help involved as soon as possible and good support system is always helpful.
Gun violence is a major contributor to our murder rate of about 59 per every 100 000 persons. It is postulated that violence in Jamaica uses up to 5% of our GDP (so about 70 million USD).
But what about the human cost?
Gun violence not only kills, but it reduces the productivity of those directly and indirectly affected by it. Since trauma affects mostly the younger age group, we have 20 year olds, 30 year olds and 40 year olds who are bed ridden, and who’s life changed in a matter of seconds.
In the treatment of gun shot wounds, the biopsychosocial model is especially needed, as it will take more than medicine and surgery to treat effectively. Therapy, both physical and psychological, play a major role in rehabilitation of these patients.
‘For gunshot survivors, recovery can last a lifetime’. The title of this article resonated with me, read it here.
To reduce the complications of gun violence, it isn’t just ensuring that persons reach hospital quickly, that more blood is available in blood banks and having more physiotherapists and psychologists/ psychiatrists… It also means prevention.
How do you think we can prevent gun violence in Jamaica? Let me know below.
Samantha C. Johnson.