The Stray Bullet Project.

Abstract

July 7, 2017, 11:50 pm—American University of Beirut Medical Center, Beirut, Lebanon. I was examining a patient in the pediatric intensive care unit (PICU) when I received the call. I ran to the emergency department (ED) to see Adam. He was intubated, waiting for transfer to the PICU. Adam was a beautiful 7-year-old boy with spiky hair and blond highlights. He was rushed to the ED by his parents, still in his tailored suit and black bowtie after collapsing while playing the tambourine at his uncle’s engagement party. He arrived pulseless; circulation returned after two cycles of cardiopulmonary resuscitation (CPR), his physical exam was nonfocal except for a pinpoint hole, as small as the tip of a pencil, on the left side of his head. Imaging revealed a penetrating bullet injury to the brain and the spinal cord. The bullet had entered from the left parietal brain, traveled through the corpus callosum and the medulla, and lodged behind T1 and T2 in the subarachnoid space. When Adam’s parents were informed of their son’s diagnosis, the word “bullet” rippled across the room. The moment of comprehension was palpable, the room transformed into a scene from a horror movie: his mother and grandmother burst into tears, kissing his hands and face, his father sat on a chair next to them breathing heavily and listening to his uncle’s screams: “I will find that shooter and send him to jail.” People take for granted the very poignant line drawn by the trajectory of a stray bullet. In an instant, a celebration irrevocably becomes a tragedy. Adam was another victim of a senseless tradition: celebratory gunfire. It is imperative to note that firearms are readily available in Lebanon—a country torn by past civil wars—and have become ubiquitous during celebrations and tragedies alike: a shower of hailing bullets to mark an engagement, a funeral, election results, and high school graduations. People fill the skies with bullets that eventually come back down claiming innocent lives, often children’s, on their way. Stray bullet injuries have become an epidemic all over the world. Since 2016, at least seven reported victims have died from stray bullets shot during weddings, engagement parties, political speeches, elections, and official exams results in Lebanon, annually.1 Failure to enforce already lenient antifirearm and shooting laws has made ownership, carrying, and shooting of firearms a common occurrence.2 July 15, 2017. 12:00 PM: Adam succumbed to his injury 6 days later. My attending physician and I went straight to the second stage of grief: anger. Something had to be done. Our rage compelled us to advocate for change. Along with two pediatric residents, we launched the Stray Bullet Project. This project aims to 1) raise awareness about the brutality of celebratory gunfire, 2) encourage the Lebanese to cooperate with internal security forces to trace shooters, and 3) (re)enforce the laws. The last has been our greatest challenge. After months of research, we were finally able to get some statistical data from the Lebanese Internal Security Forces. According to the data, there were approximately seven casualties and 167 injuries each year (2016, 2017, 2018), 50% of those injured were children, and three of the seven were children below the age of 10.1 These numbers are an underestimation, given most injuries remain unreported. Despite many challenges, our team remains motivated; we have continued our campaign by telling Adam’s story at grand rounds, at national and international conferences, and by lobbying for change with politicians. The Stray Bullet Project has been adopted as one of the American University of Beirut’s corporate responsibility projects. We even collaborated with a local NGO on behavioral economics to brainstorm on ways we could spread awareness and change behaviors around celebratory gunfire. Our hope is for our message to permeate younger generations, who will work with us toward an end to this archaic practice once and for all. After all, our role as physicians—especially as pediatricians—is not only limited to diagnosis and treatment of illness and disease. Our mission provides us with unique opportunities to offer guidance through awareness and prevention, ultimately improving the health of individuals, populations, and even nations. We hope that our efforts result in policy and law change regarding the tradition of shooting during public occasions—a practice that has claimed lives of children and adults in a country barely recovering from a history of conflict.