“But what about our kids, the ones that don’t have access to chlorinated pools? They swim in creeks, floodwaters – what do we tell them? Where is the evidence for them?”
It seemed like such a simple question.
This question was asked by an Aboriginal community member during consultation with the OMEGA First Nations Technical Advisory Group (TAG) as part of the update of the Otitis Media Guidelines for Aboriginal and Torres Strait Islander Children.
Surely there would be an answer.
The question was about children with grommets, or a hole in the eardrum (a perforation), and whether swimming in natural waterways could increase their risk of ear infection. As part of the OMEGA team, I was helping review the research that would inform the updated guidelines. It seemed like exactly the kind of question evidence-based medicine should be able to answer. But it couldn’t. Not because the evidence was poor. Not because previous researchers had asked the wrong questions. But because this particular question had not been asked.
For many Australian children, swimming means the local pool. However, for many children growing up in rural and remote Australia, particularly Aboriginal and Torres Strait Islander children, swimming means something very different. It means creeks, rivers, dams, waterholes and floodwater.
These waterways are more than places to swim. They are places of connection to Country, culture, family and community. They are where children learn to swim, develop confidence in the water and build skills that one day may save their lives.
If we advise a child not to swim, what are we really asking them to give up?
To answer the question, we searched the evidence. There was no shortage of research. Hundreds of studies had explored swimming and ear health. Many examined chlorinated swimming pools. Others focused on treated tap water, bath water, earplugs, soap entering the ear or the effects of diving.
Each study answered an important question. But not this question.
Could we confidently reassure a family whose child swims in a creek? Or a river? Or a dam? Again and again, the literature came back with the same response.
It couldn’t tell us.
The existing evidence reflected the questions it had been designed to answer. It provided valuable guidance for treated water and chlorinated swimming pools, but remarkably little about natural freshwater environments, despite these being the places where many rural and remote children swim. We also found very little evidence relating to children with a perforated eardrum.
That doesn’t mean swimming in natural waterways is unsafe. It also doesn’t mean it is safe either. It means families and clinicians are often making decisions without evidence that truly reflects the environments where those decisions are being made.
That simple question from the OMEGA First Nations TAG revealed something much bigger than an evidence gap. It showed how communities don’t just benefit from research; they help shape it. By asking a question grounded in lived experience, the TAG highlighted an important opportunity for future research: to better understand the environments where many rural and remote children live, play and swim.
Where is the evidence for them?
It is a simple question, yet it is one we still cannot answer with confidence. Perhaps that is the most important lesson of all. Not because anyone got it wrong, but because one important question had never been asked. Now that it has, we have an opportunity to find the answer.
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