Health service a mixed picture

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WHILE Nelson Mandela Bay’s two trauma units are operating smoothly despite staff shortages, the city’s ambulance service is in chaos, with vehicles failing to reach the desperately ill people who need them most.

Many drivers refuse to go into certain areas after dark as they fear for their safety, while others battle to find patients due to poor road signage.

And even when they do arrive at their destination, a critical shortage of paramedics often forces under-qualified ambulance assistants to make life-and- death calls they are not trained to make.

The city is also shockingly short of staff and vehicles. A confidential provincial Health Department report, which The Herald has seen, states that Nelson Mandela Bay should have 110 ambulances – one for every 10000 residents.

However, ambulance drivers said there were on average 13 ambulances on a shift in the city at any given time.

The city also only has three qualified paramedics to man these ambulances. A further three are in charge of training ambulance assistants to the level of paramedics, or "emergency care technicians”, a programme which itself is many months behind, according to department insiders.

There are currently 25 ambulances and 626 ambulance staff covering the vast area stretching from the Bay to Graaff-Reinet, Joubertina, Humansdorp and Willowmore.

Department spokesman Sizwe Kupelo said more ambulances were to be delivered province-wide soon, and the Transport Department was in charge of the budget for the ambulances. The contract for this is held by Fleet Africa.

Kupelo said there was a national shortage of ambulances, which the department was intent on correcting.

While outlying areas of Mandela Bay benefited from last year’s increase in personnel, emergency medical service (EMS) staff say there have been no increases in staff or vehicles for Port Elizabeth, which has the largest population in the region. Adding to the shortage of paramedics is the fact that many ambulance drivers refuse to drive deep into townships, fearing for their safety.

"It’s too dangerous,” said an ambulance assistant, who has been working for the state since after last year’s Fifa World Cup. "There are red-zone areas which we outline as dangerous areas, but sometimes there are cases when the SAPS don’t accompany us. There was a case recently when the EMS was called out to a fight, and when they got there, those guys turned on them.”

According to Health Department statistics, most ambulances are called out to deal with patients who are in labour or the victims of physical assaults – double the number for car accidents or respiratory conditions like asthma.

These figures are borne out by a study recently published by the SA Journal of Epidemiology and Infection, where it was found that between 60 and 78% of patients treated for injuries in trauma rooms at Port Elizabeth’s state hospitals tested positive for alcohol.

Meanwhile, despite enormous work pressures, emergency doctors at Livingstone and Dora Nginza hospitals have a success rate double that of many first-world countries.

PE Hospital Complex clinical governance head Dr Aydin Vehbi said 1.7% of the 5600 patients attended to by emergency rooms every month died, while the accepted mortality rate for emergency rooms in first-world countries was 2.5%. However, this might be because emergency staff were often bogged down treating patients with minor ailments who should be at a clinic rather than at hospital.

Doctors said the overcrowded "physician-on-call section” was the clearest example of the effects of a broken down referral system. "Many come to Livingstone with illnesses that could be dealt with by day hospitals or come looking for medication that should be distributed by clinics,” said one doctor.

According to staff, the emergency rooms at Livingstone and Dora Nginza hospitals were "woefully understaffed”.

They say this is not because there are not enough doctors, but because there is a high absenteeism rate among doctors – especially over weekends.

Vehbi declined to provide The Herald with details of disciplinary action taken against doctors who did not come to work but said if they could not provide a valid reason for their absence they were subject to the same disciplinary process which applies to all staff in public service.

Patients told The Herald that since the new Accident and Emergency Unit at Livingstone was opened they did not have to wait as long to be attended to.

Provincial health spokesman Sizwe Kupelo said the department alone should not be held responsible for the enormous pressure on Port Elizabeth’s emergency health services. "People must start taking responsibility for their own lives.” Emergency rooms, he said, were "buckling under the strain of assaults, alcohol and drug abuse”.

Department communications head, Siyanda Manana, said new equipment at Livingstone had motivated staff to better care for patients. The closure of the Provincial Hospital trauma unit last year also meant there was more staff at Livingstone.

"Extra staff have been appointed and others have been deployed from Provincial because the accident and emergency units at Provincial have been closed,” Manana said.

However, security guards at Provincial Hospital said the decision to close the unit had not been well-communicated. They often had to perform first aid on trauma victims before sending them on to Livingstone Hospital.

"One guy came in here with a broken bottle sticking out of his head,” one guard said. "We bandaged his head and sent him off to Livingstone. It is also very difficult for older people who live in the area (Central) to travel that far.”

Kupelo said due to budget constraints, they had decided to close the Provincial Hospital’s emergency unit.

"With our budget we cannot afford to have two emergency units in such close proximity,” he said.