Trauma units like war-zones, says SA doctor


‘Trauma cases at epidemic proportions in Western Cape – sometimes you go in there on a Monday and the place looks like a war-zone’

 Cape Hospital trauma units under threat warn doctors With trauma cases ‘reaching epidemic proportions’ in the Western Cape, medical authorities are becoming desperate to find quick-fix solutions, such as wanting to merge the medical-emergency units of its tertiary hospitals with its highly specialised, heavily-overburdened trauma units. Cape Town’s legendary Groote Schuur Hospital – where foreign doctors often are sent to learn how to run trauma units — last year treated 11,000 patients for trauma: 4,092 for serious assaults, 2,200 from traffic accidents, and 580 patients with gunshot wounds…  Countrywide, SA public hospitals treated 127,000 bullet wounds…


Melanie Gosling of the Cape Times, reports  on July 14 2009 that top Western Cape doctors have slammed the provincial government plans to merge the highly-specialised trauma units of their tertiary hospitals with their emergency departments as ‘completely bizarre’. 

The Western Cape’s health department wants to merge the overloaded casualty sections at its top tertiary hospitals with these highly efficient trauma units. However,  these authorities also reject experienced doctors’ warnings that this will  greatly compromise trauma patient care, Gosling writes.

Currently the Groote Schuur Hospital in Cape Town, the Red Cross Childrens’ Hospital in Rondebosch and Tygerberg Hospital in Parow all have dedicated trauma units to deal with complex trauma cases that need highly specialised treatment for serious motor vehicle accidents, assaults, stabbings and gunshot wounds. Emergency departments at these hospitals concentrate on entirely different medical emergency, namely the treatment of heart attacks, pneumonia, asthma, diabetes etc. Groote Schuur’s emergency department treats a monthly 3,000 such patients.

Groote Schuur: 580 patients with gunshot wounds last year:

DrudeClive_ArgusBike_Race_AttackSurvivorFeb62008 A typical trauma unit case in Cape Town: cyclist Clive Drude, who was attacked in a bizarre, very violent assault during the annual Argus Cycling Competition in February 2008. Groote Schuur’s trauma unit treated just under 11,000 such patients that year, of whom 4,092 just like Clive, had been seriously assaulted, 2,200 had been in motor vehicle accidents and 580 came in with gunshot wounds. Having a specialised trauma unit increases such patients’ survival rates by between 20 percent and 30 percent, the hospital records show.


Trauma on a par with HIV as a killer in South Africa:

Gosling writes that ‘trauma cases are increasing in South Africa, where the trauma rate is the second highest in the world after Colombia, and doctors say trauma is on a par with HIV as a killer.”

She quotes Professor Ken Boffard, president of the Trauma Society of South Africa, who has written to the Western Cape Department of Health as stating: "I would strongly advise that the decision to merge the emergency department and the trauma unit at Groote Schuur Hospital be very carefully reconsidered, with much wider consultation."

Boffard said it had been shown nationally and internationally that where a dedicated trauma unit existed, the mortality rate was "substantially lower than even the large general academic hospitals".

‘The trauma load is massive:’ … ‘it looks like a war-zone’.

Gunshot Head Trauma_TraumaSocietyOfSouthAfrica_log A typical gunshot wound in SA is often inflicted from an AK47 bullet. Countrywide, 127,000 bullet-wounds were treated at the country’s trauma units. The vast majority are never reported to the SA Police. Picture: Trauma Society of South Africa.

Professor Del Khan, head of surgery at Groote Schuur, also said while he fully supported the establishment of central emergency medical facilities at secondary and smaller hospitals, this centralised system "has no place in major tertiary hospitals where we have well-established trauma units.

  • “Trauma has reached epidemic proportions in the Western Cape. The trauma load is massive: motor vehicle accidents, violence, assaults, gunshots. Sometimes you go in there on a Monday and it looks like a war zone," Khan said.

The authorities ‘should increase resources to the creaking casualty section…’ instead of their plan to merge casualty and emergency departments:  "The real problem is the medical emergency side which has been overwhelmed with the workload. The only thing needed at Groote Schuur’s emergency unit is to increase resources," Khan said.

The provincial health authorities have insisted that their proposal does not mean a merger of casualty and trauma units, but a "re-organisation of hospital emergency services". They say they plan to develop a "more integrated way of managing emergency services" with one emergency centre at tertiary and secondary hospitals, with specialised units attached. Beth Engelbrecht, deputy director-general of of the Western Cape Health Department, said emergency services were "too fragmented".

“Trained nurses not doing anything in trauma units… but in emergency, nurses are over-strained…’ claims Beth Engelbrecht of the WC health department…

  • "There is no one in charge. I have travelled in ambulances to get some sense of what is going on," Engelbrecht said.  "We’ve got trained nurses not doing anything (in trauma) but in general emergency the nurses are overstrained. In one part they are playing computer games and in the other one are long queues. Patients are waiting hours on end in casualty," Engelbrecht said.

Engelbrecht said the trauma unit would be "positioned alongside" the emergency centre. Patients would be referred from the central emergency centre to the trauma centre. No extra staff would be hired.

Doctors slammed this however as ‘ a return to the inefficient pre-1980 system. The two sections, casualty and trauma, were amalgamated in the old days and it was a disaster," said one doctor, who did not want to be identified.

You need to be geared up for trauma with a team that’s available 24 hours…

  • "They could not cope. They had patients like diabetics and asthma cases and then a gunshot chest. You can’t work like that. That’s why the two split. You need to be geared up for trauma with a team that is fresh and available 24 hours. Now they’re trying to undo the specialised trauma system, when the real problem is that they have slashed the beds in casualty."

Khan said trauma surgeons could train only at institutions accredited by the Health Professions Council of SA. Groote Schuur’s trauma unit was in the process of being given accreditation.

  • "If we go down the route they (provincial authorities) want, we won’t get accreditation and we won’t be able to train trauma surgeons at Groote Schuur," Khan said.

Groote Schuur’s trauma unit is internationally recognised and has a patient survival rate on a par with the most developed countries. Doctors from the UK and Europe came to work at the unit for six moths or a year to learn from South Africa how to manage trauma. "The UK is now going down the road of having trauma units like ours and Professor Andy Nicol, the head of Groote Schuur’s trauma unit, has been asked to go to the UK to tell them how it’s done here," Khan said. This proposed centralisation of emergency services will happen only in the Western Cape, Gosling writes on Page 1 of Cape Times on July 14, 2009 ‘Hospital trauma units under threat’

Groote Schuur Hospital also gets a lot of medical tourists from abroad:

Do South African patients have any rights when their doctors strike?

‘Striking South African doctors are a serious threat to the human rights of all of the country’s residents — even refusing to treat emergency cases…’

 Picture: with South Africa’s 640 public hospitals facing a devastating strike by its 18,000 doctors, do the country’s more than 30million poor patients who rely on these hospitals have any other alternative health care left, other than visiting the local witch doctors?

June 21 2009 – CAPE TOWN. For the third time within two months, the country’s 18,000 overworked, underpaid and totally demoralised public hospital doctors are planning yet another wildcat strike from Monday at the 640 state hospitals. They start the strike in KwaZulu-Natal and the Eastern Cape on Monday, and it will expand to the other provinces Tuesday and Wednesday.

The SA Medical Association spokesman Lebogang Phahladira told the Sunday Times on Saturday that the striking doctors ‘will report for duty and sign attendance registers – but will refuse to treat patients, even in emergencies.” 

  • And South Africa no longer has enough doctors in the private sector nor in the military to help out in emergencies– even if they were asked. South Africa now only has about one doctor for every 200,000 people and its public hospitals are overburdened due to the combined TB-AIDS epidemics.

In 1985, South Africa’s public health service had more than 25,000 physicians and dentists; 5,100 specialists, 222 dental specialists and 18,700 paramedical workers, registered at the South African Medical and Dental Council;  and 155,000 registered and staff-nurses. South Africa is in the midst of the world’s most devastating co-epidemic of two simultaneous killer-diseases, TB and XDR-TB — and the rapidly-shrinking medical staff can no longer cope.

“Thousands of patients face being turned away from public hospitals (Monday) if the wildcat strike by South Africa’s 18,000 disgruntled state doctors goes ahead”, reports the Sunday Times.The South African Medical Association (Sama) spokesman Lebogang Phahladira said on Saturday that it ‘’expected a total shutdown” in KwaZulu-Natal and the Eastern Cape, followed by the rest of the country on Tuesday and Wednesday.

  • By late Saturday, neither the doctors in the South African National Defence Force nor the private hospital sector — both central to government’s previous strike contingency plans — had received any requests for help.

Goverment Hospitals Sowetan CartoonSama spokesman Phahladira said members had “overwhelmingly” decided to strike. Doctors would report for duty and sign attendance registers but would not treat patients. “None of the departments will be operational and we will not see any patients, even in an emergency. We will not work until our demands are met,” said Phahladira.

Sama wants a minimum 50% salary increase for its 7000-odd members. Government has offered a mere 5% – which is less than inflation. Apparently, a revised deal will be presented at a bargaining council meeting forthcoming Wednesday.

Sama chairman Mac Lukhele said although many members planned to strike, the union had appealed for patience until the outcome of this latest meeting. Some have agreed to hold off on strike action.

  • A spokesman for the Hospital Association of South Africa, Kurt Worrall-Clare, said the group had had no requests for help. He said that in the past the association, representing all major private hospitals, had received formal requests from the government at least two or three days before anticipated strikes.
  • Morgan Chetty, chairman of the KZN Managed Care Coalition representing some 3,500 doctors in the private sector, said they would not have enough doctors to help out if asked.
  • Defence force spokesman Sam Mkhwanazi said the SANDF ‘s medical teams have also had not been asked to assist.

‘There is no crisis’ – KwaZulu-Natal health MEC…

The KwaZulu-Natal provincial MEC for health, Sibongiseni Dhlomo, told the Sunday Times yesterday ‘the department did not believe outside assistance was necessary because there was no crisis.’  However, in Gauteng on Friday, a provincial memo to Johannesburg hospitals requested contingency plans be put in place and strike committees set up. Gauteng health spokesman Mandla Sidu said it was the “prerogative” of hospital chief executives to request SANDF and private sector assistance. Western Cape health spokesman Faiza Steyn said the province had a “sufficient pool” of doctors, including part-time doctors, military doctors and agency staff, to draw from. Attempts this week to get comment from the national Department of Health were unsuccessful. — Additional reporting by Chandre Prince

Nightmare scenario

During the previous wild-cat strikes on June 6, 2009 and May 29 2009, accident victims who were rushed to state hospitals in Pretoria had to wait for three days for emergency surgery, and in Cape Town, it was  reported that during a protest march on Parliament, a petition was handed in by more than 100 local doctors, pharmacists and other public sector health professionals – demanding fair pay and better working conditions. The march was organised by the SA Medical Association (Sama). The document calls for the immediate implementation of the promised Occupational Specific Dispensation, which was supposed to take effect in July last year; a minimum 50 percent increase in basic salary; and the unfreezing of all essential public sector medical posts. At the moment, more than 60% of the nursing staff posts also remain because there simply aren’t enough qualified people to fill them.

Three-day wait in trauma unit for surgery:

Nurses and doctors at the Pretoria Academic Hospital, which was renamed the Steve Biko hospital in 2008, told the emergency-room patients waiting for their emergency surgery on June 6 that ‘it was out of their control about who gets to be operated when, we are overloaded with work’, telling patients that they were so permanently understaffed that emergency patients were forced to wait for days, with wounds remaining undressed and infections setting in, even without any strike actions…. For instance, emergency cases rushed to this academic hospital now already are being forced to wait without treatment in the trauma department of the Pretoria Academic Hospital for at least three days before they can be operated on.,,3-975_2527110,00.html


Best public health system on African continent only fifteen years ago…

South Africa used to have the best Western public-health system on the African continent: In 1985, South Africa’s public health service had more than 25,000 physicians and dentists; 5,100 specialists, 222 dental specialists and 18,700 paramedical workers, registered at the South African Medical and Dental Council, and more than 127,000 registered nurses signed up at the Nursing Council – and by 2002, there were 155,000 nurses.

In 2002, Statistics SA showed that the country had 155,000 top-trained practicing nurses, for a nurse/population ratio of about 343 per 100,000, well above the  200 per 100,000 minimum required by the World Health Organization. Now, the country’s public hospitals show a severe staffing problem, with more than 60% of all the nursing posts countrywide remaining vacant for months on end. In many rural towns in all the South African provinces, there no longer are any physicians at all.


Previous strike June 2007 plunged hospitals into chaos

There had also been a public service strike in June 2007, which included all the nursing-, technical-, clerical and janitorial staffers  in the country’s public hospitals —  but which at that time, had seen doctors keeping themselves aloof from striking –,  although they often publicly did sympathise with the poor working conditions of the medical staff.  And when the nursing staff did not get the pay rises they wanted even after this devastating strike, during which many people died because they were left untreated in emergency rooms, they left the public service enmasse. Now there’s a an average, countrywide nursing shortage of 60%, with some public hospitals reporting up to 90% shortages.

Cosatu president Sidumo Dlamini said the state of staffing at the country’s public hospitals was a "ticking time bomb" and noted that if doctors were not happy in South Africa, the entire country would suffer.

  • "We are saying to our government that this matter is very urgent. Workers in this country have been in recession for many, many years. When salaries get lower, it is destroying the country," he said.

36 hour shifts for $800 a month, overtime without pay :

The doctors’ two-month campaign for better working conditions also include weeks of angry picketing . Doctors warn that they are being grossly underpaid, are forced  work 36-hour shifts without any overtime pay because of the severe shortage of physicians and specialists, that there also is an often dramatic shortages of critical drugs and equipment at all the state hospitals, and heavy workloads for physicians, with shifts lasting up to 36 hours. The government had moreover offered these doctors a deeply insulting 5% in a pay-rise, which does not even cover inflation, said the South African Medical Association chairwoman Denise White.

The Health Professions Council of SA refuses to support the strike – albeit does  ‘acknowledge the need for adequate remuneration packages”.

  • "We do not support or condone the strike by public sector doctors over salaries and working conditions as they provide an essential service. However we fully acknowledge the urgent need for commensurate remuneration packages and improved working conditions," said HPCSA Registrar and CEO, advocate Boyce Mkhize. "Public sector doctors are professional health care practitioners working under sometimes extremely challenging conditions while saving lives on a daily basis and should be remunerated accordingly."

Doctors, nurses fleeing overseas:

HPCSA statistics indicate that over the past year 3,550 certificates of good standing were issued for medical practitioners alone while 22,032 certificates were issued since 1 April 2003. The majority of these certificates are requested by doctors applying for positions overseas.


‘can any doctor still function safely after a 36-hour shift?’

Interns take home about R8,000 ($800) after deductions and specialists roughly double that, according to the United Doctors Forum deputy chair Mpho Mohlala. "We are not giving proper basic care to the patients. You are not doing justice to the patients. Do you think operating (on) a patient without having sleep for 36 hours, you are functioning? You are non-functional," said Mohlala.

Government denies there’s any crisis

"We’ve got an exodus of doctors leaving the country, going to work overseas, and we’ve got lots and lots of doctors moving out of the public sector to the private sector," she told Agence France Presse news agency.

  • The health department denies that its sector is in crisis, saying media reports are ‘alarmist’.

“Illegal strikes and illegal marches” – but would they really fire all their doctors?

At the moment, more than 60% of the nursing staff posts already are left open. The exodus of South African nurses to Western countries started from 2004 – but the government itself has made matters much worse because it failed to address the complaints issued by staffers ever since the 2007 public service strikes, which brought no improvement in the working conditions.  South Africa’s nurses started migrating abroad enmasse. And now, it looks as if South Africa’s  doctors are also throwing in the towel – thus condemning Africa’s once so brilliant First-World public health service to death.,,2-7-1442_2523853,00.html


History of South African public health service under apartheid:

South Africa’s present public health system was launched by the apartheid-government from 1977. It started an ambitious building programme of public hospitals, outpatient clinics and rehabiliation facilities countrywide for people of all races, and where patients could pay for health care according to their income. The motto of the SA public health service was: “Patients pay according to their income, and those who cannot afford it, get treated for free.” Anyone earning less than R20,000 a year did not pay anything at all – ever, even for the most sophisticated open heart-surgery.

Preventative care was emphasized during apartheid:

The emphasis at these facilities was on preventative care: focussing on the rapid detection and prevention of the huge number of diseases Africa is prone to, from bubonic plague, bilharzia, cholera, tuberculosis, leprosy, polio, smallpox, malaria, haemorrhagic viral diseases, yellow fever, venerial diseases and meningitis.

  • Within ten years after launching its public health service programme, South Africa had brought leprosy, yellow fever, smallpox and cholera completely under control, and polio and tuberculosis were ‘being well-managed’ because of the enforced, free immunisation of all children of all races against polio and tuberculosis.

By 1985, there were 122,402 beds in 623 state hospitals, and in 1985 the four provinces at that time, spent $23,7million each for maintaining their new public health facilities and clinics. The giant Baragwanath hospital built right next to Soweto’s railway line, added another 120,000 annual in-patients to this list — as well as treating 1,5-million outpatients a year, serving the entire greater-Soweto area. Its maternity wards, if put end to end, measures a total of 1km. Mamelodi hospital near Pretoria also was added at this time with 12,000 beds, serving the black community for the entire greater-Pretoria region. However all the public hospitals treated patients of all races – albeit they were treated in racialy-segregated facilities during apartheid, which ended officially in 1994.

South Africa’s first-world medical standards also drew calls for help from the rest of Africa: for instance when the greatly feared haemorrhagic Marburg fever broke out in Kenya and the Congo, South African virologists were asked to attend to these emergencies by the World Health Organisation, thus preventing large-scale epidemics.

Health schemes for 5,2-million black taxpayers during apartheid:

The South African government also set up medical-health schemes for the working black population: by the end of 1985, there were 262 such schemes with a total membership of 5.2-million black taxpayers, with the fastest-growing scheme, Bonitas, having a membership of 184,672 members by 1986, mostly black taxpayers in government service, on farms and even in domestic service.

In 1985, South Africa’s public health service had more than 25,000 physicians and dentists; 5,100 specialists, 222 dental specialists and 18,700 paramedical workers, registered at the South African Medical and Dental Council, and more than 127,000 registered nurses signed up at the Nursing Council. Source: ‘This is South Africa,’ Jan 1987, ISBN 0797006540 State Printing Office, Pretoria.

sources, links:

Wat betreft YouTube – Korfball – only mixed-sex team sport in the world

‘Technical faults’ close down both reactors at Koeberg nuclear station, Cape Town



‘Technical faults’ close down both reactors at Koeberg nuclear station, Cape Town

Koeberg nuclear power station north of Cape South Africa suddenly shuts down reactor Nr 2  last week – and four days later Nr 1 reactor also gave the ghost.

  • Yet most worryingly, nobody knows why…

Koeberg Johannesburg – July 26 2008 — Eskom has shut down both reactor units producing a combined 1800Mw of electricity. They have ‘recalled’ all their staff (from what they didn’t say) and they are now working overtime in shifts, the South African power supplier said on Friday. Koeberg is located about 30km north-west of Cape Town’s city centre along the Atlantic coastline of South Africa. The nearest town’s border is Atlantis, which borders it.

It has been running at only about 83% of its total capacity over the past three years anyway and they are struggling to get qualified personnel because of the Mbeki-regime’s black-economic-empowerment laws.

Koeberg is the only nuclear powerstation on the entire African continent and was built by French contractors during the apartheid-era.

Its average electricity production over the last three years has been 13,668GWh – about 5% of the country’s total electricity needs. Since its opening in 1984, it has used up seven and a half tonnes of uranium.

KoebergMap "The nuclear reactor side of the units have not been affected and will be kept in safe and stable condition," read ESKOM’s none too reassuring, very vague statements issued after the first breakdown. It takes at least three weeks normally to get the nuclear reactors back up to speed. 

The loss of output from this aging, French-built nuclear power station’s capacity is expected to cause massive blackouts especially in the city of Cape Town and the rest of the Western Cape.  "Eskom will do all it can to mitigate the increased vulnerability during this period. This includes increasing the use of the two new open cycle gas turbine stations in the Cape," said Eskom.

No further explanations about exactly what technical faults they are trying to correct have been forthcoming from ESKOM at all.

However two of the same era nuclear reactors in France have only recently suffered radiation leaks which may, experts believe, either be caused by aging or inherent design faults which are only being discovered now.

Koeberg claims on its website that it expects the power station to operate for another 30 to 40 years at least.,,2-7-2335_2361959,00.html

Koeberg’s ‘ cousin plants ‘ in France – built by the same state-owned company — now are experiencing serious technical problems which have been causing radiation pollution of their surrounding environment. 

The French nuclear giant Areva yesterday confirmed there had been a radioactive leak from a ‘broken pipe’ at its nuclear fuel plant in south-eastern France — only a week after a uranium spill at another of its plants had also polluted the local water supply.

  • What is particularly worrisome, is the fact that these plants were being maintained by some of the best nuclear and electrical engineers in the world.

Underground liquid uranium pipe may have ruptured several years ago – but nobody had noticed…

Yet the newly discovered leak at the Romans-sur-Isère plant in the Drôme region came from a damaged pipe which safety authorities said might already have ruptured a number of years ago – indicating a design or aging-fault which could have serious repercussions for all these French-built nuclear plants.

Areva, a French state-controlled firm which makes nuclear reactors and deals with uranium, said the leak came from a buried pipe transporting liquid uranium and that the crack in the tubing was "several years old".

  • Areva is also responsible for running the Tricastin power plant, in the nearby Vaucluse area, where a uranium leak occurred last week when a tank was being cleaned. Drinking well water, swimming and water sports in the area were banned, as well as irrigating crops with the potentially contaminated water. Both leaks ranked as level-one incidents on the seven-point scale of nuclear accidents. 

Koeberg power station cleans with seawater which then is pumped out into the Atlantic ocean again.

Killer-tbc steekt honderden ziekenhuismedewerkers aan

DURBAN, Zuid-Afrika. 3 juli 2008. De medici en verpleegkundigen bij tientallen Zuidafrikaanse ziekenhuizen trokken gisteren aan de noodklok over het bijna volledige gebrek aan controle om besmetting met de dodelijke vorm van tbc in bezoekers en medewerkers van ZA ziekenhuizen, tbc-klinieken en ziekentransporten te voorkomen.

Honderden personeelsleden die in aanraking kwamen met tbc-patiënten zijn al besmet en stierven al aan deze ‘killer-tbc’ waaraan in ZA al duizenden mensen zijn overleden de afgelopen paar jaar.  Verleden jaar werden meer als 7,500 mensen met MDR-TBC gediagnoseerd, constateerde de gezondheidsminister Manto Tshabalala-Msimang tijdens de conferentie. (* Multiple-drug-resistant Tuberculose).


  • Toch wordt er van hogerhand nog steeds bijna geen maatregelen getroffen om besmetting te voorkomen onder gezondheidswerkers, werd er gisteren gewaarschuwd: Zo moeten bijvoorbeeld de busbestuurders van ziekentransporten de hoogst-besmettelijke tbc-patiënten gewoon met niet-besmette patiënten op dezelfde bussen vervoeren en raken dus zelf ook besmet; er is geen bescherming voor verpleegkundigen die waarschuwen dat ze doelbewust door boze tbc-patiënten besmet worden omdat de patiënten behandeling weigeren in isoleringsafdelingen; de tbc-klinieken zelf houden hun reeds besmette tbc-patiënten niet apart van andere bezoekers om besmetting te voorkomen; verpleegsters in een groot Johannesburg ziekenhuis waarvan de hoofdmatrone aan MDR-TBC was overleden, moesten nog twee maanden wachten voordat ze gezichtmaskers kregen; de UV-lampen in ziekenhuizen, geïnstalleerd om besmetting te voorkomen, werken meestal al snel niet meer vanwege het gebrek aan onderhoud. De klachtenlijst die gisteren door boze dokters en verpleegkundigen werd afgewerkt, was erg lang en zorgwekkend. Verpleegkundigen waarschuwden dat ‘de MDR-TBC epidemie volkomen losgeslagen is’ en dat er dringend betere maatregelen getroffen moeten worden.

Een dokter waarschuwde: ‘ wij zitten op een tijdbom, maar niemand wil naar onze waarschuwingen luisteren.’