A small band of emergency medical staff at Khayelitsha District Hospital is running a daily gauntlet of armed robbers and hijackers as they travel to and from work, even as the festive season pushes patient numbers and trauma cases to their annual peak.
The passage leading to the Emergency Medicine Unit at Khayelitsha District Hospital. (Photo: Khayelitsha District Hospital Emergency Medicine team)
The passage leading to the Emergency Medicine Unit at Khayelitsha District Hospital. (Photo: Courtesy of the hospital’s Emergency Medicine Team)
Over the past two months, two community service doctors in Khayelitsha have been forced off the road, and one was robbed at gunpoint. An internal medicine registrar narrowly escaped an attempted robbery. All were women. One doctor was so traumatised she was unable to function and took two weeks off work.
Dr Crispin Kibamba, the head of Emergency Medicine at Khayelitsha District Hospital, said construction work on the nearby Spine Road had increased staff vulnerability. In one incident, attackers smashed a doctor’s windscreen and threatened her with firearms. “They demanded money, which she immediately handed over. Luckily, they did not take her or the car,” said Kibamba.
In another case, a community service officer noticed a car with two men following her and drove to a police station, with the suspects close behind. When the police confronted the men, they claimed she had been “stalking” them. A third incident involved a registrar whose vehicle was boxed in by two cars. She managed to find a narrow gap and sped towards the hospital.
Bateman-khayelitshatrauma
The car of a community service doctor who was ambushed by robbers who took her wallet at gunpoint while she was en route to work at Khayelitsha District Hospital. (Photo: Khayelitsha District Hospital’s Emergency Medicine team)
Kibamba said the matter had been escalated to senior management, who consulted with the police about establishing a safe travel corridor for staff. “But it’s inconsistent and depends on whether a patrol van is available,” said Kibamba. In the meantime, staff attempt to mitigate the risk by travelling in groups or leaving and arriving in convoys.
The impact on patient care is immediate. Any time taken off by doctors increases pressure on colleagues who collectively see between 3,000 and 3,500 patients a month. The emergency centre deals with the full spectrum of trauma, polytrauma and medical emergencies, much of it driven by alcohol and drug use. These peak at month-end, payday and social grant payout days.
advertisement
Don’t want to see this? Remove ads
Khayelitsha District Hospital’s emergency unit gained international attention in 2014 when the South African Medical Journal reported on its exceptional survival rate for stab wounds to the heart. That rate has remained at about 75% — roughly 60% higher than international norms cited in medical literature.
Gunshot wounds
However, the profile of trauma has shifted. “Khayelitsha was not known for gunshots,” said Kibamba. “Now we are seeing more and more.” He pointed to recent cases of patients shot in the chest and limbs who survived because of rapid emergency intervention.
Kibamba described several “syndromes” driving pressure on the system. One involves patients arriving directly from the Eastern Cape after long bus or taxi journeys, often without local family support. They receive treatment and then travel straight back home.
Another is the festive season “dumping” of elderly relatives at the hospital by family members travelling to the Eastern Cape, leaving patients with nowhere else to go. “We can have on average 10 extra patients for up to three weeks,” said Kibamba.
A third involves patients returning in January after running out of chronic medication while away, often presenting with serious complications that add to bed pressure.
The hospital, completed in 2012, was built to serve about 400,000 people. Its catchment area has since expanded to include Emfuleni, pushing the estimated population served to around 2.3 million. Census figures do not fully capture migration from the Eastern Cape or the widespread practice of maintaining homes in two provinces.
Khayelitsha District Hospital has 330 beds. The emergency centre has 20 trolleys and seating for a maximum of 16 patients. During heavy periods it can barely cope with an additional 30 intoxicated or drug-affected patients with minor injuries. On average, about 70% of patients are treated and discharged or referred.
Bateman-khayelitshatrauma
A victim of a community assault after he was accused of committing a crime in Khayelitsha. The weapon of ‘retribution’ was boiling water. (Photo: Khayelitsha District Hospital’s Emergency Medicine team)
Other contributors to trauma include what Kibamba calls the “party syndrome”, linked to social events, major restaurants and soccer matches, and the “extortion syndrome”. Gangs extort money from an estimated 5,000 businesses in Khayelitsha and Emfuleni, with late or missed payments sometimes resulting in violent assaults and hospitalisation. The resulting cash flow fuels the illegal gun market.
About 90% of trauma cases are drug- or alcohol-related. Substances include tik, nyaope, cannabis and, increasingly, “dirty” cocaine. Mental health emergencies — often involving drug-induced psychosis — consume large amounts of staff time. Patients are sedated and held for the statutory 72 hours before discharge or referral to Lentegeur Psychiatric Hospital in Mitchells Plain.