Keith Cloete
Cape Town - Trauma cases continue to burden our health system with interpersonal violence among the biggest contributors to the province’s quadruple burden of disease.
While the Department of Health feels the effects of violence and injuries, addressing upstream factors must be a collaborative effort.
Internationally, life-threatening emergencies are prioritised over non-life-threatening ones. In many cases, these life-threatening conditions are due to violence, leading to other patients having to wait longer, often with potentially detrimental effects to their health.
Since the beginning of 2022 until June, almost 80 000 trauma patients were treated at our 27 sentinel Emergency Centres (ECs) sites. Of the 79 058 cases:
- Almost half (35 108) trauma injury patients presented due to interpersonal violence
- These patients are young adults often between the ages of 20-40 years
- The weekend and end-of month saw considerable spikes in cases compared to midweek or mid-month
Our ECs continue to see sharp increases in injury-related cases, which negatively impacts services, resulting in delays in the treatment of many elective procedures.
Due to a combination of pre-Covid-19 surgery lists, the pandemic, along with the high number of trauma cases, the province currently has a surgery backlog of 77 139.
The Department has set aside an additional R20 million towards catching up on surgeries and additional theatre slots for this financial year.
While the Department tries to reduce this backlog, it is very difficult for the health system to make significant inroads if there is a consistent flow of trauma cases, needing to be prioritised over other conditions.
This is the reality that many of our clients, especially the vulnerable and elderly, must endure – meaning they must wait longer to undergo elective surgery, which will improve their quality of life.
We can help ease the pressure on our health system by considering how our personal choices relating to consuming alcohol, not only impacts the individual, but robs other patients of much-need medical attention.
The 2019 Rapid Review of the Burden of Disease found that from 2010 to 2018:
- Most deaths in the 15–25-year age group were in boys/men with the major causes being intentional injuries followed by unintentional injuries
- the rate of homicides due to guns doubled from 2010 to 2016
- half of homicide victims tested positive for alcohol; 45% had blood alcohol concentration higher than the legal driving limit (0.05g/100ml)
- 48% of road traffic victims tested positive for alcohol
- 42% had blood alcohol concentration above legal driving limit (0.05g/100ml)
In addition to the unfair longer waiting period our vulnerable clients endure, there is also the financial implication this has on the broader health system.
Using data from five hospitals in the province, the Medical Research Council was able to model the cost of trauma to the Department in 2020.
This costing includes EC visits, admissions to wards and ICU admissions. For one year only, at five hospitals, more than R1.3 billion was spent on treating trauma cases. This is money which could have been directed to improve or expand our health system.
Addressing issues which fuel trauma incidents requires a whole-of-society, whole-of-government approach.
The Western Cape government recently launched Safety Dashboard is one initiative that will support this approach; by providing real-time data to provincial safety stakeholders including the SAPS, the Department of Police Oversight and Community Safety and the City of Cape Town and ensuring data-led and evidence-based law enforcement deployments to guide violence prevention interventions.
This Safety Dashboard, using data from 34 health facilities, will further support the establishment of the Provincial Government’s Violence Prevention Unit (VPU) and allow for the identification of patterns of admissions into these ECs.
The VPU will primarily be responsible for providing strategic direction and oversight of a Comprehensive Violence Prevention Strategy and will work in partnership with key stakeholders, including Government Departments, Civil Society, Businesses and Research Units/ HEIs.
“Health is Everybody’s Business”, thus each organisation, government department and every individual have a part to play in lessening the burden on the health system by addressing the upstream factors.
The whole of society needs to take co-ownership - specifically for the reduction of violence-related trauma. This is in line with the provincial focus on safety and economic growth.
If citizen safety can be better protected, the health system would not waste resources on addressing the effects of the scourge of violence. A healthier, safer society makes economic sense also – healthy citizens are more economically productive.
Dr Cloete is the head of the Western Cape Department of Health
Cape Times