Cape Town - “Trauma-related violence is overwhelming our services.”
This is the assessment of trauma surgeon and head of surgery at Tygerberg Hospital, Professor Elmin Steyn, who sees first-hand the effect that it has on her patients and staff.
“Cancer patients who need urgent surgery may end up having delayed surgery because of the violence,” she said.
Trauma patients often require very demanding treatment involving major surgeries and long hospital stays, which is a massive drain on resources.
“They’re using up our ICU beds, they are using up our theatre time and all of that is vastly too little,” she said. “It’s not only that those guys are injured and lying in hospital, they’re also displacing other cases. So if you have cancer or you have a serious risk condition like a big hernia that needs urgent repair, your case may be delayed or postponed again and again, because there’s just no theatre time or ICU beds.”
Steyn said her staff are exposed to some of the most horrific things humans do to one another and yet the most mentally taxing part of the job is having the skills to treat trauma injuries, but not the resources.
“The frustration is not as much in looking at all these stabs and gunshots - it’s that we can treat them, but we just don’t have the beds. We can fix them, but we haven’t got theatre time so they lie for three days waiting for an operation,” she said. “That’s much more stressful for the staff.”
When trauma patients wait for treatment, they are likely to develop expensive and dangerous complications, which then cost even more in medication, further surgeries, and recovery time in a hospital bed.
“If we could’ve dealt with them immediately and properly, we could’ve had them out of hospital quickly. But because they wait, they all get complications, like infections and so on, and that means that they’re in ICU for two weeks,” Steyn said.
Western Cape Health MEC Nomafrench Mbombo said the medical staff experienced psychological pressure due to the case overload.
“When you know you’re supposed to save 10 patients, but because of (lack of) resources and demand that is more than supply, you’re able to save five or six. As a clinician, you know you should have saved that person as well. We have to send staff for counselling now and again for such cases.”
Mbombo said finances were restricting her department from hiring more doctors to deal with the trauma load.
She said that patients who aren’t categorised as “red” in the triage system often wait a day or two to receive medical help.
“It’s quite a lot, the waiting time that we’re seeing - waiting by small children, older persons, other sick people, because we have to prioritise these patients who present with gunshots and injuries as a result of interpersonal violence,” she said. “It impacts on everyone. This is a community issue; it needs community intervention.”