Gunshots, stabs and community assaults flood Cape's trauma centres

By Chelsea Geach Time of article published Oct 19, 2019

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Cape Town - It's Sunday morning in Groote Schuur’s Trauma Centre and director Professor Andrew Nicol is leading ward rounds. In the beds lie the aftermath of Saturday night’s violence and the days of bloodshed before that.

There are patients who have suffered gunshots to the face, panga slashes, bricks to the head, stabbings - even two with broken ribs after allegedly being beaten up by soldiers in Athlone.

Nicol and his team treat nearly 40 patients, including a man with eight gunshot wounds and another who suffered 13 stabbings. One patient is paralysed after being shot through the spine in his sleep; another is an amputee assaulted with his own crutches. “The average age is 23 to 24, and it’s all men,” Nicol said. “Men and violence.”

Related: Red Cross trauma doc: children younger than 5 being targeted in shootings

Interpersonal violence accounts for 60% of all patients at the centre. Doctors were optimistic that the deployment of the SA National Defence Force on the Cape Flats in July would offer some respite.

“When the army arrived we had this impression that the numbers had dropped, but they seem to be picking up again,” Nicol said. “For September, we saw 1 197 patients come through the doors, which is a horrifying figure. We were averaging around 73 gunshot patients before the army came in and I think we’re still averaging round about the same. It’s outrageous, in a society that’s supposedly not at war.”

Nicol has developed his own brand of “battlefield medicine” to stop patients’ bleeding and prevent contamination. “We call it damage control surgery, and they’re using this on the frontlines of war-torn areas.”

He has even been invited to international military congresses to teach surgeons how to deal with chest wounds, because he treats more of them in Cape Town than they do in war zones.

“A young man comes in (on the Saturday night) stabbed in his heart, and I realise he’s got 15 minutes to live,” Nicol said. “If we push him up into theatre, it’s going to take us 10 minutes to get into theatre, probably another 10 minutes before we’re ready to operate and he’d be dead.”

So his team opened up his chest in the resuscitation area. “The blood was squirting this high,” Nicol said, gesturing around his forehead. “We were covered head to toe. There was so much blood one of our medical students fainted.”

Nicol managed to find the damage and suture it, although the patient suffered a heart attack in the process.

The next morning, he was awake and shaking his head in response to questions. “Do we know his HIV status?” Nicol asked a fellow doctor, who had been drenched in the patient’s blood, and found a nick on his gloves. It was an anxious trawl through the digital file for the result: HIV negative.

Related: "Trauma-related violence is overwhelming our services" - trauma surgeon

Groote Schuur is on par with arguably the best trauma centres in the US.

“For penetrating trauma, we achieved exactly the same outcomes as a major Level 1 trauma centre in the US, and they have six times the amount of staffing. To achieve those sorts of results is absolutely phenomenal,” Nicol said.

Yet the burden of an increasing number of gunshot wounds is immense, he added.

“We’ve noticed this disturbing trend away from single gunshots towards multiple gunshot wounds, causing incredibly complex injuries. The cost to the hospital is absolutely massive.”

The load has been even heavier at Tygerberg Hospital, which serves a larger area including some of Cape Town’s most violent neighbourhoods.

Professor Elmin Steyn, trauma surgeon and head of surgery at Tygerberg, said she had seen a radical increase in gunshot wounds after the past three years.

“If I look back at 2015, we could have seen about 80 gunshots per month. Now we see 200,” Steyn said. “They are a really big burden on the health-care system.”

Gunshot wound patients account for roughly 20% of Tygerberg’s trauma team’s work and the numbers are closely linked to gang activity.

Another assault which has been on the rise is what doctors have labelled “community assault” or vigilantism, which results in blunt force wounds, long hospital stays, frequent kidney failure and traumatic brain injury.

“It’s not being seen as a problem because nobody’s given it a name, but it is a huge problem,” Steyn said.

“Just looking at my patient turnover recently, there can be almost twice as many as the gunshots and stabs. We see five to 10 a day.”

Without an official categorisation, there is very little data available on the prevalence of such assaults, but trauma doctors have speculated as to the motivation of the attacks.

“Ordinary, good people... are so angry and so disappointed in the lack of policing that they just turn on people who they suspect of being criminals,” Steyn suggested.

“They beat them up extensively and viciously, sometimes killing them. They use everything they can lay their hands on. They beat them, burn them, stab them, some even have dog bites as well. It’s horrific.”

UCT, academics have asked the Trauma Advocacy Group for better research into the causes of such violence as well as for immediate interventions.

The Trauma Society of South Africa has also called on authorities to take decisive action.

Back in Groote Schuur’s trauma ward, the patient with the stabbed heart seemed to be one of the lucky ones. He pulled through the worst and was likely to recover from his attack, thanks in no small part to Nicol’s well-oiled trauma team.

“I’m just amazed he’s still alive,” Nicol said. “It’s not the surgeon that’s doing the saving; it’s the whole team, from the ambulance driver, the initial doctor who does the resuscitation, the ICU team and the sisters. Without them, none of these patients would survive.

“That’s why we do this job, because of that satisfaction of getting people to survive. There is no greater reward in the world than saving people.”

This is part two of a series in which writer Chelsea Geach and photographer David Ritchie document the impact of violent crime on the Western Cape’s health services. 

Weekend Argus

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