Cape Town - It's dusk at the Lentegeur Psychiatric Hospital and the parking lot is full of ambulances pumping their sound systems.
Heavy house beats fill the air, drowning out even the low-flying planes on their flight path from Cape Town International Airport. Men and women in green reflective uniforms carry medical supplies from the replenishment store to the vehicles, grooving along to the music.
They count packs of gauze, fold fresh linen and stow them away, run a test on the defibrillator, check for leftover smears of blood from the previous shift. Nothing in their demeanour gives away the danger implicit in the 12-hour overnight shift ahead: the risk that they could have a gun pointed in their faces again tonight, be searched at knifepoint again tonight, drive into an ambush again tonight.
These are medics on duty for the Western Cape Health Department’s Emergency Medical Services (EMS).
Medics prepare for an overnight shift at the ambulance station of the Cape Metropole: Southern Division Emergency Medical Service (EMS). Picture: David Ritchie/African News Agency(ANA)
We’re in an ambulance with Advanced Life Support paramedic Grant October and his long-time work partner Rushaana Gallow, who is an Intermediate Life Support medic. They will be serving the areas of Lentegeur, Mitchells Plain, Philippi and surrounds. It’s a Friday night just after payday and that means it could be a busy shift - where there’s money there’s alcohol, and when people are drinking, violence isn’t far behind.
Before they clock on for the nights’ calls, Gallow teaches us how to stash our phones so they’re harder to find if a criminal frisks us at gunpoint while we’re responding to a call. October shows us the secret nooks in the ambulance where we hide the rest of our things. They know, from experience.
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Chelsea Geach and David Ritchie spent a night with on-duty paramedics Grant October and Rushaana Gallow of the Cape Metropole: Southern Division Emergency Medical Service (EMS). Video: David Ritchie/African News Agency (ANA)
A call comes in: a pedestrian has been knocked down in Philippi East. Red lights flashing, DJ Ganyani blaring, siren used sparingly, we move off. It’s in a red zone, which means ambulances have been attacked there recently, but Fire and Rescue is already on scene and we don’t wait for a police escort.
When there’s no patient in sight, we make a U-turn and get out of there in a hurry, suspicious of a set-up. It turns out this time there was a legitimate patient, who was taken to hospital in a private car - but ambushes happen often enough to warrant constant vigilance.
Related: Paramedics risk their lives to save the innocent and the guilty
The next call is to a shooting. There is no life to be saved, just a victim to be declared dead, which must be done by a medic. The man was shot six times in the head while washing his father’s car. Along the tightly packed row of houses in Philippi, neighbours spectate and chat while the police forensic officer processes the scene, placing evidence markers where the bullet casings lie on the tar. October munches a plum.
Later we rush to a stabbing, Gallow and October pulling on latex gloves while changing gears and punching details into the touchscreen tablet which records data for every call.
A young man has been stabbed twice for his phone and a little cash in Brown’s Farm, Philippi. He sits in the light of four police vans, holding his perforated side. Blood runs down the steps of Lina’s Hair Salon.
The stabbed patient is lifted onto a stretcher to be wheeled to the back of the ambulance for treatment. Picture: David Ritchie/African News Agency (ANA)
The police agree to wait a few more minutes for protection while the medics cut away blood-soaked clothing in the back of the ambulance, hang an IV to replace lost fluids and patch up the wound with fat and bowel bulging out. Without a police presence, they wouldn’t dare linger on the scene.
October works in the back of the ambulance to patch up a man who has been stabbed for his cellphone and a little cash. Police keep watch outside. Picture: David Ritchie/African News Agency(ANA)
When the next stabbing call comes, there’s no use hurrying. We can’t enter this area without a police escort and police are in no rush. We wait outside Philippi SAPS for around 15 minutes while less than a kilometre away, a man is bleeding.
When we finally arrive, everyone in the house is drunk and the stabbed man walks himself out to the ambulance. Gallow drives him to Mitchells Plain District Hospital’s makeshift emergency centre, only accessible by a long route round the back of the hospital and a painstaking reverse up a narrow gravel driveway.
The new revamped emergency centre was opened this week on Wednesday, after a fire destroyed it in February last year.
Related: 9/10 chance Cape paramedics will face being attacked on the job in red zones
People sometimes accuse the medics of being heartless because they remain impassive and professional in the face of pain and trauma, but their care is clear in the way they handle families and patients. It’s in the way Gallow carefully tucks a young poisoned patient’s feet into a blanket so she doesn’t get cold en route to hospital; how October changes the ambulance soundtrack to smooth jazz because it helps soothe a panicking family member.
It’s in the sensitivity with which they treat a woman who “collapsed” as an attention-seeking antic after a fight with her boyfriend and how they reassure the daughters of an elderly woman with dementia that while her vital signs are all fine, they can call again any time they’re worried.
Gallow and October are tasked with transporting a young girl with suspected poisoning to Red Cross War Memorial Children's Hopsital. Gallow tucks her feet into the blanket for the drive. Picture: David Ritchie/African News Agency (ANA)
At 5am, just as it looks like our shift will end quietly, another call arrives on the tablet screen. The incident description says Bundu Court.
“Do you know what a bundu court is?” Gallow asks. “It means community justice. Now you’ll see something.”
A man has broken into a house and the neighbourhood has been roused to deal with him. He has suffered severe head injuries, but another ambulance reached the scene first to whisk him to Groote Schuur Hospital.
We arrive just in time to see neighbours upending buckets of water to rinse the blood down the street.
Back at Lentegeur Psychiatric Hospital, Gallow and October check that the ambulance has been thoroughly cleaned with alcohol to disinfect it from blood and other bodily fluids.
The sun is up and another shift down. They’ll be back for more tomorrow night.
This is part one 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.
Part 2: The trauma surgeons on the frontlines of saving victims of violence
Part 3: The long road to rehabilitation for those left paralysed by stabbings and shootings