Public Health & Health Systems

A night at Tambo Memorial

Written by Health-e News

The closure or scaling back of the Kempton Park, Germiston, Edenvale, Far East Rand, Pholong and Nigel hospitals has put severe pressure on Tambo Memorial.

She’€™s only 20 years old. Her pinstriped skirt is all that remains of her Friday night dreams. Her head is a mass of lacerations, her left eye has been destroyed and her brain is probably injured too. As Sister Gladys Sibeko undoes the dressing on the girl’€™s left thigh, a chunk of her leg comes off with the bandage.

The stretcher is awash with blood. It splatters on to the floor of the emergency room at Tambo Memorial Hospital in Boksburg.

‘€œThere’€™s no peripheral pulse,’€ says one of the doctors, checking her limbs. ‘€œShe was probably brain dead on arrival.’€

A few minutes later, her heart stops.

Outside, the girl’€™s sister waits, unable to sit still, aware that the situation is serious but not yet aware that her sister has breathed her last. It’€™s 10.30pm on Friday night. Three hours ago the two sisters were walking along the side of the road in Daveyton when a car drove into the younger girl. The driver never stopped.

It took another three hours for the ambulance to arrive. The hospital does not have it’€™s own ambulance and relies on the central emergency services to ferry seriously ill patients.

‘€œAbout half of all the motor vehicle accidents we see are hit-and-run,’€ says Dr Zoltan Risko, the orthopaedic surgeon on duty, shaking his head as he takes off his bloodstained latex gloves.

Car accidents, assaults and gunshot wounds dominate the intake over weekends ‘€“ many alcohol-related.

‘€œLast year, we treated 2 030 gunshot cases. In the past seven years that I have worked here the police have never once bothered to come and collect the bullets. We have a cupboard full of bullets,’€ adds the huge Hungarian.

All the doctors on duty tonight are foreign. Risko is the only one who agrees to be identified. The others fear discrimination as they raise problems with their working conditions.

The closure or scaling back of the Kempton Park, Germiston, Edenvale, Far East Rand, Pholong and Nigel hospitals has put severe pressure on Tambo Memorial, which serves a population of some 2.2 million people.

In 1995, the hospital was forced to do away with 95 beds, including a 25-bed state of the art burn unit, because it did not have enough staff.

‘€œThe shortage of beds means men and women are sometimes put in the same wards. It’€™s not right,’€ says Dr R, a soft-spoken man from the Democratic Republic of Congo.

It is now the only hospital on the East Rand that offers orthopaedic services (the treatment of injuries or problems with the skeletal system, muscles, joints and ligaments).

But severe budget cuts mean that even this service is being curtailed. In addition, a meeting at the end of October will decide whether the hospital can continue to serve as an academic site for Wits University’€™s orthopaedic students. ‘€œI don’€™t have the budget to provide an academic orthopaedic facility,’€ says Tambo’€™s CEO, Dr Paul Kapp. ‘€œThe registrars from Wits need longer time in theatre because they are learning. If I were given the funds to employ another theatre sister, I would be able to accommodate the students. We also don’€™t have enough radiologists or physiotherapists and no occupational therapists.’€ ‘€œWe do about 100 hip replacements a year and have a waiting time of about a month,’€ adds Kapp. ‘€œBaragwanath Hospital does about 10 a year, and Johannesburg has a waiting list of about three years. This is a necessary service but it may have to fall away because we are simply not getting the funds to continue. If province funded us per procedure, perhaps we would be able to continue.’€

Kapp says that while the private sector has donated various items ‘€“ including a fully equipped ambulance which is expected within six weeks ‘€“ ‘€œit’€™s my operational budget that is lacking’€.

One possible way of raising additional cash is from the Road Accident Fund for the medical costs of treating road accident victims. However, this route seems to be snarled up by red tape and Kapp is waiting for clarity from the Gauteng health department.

As the night wears on, the walking wounded continue to stagger in ‘€“ and the close correlation between alcohol abuse, assaults and accidents is impossible to miss.

A survey of non-natural deaths in South Africa released two weeks ago by the Medical Research Council found alcohol in the blood of half of all those who had died in homicides and accidents in 2000.

Two teenage girls from Windmill Park, one 16 and the other 18, are brought in by friends at around midnight. The girls have stabbed one another. Leonie has a nasty wound above her left eye while Michele has a huge gash down her left arm that needs stitching.

A man who has been slashed by a broken bottle curls up in foetal position on a bed and waits for treatment. At least half the people in casualty tonight have injuries that were inflicted by other humans.

‘€œThese are the patients who are draining the budget, the ones who are drinking and stabbing,’€ says Dr R in despair.

Another problem, adds Risko, is that over 80% of beds in the medical wards are taken up by HIV positive patients. ‘€œThe HIV patients stay longer as they take longer to heal,’€ says night supervisor Sister Nompi Meloa.

‘€œIsn’€™t the world a crazy place,’€ croons Whitney Houston on the radio as a somnambulist cleaner with swollen ankles slowly pushes a mop over the bloodstained floor.

Unconcerned that many of those entering the ward are seriously ill, she warns patients not to cross the wet floor. After mopping one half of the ward, she starts moving patients from the other, slapping their files down on their stomachs and roughly banging their beds on the walls.

The medics bring in another load of injured people, this time two men more who have been stabbed in a drunken brawl.

‘€œHulle baklei soos kat en hond vanaand,’€ yells the one medic.

‘€œI don’€™t know why the government started with smoking. They should have clamped down on alcohol abuse first. People get drunk and they stab and shoot each other or they drive into others with the cars,’€ says Kapp.
‘€“ Health-e News Service.

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