Those dependent on government emergency medical services (EMS) in the province hope that a South African Human Rights Commission (SAHRC) report to be released by end of July will address a shortage of ambulances that is killing those too poor to buy private transport to hospital.
Nofundile Sipatana lives one river, several hours’ walk and a taxi ride away from Madwaleni, her nearest hospital. Living with epilepsy, she is plagued by seizures that come over her like the mist rising from the ocean below her family’s home in Nqileni village.
“I usually feel sleepy and sometimes I experience a severe headache… that’s when I start to be attacked,” said Sipatana, who heads a household of seven children and four grandchildren that subsists on child grants.
A severe seizure can leave Sipatana immobile for days. When this happens, her frightened children go door-to-door pooling money from family and neighbours to hire a car to take her to Madwaleni Hospital.
“We have never seen an ambulance in this area so my children and my neighbours together with my relatives don’t bother to call an ambulance because we know we’ve never seen one,” she said.
When the collection comes up short of the R600 to hire a car, the family turns to the local loan shark who charges about 50 percent interest.
The Sipatana’s kraal – once full – stands empty save for a handful of an uncle’s cows.
“There was a time when I was not able to finish paying the loan shark’s interest and that’s when we called a family gathering and decided to sell the sheep and goats,” Sipatana told Health-e News. “I am the poorest of the poor in the village because I used to have herds, but now I sold them because of my poor health,” said Spitana.
The call unanswered
Xolisile Sam recalls how he anxiously re-dialled “112” on his mobile phone, afraid that he was watching his little sister Tumeka Sam die.
Tumeka had left her job in East London and returned home to Isilatsha village after developing tuberculosis. Despite treatment, her condition had deteriorated. Her round face had grown gaunt as if a tide had washed over her and then receded, revealing sharp cheekbones. Bed-ridden she was now was racked with seizures.
The seizures scared the Sams, but when Xolisile called an ambulance on 26 September 2014, he was told help was unlikely to arrive.
“They told us they did not come for bed-ridden patients, they came only for injured people and not to take people from their places to hospital,” said Xolisile, who added dispatchers advised him to take Tumeka to the nearest clinic.
“I explained a car to the local clinic would cost R150 and to Frere Hospital it would cost R500,” he told Health-e News. “I could not afford to pay these sums. I was instructed that we could wait at the nearby local school and that the ambulance might come, but that it was not likely.”
The family walked to the primary school where they waited for hours in hopes of being able to show an ambulance the way to their home. Xolisile phoned emergency medical services (EMS) again about six hours later. An operator accused him of exaggerating Tumeka’s condition to get an ambulance, he says.
The family was again told to wait at the school. No ambulance arrived. Two hours later, Xolisile called emergency services again. He was asked if this was the first time he had phoned.
At home, his elderly mother crouched beside Tumeka’s bed, tending to her daughter who was writhing in pain and crying for an ambulance in between violent seizures.
Xolisile slept in his clothes that night, ready for an ambulance that never came.
Sick, dying told to walk to nearest road
This year, Xolisile was elected by villagers to represent Isilatsha and testify before an SAHRC enquiry into Eastern Cape EMS services. The hearing drew hundreds of people from across the province. About 25 percent of those at the hearing reported having called for ambulances that never came.
In affidavits submitted to the SAHRC, old people reported never having seen an ambulance. Others, like Nomfundo Mbelebele, said EMS dispatchers often told people from rural areas to bring their sick and dying to the nearest road. She watched her father succumb to cancer after EMS dispatchers told her the dying man would have to walk from his rural homestead to the nearest gravel road if he wanted an ambulance.
But Nomalinge James, a community health worker (CHW) with the non-profit organisation the Keiskamma Trust, said Mbelebele and the Sams were lucky.“You are very lucky if you are told to go wait on the road because usually the phone is not answered,” said James, who added CHWs had been forced to deliver babies and watch those babies die when EMS did not respond. “I am not trained to deliver a baby. I am trained to ask you if you have taken your medication.”
“Sometimes the nurse will use her own car (to take a patient to hospital) because the nurse cannot endure to see someone in pain,” added James. “We used to think that the phone was never answered because we are uneducated and live in villages, but when even the sister cannot get an answer…”
Prior to getting 110 new ambulances in July 2014, the Eastern Cape had just 243 ambulances, excluding those dedicated solely for pregnant women. While it has increased its fleet by about 45 percent since 2014, the province would need to almost double its fleet to reach national standards of one ambulance per every 10,000 residents.
As of 26 June, nine percent of the current 416-vehicle fleet was out for repairs, according to Eastern Cape Department of Health Spokesperson Sizwe Kupelo.
James’ Amathole home district has about one ambulance for every 17,000 people. In urban areas surrounding Port Elizabeth or East London, on average an ambulance could be expected to cover about 50 square kilometres. In the expansive and rural Amathole District, there is one ambulance for every 415 square kilometres.
“It is totally unacceptable for someone to call for an ambulance the whole day and that ambulance does not arrive,” said Mbengashe, adding the department had procured three EMS helicopters to be based at Port Elizabeth, East London and Mthatha.
Dr Prinitha Pillay works for the non-profit Rural Health Advocacy Project and served as an external panellist at the hearing.
Based on community testimonies, Pillay estimated that poor, rural populations in the Eastern Cape could be spending as much as R40 million out of pocket on private cars in the absence of ambulances.
Loan sharks: Sinners or saints?
When Eastern Cape ambulances do not arrive, families are forced to spend hundreds of rands to rush the ill and dying to the nearest health facility. When they do, they turn to women like Lusanda Mtshiswa*
A middle-aged, single mother of three, Mtshiswa is a loan shark. Her children’s school pictures hand beside a refrigerator topped with a microwave in Mtshiswa’s home outside Port St. Johns.
Her house is not impeccable, it’s new – with gleaming vinyl floors and a rack of dress shoes hung behind the door.
Mtshiswa offers the standard lending rate of about 50 percent interest on any loan. With many seeking loans to cover emergency transport to hospital, she works odd hours.
Usually, they come asking for money that I loan them to take their relatives to hospital so they usually come during the night,” she said.
“I give them money and take their SASSA (South African Social Security Agency) cards in return,” she explained. “When they return my money, I give them their SASSA cards back.”
“By taking their SASSA cards and IDs, I want to make sure…she cannot do another SASSA card and by doing so, she could dodge me.”
With 6.5 million people, the Eastern Cape recieves about 2.7 million social grants. Here, SASSA cards are a life line and what Mtshiswa doest to retain surety on loans is illegal, according to the National Credit Act. She requested not to be named in this article.
According to presentations made to Parliament by the non-profit, consumer organisation Consumer Fair, five million South Africans may rely on loan sharks like Mtshiswa.
Unlike the loan sharks you see on TV, Mtshiswa does not break knee caps to collect on debts. Instead, she works out payment plans with customers, who also include patients on chronic medication who are forced to borrow money to seek drugs farther afield when their local clinic is hit by drug stock outs. If clients fail to pay, she reports them to the local headman.
Although illegal, her profession has provided her family with a way out of poverty.
She has named her business Masizame, or “Let’s try” in IsiXhosa.
“After I registered my three kids on the child support grant, it came up as a large sum of money. I took it from there that in order to sustain this money, I would have to do loaning.
“I managed to build this new house out of the money,” she said.
Money alone won’t solve the problem
But Fikile Boyce, spokesperson for the civil society Eastern Cape Health Crisis Action Coalition, says “the numbers don’t add up”.
“We’ve been monitoring the number of allocated EMS vehicles in districts and have found that there are tragic inconsistencies regarding the numbers.”
“There is an element of contempt for the poor, which is very real and impedes access to the human rights contained in our Constitution,” said SAHRC Deputy Chairperson Pregs Govender at the hearing.
Under-spending is part of a complex equation of factors stifling EMS in the province. Between 2010/11 and 2012/13, the EMS programme failed to spend about R94 million.
“The department cannot carry the full blame for challenges,” said budget expert Debbie Budlender in her submission, describing how varying population estimates have reduced the Eastern Cape’s allocation from Treasury.
“Eastern Cape Department of Health is not making full use even of the inadequate resources made available to it,” she said. “An increased budget will not solve the problem in EMS in the Eastern Cape. However it is also true that the problem will not be solved without an increase in the budget.”
According to Kupelo, budget constraints have led to a 35 percent vacancy rate for medically trained EMS staff despite the department being able to fill more than 1000 posts including those for district managers.
Tumeka Sam was taken to hospital five days after her brother Xolisile first called an ambulance. She died on 7 October 2014, days after reaching Frere Hospital.
The bricks Tumeka bought to expand the family house still stand stacked in the yard.
“She had big dreams, big dreams there are no other words to explain it,” Xolisile said. “She wanted to develop everyone.”
Her older sister, Nolusapho Dyani, continues to blame the Department of Health.
“Deep down in my heart, I think we should still be living with my sister,” Dyani said. “If the Department of Health could have responded earlier, Tumeka would still be with us.”
For the Sams, the commission has given them hope that other families will not go through what they went through.
“I was very grateful when my brother stood up at the podium and stood up for our pains and for our challenges as a community and as a family,” Diyani said.
“Now that we have visited East London for the hearing and expressed how her death happened, I know that there is a light at the end of the tunnel and that this situation is not going to happen to another person.” – Health-e News.
- Read more heartbreaking testimonies from the hearing
- Poor care, ambulances shortages blamed for toddler’s death
An edited version of this story first appeared in the Sunday Independent.