When Lizeka Ngcozana’s cousin had a stroke on a Tuesday morning, she took her to Ngonyama Clinic outside Cacadu in the Eastern Cape.

But there was no ambulance available to take her to hospital.

Ngcozana says nurses told the family to find their own transport to Frontier Hospital in Komani, about 70km away.

“We have to hire a car to Frontier Hospital in Komani. People pay up to R500,” she says.

Health-e News confirmed with local transport operators that residents can pay R500 for a special return trip to hospital, which includes the driver waiting for the patient. If the patient is admitted, the driver leaves but the charge remains R500.

Ngcozana says nurses at the clinic told her they often struggle to reach ambulance services by phone, or are told that no ambulance is available.

“If we did not have a car we would have suffered a lot,” she says.

Her experience is echoed by residents in other parts of the Eastern Cape, who told Health-e News about long waits for ambulances, missed hospital appointments and having to find their own transport.

The accounts come as the provincial government battles to keep ambulances on the road and rolls out more vehicles across the province.

Patients miss appointments

In Hofmeyr, a small Karoo town between Cradock and Komani, resident Emihle Winter told Health-e News that the town has been without an ambulance for more than a month.

“We have a problem of not having an ambulance and it’s been more than a month. Patients can’t go for their doctors appointments in Gqeberha,” she says.

Winter says her mother was supposed to have an operation in December last year, but the ambulance was not available and the operation did not happen. Winter says her mother has since missed check-ups at Livingstone Hospital because she cannot get there.

“There seems to be no solution,” Winter says.

The Hofmeyr Community Development Forum says the town had gone five weeks without an ambulance when Health-e News spoke to residents. The forum says patients have had to find private transport to Cradock or miss specialist appointments in Gqeberha, more than 200km away.

In Thornhill village near Komani, Bulelwa Hemeni told Health-e News that she recently called an ambulance for a relative and was told it was attending to another patient elsewhere.

The ambulance arrived the next day. She says the person had already died by that time.

Another Thornhill resident, who asked not to be named, says her family recently waited more than five hours for an ambulance.

Twelve-hour wait for an ambulance

In Gqeberha, a family’s struggle to get an ambulance for a seriously ill 17-year-old boy has been added to a South African Human Rights Commission (SAHRC) investigation into access to emergency medical services in the province.

On 18 August, relatives sought help from the Department of Social Development, which opened a priority case and said the boy needed medical attention.

Family spokesperson, Luzuko Gedze says the family started trying to get an ambulance at about 11am.

Gedza says they called several numbers provided by the provincial Health Department and Dora Nginza Hospital.

“The number provided to us rings, no one picks up. So it could be that there’s no one there to man the switchboard, or there’s a systems issue,” Gedze says.

Gedze says an ambulance eventually arrived at about 11.15pm, around 12 hours after the family began trying to get help.

“It’s a hopeless situation. You first become frustrated, but then you kind of accept that no one is coming to your aid,” Gedze says.

Gedze lodged a complaint with the SAHRC.

“We’re talking about an essential service. It’s a critical life-saving service that the public must – not partially, not sometimes – have access to,” he says.

SAHRC Eastern Cape provincial manager Dr Eileen Carter confirms the complaint has been added to a pending systemic investigation into access to Emergency Medical Services (EMS) in the Eastern Cape. The investigation includes concerns around emergency lines, ambulance dispatch and operational capacity.

“Failures in access to emergency medical services may have serious implications for the constitutional rights to healthcare, dignity and, in appropriate cases, life,” Carter says.

The Commission’s concerns about Eastern Cape’s ambulance services stretch back more than a decade. It held public hearings into EMS in the province in 2013 and published a report on access to emergency medical services in 2015.

Earlier this year, the SAHRC took the provincial health department to court over access to emergency medical services in Xhora Mouth and surrounding areas. In March, the Commission said that despite years of engagement with the provincial government, “little progress has been made in addressing the systemic challenges affecting emergency medical services in the province.”

Ambulances sitting off the road

The patients’ experiences shared with Health-e News come amid a shortage of operational ambulances across the province.

In a written response to a parliamentary question last month, Eastern Cape Health MEC Ntandokazi Capa reported that the province had a fleet of 353 ambulances. Of these, 192 were operational and 161 were grounded.

This means almost half of the fleet was off the road.

The Federation of Unions of South Africa (FEDUSA) has also called for an urgent investigation into the ambulance crisis.

FEDUSA says the investigation should look at the management and maintenance of the ambulance fleet and has called for the responsible directorate to be suspended while the investigation takes place.

The federation says the shortage is affecting both communities and EMS workers and has questioned how money allocated for the servicing and maintenance of ambulances has been spent.

Government rolls out more ambulances

The Eastern Cape government has started rolling out more ambulances as it tries to improve the availability of emergency vehicles.

On 4 September, the provincial health department announced that new ambulances would be deployed to districts across the province as part of a phased rollout of 195 ambulances.

The department says the rollout is intended to strengthen EMS capacity, improve fleet availability and provide more reliable access to emergency medical care, particularly in rural communities.

But the rollout will not immediately solve the province’s shortage.

Capa says the Eastern Cape needs about 600 ambulances to operate at full capacity. She says the province currently has about 400, including vehicles that are grounded.

Twenty-six ambulances were handed over on 4 September, following another 21 about two weeks earlier. Further vehicles are expected to be rolled out in phases.

Capa says the vehicles being delivered are replacements for ambulances already in the fleet rather than simply additions to the existing fleet.

Capa has described the ambulance situation as “dire in the entire province”.

“There is one ambulance in every area of Enoch Mgijima except for Hofmeyr. 14 ambulances in Chris Hani. One in Tarkastad which also caters for Cradock,” she says.

“At present Sarah Baartman had no ambulance, Alfred Nzo had three and OR Tambo had two.”

Capa says the department is looking for ways to address the shortage.

“We are trying to get a solution,” she says.

The department has also considered using private ambulances for interfacility patient transport so that state ambulances can be prioritised for emergencies in communities.

Ageing fleet and repair delays

The Eastern Cape Department of Transport manages the provincial government vehicle fleet through Government Fleet Management Services (GFMS).

Department spokesperson Unathi Binqose says one of the problems is the age of the ambulance fleet and the amount of maintenance required.

“The problem we’ve had is that the fleet of ambulances that we had has been very old. We are in the process of handing over a new fleet of ambulances through our entity, which is GFMS,” Binqose says.

He says vehicles have been moving through the process of being converted into ambulances before being handed over to the health department.

“There were ambulances that we had handed over to them very late last month, and there’s another batch of ambulances that we will be handing over to them. I think about 20 of them very early this month,” Binqose says.

“But a lot of them are ready now. They are coming out of that pipeline and being handed over.”

Meanwhile the Democratic Alliance (DA)’s Jane Cowley says a transition in the management of the national contract for the maintenance and repair of state vehicles created repair backlogs after Afri-Rent took over the contract.

Health workers under pressure

Thembisa Witbooi, Eastern Cape labour relations organiser for the Health and Other Services Personnel Trade Union of South Africa (HOSPERSA), says ambulance response times in Nelson Mandela Bay have deteriorated because too few vehicles are available.

Witbooi told Health-e News that EMS workers are dealing with heavy demand throughout the week, including crime and gunshot injuries in Kariega and elsewhere in the metro.

Witbooi says HOSPERSA has lodged a complaint with the Health Professions Council of South Africa (HPCSA) over conditions in the provincial EMS.

She says practitioners can be placed in a difficult position when systemic failures prevent them from meeting professional standards.

Problems reaching EMS

The provincial health department also acknowledges intermittent problems with its EMS telephone services.

Health Department spokesperson, Siyanda Manana says these have included temporary line drops, cable theft and vandalism. Manana says a problem with one line does not mean the entire EMS communication system is down.

“The department acknowledges the concerns raised regarding access to emergency medical services and remains committed to ensuring that residents can access EMS when they need it,” Manana told Health-e News.

“Our priority remains clear: when a member of the public requires emergency medical assistance, the system must be accessible, responsive and capable of mobilising the appropriate assistance as quickly as possible.”

The department did not respond specifically to Health-e News’ questions about the experiences reported by residents in Ngonyama, Hofmeyr, Thornhill and Gqeberha.

The DA’s Cowley says the rollout of more ambulances is welcome but does not resolve the immediate problem of vehicles already sitting off the road.

“It does not address the immediate crisis of more than 200 ambulances standing idle, nor the systemic delays that have kept vehicles grounded for months,” she says.

“The failure does not lie with EMS personnel. Paramedics and frontline managers continue to work under extraordinarily difficult conditions.”

Cowley has asked Capa to investigate the repair and maintenance of the provincial ambulance fleet and has approached Premier Oscar Mabuyane for intervention.