/ 28 August 2006

There’s no room

The young man briefly opened his bloodshot eyes and scanned the bleak, chaotic surroundings. His muscular body shivered uncontrollably beneath the white, government-monogrammed sheet as the paramedics lifted him on to another trolley. He tried to raise his arms; his hands and forearms, thighs, chest, back and feet were wrapped in thick, white bandages. An empty drip bag, still connected to his arm, lay next to his head.

With 40% burns caused by electrocution and almost certain to lose one hand, the young man, or Patient 1266089-0, should have been referred to Tygerberg Hospital’s 22bed burns unit immediately.

Tygerberg is a massive tertiary hospital and the place where secondary hospitals refer patients in need of specialist care. But Patient 1266089-0’s luck had run out. Tygerberg refused to take him, saying they had no beds.

GF Jooste Hospital, Western Cape

His first port of call, Khayelitsha Day Hospital, was not equipped to care for him and so, after 24 agonising hours, the severely traumatised 25-year-old man from Khayelitsha found himself on a trauma trolley in GF Jooste (GFJ) Hospital’s bustling trauma ward, his naked body shaking from shock, pain and severe dehydration.

A week later, he was still there. By this stage his chances of survival were between 30% and 40% and decreasing rapidly, as he risked sepsis from being in an open ward.

Dr Neshaan Schreuder had wearily signed the burn patient’s ambulance release form, but could not attend to him. He had 80-odd other equally pressing emergency cases to deal with — and it was only noon.

Some patients had arrived the previous afternoon. Others, like the young woman in the resuscitation area who had overdosed on rat poison, arrived with the early morning rush. She would occupy the life-saving equipment for a day or two as the hospital’s high-care unit was already full.

It was like a scene out of a nightmare. Patients rushed or shuffled back and forth across the hall-like room with its dull walls, many with soulless eyes and drip bags clutched in boney hands. Doctors looked soulless, too, rushing around in their white coats, stethoscopes around their necks.

All the action revolved around a hefty ledger book where the reception nurse records patients’ names, prognoses and levels of emergency, which are indicated by a coloured sticker next to their name.

If patients have a red sticker they will be seen immediately. An orange sticker will be seen soon after and a yellow should be attended to within an hour or two, but the patient could wait up to 12 hours.

Green stickers are awarded to patients who should be seen at primary health care level and are complaining of anything from hemorrhoids to hangovers.

As one doctors quipped: “Good luck” if you have a green sticker.

The referral system was introduced by the government to decrease the load on tertiary and secondary hospitals. It meant that non-emergency or non-trauma patients would first be seen at primary health care level (clinic or community health centre) and would then be referred to the various levels of hospital care — district, secondary and, finally, tertiary.

But many patients who are waiting to be referred, or are not able to secure a bed because the hospitals are full, end up waiting in overnight trauma wards for days on end, collapsed on trollies with thin mattresses, scant bedding and inadequate ablution facilities. This is no ER.

“Forget everything you’ve seen on ER,” mumbled trauma doctor Julian Fleming. He squeezed his bulky frame between the trolleys and pushed a thin, tall man in a wheelchair to a quiet corner where he examined him on a chair because there were no beds.

Nearby, a woman groaned and vomited into a stainless steel bowl, her yellow complexion a clear indication of jaundice. She was sitting on a chair, squeezed between two other patients whose HIV-wracked bodies hardly made bumps under the baby blue hospital blankets.

No nurses were in sight and her friend took the bowl to empty it in to the public toilet at the entrance to the trauma ward.

Fleming said many nurses simply run away and hide on their shift, unable to cope with the relentless stream of new patients and those waiting for a bed in one of the wards or at the tertiary hospitals. “Those nurses that do try to get the work done are inundated,” he added.

The numbers are mind-boggling. Located in the Cape Flats badlands, GF Jooste has 184 beds and services 1,5million residents. The hospital also catches the bullets of endemic gang violence. It sees between 7 000 and 8 000 casualty patients a month, more than double the average of similar hospitals. Add to this the growing incidence of Aids-related admission and it’s no wonder Dr Gio Perez, the hospital manager, says, “We see the sickest of the sick, and I guess the fact that we only get to see patients once they are half dead shows up the failure of patients to access the health system.”