Emergency resuscitation needed

Emergency resuscitation needed

For the first time in years, on paper at least, the beleaguered Limpopo Health department has something to celebrate: 110 new ambulances are to be purchased in the 2015/2016 financial year, and a new rescue helicopter has been earmarked for the province.

A fleet of over a dozen ambulances and emergency services vehicles has been parked outside a private service centre workshop in Tzaneen for at least the last four years. This, while there’s a gross shortage of ambulances in the province.

To date, the services of the ambulance fleet, and indeed of the 1 860 qualified paramedics employed in the province, have not filtered through to the people who need them most. In fact, the Emergency Medical Services (EMS) in Limpopo is one of the glaring failures in the department.

For example, of the 50 new ambulances bought in the 2014/2015 financial year, only 23 are operating. The remaining 27 are currently “still in the process of being licensed” according to Department of Health spokesperson Matome Lebea.

For this reason, the Treatment Action Campaign in Limpopo has made EMS in the province a central campaign this year. People are dying because of EMS failures, say Tzaneen management team members Jennifer Chabala and Moses Makhomisani.

In the course of its EMS campaign, which includes door-to-door canvassing, TAC has collected numerous personal testimonies, which will comprise a series of affidavits that will be used to form a challenge against the provincial authorities.

The challenge stems from consistent failures and repeated foot-dragging by the province.

A TAC memorandum sent to the Department of Health in November 2014 addressing EMS as an urgent issue only garnered a response in the middle of April this year – nearly six months later. It is clear the responses were worked on before the festive season, but were only sent out in April.

“It means they are not taking this matter seriously, even as people are dying as they wait for ambulances,” says Makhomisani.

Affidavits in the TAC’s possession all have the same thread: distressed families wait for a very long time when they phone ambulances services. Minutes turn into hours, and then all hope fades that they will receive any help at all. Many are forced to scramble to find a private vehicle, or to hire transport. Explanations and apologies are never forthcoming.

Among the incriminating allegations in the affidavits are claims such as these: “We had to wait for a long time, six hours maybe, and when EMS arrived the driver was very angry and rude with us.”

And: “My niece was in labour and it was raining that day, and we waited for three hours for the ambulance, standing in the mud.”

Says Makhomisani: “The ambulance service is much more like a taxi service – you’re told that they will get to you when they’ve picked up another three people. They don’t treat it like an emergency,”

The dire lack of resources is compounded by multiple systemic deficiencies, including the bad management of resources. Allegations abound of officials who fail to do their jobs effectively, of an ambulance despatch system that doesn’t optimise the spread of ambulances to where they’re needed most, of a fleet of ambulances with broken or missing life-saving equipment and a shortage of skilled paramedics. This is exacerbated by poor infrastructure, such as pot-holed roads which make it difficult for vehicles to travel.

The Limpopo Department of Health has acknowledged the shortage of ambulances, citing problems of operation with an old fleet, and delays in repairs of vehicles “due to poor service from a new service provider”. It claims that “the Department could not procure ambulances for three years between the 2010/2011 financial year till 2013/2014”.

The Department is determinedly upbeat that the EMS will improve dramatically in the months ahead. Lebea says: “The challenges you have raised will become history.”

Limpopo premier Chupa Mathabatha, speaking at the close of the province’s health summit in March this year, pledged to improve ambulance response times, to increase staff numbers, and to train and develop EMS personnel.

But this is not good enough: there are neither adequate specifics, nor proper timeframes. The government response fails to answer crucial questions, such as when the entire fleet of vehicles will be registered and operational; what the new despatch system will involve, to ensure ambulances reach their destinations promptly; and perhaps most importantly, what recourse citizens have when they are failed, and if heads will roll.

Tackling EMS in the Eastern Cape

Long road to health in the Eastern Cape.
Long road to health in the Eastern Cape.

The right not to be refused emergency medical treatment is laid out in section 27(3) of the Constitution, and is an immediately realisable right. This means that it is not subject to limitations, including resource limitations. The Department of Health is obliged constitutionally to prioritise emergency medical treatment in its planning and budgeting. Unfortunately, in many provinces, this does not appear to happen. The inadequacy of EMS systems is wide-ranging; occurs across the country; results in the loss of life, in ongoing sickness and sometimes disability, in the violation of the dignity of the elderly, the disabled, mothers, babies, children, and men; and in the violation of the right to equality of people who are denied the rights accorded to people who have the resources to rely on private healthcare services.

On 25 and 26 May 2015, the South African Human Rights Commission held a hearing into EMS in the Eastern Cape. The EMS Hearing was quite unlike the normal consultation and other processes attended by government officials and community members. It was preceded by mass meetings in four particularly affected communities, in which attendees spoke about EMS problems in their areas and elected representatives to attend the Hearing. The Hearing itself had the feel of a truth and reconciliation commission, with old women, young men, chiefs and grief-stricken family members standing up and talking publicly about the tragedies they have witnessed when an ambulance fails to arrive or arrives hours after it was called.  Government officials from the Department of Health, Provincial Treasury, and Planning and Roads presented their plans and answered questions. There was nowhere to hide.

The Human Rights Commission will publish a report on the Hearing in the next few months. In the report, the Commission will make findings and recommendations for the improvement of the EMS system in the Eastern Cape. We look forward to the report, and to the implementation of its recommendations by the Eastern Cape Department of Health. We cannot allow the Department to continue to fail in its obligations to healthcare service users in their hour of most desperate need; and the EMS Hearing and report are a step in the right direction.
Sasha Stevenson, SECTION27 


A Mother’s Death: Unresolved and Unexplained

Orpa Mavutana holds a tablet that has a photo of her mother, Mphephu Mavutana. Her mother died while waiting for an ambulance to arrive. (Image: Ufrieda Ho)
Orpa Mavutana holds a tablet that has a photo of her mother, Mphephu Mavutana. Her mother died while waiting for an ambulance to arrive. (Image: Ufrieda Ho)

Friends remember how Mphephu Mavutana collapsed and later died on the midsummer day of December 1 last year.

They recall how the 64-year-old woman appeared to be as fit as ever as she walked in the streets, greeted people, and jokingly asked for lucky numbers for her regular gambling bet with the “‘ma-china’, the local fahfee man in the village of Mariveni, outside Tzaneen.

A few hours later she made her way to her son’s home in the same village for a visit. While working in his garden, she suddenly collapsed and lost consciousness.

Her daughter, Orpa Mavutana, with whom Mphephu lived in another section of the village, received a panicked phone call from her family. They told her they had already called the ambulance services, and had been assured an ambulance would be on its way. Orpa rushed to her brother’s home to be with her mother.

“My mother was just lying there, and we kept calling the ambulance,” Orpa remembers.

Two hours passed, and the ambulance still hadn’t arrived. The desperate family managed to arrange for a car, and they drove Mphephu to the Mariveni Clinic. But Mphephu was declared dead on arrival.

“I’m sad and angry. Maybe if the ambulance had come on time, my mother would have had a chance,” says Orpa.

The family say no post-mortem was conducted, and they do not know the actual cause of her death. The death certificate bears the umbrella phrase of  “natural causes”. Four months later, the family has not had an explanation, apology, or even a conversation about why the ambulance service failed Mphephu Mavutana and her family.

Orpa and her family have not taken up these issues with the clinic, the emergency services or the Department of Health, because they believe it would be pointless.

“I have to accept that she is gone, but we don’t know what happened to her and why she died. She wasn’t on any medicine, and she never complained about being sick or anything.

“I miss her a lot. The vegetables she planted in this garden were growing so nicely. She really looked after them … but now that my mother’s gone, there’s nothing,” says Orpa.


Healthcare system fails sis Anna

Anna Chauke was a home-based caregiver to her relative and friend Anna Maluleke. She watched as her friend died, as they waited for an ambulance to take her from the clinic to hospital.
Anna Chauke was a home-based caregiver to her relative and friend Anna Maluleke. She watched as her friend died, as they waited for an ambulance to take her from the clinic to hospital. (Image Ufrieda Ho)

The midday April sun pushes up the mercury, but Please Baloyi is wrapped in a puffer jacket, squinting against the sharp rays that seek out his front yard. He manages a friendly greeting, but his smile is fleeting.

Baloyi’s health hasn’t been good; his voice is raspy, and he speaks slowly. He’s in mourning, too. He has been a widower for only five weeks. On 5 March his wife, Anna Maluleke, became another victim of a healthcare system that is failing residents of Limpopo province.

Baloyi says he wants to talk about what happened that day, because he’s hurt and angry that his wife died without adequate medical help. Her death and the reasons for it have been marked by apathy, lack of communication and information, and very little common decency or dignity.

Both Baloyi and his wife had been undergoing antiretroviral treatment and were receiving home visits from their care worker Anna Chauke, who is also a family friend.

“She was weak, she was not talking, and she was very still,” he remembers of the day she became ill. When he found his wife in that state that morning, he turned first to Chauke, asking her to come over and see if she could help.

Chauke had been with the family the day before, and couldn’t believe what she was hearing.

“She was fine the day before. We were talking and laughing. She was sick, but she dressed herself and was eating by herself,” Chauke remembers.

When Chauke heard how serious Maluleke’s condition was, she told Baloyi it would be best to get her to the clinic immediately. However, she pointed out that only one ambulance, based at Nkensani Hospital, serviced their entire district in Giyani. She said they would be better off finding a private car to take Maluleke to the clinic. The family found their way to the clinic, where they met up with Chauke.

“We rushed into the clinic, and the nursing sisters were having a meeting. The had to cancel their meeting to try to help Sis Anna, but the oxygen they gave her wasn’t working, and the nursing sisters said they had been complaining for weeks that the oxygen supply system was broken,” says Chauke.

She continues: “The nurses kept calling for an ambulance, every 30 minutes, and they were told that there were still three other people waiting. They put Sis Anna on a drip, but by the time they put a second drip on, she was not there anymore. I could see that her nails were going black. Then, at just past 1pm, she died.”

The ambulance never arrived. Nearly five hours had passed from when the first call was made.

Chauke says: “I feel sad. Maybe if the ambulance had arrived early, Sis Anna would still be here.”

Baloyi says that although his wife, like him, was ill, she took care of him and of her two teenage sons. Now, he says: “I’m all alone.”