Violence, trauma and alcohol has devastating effects on WC Health system

Today, Western Cape Minister of Health, Dr Nomafrench Mbombo briefed the media on the impact of violence, trauma and alcohol has on the health system.

The recently concluded Festive Season once again posed a range of challenges to our health system. Numerous crashes kept our Emergency Medical and Forensic Pathology Services very busy while staff at our Emergency Centres had to bear the brunt of an additional, yet avoidable, burden of injury-related cases fuelled by violence and alcohol abuse.

Injuries and interpersonal violence are one of the biggest contributors to the province’s quadruple burden of disease. While the Department of Health feels the effects of violence and injuries, addressing the upstream factors must be a collaborative effort by all departments.

The Head of Health, Dr Beth Engelbrecht says: “I wish to thank all Health staff who worked extremely hard during the Festive Season to ensure all our people are cared for”.

Festive Season impact (15 December 2018 to 15 January 2019)

Emergency Medical Services:

During this period, over 30 000 emergency cases were transported to hospitals by our emergency medical services. Of these cases, 23% (8 069) were as a result of patients sustaining injuries, which range from violent trauma such as stabbings and gunshots to physical and interpersonal violence as well as accidental injury.

Of the 8 069 cases the top three causes were:

• Assault with a weapon: 2 894 cases were seen where people were assaulted with a weapon – which includes all types of weapon and is not limited to a knife or gun;
• Physical assault: 956 cases and
• Accidental injury: 864 cases (presumed unintentional) were taken to hospital by ambulances

In addition to the emergency cases treated at the emergency centres, EMS facilitated over 14 000 inter-facility transfers. Of these, 1 481 (10%) relate to all forms of injuries whereas a staggering 1 131 cases were as a direct result of violence:

• 427 cases of assault with weapon (other than a firearm)
• 203 – physical assault
• 169 – accidental injury (at home)
• 101 – gunshot
• 96 – self harm
• 69 – self harm through poisoning
• 44 – self harm with a weapon
• 10 – self harm with firearm
• 7 – assault through poisoning
• 5 – sexual assault

Forensic Pathology Services:

Our Forensic Pathology Service also dealt with a spate of admissions – whether through violent crimes or accident related deaths caused by reckless behaviour and driving under the influence of alcohol.

Over 11 000 mortuary cases were admitted across the Western Cape in 2018. The impact of the high number of deaths due to unnatural causes has resulted in a backlog and an increase of our caseloads at our mortuaries. In the Metro alone, we received over 8000 admissions at our two large state mortuaries situated at Tygerberg and Salt River (4 400 cases at Tygerberg and 4 037 at the Salt River mortuary).

Over the last few years, we have also seen a significant increase at our Forensic Pathology Services. Our FPS had a 17% increase in caseload between 2010 and 2016, an average increase of 2.5% per year - 10 985 cases were received by FPS in 2016, compared to 9 381 in 2010.

According to the Mortality Profile, the 2016 the male homicide rate was 96 deaths per 100 000 - a 38% increase since 2010. The increased homicides in males was due to an increase in firearm-related deaths. Homicides also doubled between 2010 and 2016, mainly in the Metro subdistricts of Klipfontein, Tygerberg and Mitchells Plain.

Injuries accounted for 14% (6 770 ) of all deaths in the Western Cape in 2016, with over 80% affecting males, in particular 20-39 year olds. Of the 6 770 injury-related deaths: 3 385 (51%) were homicide and half of them tested positive for alcohol.

Interpersonal violence and gender based violence also impacted on our clinical forensic medicine services where as an example our Khayelitsha and Heideveld TCCs and Victoria Clinical forensic Unit had examined 227; 136 and 78 sexual offenses cases respectively.

Estimate cost for treating gunshot victims

The estimated cost for admitting and treating a patient with a gunshot injury is approximately R22 000 per patient and should the patient also require orthopaedic surgery it is a further R25 000. These costs excludes the transport cost (by ambulance), treatment received in an Emergency Centre (when they first arrived at hospital) as well as either rehabilitation cost or forensic pathology (if an autopsy is required).

The sharp increase in injury-related cases negatively impacts on the services available within the health system.  This is because violence is a major contributor to the pressures we experience especially within our emergency centres, which causes delays in the treatment of many elective procedures.

Patients requiring emergency treatment as a result of violent injury often take preference. This will cause the other patients to wait longer, often with potentially detrimental effects to their health.

“Service pressures are experienced across facilities, and we see quite a number of these injuries fuelled by substance abuse. Western Cape Government Health Facilities deal with way more than what they are designed for. This is a call to the public to consider these facts, especially how the personal choice to consume alcohol irresponsibility, not only impacts the individual, but robs other patients of much need medical attention. To curb this immense and unnecessary pressure we experience on our available services, we need communities to work with government to ensure we keep the unnecessary levels of trauma and violent injuries through irresponsible substance use to a minimum” said Minister Mbombo