As a patient, the most basic test of emergency medial services (EMS) is whether an ambulance will show up when you need it, in time to save your life. According to the SAHRC’s Access to Emergency Services in the Eastern Cape Hearing Report, however, some rural communities in the province claim to have no access to ambulance services.

“Phone an ambulance? My dear, phoning an ambulance doesn’t even cross my mind. In my seven years at Pilani Clinic I have never ever seen an ambulance at this clinic,” an assistant nurse said.

The SAHRC, whose hearings called for stakeholder comment and allowed victims of bad EMS services to describe their experiences, is now taking the study national. It aims to hold hearings towards the end of October and in November to gauge the state of ambulance services across the country.

“We publicly resolved we need to have a national inquiry based on the report from Eastern Cape but also the number of health related complaints that we deal with in our provincial offices. We thought that perhaps the issue around ambulances and health in general is not limited to Eastern Cape,” said SAHRC spokesperson Isaac Mangena on Monday.

“We have identified a range of problems with the healthcare service, with ambulances and planned patient transport services, which includes the complete lack of services in certain communities, especially the rural communities – poor response times, the lack of equipment including inside the ambulances, the shortage and incompetence of staff,” Mangena said.

“We want to get the sense of what’s the cause of these, as well as challenges faced by various spheres of government in addressing them. Our ultimate objective is that those who have been denied access to health services are able to experience their rights as articulated in the Constitution.” Mangena said Deputy SAHRC chair Pregs Govender is speaking to the Department of Health to ensure it is available for the national inquiry.

Department of Health spokesperson Joe Maila on Monday welcomed the inquiry and committed to making relevant information available. “Every now and then you’ll find challenges from time to time, but what we are doing is to make sure that our people are receiving emergency medical services as they should. We’ll do everything possible,” he said.

The EMS hearings in Eastern Cape heard shocking stories on the loss of life. The report includes one instance of an ambulance being called at 9:00 to assist a critically ill child. The callers were told the ambulance was on its way but had stopped to fill up petrol. The child died that afternoon. The ambulance arrived at 14:00 the following day.

Another story went, “In his submission to the commission, a man from Isilatsha Village described that the call centre refused to dispatch an ambulance for his terminally ill sister on a Friday evening, giving the reason that ambulances are not available on the weekend, and further insisted that ambulances are not dispatched for terminally ill patients, only for patients that have been injured and stabbed. The caller placed calls regularly and was told the same thing repeatedly.” An ambulance was only dispatched on Monday after the media reported the issue.

The report concluded insufficient progress has been made by the Eastern Cape department of health to past recommendations. Its fleet is too small. The services are understaffed and struggle to get to rural communities. “Shortages of medical supplies, equipment and staff; inappropriate policy design and implementation; insufficient consultation and provision of access to information; unreliable information management systems; and poorly managed and resourced call centres have further contributed to a severely constrained EMS programme and an unequal provision of services,” the report reads.

The impact on an individuals’ health is obvious, but the SAHRC found EMS services limits attempts to eradicate poverty. It continues, “The high costs involved in obtaining private transportation services place an incredible financial burden on families, often with devastating effects. Daily necessities such as food, clothing and education are sacrificed, while the reliance on already unaffordable loans at high interest rates drive families deeper into poverty.”

Recommendations included that the Eastern Cape Department of Health get its fleet fully operational, prioritising 4×4, inter-facility transfer and planned patient transport vehicles, and ensure each district has the right number of equipped ambulances according to population and terrain.

In reviewing its policies the provincial department should look to ensure patient transport is available for those who have no other options, particularly those with mental and physical disabilities. It needs to accurately record response times and staff should know of the new policy aim of getting to an emergency situation in between 15 and 40 minutes, within four hours maximum. The SAHRC also made recommendations on human resources and using 4×4 vehicles to cover poor road networks.

“It would be good if there can be a national inquiry to get stories of public healthcare users to see how they are frustrated by the use of ambulances,” said Treatment Action Campaign general secretary Anele Yawa on Monday. “It is not only in Eastern Cape,” he said, listing other provinces, most of them, with problems. He noted some of the recommendations aimed at improving response times and tracking vehicles, but questioned whether they would be implemented.

Even if they are, Yawa said there will still be a huge gap between emergency services for the rich and poor: “They are coming up with these recommendations simply because they know they apply to the poorest of the poor.”

While calling for more national oversight of the SAHRC’s recommendations, the Democratic Alliance welcomed the investigation. “Desperate patients, especially those in rural areas, are being unnecessarily exposed to suffering, and possible death, due to the lack of ambulances and emergency services,” said Heinrich Volmink, the party’s deputy shadow minister of health. DM

Read more:

• SAHRC’s Access to Emergency Services in the Eastern Cape Hearing Report
• Where there are no ambulances, in Daily Maverick
• National inquiry to be launched into emergency medical services in Health-E News

Photo: Injured commuters are treated in an ambulance after a commuter train crashed through a wall at the main station in Cape Town, South Africa, Friday 24 October 2003. EPA/STR