New ambulances for Northern Cape but critical vehicle, staff shortages persist
A shortage of personnel, lack of equipment, and not having enough ambulances on the road are all challenges hampering response times and the quality of emergency medical services in the Northern Cape. Refilwe Mochoari spoke to relevant stakeholders, including healthcare users and EMS staff about these perennial problems and what is needed to fix them.
It was around 10:00 on 11 March 2022, when Masego Kolane (23) from Barkley West, about 35km outside Kimberly, says she called an ambulance. She was in labour. Kolane was 39 weeks pregnant and after several calls, she says no ambulance came to her rescue.
“My sister eventually called the police station, asking them to help take me to the hospital,” Kolane tells Spotlight. “But unfortunately, the police [said they] do not have authority to transport me, so they had to drive to the Barkley West Hospital to fetch the ambulance themselves,” says Kolane.
Four hours later, the ambulance arrived at the Kolane residence, she says.
“When we arrived at the Prof ZK Mathews Hospital in Barkley West, nothing could be done because my blood pressure was too high and I had to be rushed to the Robert Mangaliso Sobukwe Hospital in Kimberly where the child was born. I really don’t know how I managed to come out of that terrible situation alive. I don’t know what would have happened to me and my child if the police did not come to my rescue,” says Kolane.
She says she will never advise anyone to rely on ambulances in the province because “that is taking a risk with one’s life”.
Some Emergency Medical Services (EMS) personnel members blame ambulance shortages, staff shortages, and inadequate occupational health and safety measures. They say they can only work with what is available.
Prince Naidoo* who has been an emergency medical services worker for more than ten years, during an interview with Spotlight says it is often the community who suffers most when it comes to emergency medical services in the province. “The reason we are always late for our patients is [that] there [are] not enough vehicles and staff members and often the ambulances don’t have working equipment. As a result, we use our own personal equipment that we have invested in for ourselves as emergency services personnel,” he says.
“We are understaffed, we are strained, we do not have the proper equipment to help the patients when in the ambulance, and there [are] not enough vehicles. Ideally, there has to be a minimum of ten ambulances in Kimberly alone,” he says, but often they have to operate with fewer than ten vehicles.
Beefing up the numbers: A timeline
In 2019, Northern Cape Premier Zamani Saul announced that instead of spending money on vehicles for the executive, the provincial government made funds available to procure 27 new EMS vehicles. In 2014, the provincial government under former Premier, Sylvia Lucas, also procured 110 emergency vehicles for the health department.
Yet, despite the procurement of more EMS vehicles over the years, the department continues to face the same challenges.
In its 2nd Quarterly Performance report for 2021/2022 tabled in the provincial legislature, the department raised concern over service delivery and patient outcomes. The department cites limited resources, including ambulances and staffing as reasons, as well as a significant increase in demand for EMS services.
“EMS is largely dependent on vehicles to provide a service hence, it becomes critical that our operational status remains high and sufficient at all times,” reads the report. “Unfortunately, due to the Northern Cape’s vast geographical area, it makes the availability of EMS more challenging. The conditions of roads in the province contribute to the rapid ageing of the departmental fleet and the delay in maintenance and repairs has a negative impact on the response times as the majority of the available fleet are often out of service,” the report states.
By the second quarter of the 2021/2022 financial year, there were 75 ambulances per day operational in the province while 73 were non-operational, 28 patient transport vehicles were operational and 28 were non-operational, 18 rescue vehicles were operational and eight were non-operational.
The 4th Quarter Performance report, which should provide more current numbers, is not yet available as it has not yet been tabled in the provincial legislature.
But Northern Cape MEC for Health Maruping Lekwene during a media briefing in March said the department has invested in 92 new vehicles worth over R50-million since the start of the sixth administration (2019) in an effort to beef up ambulance capacity and ensure better response times during emergencies. This included ambulances, patient transporters, and response vehicles.
Lekwene said during the 2020/2021 financial year, the department added 45 ambulances to reinforce the current fleet, which means that there are between 80 and 90 ambulances on average per day on the road.
“As a department, we have kept our promise that we will reinforce the existing fleet by a further 20 ambulances and 10 (35-seater buses) during the third quarter of 2021/22 financial year. Furthermore,” he said, “the department is in the process of procuring another 54 vehicles consisting of 32 ambulances, 20 (4×4) ambulances with off-road capability, and two additional patient transporters for delivery in the new financial year (2022/23), however, it must be noted that there is a global supply challenge with the availability of vehicles, which might impact the speedy delivery.”
New fleet, same problems
Naidoo says the new vehicles are useless if EMS remains understaffed and personnel overworked. “The new vehicles came with no new equipment,” he says. “They took the equipment, which [is] not in working condition from the old cars and placed them in the new vehicles, which do not make sense to us as EMS workers.
“We are forced to work in these unacceptable conditions and it is bad for the community because they are affected badly. So, basically, we have new cars with no equipment [or] the equipment is faulty.”
Naidoo says some EMS workers had to buy their own equipment such as thermometers, blood pressure monitors, and blood glucose monitors. “That is all we have [and] if a patient is critical, we have to rely on [the] cardiopulmonary resuscitation procedure (CPR) until we get to a hospital and sometimes we find ourselves losing patients. We also use our own cell phones to communicate with the hospitals when we have patients on board.”
According to the Western Cape health department’s website, equipment that is expected to be in an ambulance includes, among others, ventilators, a bag valve mask for patients that struggle to breathe, a communication radio, a spinal board, and an ECG monitor with a defibrillator.
Staff and ambulance shortages
Speaking to Spotlight, President of the South African Emergency Personnel Union (Saepu) Mpho Mpogeng, says following a visit to the Northern Cape in April this year, it is clear there are many challenges in the province.
“We met with the MEC, and the first issue we want to have addressed is that of the shortage of ambulances and staff. It becomes very difficult for EMS workers to deliver quality service if they are overworked with limited resources. We have noticed that the Northern Cape is a big province with a small population, so it is difficult for the department to run smoothly because of budget constraints. We do, however, welcome the procurement of new ambulances, but the burning issue for us is that the department does not follow the occupational health and safety measures of the EMS workers. Many workers,” Mpogeng says, “do not have uniforms, and it’s challenging because when they go into the community, they sometimes get attacked because people are unable to identify them.”
Democratic Alliance (DA) spokesperson for health in the Northern Cape, Isak Fritz says the DA has been voicing concerns regarding the Northern Cape EMS, which they say continues to offer inadequate ambulance and patient transport services to residents.
“Considering that the department ideally needs 184 ambulances to be operating every day, we welcome the procurement of new ambulances,” Fritz says. “Due to the distances travelled by ambulances and the poor quality of the province’s roads, many of the newly procured ambulances end up being replacement ambulances and do not always help to add additional capacity to EMS. In effect, ambulance services do not always improve after the procurement of new ambulances, but often stay the same.
“At the same time, aside from simply procuring new EMS vehicles, we have been asking the department to look into the slow turnaround time in respect of repairs by Transit Solutions Fleet Management. [I]mproving the repair time of EMS vehicles could also go a long way toward addressing the shortage of ambulances on the roads.”
Fritz says another factor to consider is that the EMS personnel have remained in the region of 800 staff members. “However, a staff component of 1,830 is ultimately required for the department to realise the target of two-person crews. Procuring ambulances should, therefore, also go hand in hand with appointing additional EMS personnel,” Fritz says.
The use of one-person ambulance crews in the Northern Cape appears not to be in line with national EMS regulations. According to regulations issued in terms of the National Health Act, a minimum of two persons must staff an ambulance or a medical rescue vehicle and a minimum of one person must staff a medical response vehicle.
In practice, a one-person ambulance crew means that the paramedic has to drive the ambulance, which leaves the patient unattended during the journey.
The issue is not new.
In 2018, Noel Desfontaines, General Secretary of Health and Other Service Personnel Trade Union of South-Africa (Hospersa), wrote in a letter to the Northern Cape Department of Health that this practice is taking place in over 20 EMS stations across the province.
“We strongly condemn the practice of one-man ambulance crew in the Northern Cape. The department is in contravention of the EMS regulations which clearly state that an ambulance must have two crew members. The one-man crew is putting enormous pressure on our members when attending to medical emergencies which in turn affects the delivery of service,” he wrote.
What the department says
Spotlight contacted the Spokesperson for the Northern Cape Department of Health Lebogang Majaha repeatedly for over two weeks to get comment, but Majaha did not respond.
However, in the latest available performance report, as tabled in the provincial legislature, the department notes several challenges relating to emergency medical services. In the report, the department says staff shortages prevent them from meeting the national response time and delays in filling vacant funded posts mean the one-person crew situation in the EMS programme, as well as personnel shortages in the administration section, continue.
The department says it has a proposed corrective action plan to fill vacant funded posts and will seek approval to appoint more staff, including the vacant funded posts. The plan is also to replace and procure additional ambulances and to request more money from the Northern Cape Treasury to appoint more staff and procure more resources. The department also notes low staff morale and an increase in labour disputes due to non- or late payment of overtime and allowances as challenges. The timeframe for these plans is unclear. DM/MC
*Not his real name
*This article was published by Spotlight – health journalism in the public interest.