Elsevier

Injury

Volume 34, Issue 9, September 2003, Pages 704-708
Injury

Trauma care systems in South Africa

https://doi.org/10.1016/S0020-1383(03)00153-0Get rights and content

Abstract

Aim: To provide an overview of the provision of trauma care in South Africa, a middle income country emerging into a democratic state. Methods: Literature review. Conclusions: South Africa is gripped by an almost hidden epidemic of intentional and non-intentional injury, largely driven by alcohol and substance abuse, against a background of poverty and rapid urbanisation. Gross inequities exist in the provision of trauma care. Access to pre-hospital care and overloading of tertiary facilities are the major inefficiencies to be addressed. The burden of disease due to trauma presents unique opportunities for reconstruction and clinical research.

Section snippets

Socio-economic

South Africa is a middle income country with a GDP per head of US$ 3110.00 p.a. (UK US$ 24,390.00 p.a.), a population of 42 million, and an average life expectancy of 46.5 years for males and 48.3 years for females [22]. Annual incomes vary by a factor of 17 between the highest and lowest socio-economic groups, and a wide discrepancy exists in the services available. In general, 20% of the population have access to private medical funds, usually subsidised by employers, while an estimated 80%

Pre-hospital care

South Africa is the only country on the African continent with an organised, statutory system of pre-hospital care, and the National Healthcare Plan aims to ensure at least basic life support available to all within 20 min [21]. In the past, pre-hospital care suffered from racial inequities, where ambulance/fire stations were located in (white) city/town centres, whereas most injuries occurred in the peripheral, black townships. Following the advent of democracy in 1994, this is being addressed.

Inter-hospital transfers

All secondary hospitals are designed to provide comprehensive care, but care is compromised by a shortage of specialists, not available posts. Major injuries tend to be referred to tertiary hospitals. Availability of beds is therefore a major problem in teaching hospitals, with decanting of stabilised patients a common occurrence. The benefit of this system is that all care is provided under one roof—there are very few specialist hospitals, where trauma patients with multi-system injuries could

Acknowledgements

The authors wish to acknowledge the contribution of Dr. P. Demmer to training in the surgery of Orthopaedic trauma in South Africa.

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