Trauma care systems in South Africa
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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