Saving Soweto - episode 1 - trauma

24 hours of trauma

Al Jazeera spends a shift in the emergency unit of Soweto’s only hospital.

Watch part two

In the first part of a new series inside Soweto’s only hospital, Al Jazeera spends a shift with the doctors of one of the world’s busiest trauma units.

Isaac is Kaajal Pharboo’s first patient of the morning. He has been assaulted, sustaining multiple stab wounds from, it transpires, a jam jar.

He has surgical emphysema from a wound in his neck all the way down to his abdomen meaning he has to be anaesthesised before Kaajal can attempt to stem the bleeding.

Such a violent start to the day is a frequent occurrence in the trauma unit of Soweto’s Chris Hani Baragwanath Hospital known affectionately as “Bara”.

Bara is the only hospital in South Africa’s largest township and the biggest hospital in the world sprawling over 173 acres, 429 buildings and 10km of corridor. The hospital has more than 3,000 beds to serve a population of about four million.

Saving Soweto

Treating Isaac at 7am is just the tip of the iceberg for Kaajal in what will be a long 24 hours in the trauma unit, one of the hospital’s busiest departments.

The pressure is particularly on as it is pay day weekend in Soweto when alcohol flows freely and violence erupts.

“There are lots of patients that come in assaulted, because this is the end of the month, its payday, so it’s exceptionally busy,” Kajaal says.

Limited resources

It is a case of being thrown in at the deep end for Kajaal who is a first year intern in the trauma unit working under the tutelage of Patrick MacGoey, a native of west Ireland who previously worked in Scotland for eight years.

“I was working in emergency medicine. Bara is probably one of the busiest trauma units in the world and I came for the experience here,” he says.

The volume of patients in Bara is not often matched by its resources and by 10am Patrick and the team are already using all of the unit’s ventilators.

“When it gets busy, we have probably about a third of the amount of space that we need,” he says.

Patrick MacGoey came to
Bara for the experience

“We don’t have enough staff, we don’t have enough nurses, we don’t have enough doctors, we don’t have equipment, a lot of the equipment doesn’t work, or breaks when you need it.”

By mid-morning Bara is full to capacity and is forced to close so doctors can clear the backlog. Drunk patients are left near a fire escape to sober up before they are treated.

With staff shortages a constant problem, interns like Kaajal are heavily relied upon to keep the place functioning and despite their lack of experience, are often faced with life and death situations.

“Because we have such a shortage of doctors here, our interns are left unsupervised an awful lot of the time,” Patrick says.

Kaajal picks up Isaac’s scans and discovers he has escaped serious injury, suffering only superficial lacerations to the skull.

‘Worst of society’

Others are not so fortunate. Patrick treats a woman who has been raped and violently assaulted, referring her to gynecological doctors.

Statistics show that a woman born in South Africa has more chance of being raped than of learning to read.

“I guess if you’re working in the emergency department anywhere in the world then you see pretty much the worst of society and the worst of what one human can do to another,” Patrick says.

“Every day we see people who have been murdered, assaulted, raped.”

Treating victims of violence also carries personal risks for the doctors, often getting blood on their arms and clothes.

“Probably 50 to 80 per cent of our patients have HIV and quite a lot of them have hepatitis also so we try to keep gloves on as a minimum,” Patrick says.

Patrick’s next patient, Sipho, has a serious stab wound but only arrived at Bara ten hours after his injury occurred because the ambulance had been tied up with other cases.

Patients can wait for many hours to be seen to

He has to make his own way to the x-ray department, five minutes walk from the trauma unit. Patients often lose their way or simply disappear.

“We sometimes lose people,” Patrick says.

“In the UK, you get like 95 per cent of the patients discharged or addmitted within 4 hours. It’s different here; they can spend 36 hours in the department.”

As the backlog finally begins to clear in the afternoon, Patrick takes a break for a drink, the minute he does 12 victims of a mini-van accident are brought in.

Meanwhile Sipho, who had arrived at 9am, admits he is “feeling a little sleepy”.

Unit closure

The sentiment is shared by nurses and doctors but as night falls they are only half way through their shift and news comes through that police have opened fire on a group of raucous funeral-goers. Ambulances arrive with the wounded.

“They started shooting without any order, without telling us whatever, we should do something,” one of the patients says. “They just started shooting at us, I don’t know why.”

One of the men has been shot in the face, his entire neck is swollen meaning doctors have great difficulty opening an airway for him to breath. It is a life-threatening condition that requires an operation.

Meanwhile facilities are once more at breaking point and Patrick has to close the unit to patients once more in order to clear the backlog.

But that does not prevent new arrivals. One paramedic has been diverted to Bara from Johannesburg General Hospital with a crticial patient referred to as “P1”.

“We’re shut to P1s. You’re supposed to phone first and check with the P1s. You didn’t phone ahead, you didn’t follow the structure,” Patrick informs him.

The trauma unit is one of
the busiest in the world

“It’s not my problem now. You need to sort it out, okay. We’re shut [to] P1s until 3 o’clock okay. I’m sorry, but that’s the way it is.”

Among the patients still awaiting treatment is a baby, who was burned in a shack fire. Paraffin stoves are often the cause of accidental fires in Soweto.

“The paramedics when they got to the scene, there were only four people in the shack,” Kaajal says. “Three were burned beyond recognition and this baby was the only one that survived.”

The trauma unit is hit with an added complication when the electricity cuts out, a symptom of South Africa’s recent energy crisis which has caused frequent power cuts nationwide.

Frantic end

With some of the backlog cleared, new patients are wheeled in. A drunk driver called John is brought in by paramedics in a critical condition.

Having bled a lot from his two broken legs, John needs fluids urgently but despite repeated efforts the trauma team are unable to get a drip up.

He dies in the early hours of the morning.

“The longer it went on, the less chance we had of being successful. Essentially this patient shouldn’t have died if we could have given him fluids and given him blood,” Patrick says.

“At the moment there are so many other patients that we have to see who we can prioritise. Instead of mourning one guy we try to find other guys and see if we can make a difference in their lives.”

A frantic 24 hour shift finally ends for the trauma team at 7am and after 22 hours in the unit Sipho is located and finally tended to.

“The last 24 hours were probably the busiest trauma call I’ve done so far,” Kaajal says. “Just when you thought it was getting a little bit more manageable and another lot came in.”

“In my 8 months here I think I have seen Bara closed three or four times,” Patrick says. “It’s not something that we do that often but last night we got hit fairly hard.”

“We saw probably 15, 20 attempted murders; two people died in our shift, two women who had been raped, children with burns. All in all, it was a lot.

“I’m going to go home and hopefully not fall asleep on my way home, which has happened before. I am going to have a shower and go to bed. I’m back here at 7am tomorrow.”

24 Hours of Trauma, the first part of Saving Soweto can be seen from Friday January 9 at the following times GMT: Friday 2230; Saturday 0730 and 1900; Sunday 0130 and 1230; Monday 0630 and 2330; Tuesday 1030; Thursday 0330