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Rural Eastern Cape ‘critically under-resourced’

Patients in the Eastern Cape’s rural areas could wait up to 29 hours for an ambulance, according to an SAHRC report released on Thursday.

In medical emergencies rural Eastern Cape patients may walk 30km to the nearest medical facility, transport the ill in wheelbarrows and donkey carts, or, for the few who have access to R800, use private transport. 

This is according to a South African Human Rights Commission (SAHRC) report, which was released on Thursday. The report found the provincial emergency medical services to be “critically under-resourced”. A public hearing conducted by the SAHRC in March found that, considering national guidelines, there is a 27% shortage of the needed ambulances in operation. There is also less than a third of the necessary paramedics despite the fact that the SAHRC identified that services were drastically insufficient during another public hearing in 2007.

Rural patients have the least access to these services and sometimes pay for private transportation out of “desperation”. According to the SAHRC 62% of the Eastern Cape’s population lives in rural areas and are poor. 

The province is also the largest recipient of social assistance in the country – according to Statistics South Africa 37.4% of households rely on state grants as the only source of income. The SAHRC warns these costs are “devastating” to communities and have long-term effects, “depriving families of other daily essentials which are no longer affordable or compelling families to obtain loans at high interest rates, ultimately perpetuating the prevalence of poverty and inequality”.

In addition to the vehicle and personnel shortage, rural areas have limited access to emergency medical services because of the terrain and inadequate road infrastructure – only 19 of the province’s working ambulances have 4×4 capabilities. But SAHRC says the provincial government has committed to introduce 141 4×4 enabled ambulances by the end of the year. 

Even for the most serious emergencies, where national guidelines stipulate one hour as the maximum response time, ambulances can take hours and even days to arrive. Some don’t arrive at all. 

28 ambulances for 1.3-million people

In one example given by community members and detailed in the report, an ambulance was called at 9am but only arrived the following afternoon – 29 hours after being called. The sick child who needed to be hospitalised had already died the previous afternoon. 

This year’s hearing was conducted after a non-profit organisation complained in 2013 saying there was no access to emergency transport in some rural areas – particularly in Xhora Mouth in OR Tambo district. Despite it being the most populace district with an estimated 1.3-million people it only has 28 ambulances when, according to national standards, 136 are needed. 

The situation is so dire in rural areas that some people don’t even know what an ambulance is. One community member from Xhora Mouth says in the report: “I am grateful to hear that there is something called an ambulance that the government has issued out; we have never even heard of an ambulance.”

Amy Green was a health reporter at Bhekisisa from 2013 until 2016.