Groote Schuur treats up to 90 gunshot victims a month: 'And we're only seeing the survivors'
21 July 2019
The bullet-riddled victims, who end up on the operating table of his team at Groote Schuur Hospital, are casualties of a bloody civil war playing out on the Cape Flats, seasoned trauma surgeon Professor Andrew Nicol believes.
Up to 90 victims are treated per month at the government-funded institution in Observatory for gun-related injuries, an average of about three a day.
"And we are only seeing the survivors," Nicol pointed out.
Between January and June, 1 995 bodies, which had sustained gunshot or stab wounds, were admitted to the province's forensic pathology services for post-mortems.
In June alone, 448.
Nicol, who has headed hospital's trauma unit for the past 20 years, has seen the steady increase in the number of trauma patients admitted over the last two decades as well as the change in the severity of their injuries.
Single gunshot admissions are becoming rarer as patients with multiple wounds outnumber them.
Last weekend, Nicol said, one of their patients was a woman who had been shot 20 times.
Saving patients 'from death's door'
Fittingly, techniques developed by the military to get patients through massive trauma have been adopted.
One is a shunt, which involves plastic tubing being inserted into the arteries to act as a conduit for the blood until the person is stable.
"Damage control surgery" aimed at getting patients "from death's door" through the next 24 hours before completing the full procedure is also performed.
In one instance, Nicol explained, a 16-year-old was admitted with shots to his chest, abdomen, both arms and both legs. The abbreviated procedure was used to ensure that he survived.
"But dealing with gang violence and its effects divert resources from providing health care to saving patients from what are preventable injuries. It is essential to look upstream to see what can be put in place to stop this violence from happening," Nicol maintained.
The number of trauma admissions is so incredible that international specialists from countries with low levels of violence visit Groote Schuur for insight into how it manages emergency treatments.
One trauma surgeon visiting the hospital from the UK has not seen a gunshot wound in three years.
Nicol sees it every day.
From Monday to Friday in an average week, the trauma unit sees mostly injuries related to accidents, stabbings and the "occasional gunshot".
But come nightfall at the start of the weekend, the trauma unit is ready for "disaster".
One trauma theatre is operational over weekdays. Last Sunday, there were four.
The unit can accommodate six patients at a time, but every weekend it becomes overwhelmed with the number of victims of violence in need of surgery.
The cost of treating a gunshot wound is reportedly about R22 000. Should the patient also need orthopaedic surgery, this increases to R25 000.
This money diverted to cover emergency surgery could have been spent on health care, Nicol said.
A number of his patients are innocents caught in the crossfire.
Shot mother 'just grateful it wasn't her kids'
Nicol has heard umpteen horror stories from victims who during his rounds told of how they ended up in his ward.
One woman, who is at risk of losing her leg, had been walking with her four children in Hanover Park last week when she was hit by a bullet that damaged her femoral artery.
"These experiences are depressing and heart-wrenching to hear. This mother had been lying there after being shot with her children standing over her. She was just grateful that none of her kids had been hit."
But it is the young patients admitted to their unit who disturb the trauma team.
Child casualties aged 12 and older are admitted at Groote Schuur.
Recent figures show that 35% of minors treated at the hospital had gunshot wounds.
"It is incredibly traumatic to deal with cases involving children," Nicol admitted.
He told of one instance last year, when the parents of an eight-year-old boy rushed him to the hospital after he was shot in the chest.
"We operated in the resuscitation room because he was bleeding so heavily. He ended up dying in our theatre."
Despite a tight budget and limited resources, Nicol pointed out the academic hospital boasted a survival rate comparable to institutions in the US.
"We are very proud of the work we do. This is a fulfilling job, but at the moment it's an overwhelming one," he said.
"We try to cope, but there is no doubt we need more staff. Everyone working here is feeling the pressure."
'What can we do to stop this?'
Faced with the damage caused by firearms daily, Nicol believed greater gun control was necessary to decrease the number of casualties who ended up in his unit.
"It's time that we make bold assertions about what to do about our massive gun problem. What can we do to stop this excessive violence from happening?"
Some casualties, however, die or never make it to the trauma unit's operating tables.
At the overburdened Salt River mortuary, some bodies are being stored in refrigerator shipping containers as an increase in violent crime and population growth have reportedly seen the morgue becoming excessively overcrowded.
The facility has 150 permanent refrigerated body spaces, 30 temporary refrigerated body spaces and 10 autopsy tables.
A R281m laboratory is currently under construction to replace the age-old mortuary. The multimillion-rand lab will have 26 autopsy tables - four dissection suites with six tables each as well as two teaching and training dissection suites - as well as 360 refrigerated body spaces, 180 admission fridges, and 180 dispatch fridges.
The Observatory Forensic Pathology Institute would provide forensic services aimed at extracting, analysing and preserving the integrity of evidence for use by the criminal justice system, health department spokesperson Mark van der Heever said.
Meanwhile, the killings in Cape Town continue to increase.
Last weekend, 43 murders were recorded by the forensics services in the metro between Friday night and Monday morning.
Of these, most had been shot dead.
