Doctors in South Africa becoming gun-shy

CMAJ 2000;162:1602

On average, Stoltz and his colleagues at the 100-bed hospital, which is about 45 minutes outside Cape Town, treat about 60 victims of common assault on Friday and Saturday nights. Most of these emergencies now involve stab wounds; the number of gunshot wounds has declined in recent months. This is not unusual. Indeed, hospitals throughout the country are dealing with an epidemic of violent injuries. Stab wounds are common and in some areas the number of gunshot victims is soaring.

In fact, the number of gunshot wounds was so high last year at the Groote Schuur Hospital in Cape Town — 981 patients in total — that doctors and nurses in the trauma unit embarked on an awareness campaign that included placing posters throughout the hospital to increase understanding of the seriousness of the problem. Part of the problem is that firearms are easily available and legal to obtain in South Africa, where Uzi sub-machine guns and AK-47 assault rifles are common.

The problem also extends outside the trauma unit. Doctors at the Stellenbosch Hospital have found themselves caught in the middle of all-out warfare between rival gangs. If a gang member failed to die in a shootout and doctors were lucky enough to be able to save his life, opposing gang members often show up to finish the job, says Stoltz. (For the security of these patients, they are routinely and randomly moved within the hospital.)

The threat of violence also extends to medical staff, particularly nurses who live in the townships where many of the patients, their families and their "visitors" also live. "Staff get threatened that they will be 'gotten' in the community," says Stoltz. — — Donalee Moulton, South Africa

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