The Daily Maverick recently published an article written by Mandy de Waal entitled ‘Baragwanath’s shame: a good man dies’. Sadly there are only two shames here and neither is that of a hospital or its staff. Firstly it is terrible that a man lost his life and even more unfortunate that by all accounts he seemed to be a caring and community focused individual. Secondly it is particularly appalling that the death of someone has been used to benefit a journalist and malign healthcare providers who do the very best for their patients in exceptionally difficult circumstances.
Essentially the exposé is about Godfrey Tenehi who passed away due to burns he sustained as a result of a fire in his shack. This is where the truth of the article begins and ends. The poor research and multitude of errors are quite frankly astonishing.
The article claims that an Advanced Life Support (ALS) Nurse was on the scene with the patient yet there is no such qualification. A nurse may have additional Trauma or even ICU qualifications but at no point are they specifically referred to as ALS, as is the case with Paramedics who can achieve this level of qualification. A simple search of the South African Nursing Council’s website would have revealed this simple fact.
One of the more junior Paramedics treating the patient says that ‘burn wounds are the worst because they are so painful’. While burns can be exceptionally painful this is entirely dependent on the extent and the depth of the burn wound. As it turns out the most severe burns, full thickness or what is also known as third degree burns, are painless because the nerves are destroyed. Since the journalist in this case emphasised the severity of both patients’ injuries, and having dealt with several shack fire victims, it stands to reason that the burns sustained here were mostly full thickness. A quick search of burns on Wikipedia would have revealed this simple fact.
Mandy goes on to describe Baragwanath Hospital as having one of the best burn units on the continent. This is not the case. Chris Hani Baragwanath Academic Hospital (CHBAH) has one of the best burn units in the world. It also has one of the largest most able trauma units as well as a very busy Intensive Care Unit. However CHBAH also serves an estimated population of six million people which means that resources are scarce. These include but are not limited to ICU beds, ventilators, heart monitors, stretchers and staff. On occasion the hospital becomes full and may not be able to cope with any further patients. This is the ‘divert’ as described in the article and had the Paramedic followed the protocol and taken the patients to Charlotte Maxeke Johannesburg Academic Hospital, an eleven minute journey with lights and sirens not 30 minutes as stated, both patients may have been better served on that particular night. A short conversation with any senior emergency service personnel would have revealed this simple fact.
After Godfrey was admitted to the hospital his brother, Ted Tenehi, claims that he was not seen by a doctor and was simply sent to a ward with ‘just a pipe in his mouth’. Ted also claims that despite being told that Godfrey was in the trauma ward this could not be the case because ‘there [were] people there who [were] sitting eating…and walking around’. Mr Tenehi’s ignorance can be forgiven, he is a layperson who is grieving a great loss. This does not excuse the failure of de Waal to explore the truth that no patient can be admitted to a ward without an admitting doctor; that no patient ends up with an endotracheal tube to maintain and protect their airway without a doctor; that no patient with burns is admitted to a hospital without large volumes of pain drugs (usually intravenous Morphine); that a trauma ward is one which has a spectrum of patients some of whom may be very ill and others who are/have recovered. A quick telephone call to any one of the thousands of doctors listed in the phone book would have revealed this simple fact.
The answer to Ted Tenehi’s question of ‘why his brother’s girlfriend was taken to ICU and his brother was taken to an open ward’ is much like many of the other facts in this case, very simple. The greater the percentage of burns the less chance a person has of surviving and the higher the mortality rate. Essentially any patient with more than 60% body surface area burns has a low chance of survival with that chance decreasing exponentially with each increasing point closer to 100%. Given the limited resources in all hospitals patients with a very poor prognosis are not considered candidates for ventilators or ICU beds. These are saved for those we know based on evidence have a fair chance of survival. This is not a South African phenomenon as all healthcare systems need to allocate resources effectively. Much can be said about public healthcare, but none should be without an appropriate amount of understanding of what is involved. When reporting on anything medical or otherwise a little bit of research goes a long way. Perhaps a first year journalism textbook would have revealed this simple fact.