Pre-hospital emergency care in Africa is a difficult part to manage properly, and many times there are issues which go around the efforts of some professional.

However, in some country, this story is changing, starting with South Africa and its pre-hospital emergency care, for example. This will be discussed during the Africa Health Exhibition 2019

South African pre-hospital emergency care is supported by the ECSSA (Emergency Care Society of South Africa), a professional society representing pre-hospital emergency care workers. ECSSA serves on a number of committees within the healthcare domain and they are involved in many initiatives with National Health: Directorate EMS and the Emergency Care Forum as well as with the African Federation of Emergency Medicine.

As this is a crucial year for South Africa because of the ballot, we are wondering what will happen to EMS system in Africa, what is the effort of ECSSA for it, and which are the issues of the emergency handover.

We interviewed Mr Andrew Makkink, President of ECSSA and Lecturer at the Department of Emergency Medical Care, University of Johannesburg, and with him, we tried to better understand what are the current problems in EMS and the incoming changings.

 

What about ambulance service in South Africa? On the occasion of the development in the EMS system, what will change for them?

“Unfortunately, the emergency services in South Africa (pre-hospital emergency care in particular) are very fragmented and not only do we have private and public ambulance services, but the public services differ from province to province so this makes EMS systems development quite challenging.”

Is there a specific need for training to use and manage medical devices (stretchers, and so on)?

“As technology advances, so does the requirement for up-to-date training. One of the challenges that we face is the disparity in funding, meaning that some services may be well equipped and some may only have rudimentary equipment. Of course, it would be the individual practitioner’s responsibility to keep up to date, however, whether or not the service in which they work advocates current, evidence-based best practice is the question that we really need to be asking. As here in Africa, emergency services are not well funded as similar in Europe, for example, I suppose that moving towards an evidence-based medicine is the way to go, in order to reach a direction for what equipment we are using should be suitable for ambulances. Now, this is difficult when funding dictates what evidence-based medicine we can and can’t use, which is a misfortune.”

Do you take care of training with equipment and to organize courses for ambulance workers?

“The ECSSA has an online platform that is currently available to members. This platform has a number of CPD-accredited activities and members are able to complete these. One of the challenges is that our members are spread throughout the country, making formalised training challenging. One of the other challenges is the spread of qualifications and scope that makes genericity sometimes the only practical option. One of the solutions we found to support the spread of knowledge in pre-hospital care is the publication of the first issue of the South African Journal of Prehospital Emergency Care (SAJPEC) under the editorial leadership of Professor Chris Stein. We see this as a major milestone in that this will be the first pre-hospital-focussed journal on the continent. A journal such as this will empower our profession, both nationally and internationally to provide guidance within Afrocentric and resource-constrained healthcare systems where pre-hospital emergency care is either established or still in its infancy.”

What are now the issues of emergency centres handover in South Africa?

“This is a very difficult question to answer. Given that funding is a primary concern for most emergency centres, the staff shortages and the general busyness of the emergency centres, the issues are diverse and very often differ from EC to EC. As far as handover goes, this is often linked to factors such as staff shortages and many of the issues that go with it. Perhaps one of the issues, specifically in the emergency centre and specifically with the handover, is that there seems to be a bit of disjuncture between the prehospital emergency care personnel and the emergency centre. Another issue is the language. As you may know, Africa hosts many dialects and few people do know English and, whether they do, accent and pronunciation are not correct. So, one of the goals is to reach basic communication from a medical perspective. The aim is not seeing each other as uniforms, but humans and similar.”

At Africa Health 2019 you will hold a conference on “Emergence Centre handover: we all just human after all”. Why this topic and what do you wish to communicate with it?

“One of the themes that have become apparent is that we seem to be forgetting that not only is the patient human, but our fellow healthcare practitioners are also human. Sometimes we forget that we are all here for each other, in fact, in the spirit of Ubuntu which loosely translated means “I am because we are”, we are are all here because of each other.

Everyone is allowed to have a bad day, including ourselves, and this may affect how we interact during handover. We so often focus on respecting our patients, and yet, we do not afford our colleagues the same respect. When we start to realise that we are all human, with emotions, dreams, challenges and normal daily lives, perhaps then many of the communication issues that plague handover can be resolved. We are a team focussed on doing what is best for the patient, but also what is best for each other. Let’s start talking firstly as humans, in the spirit of Ubuntu, recognising that we are just human after all and that as healthcare professionals, we need each other as much as the patient needs us.”

 

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