Asathandile Rulumeni (25) from Tshezi village in the Xhora Mouth area in the Eastern Cape never thought she would one day give birth at home due to lack of Emergency Medical Services (EMS). She says the ordeal of delivering her second son alone outside her home will forever traumatise her.
Rulumeni grew up in Xhora Mouth, 100 kilometres from Mthatha.
She tells Spotlight she grew up solely using a mobile clinic that provides health services to her area once a month. However, the mobile clinic's services are intermittent as it can take a long time between visits.
Residents of Xhora Mouth have to walk long distances including crossing the dangerous Xhora River to get to the nearest clinic in Nkanya Village, which is about 15km away. Accessing the village is very difficult as there is no public transport or tarred road to Xhora Mouth, prompting villagers to navigate through thick bushes when they go to the clinic. This situation also makes it difficult for ambulances to arrive on time. At worst, the ambulances do not turn up at all.
Rulumeni joins a long list of women in Xhora Mouth with horrific experiences of going into labour without professional medical help, which often means they give birth at home or in back of hired transport on their way to Zithulele Hospital which is about 39 km away.
Not all babies who are born without proper medical help survive. Spotlight understands a baby died at birth in November on the way to hospital in a private vehicle and after the ambulance failed to show up. The family was not willing to talk about the incident.
The lack of EMS has been a longstanding problem in many rural areas in the Eastern Cape.
When pregnancy becomes "an ordeal"
Rulumeni was lucky. She safely delivered her baby boy, now 10 months old, without emergency patient transport to hospital. The young mother tells Spotlight she went into premature labour and there was no money to hire private transport to Zithulele Hospital, which is about 35km away.
"I went for my antenatal services at Nkanya Clinic, where nurses told me that I was going to deliver on 9 February. I had prepared [so] that I would be at the hospital two days before [because] transport is a problem here. To my surprise, on the first of January, I started experiencing painful contractions while at home," Rulumeni says.
"The pains didn't stop, and the following morning I eventually delivered prematurely when I was doing house chores. I immediately called EMS for an ambulance to take me to Zithulele Hospital. Despite EMS' assurance that an ambulance was on its way, it never arrived, making me very concerned. Private transport was demanding R700 for a one-way trip to the hospital, which I did not have," she says.
"The following day I hitchhiked to the hospital. Giving birth in that [way] stripped me of my dignity and violated my human rights. It is high time government sees the urgency of providing ambulances in our village because some mothers or their babies won't be lucky enough to survive the ordeal."
Noluthando Mbele of Folokwe Village is also concerned.
The 28-year-old who is also pregnant now, months later, faces the same daunting task of walking gruelling distances to the nearest health facility for antenatal check-ups and the possibility that the ambulance will be a no show when she goes into labour.
"I have to wake up as early as 5am to get to clinic [and] walk a gruelling three to four hours through dangerous bushes and crossing the Xhora River," Mbele says. During Spotlight's visit the Xhora river was in flood, making it dangerous for someone in Mbele's condition to cross.
"I'm worried about what I will do when I am due for delivery."
For many women like Mbele and Rulumeni, the prospect of giving birth is not something they are excited about but rather great cause for anxiety over the unavailability of ambulances to ferry them to hospitals when in labour.
Mbele tells Spotlight she is worried since there are few women who make it to hospital on time for delivery due to the scarcity of ambulances. "This has led to some expecting mothers to go to hospital [sometimes] a week before their promised date of delivering. Staying at the hospital is not easy because they have to sleep on benches waiting for their dates," Mbele says.
The difference between life and death
A nurse from Madwaleni Hospital, about 54km from Folokwe, who spoke on condition of anonymity tells Spotlight accessing ambulances is a big challenge. "It put the lives of patients at serious risk as some have to [be] carted by wheelbarrow. Pregnant women are being assisted by ordinary women to deliver their babies. Sometimes to have the right person with professional knowledge to manage an emergency will make a difference between life and death of the mother or the baby," she explains.
Eastern Cape Department of Health spokesperson, Sizwe Kupelo said the allocation of ambulances is not done based on geographical considerations but is done based on the district offices. "We've got a centralised system. If people need ambulances, they call a common number which is 10177, and if you dial that number it goes to the nearest centre that may dispatch their ambulances. We also use helicopters to respond to some emergencies," he explained.
"It is not true that people of Xhora Mouth have no access to ambulance services because everybody in the province that use that number get ambulance assistance. People sometimes use [the] 112 number which doesn't belong to the department. It's a helpline for cell phone networks and it delays. That number doesn't go directly to our call centre."
Spotlight understands from some locals that "health workers told them" to use the 112 number because they do not have landlines to call the 10117 number. The 112 number is free from a cellphone while they need airtime to call the 10117 number.
For Nosizwe Silele of Nqileni Village, accessing health services is a struggle for her husband who suffered a stroke and who now has to get physiotherapy sessions every month.
"My husband suffered a stroke in August. I resorted to taking him to Zithulele Hospital with private transport that costs R700." Silele says in an emergency like her husband's stroke, the first hour after the incident can make the difference between life and death. "It is not wise to wait for an ambulance that we are not sure whether or not it will arrive," she says.
"Since August we have been going to hospital for his physiotherapy sessions, using his social grant to pay R700 for a single trip to the hospital. We are often left with very little money after we spent R1 400 on transport each month. Sometimes I have to borrow money from loan sharks in order to survive."
Another resident, Nolindile Mbele, tells Spotlight she arrived in Folokwe Village as a newly-wed in 1985. She says since then she saw an ambulance twice in the village.
"Every time I need to access [a] hospital I have to hire a car at a cost of R700 while at night they charge R800. Recently, I transported my ill husband to Madwaleni Hospital after he fell sick. If it was not for the private car that I hired, his chances of surviving were slim."
In dire need for EMS
Nokubonga Nkasithu, secretary of the clinic and ambulance committee in Xhora Mouth, says the people of Xhora Mouth are in dire need of ambulances.
"Mothers give birth in private cars on their way to hospital. Some give birth at home because ambulances arrive late or fail to come. Several people in our villages have lost their lives while waiting for ambulances to arrive. Had ambulances been closer at hand, I believe some of the deaths could all have been avoided," she says. Nkasithu says she cannot give an exact number of these deaths, but "this has been happening over and over again". She recalls an incident where an old man from from Nqileni village was stabbed in his upper body. He was rushed to hospital with private transport, but was declared dead on arrival.
"Ambulances should be strategically placed in rural areas in order to service patients as quickly and effectively as possible," she says. "People spend long hours waiting for an ambulance to collect patients requiring hospitalisation. The poor response time and lack of ambulances means that the fate of patients in outlying areas such as Xhora Mount is sealed, as ambulances will never reach them in time."
Nkasithu says setting up satellite ambulance service in Xhora Mouth will assist greatly in improving medical response times. "People are now becoming casualties of food insecurity because they used their social grants to hire private transport. Without proper nutrition, none of our people would be healthy and more people will get sick," Nkasithu says.
Eastern Cape Health Crisis Action Coalition co-ordinator and Section27 field researcher, Thoko Mtsolongo says it is frustrating that nothing is happening in Xhora Mouth with EMS services.
"The department of health has many stories when it comes to EMS services," she says, while also calling for a satellite ambulance centre in Xhora Mouth. The vehicles for EMS should be the off-road types, including 4×4 vehicles that can drive into deep rural areas. If the Department of Human Settlements is able to send material for RDP houses in deep rural areas, why can't the Department of Health not send its services? Until the Department of Health addresses this issue of shortage of ambulances across all districts, the citizens of this province will continue to be at the mercy of a system that fails them instead of a system that saves their lives," says Mtsolongo.
In the department of health's 2020-2021 Annual Report released in May, the department announced that it will replace 269 EMS vehicles which included 20 heavy duty mobile clinic trucks to increase access to health services to most rural areas, especially those that are very far away from urban centres.
In the report Health MEC Sindiswa Gomba promised to improve access to good quality EMS.
In February this year she convened a summit to address key issues plaguing the industry. A departmental press statement says a strategic plan was developed aimed at improving turn-around times for vehicles in repairs and to improve the response times of EMS.
According to the annual report, an amount of R1 4 million was set aside for EMS in this financial year. This budget is aimed at ensuring the provision of emergency services and patient transport in terms of applicable norms and standards. The budget will also be used to procure systems to secure ambulances and crews when on duty.
But for now, the people of Xhora Mouth still have to wait...
NOTE: Section 27 is mentioned in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.