Intended for healthcare professionals


A theme issue by, for, and about Africa

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:780

South Africa is still blighted by trauma

  1. Douglas M Bowley, honorary lecturer (dougbowley{at},
  2. Euan J Dickson, registrar,
  3. Nigel Tai, honorary lecturer,
  4. Jacques Goosen, consultant,
  5. Kenneth D Boffard, professor of surgery
  1. Department of Surgery, Medical School, University of the Witwatersrand, Johannesburg, South Africa

    EDITOR—Our hospital (close to the urban slum areas of central Johannesburg) has seen an increase in volumes of patients with multiple injuries. Between 1997 and 2004 the intake of patients requiring resuscitation for life threatening trauma at our unit increased by 56%. Penetrating injury now accounts for nearly 60% of this workload.

    Substance abuse is a common factor and, in a recent study of patients with major trauma from our institution, 59% were positive for blood alcohol.1 The average blood alcohol concentration was more than three times the legal limit for driving, and more than 40% of the patients were positive for urinary cannabis.

    Over 90% of our unit's nursing and medical staff have experienced verbal abuse, 75% have been threatened with violence, and 42% have experienced violence from patients in the previous two years.2 In addition, serial exposure to critical incidents increases the risk of burnout. Staff lose their ability to feel emotionally involved in their work and develop a cynical attitude towards patients, resulting in compromised care, dissatisfaction, and high turnover. Our centre attracts foreign healthcare practitioners who work in the unit for short periods of time. This is a mutually beneficial arrangement, but local staff are our backbone, and we can ill afford them to leave to work in other, less stressful environments locally or overseas. Nurses particularly have to deal with distressing events, violent patients, and work in an environment of high HIV seroprevalence (37% in a series of major trauma patients in 2002).3

    Africa is blighted by trauma, and efforts are required at all levels to ensure that development proceeds with injury reduction strategies. Meanwhile hospital authorities should recognise the high stress for health workers and improve the provision of care for them.


    • Competing interests All authors all work, or have worked, in the Johannsburg Trauma Unit and are committed to improving trauma care.


    View Abstract