People look up, some raise a hand, as an ambulance growls up a dusty street in Hangberg above Hout Bay harbour, looking for a shack number or the person who made the call for help on a Sunday afternoon.
Unlike paramedics operating elsewhere in Cape Town — or across the country — the crews of the Hout Bay Volunteer Emergency Medical Service do not fear attack while on duty. They have been safe since the organisation launched in 1994, allowing them to respond without delay to life-threatening emergencies instead of having to wait for a police escort.
“We know the communities and leaders in Hout Bay and our experience has been good,” says 32-year-old volunteer paramedic Matthew Rosenberg, who has worked for the service for 13 years. Sunday was his third shift for the week, on top of a full-time job for the city.
The ocean and mountains isolate Hout Bay, and the geography gives an ambulance based in the valley significant advantages over traditional services in responding to emergencies.
A study found that the Hout Bay EMS mostly met the target time of 15 minutes or less for priority calls between 2015 and 2020, as well as easing the load on the Western Cape government’s overstretched services.
Dr Shaheem de Vries, the medical director of the Western Cape government's emergency medical services, says the volunteer ambulance service is a model for how to partner the people they serve, as well as how to get active citizen support.
“What the EMS has done exceptionally well is working to achieve mutual support in the communities. To provide critical services we need to heed the lessons from Hout Bay. We want to build stronger relationships, particularly in ‘red zones'.”.
Ambulances no longer enter high-risk areas without police protection in Cape Town, where 78 paramedics were attacked while on duty in 2021, says Western Cape EMS spokesperson Deanna Bessick.
The risk of violence against paramedics is a national problem, says Mpho Mpogeng, president of the South African Emergency Personnel’s Union.
“We raised the issue of safety long before Covid but the government has not implemented a single solution we proposed, like vest cameras,” he says. “All the provinces have no-go zones and the attacks are not stopping.”
What Hout Bay Volunteer EMS has done exceptionally well is working closely to achieve mutual support in the communities
— Dr Shaheem de Vries, medical director of Western Cape EMS
De Vries says the Western Cape has been experimenting with alternative options for crews such as “embedding” paramedics who live in so-called red zones to do shifts in their own area, at their request.
Tafelsig, in Mitchells Plain, has for a few years had resident EMS crews who can move “relatively safely” through the community, improving response times. A similar initiative in Philippi recently got off to a rough start when an ambulance crew was held up at gunpoint, he says.
“They were away for a few months but they want to start up again. There is no silver bullet but we have to continue to provide critical services.”
Hout Bay, a tourist destination, is not exempt from violence or crime and has extreme disparities in living conditions. Most of the emergency call-outs come from the denser settlements of Imizamo Yethu and Hangberg.
The Hangberg fishing community has been stricken by job losses and hunger, allowing substance abuse and abalone poaching to thrive and foster violence. But last Sunday it seemed sleepy as Rosenberg attended to a patient who wanted help for an alarming nosebleed and agonising mouth sores.
During this exchange, a frail man walked up to the ambulance, uncomfortable with his fast heart beat. The second paramedic, Ewald Bonzet, took a short history and the patient climbed aboard to have ECG sensors attached to his chest.
The new patient had TB (as had the first one), according to neighbours. Covid is less of a threat but the paramedics must wear masks to stave off ancient spectres like TB and other risks.
The man’s ECG results showed he needed urgent medical attention so the crew took off for the nearest emergency department at Victoria Hospital, a public hospital about 10km away. Most of their patients are not insured.
“The most common calls are for assaults — which dropped off sharply in lockdown — and for chronic conditions like heart problems or TB that get worse, or an acute attack like asthma,” says Rosenberg. “I have even delivered five babies at home.”
After dropping their patient at Victoria Hospital, the crew was dispatched to a woman short of breath in Imizamo Yethu. Manoeuvring the ambulance through its narrow streets, where children play and dogs scavenge in the ubiquitous litter, proved tricky. Slowly the paramedics ascended to the top of the sprawling settlement to find their patient. Another examination. Another walk-in patient, with a sore shoulder. More referrals to the Hout Bay Clinic.
As the ambulance is leaving, a top priority call comes in: a double stabbing and assault in Ocean View, about 20km away. The Hout Bay EMS gets all its calls from the Western Cape EMS control centre and — as they have no immediate local calls — they take it on.
With Rosenberg at the wheel, the ambulance flies across Chapman’s Peak Drive, siren blaring. Driving the winding road at speed is an F1-style stunt, yet Rosenberg looks as if he is out for a Sunday drive as he races through the turns. I brace with hands against the roof as the sun sets over the sea below.
In February, the volunteer ambulance transported a gravely injured patient off Chapman’s Peak Drive after her car plunged over a cliff and burst into flames, setting the mountain vegetation alight. Rescue and EMS teams working together got her to safety.
As Rosenberg exits Chapman’s Peak Drive, a call comes in to stand down because the Ocean View patients had been transported privately to hospital. Instead, the crew attends to a woman nearby who has chest pain and difficulty breathing. The diagnosis: a severe allergic reaction.
Bonzet, who volunteers for the NSRI and the air-sea rescue unit, says: “I am volunteering on the road to keep as current as possible with medical conditions and to keep me sane for my desk job.”
In load-shed darkness, the pair turn back to base, no sirens. Surprised at how quiet the shift is, they call the control centre for permission to sign off, which is granted. They usually cover at least eight hours and sometimes 12 hours or more.
Rosenberg says of the provincial EMS: “Their workload is endless and relentless. You hear it over the radio.”
Last weekend the Western Cape EMS responded to 5,211 incidents, more than a third of which were life-threatening conditions requiring urgent treatment.
In the upcoming September African Journal of Emergency Medicine, the first author of the new study, Dr Charmaine Cunningham, of UCT surgery’s EMS division, writes with her co-authors that “developing community-based ambulance services, especially in areas that are remote due to distance or topography” has proved beneficial.
But volunteer services are confronting staffing challenges now that short courses for lay people in basic and intermediate life support — such as Rosenberg did in his university holidays — no longer exist.
“My dad was a volunteer at St John’s Ambulance for years and 70% of my staff, if not more, started their careers as volunteers,” says De Vries, recognising the value of the “weekend warriors”, as they are sometimes dubbed.
Cunningham says that training community first-aid responders who can slot in with ambulance services must be a priority. A paramedic and critical care nurse with a PhD in emergency medicine and an MBA, she has an overview of what emergency services need from the ground up.
“If we can test this model in an active community like Hout Bay — which has resources, leaders, community structures and apps — and demonstrate it works,this model could potentially be scaled up for rural areas and even rolled out across Africa,” she says.
NATIONAL EMERGENCY
News reports show ambulance crews attacked in every province, apart from Northern Cape. EMS staff risk robbery at gunpoint and knifepoint, stoning and assaults, to save lives.
- North West, June 7 2022: Robbery of ambulance crew in Rustenburg.
- Mpumalanga, May 15 2022: Hijack of ambulance crew in Belfast.
- Eastern Cape, May 31 2022: Ambulance crew attacked in Nelson Mandela Bay.
- Gauteng, March 22 2022: Mugging of ambulance crew in Alexandra.
- Western Cape, March 15 2022: Brick smashed through ambulance window in Delft.
- Limpopo, July 8 2021: Ambulance crew robbed at gunpoint on N1.
- KwaZulu-Natal, May 26 2021: Mugging of ambulance crew in KwaMashu.
- Free State, August 17 2019, Ambulance crew attacked in Theunissen.
ON THE SMALL SCREEN
The popular American TV show 9-1-1 raised the profile of first responders who risk their lives for others. But paramedics' stories have featured less on small and big screens than police, hospital and firefighter dramas.
• Sources: SA Emergency Personnel’s Union & news reports
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