The role of healthcare professionals in tackling the root causes of violence

In his introduction to the inaugural lecture of Professor Sithombo Maqungo, Professor Robert Dunn praised Maqungo’s clinical expertise, research, and advocacy in addressing trauma’s causes and saving lives. Professor Maqungo is the head of the Orthopaedic Trauma Service at Groote Schuur Hospital and the University of Cape Town (UCT).

Professor Dunn, head of UCT’s Orthopaedic Research Unit in the Faculty of Health Sciences, highlighted Maqungo's groundbreaking contributions as a trailblazing orthopaedic trauma surgeon.

Maqungo used his inaugural lecture, delivered in the last week of November, to unpack the state of violent injuries in South Africa. He called for greater action across all levels and sectors of society to tackle these issues.

Inaugural lectures at UCT mark the ascent to full professorship, the highest academic rank. These events celebrate academic achievements and provide professors an opportunity to share insights from their careers.

A sobering moment in the career of Maqungo was, at the start of the Russian war against Ukraine, when he was invited by the Ukrainian military to train their doctors on how to treat gunshot wounds.

“We work and live in a civilian setting but we have army doctors reaching out to us for our expertise.” 

“For me, this was really the saddest indictment of our situation in South Africa. We work and live in a civilian setting but we have army doctors reaching out to us for our expertise,” he said.

Maqungo, known on the international medical conference circuit as “the gunshot guy”, has dedicated much of his professional research career to better understanding how to treat gunshot wounds in orthopaedic trauma surgery. But, he asked, is it enough to just treat these patients when they come in, usually repeatedly, with gunshot wounds? Should we be doing more?

The state of gun violence in Cape Town and SA

Maqungo noted that Cape Town was named the third best city in the world to live. What stopped it from topping the list was the rate of violence. The murder rate in Cape Town hovers at around 65 murders per 100 000 people. This, he said, is double the national average and more than 10 times the global average.

“We are a violent city in a violent country,” he said.

In South Africa, according to recent statistics released by the Minister of Police, 25 000 people are murdered annually and most of these deaths are caused by firearms. They have overtaken knives as the preferred method of committing murder.

“When I was studying medicine, we saw very few firearm injuries,” said Maqungo. But he went on to note the many reasons why handheld firearms have become so popular.

“Recent statistics say more than 1 600 children in the Western Cape were wounded in shootings and stabbings.” 

“They are light and easy to use. You don’t have to get close and dirty with your victim – you can kill them from far,” he said.

He also noted their efficiency as a weapon. “One in four people who have been shot will die, as opposed to one in 55 for a stabbing. Also, you can shoot multiple people multiple times.”

While young men, at the prime of their economic lives, are disproportionately affected, both as victims and perpetrators in shootings and violent injury, Maqungo also pointed to the impact of the country’s high rates of gun violence on women – and particularly children.

“Recent statistics say more than 1 600 children in the Western Cape were wounded in shootings and stabbings,” he said. Over 40% of these are simply children caught in the crossfire of violence between adults.

Impact of violence on healthcare system

These levels of violence, stressed Maqungo, can and must be reduced for the sake of South African society, the healthcare system and the personnel who work in that system.

“When we talk about violent crime, we usually talk about the patients who succumb to their injuries,” he said. “But there are also those who survive and become a burden on the system. They are young men in the prime of their lives who are removed from the economy; they become recipients of social grants.”

He noted that when the outcome of the gunshot wound is paralysis, usually the mother gives up her job to look after her son at home, so yet another person gets removed from the economy.

“Our doctors did not sign up to work in a military zone.”

Beyond this, surgical care is a scarce resource in Africa. Reducing the number of people that need surgery by addressing the root causes of these preventable traumatic injuries by stabbing, gunshot wounds and car crashes can save the healthcare system a great deal in terms of resources – resources that can then be diverted elsewhere.

Finally, the impact on healthcare personnel is overwhelming. 

“We have seen high rates of burnout from junior doctors working in trauma,” Maqungo said, comparing the rates of deaths and firearm injuries to those of countries at war. 

“Our doctors did not sign up to work in a military zone.”

The responsibility lies with us all

Maqungo quoted the late Archbishop Emeritus Desmond Tutu when he said: “There comes a point when you need to stop just pulling people out of the river. We need to go upstream and find out why they are falling in.”

The big question he asks of his colleagues and all South African clinicians is: Do we have an ethical obligation to be involved in injury prevention? How long do we continue to mop the floor while the tap is wide open?

He pointed to effective gun control laws in the United Kingdom and New Zealand, among other countries, and also to how quickly and effectively the government acted in the face of COVID-19.

“We know that to control an epidemic you must contain and control the vector. The vector is the transmitting organism, and whether that is a bullet or a virus the principle is the same.” 

“COVID-19 was deadly but firearms in South Africa kill far more people than COVID-19 did,” he said. “We know that to control an epidemic you must contain and control the vector. The vector is the transmitting organism, and whether that is a bullet or a virus the principle is the same. We have to reduce the circulation of the vector in the community.”

He concluded by noting that waiting for the government to enact legislation and make a change is not a solution. A problem of this scale needs to see action at every level of society. A multisectoral approach is necessary to effectively tackle this problem, including work in early childhood development, education, job creation and other long-term programmes to make a tangible change. 

Maqungo’s key message was that it will take a concerted effort from all. Quoting from former President Nelson Mandela, he said: “Safety and security don’t just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear.”