700 amputations at hospital
DOCTORS at Livingstone Hospital in Port Elizabeth have amputated 700 legs in the past 18 months with management linking the high number to the poor medical treatment diabetic patients receive in the Eastern Cape.
Hospital chief executive Thulani Mandonsela said the majority of amputations were caused by complications due to diabetes and atherosclerosis.
The number of amputations are almost double compared to Durban and Pietermaritzburg, where doctors carried out 464 amputations in 2014, according to a study recently published by the SA Medical Journal.
“There has been a significant increase in the incidence of diabetes and generally it is very poorly treated,” Madonsela said.
“All these patients have risk factors such as smoking, hypertension and especially diabetes.
“Patients generally only seek medical help, from clinics or hospitals, when it is too late to still save their limbs,” he said.
“There are well-established guidelines on how to modify these risk factors, but these are not adhered to.
“By the time patients get to Livingstone Hospital they have a very advanced degree of the disease resulting in an amputation.”
An SA National Health and Nutrition Examination Survey revealed that only one in six patients with diabetes received adequate treatment.
The survey found that 4% of patients in the country had been diagnosed with diabetes but were not receiving treatment, while 25% of patients who were being treated did not have their blood sugar levels under control.
“If patients can get to the hospital earlier, or if the risk factors were better managed, it would in all probability have been possible to save their legs,” Madonsela said.
“In the vascular unit at Livingstone Hospital we have access to . . . the most up-to-date treatment options, but most of the time there is little we can do for them.”
He said the sheer number of patients needing amputations was placing a huge burden on theatre time and hospital beds.
“Almost all amputations from the western part of the Eastern Cape are done at Livingstone Tertiary Hospital because there are no other hospitals offering this surgery,” he said.
“At present patients who have one leg amputated do get crutches and walking frames. For amputees who lose both legs wheelchairs are available.
“There are a significant number of patients waiting for wheelchairs due to the fact that they are manufactured for the individual needs of a patient and must first be assessed by an occupational therapist.”
He said the waiting time for wheelchairs was 12 months and for prosthetic legs 18 months.
Family medicine specialist Dr Don Papuma said doctors were seeing an explosion in the numbers of obese children and patients diagnosed with diabetes.
“The Minister of Health [Aaron Motsoaledi] has said that the cost of cardiovascular disease, wheelchairs and amputations could break the public health system,” he said.