Emergency Care in Namibia

doi:10.1016/S0196-0644(98)70017-4

Annals of Emergency Medicine

Volume 32, Issue 3, September 1998, Pages 373-376

Presented at the second annual Emergency Medicine Research Forum, April 1997, University of North Carolina; and at the Fourth World Conference on Injury Prevention and Control, May 1998, Amsterdam, The Netherlands.

https://doi.org/10.1016/S0196-0644(98)70017-4 Get rights and content

Abstract

Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.

[Tintinalli J, Lisse E, Begley A, Campbell C: Emergency care in Namibia. Ann Emerg Med September 1998;32:373-377.]

Section snippets

INTRODUCTION

Namibia is an independent nation in southwest Africa, bordered by Angola and Zambia on the north, South Africa on the south, and the Atlantic Ocean on the west. It was declared a German protectorate by Bismarck in 1884, and at that time was called German Southwest Africa. After World War I, it was declared a mandate of the League of Nations and administered by South Africa.

Protracted fighting between South Africa and the South West African People’s Organisation (SWAPO) resulted in Namibian

HEALTH CARE ORGANIZATION

The Namibian National Budget allocates approximately 14% to the Ministry of Health and Social Services; for comparison, about 20% is allocated to education. Patients pay approximately $1 (US$) for outpatient visit and $4 (US$) for hospital admission. These fees include medication and, if necessary, tertiary care referrals outside of Namibia.

Medical officers are the backbone of the state-run health service. They are in some way comparable to residents but in other ways to family practitioners.

PREHOSPITAL CARE

The prehospital care system reflects the geography and economy of the nation as a whole. The state provides patient transport to the state-run hospitals. There is no 911 system because only about 4/100 people in the country have telephones. Most native patients arrange their own transportation to the hospital, or are brought from clinics to the main hospital by state transport. There is no basic or advanced EMS system provided by the state. The Namibian “EMS system” is privately owned and

EMERGENCY CARE

The only true “emergency department” in Namibia is at Katatura State Hospital. All other hospitals have “emergency rooms” covered by on-call staff physicians, who are summoned if patients present after clinics have closed. Katatura State Hospital emergency services treats about 100 adult medical/trauma and about 50 pediatric patients daily. The admission rate is about 30%, and about a third of emergency patients are transported from regional clinics by the state-run ambulance service. There is

FUTURE DIRECTIONS

The geography, sparse population, and economic realities in Namibia preclude the development of emergency medicine as a separate specialty in that country.

The amalgam of the state-run health care system and private enterprise meets medical needs efficiently. Medical developments in South Africa ³ can be expected to continue to have a positive impact in Namibia, especially in trauma care. The specialty of emergency medicine should undertake efforts to share knowledge in areas of common interest

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There are more references available in the full text version of this article.

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^☆: From the Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, ^* State Hospital, ^‡ and Medical Rescue International Namibia, ^§ Windoek, Namibia.

^☆☆: Reprint no. 47/1/92373

^★: Address for reprints: Judith E Tintinalli, MD, MS Department of Emergency Medicine University of North Carolina at Chapel Hill CB 7594 Chapel Hill, NC 27599-7594

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