On-line version ISSN 2078-5151
S. Afr. j. surg. vol.46 n.3 Cape Town Aug. 2008
G. WatermeyerI; M. E. C. Van WykII; P. A. GoldbergIII
IF.C.P. (S.A.), CERT. GASTROENTEROL. (S.A.); Division of Gastroenterology, Departments of Medicine and Surgery, Groote Schuur Hospital and University of Cape Town
IIDIP. NURSING (GENERAL AND MIDWIFERY); Division of Gastroenterology, Departments of Medicine and Surgery, Groote Schuur Hospital and University of Cape Town
IIIF.C.S. (S.A.) M.MED. (SURG.); Division of Gastroenterology, Departments of Medicine and Surgery, Groote Schuur Hospital and University of Cape Town
BACKGROUND: While disorders such as gastro-oesophageal reflux disease, gastrointestinal (GI) cancers and inflammatory bowel disease are prevalent among all racial groups in the Western Cape, there is little knowledge of local GI service provision. The state of equipment, facilities and staffing is largely unrecorded and to date unknown. The aim of this study was to audit the availability of GI facilities in the provincial sector, which provides care for the majority of people in the Western Cape.
METHOD: All hospitals in the Western Cape providing en-doscopy were evaluated by means of a hands-on audit, to identify available organisational infrastructure. Data including staffing, details and utilisation of existing equipment, maintenance and disinfection techniques and delays in service provision were collected.
RESULTS: Over a period of 12 months, 17 Western Cape hospitals were visited: 3 tertiary, 5 regional and 9 district-level institutions. There are currently 89 GI endoscopes in state service, with an average age of 6.1 years (range 1 - 23 years). While most institutions utilise video endoscopy, in many instances equipment is near the end of its economic life. A total of 26 434 endoscopic procedures were performed over a 12-month period. Overall at least 60% of all adult endos-copy was undertaken at tertiary institutions. The mean delay from consultation until gastroscopy or colonoscopy was 9.25 weeks (range 0.5 - 28 weeks) and 8 weeks (range 1 - 20 weeks), respectively. Only 1 tertiary and 1 regional hospital employed fully trained, registered nurses, and the majority of institutions did not conform to internationally accepted standards for the maintenance and disinfection of endoscopic equipment.
CONCLUSION: While endoscopy equipment is widely distributed throughout the province, it is evident from this study that services in the Western Cape fall short of international standards, with delays in endoscopic provision, lack of adequate equipment, inadequate scope maintenance and disinfection and a shortage of trained staff. As such, much of the population reliant on state facilities has poor access to GI health care. These deficiencies need to be addressed.
“Full text available only in PDF format”
1. Talley NJ, Vakil NB, Moayyedi P. American Gastroenterological Association technical review on the evaluation of dyspepsia. Gastroenterology 2005; 129: 1756-1780. [ Links ]
2. Wright JP, Froggatt J, O'Keefe EA, et al. The epidemiology of inflammatory bowel disease in Cape Town 1980-1984. S Afr Med J 1996; 70: 10-15. [ Links ]
3. Bradshaw D, Nannan N, Laubscher R, et al. South African National Burden of Disease Study, 2000, Estimates of Provincial Mortality. Cape Town: Medical Research Council, 2004. http://www.mrc.ac.za/bod/bod.htm (last accessed 18 April 2008). [ Links ]
4. National Institute for Health and Clinical Excellence. Dyspepsia: Managing Dyspepsia in Adults in Primary Care. London: NICE, 2004. [ Links ]
5. Yeoh KG. Review. How do we improve outcomes for gastric cancer? J Gastroenterol Hepatol 2007; 22: 970-972. [ Links ]
6. Antenatal Survey 2002: National HIV and Syphilis Antenatal Sero-prevalence Survey in South Africa - 2002. Pretoria: Department of Health, 2003. http://www.doh.gov.za/docs/reports/2002/hiv-syphilis.pdf (last accessed 18 April 2008) [ Links ]
7. Lennard-Jones JE, Williams CB, Axon A, et al. Provision of gastrointestinal endoscopy and related services for a district general hospital. Working party of the Clinical Services Committee of the British Society of Gastroenterology. Gut 1991; 32: 95-105. [ Links ]
8. Cleaning and disinfection of equipment for gastrointestinal endoscopy. Report of a working party of the British Society of Gastroenterology Endoscopy Committee. Gut 1998; 42: 585-593. [ Links ]
9. Mulder CJJ, Tan ACITL, Huibregtse K. Guidelines for designing an Endoscopy Unit: report of the Dutch Society of Gastroenterologists. Endoscopy 1997: 29: I-IV. [ Links ]
10. Axon ATR. Staffing of endoscopy units. Acta Endoscopica 1989; 19: 213-216. [ Links ]
11. Lennard-Jones JE. Staffing of a combined general medical service and gastroenterology unit in a district general hospital. Gut 1989; 30: 546-550. [ Links ]
12. Burnham WR, Lennard-Jones JE, Slade GE. Report of a working party on the staffing of endoscopy units. Gut 1987; 28: 1682-1685. [ Links ]