Streets of Khayelitsha are a real-life fight club for young men, say doctors

If you're assaulted in the Cape Town community that has been described as one of the world's largest slums, it's probably just the tip of the iceberg.

New research by experts in emergency medicine has found young men have a good chance of being back in the trauma unit with another violent injury - or dead - within the next 15 months.

Leaving aside the gangsterism, drug use, binge-drinking, HIV and tuberculosis that are widespread in Khayelitsha, the violence young men experience takes lives at a rate 25 times higher than the global average.

The study of 320 assault victims who ended up in the emergency rooms at Khayelitsha Hospital and Site B Community Health Centre, as well as 185 patients who were not assaulted, also found a troubling level of psychological distress.

“Over 30% of our sample suffer from sadness/depression, which is a concerning feature on its own,” according to a paper in the African Journal of Emergency Medicine.

Lead author Dr Sarah Leeper, from the University of Maryland Medical Center, with colleagues from the US and SA, added: “The complex interplay of depression and violence warrants further investigation to understand this high level of 'sadness' among this population of youth.”

Leeper's team found that one in seven of the 14 to 24-year-olds who sought treatment after an assault between 2016 and 2018 either returned for more treatment or died in the next 15 months.

“Males, students, marijuana users, gang members, those with a criminal history, and an initial injury with penetrating trauma had a greater likelihood of emergency care recidivism,” they said.

Because assault is the most common reason injured young people end up in hospital, “the emergency centre provides an ideal opportunity to explore risk factors for violence among youth and subsequently to deploy targeted interventions at the bedside or provide linkages to community programmes that seek to prevent future violence”.

Leeper said the level of alcohol abuse among young people in Khayelitsha meant a screening, brief intervention and referral to treatment programme in the emergency centre might be achievable, affordable and effective.

“However, this approach may also be feasible for other risk factors for youth violence and emergency centre recidivism,” they said.

“A combination of emergency centre-based screening for targeted risk factors (with linkage to community services) and in-hospital based intervention programmes would likely provide the greatest benefit to this population.

“Effective interventions for youth violence can be initiated during early childhood education and continue through all school ages, involve family, as well as community and public health programming.

“Additionally, the social determinants of health, which aggravate risk factors for violence, should be continually addressed within this community.”

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