Doctors learn a hard lesson on SA frontline: John Carlin meets medical staff in Sebokeng, where murder has become the routine method of resolving neighbourhood disputes

'OUR WORK,' said the chief of the ambulance division at Sebokeng Hospital, 'is mostly scoop and run.'

By which Sakkie Louwrens meant that it was not healthy for his men to pause and apply standard emergency procedure to the patients they collect in the five townships and half dozen squatter settlements that the hospital services. 'Sometimes my guys refuse to go out to certain areas. You see, they get ambushed. Last month, for example, three of my ambulances were stoned on the way to a fire. Another time, one of my drivers had an AK-47 stuck into his stomach while the tsotsis (criminals) cleaned out the vehicle's equipment.'

Amazingly, none of Mr Louwrens' staff has been killed yet. The area they operate in, 40 minutes' drive south of Johannesburg, is known as the Vaal Triangle, twowords which have come to conjure up the spectre of murderous anarchy to which many fear South Africa is fated to descend.

Official figures released this week showed that in the past six months the Vaal Triangle, home to some 2 million people, has witnessed 464 murders, 208 cases of arson, 1,656 robberies and 186 stone-throwing incidents. In Sebokeng township alone, 137 attacks have been registered on policemen, 10 of whom have died.

'One thing I definitely don't do,' Mr Louwrens said, 'is run with the police or army. The minute we do that, all my people will be dead within 24 hours.' He himself receives regular death threats and his home has been petrol-bombed three times. 'One night we picked up a guy at a hostel and brought him in. Soon after I got a call here in my office: 'Hey, you picked up an Inkatha guy, we're going to kill you.' And then it turned out the guy was ANC] What must I do? Have five ambulances for Inkatha and five for the ANC? Ask the patients first what organisation they belong to?'

But it is not just a question of Inkatha versus the African National Congress. Until a year or so ago perhaps such categories could be applied. Indeed they could again in June this year in Boipatong, the Vaal township where Inkatha hostel-dwellers massacred 41 men, women and children. But everywhere, especially in Sebokeng, ANC supporters have turned against ANC supporters, criminal gangs have proliferated and murder has become the routine method of resolving neighbourhood disputes.

If Mr Louwrens is bordering on despair, the mood inside the hospital, among the doctors, is far from cheerful. The chief surgeon, George Patrikios, said that sometimes he had the sense he was working in an army hospital. One of the doctors working under him described the casualty ward on Friday nights as a butcher's shop.

Mr Patrikios, a Fellow of the Royal College of Surgeons, was born of Greek parents in what used to be called Rhodesia and obtained his medical training at Trinity College, Dublin. He smokes relentlessly, drives through country roads at 90 miles an hour and charges around the hospital, where he has worked for nine years, at a similar rate.

Eighty per cent of the operations he performs are violence-related, one of the reasons why he has reached the point where his first thought when a patient from the township does not turn up for an appointment is that he or she must have been killed. That was what went through his mind after Armstrong Motale, a schoolteacher from Sebokeng on whom he operated last month, failed to make it to his office this week.

'Armstrong got a bullet through his liver, stomach, colon and diaphragm in a gun battle outside his home on 12 November. He fired back and shot dead two of his assailants,' he said. 'One of the two lay dying in the intensive care unit as I operated on Armstrong next door.'

Mr Motale had no idea why he was attacked. Mr Patrikios has no idea why any of his patients are attacked. Ask him or any of the doctors for an explanation and they give you the same shrug of the shoulders, the same wry look. 'Don't look for answers to these questions. It's hopeless. I ask everybody I treat why they were attacked and in nine cases out of 10 they reply, 'I don't know'. The thing is that even if they do know, they are too afraid to speak up.'

Adding to the bafflement and sense of siege inside the hospital, doctors and nurses have lately become targets. Five doctors in the area have been murdered in as many months. Several have been attacked. On Monday night, unknown assailants opened fire on a mini-van taking home a group of uniformed black nurses, two of whom were wounded. The attack has prompted talk among the doctors that the time has come to close the hospital for a week as a message for the community to take action against the criminals.

The police seem unable to offer any protection. The ANC believes this is part of a deliberate policy to destabilise the townships, but a female doctor in the staff tea room saw things more simply. 'The police? What can they do? They come in dead on arrival.'

Of 46 doctors at Sebokeng Hospital, half are foreign. 'For obvious reasons South African doctors are not to keen to work here,' said Mr Patrikios, who bemoaned the fact that a young intern, Sebokeng-born and bred, had just announced he was leaving the area and moving north to Pietersburg, to the relative safety of an Afrikaner area notorious for its right-wing racism.

Interestingly, however, the South African doctors who work at the hospital are mostly Afrikaners. Utterly dedicated to their tasks, revealing no indication whatsoever - as in Mr Louwrens' case - that they would treat their patients any differently if they were white, they seemed more acclimatised to the Sebokeng environment than their Zairean and Pakistani colleagues.

Dr Patrikios, the most philosophical of them, described his workplace not as a teaching, but as a 'learning' hospital. 'Each patient we operate on who's been struck by a bullet presents a novel challenge, something we haven't read about in the textbooks.'

Did hope, perhaps, keep him going? Was there any reason to believe things might improve, the workload might decrease? 'Only in the sense,' regretfully he replied, 'that as the proportion of people who come in with bullet wounds rises, the greater the chances that people will arrive at the hospital dead.'