JOHANNESBURG - A disaster during the World Cup could overwhelm the fragile network of hospitals and ambulances on which most South Africans depend, experts and health workers say.
But the public system won't have to cope alone, the chief medical officer for local tournament organizers said in an interview this week. Dr. Victor Ramathesele outlined plans for what he said would be unprecedented coordination between the public system, the military and the private sector in case of emergency during Africa's first World Cup.
"This event has forced us to work together. We've had to establish processes and systems to work together," Ramathesele said. "We are ready."
Some of what Ramathesele calls South Africa's resource and infrastructure challenges have made headlines in recent weeks.
Last month, South Africa's high infant mortality rate was underscored when an unusually high number of babies died in hospitals in Gauteng. The province includes Johannesburg and will host the most World Cup games, most of the teams and most of the tourists coming for the tournament.
The health minister said AIDS contributes to the deaths of many babies in South Africa. The country has an estimated 5.7 million people infected with HIV, more than any other country, putting an extraordinary burden on the health care system in this nation of about 50 million.
Also last month, Soweto's Chris Hani Baragwanath Hospital had to rely on generators after thieves stole power cables. It ran out of fuel for its generators before city power was restored.
Baragwanath, which has more than 3,000 beds and bills itself the largest hospital in the world, is the hospital closest to Soccer City, the main World Cup stadium.
For its April edition, the South African Journal of Medicine surveyed disaster management specialists at Baragwanath and two other major public hospitals in Gauteng. The journal reported shortages of equipment, space in intensive care units, money and trained staff, but said "Herculean efforts" were being made to ensure South Africa was ready for the tournament.
Paramedics speaking to The Associated Press on condition of anonymity because they feared losing their jobs said working ambulances were in short supply and described having to buy some of their own equipment, such as safety helmets.
They also said there was not enough qualified staff to run the ambulances.
Shalen Ramduth, head of training for Netcare 911, the emergency response arm of a major private hospital chain in South Africa, said Netcare paramedics and ambulances were ready to step in _ and were already boosting government services.
"If something does happen (during the World Cup), we have the capability to manage it," he told AP. "As South Africans we need to do whatever is necessary to make it happen. As a collaboration, we're ready."
Ramduth, who moved from the government to the private sector in 1994, said support from military health workers and facilities would also be key during the World Cup.
Health care is where the developing world meets the developed world in South Africa. While its public hospitals struggle, medical tourists come to its private hospitals for affordable, excellent care.
"The health care system in this country can be improved and is currently undergoing a major reform," said Ramathesele, the World Cup medical chief.
But he said that same beleaguered public system has coped with disasters in the past, such as outbreaks of cholera and measles. In 2001, more than 40 people were killed in a stampede before a match between local soccer teams at Johannesburg's Ellis Park, one of the stadiums that will host World Cup matches. The South African Journal of Medicine noted in its April survey that Johannesburg's Charlotte Maxeke Hospital successfully treated 146 people after the 2001 stampede in just over two hours.
Ramathesele's argument that South Africa would cope during the World Cup by pooling health resources was echoed by Jack Bloom, a frequent and sharp critic of health care services in Gauteng. Bloom, of the main opposition Democratic Alliance, is a member of the Gauteng legislature who made health one of his specialties.
"We'll pull together for the World Cup," Bloom said. "It would be nice if this sort of level of preparedness was permanent."
Analyst Mark Schroeder, whose Texas-based STRATFOR advises corporations and government agencies around the world on security and other concerns, said the emergencies health care workers are bracing for range from major traffic accidents to a terror attack. Schroeder, like the U.S. and South African governments, said there was no specific terror threat to the World Cup.
"If a large-scale attack were to occur, South Africa's medical services and transportation infrastructure would be overwhelmed," STRATFOR concluded in a recent World Cup security assessment.
Coping with a major disaster would stretch resources even in more developed countries, Schroeder said.
"It'll be sort of a nervous month," Schroeder said.
Associated Press Writer Nastasya Tay in Johannesburg contributed to this report.