By: Dr. Frans J Cronje, MD, BSc(Hons) Aerosp Med. CHT

HBOT is not new to South Africa. Five of the leading national Government Hospitals acquired Vickers monoplace chambers over the period of 1960 to1983. HBOT was primarily used as a radio-enhancer for external beam radiotherapy during this time, and most of the hyperbaric chambers were therefore installed in the respective radiotherapy departments. HBOT was also occasionally used in the treatment of gas gangrene and necrotizing infections, but when the indication for radiotherapy became obsolete, most of these units closed down. Only the unit in Bloemfontein is still providing regular HBOT to this day. There are also five Naval recompression facilities, situated in the major coastal cities around the country and these have all occasionally treated patients with HBO over the past ten years. However, none of them provide a regular HBO service and are primarily available for naval dive operations and for treating occasional civilian cases of decompression illness.

The recent revival in clinical hyperbaric oxygen therapy started in 1993 at the Institute for Aviation Medicine, a specialized unit in the South African Military Health Service (SAMHS). The small five-foot (1.5 meter) Draeger recompression chamber (formerly used to treat divers and aviators with decompression sickness) was employed by the author to treat a small number of patients with mandibular osteoradionecrosis, referred from Pretoria Academic Hospital. These few incidental treatments soon made way to what has become a full-time dedicated clinical HBO service, and the rapid growth required the installation of a larger chamber in 1996. This chamber (nicknamed “Miss Piggy” due to its apricot-peach color) increased the level of awareness of HBO, while the results obtained re-established recognition for the therapy. The author eventually resigned from the SAMHS in 1998 and opened the first private HBO facility at the Eugene Marais Hospital in Pretoria. Recently, three additional hospital-based, private, multiplace hyperbaric chambers have started up in South Africa, and one monoplace facility in Namibia. This development is once again making HBOT more readily available, and promoting its appropriate use in South Africa.

From 1983 to 1998, the UHMS indications were almost exclusively applied in South Africa, with the exception of isolated cases of multiple sclerosis in the early 1980’s and some sports injuries and problems with non-union and septic non-union of bone. However, in 1998 a parent-group in Pietermaritzburg initiated the use of low-pressure HBOT for the treatment of cerebral palsy. A total of nine informal CP-treatment chambers opened between 1998 and 2000. This urged the Southern African Undersea and Hyperbaric Medical Association (SAUHMA), the official scientific and peer-review organization for diving and hyperbaric medicine in this country - affiliated to the UHMS - to formalize safety, training and reimbursement standards for South Africa as a matter of urgency. Three of the former CP treatment facilities have since evolved towards becoming mainstream HBO facilities, while several others have closed down.

In 1997 the author developed the Diving and Hyperbaric Medicine Staff Training course (DHMSTC) which has since been designated by the UHMS as a sponsored introductory course in hyperbaric medicine. A Clinical Hyperbaric Chamber Operator’s Course (CHCOC) was subsequently developed and these two courses have been endorsed by SAUHMA as forming the minimum recommended training for the practice and application of HBOT. Through the efforts of SAUHMA, the DHMSTC, CHCOC, NFPA 99 Chapter 19 Safety Guidelines for Hyperbaric Facilities, as well as the UHMS documents on multiplace and monoplace chamber safety have been accepted and adopted in South Africa. Recently, Francois Burman, a South African mechanical engineer and technical advisor of SAUHMA published a Risk Assessment Guide for Recompression Facilities through the International Divers Alert Network. This reference is likely to become an international hyperbaric safety benchmark and forms the basis of the evolving South African Bureau of Standards’ statutory safety and standards document on hyperbaric chambers.