Unrest over the past week has severely affected medicine distribution and laboratory services in KwaZulu-Natal and Gauteng.

NHLS affected

The National Health Laboratory Service (NHLS) has confirmed to Spotlight that the unrest has affected its operations in Gauteng and KwaZulu-Natal. The NHLS handles laboratory services for the public sector, including HIV, tuberculosis and Covid-19 tests.

“In KwaZulu-Natal, the NHLS is faced with several challenges, namely, the province has no movement due to lack of transport and insufficient fuel, with most healthcare facilities in the urban settings functioning with a skeleton staff. NHLS facilities in the urban settings are operating with a staff complement of between 20%-60% during the day and between 0%-20% at night,” says Mzimasi Gcukumana, spokesperson for the NHLS. He adds that this is due to road blockages and unavailability of public transport.

“This poses challenges for the eThekwini Metro who are unable to send specimens to our laboratories for referral testing and any testing support. With the limited human resource capacity at our disposal, we are only able to process urgent samples,” he says.

According to Gcukumana, in rural settings, NHLS laboratories are operating with a staff complement of between 30-70%. However, he says they are offering a full service except for referral tests that could not be referred because of restricted movement in the province.

“The situation is slowly improving with the biggest challenge now being the severe shortages of fuel. With the freeways being blocked, the supply of much-needed laboratory consumables such as reagents from Gauteng has been impacted,” he tells Spotlight. “As part of our contingency plan, we have decentralised Covid-19 PCR testing through leveraging our GeneXpert footprint. In addition, we have encouraged health facilities to use rapid antigen testing where clinically indicated according to the Covid-19 standing guidelines.”

Gcukumana says that the NHLS is working with private laboratories to assist with Covid-19 PCR testing although the demand remains very low across the province.

“Due to the non-availability of public transport, hospitals in and around Durban have been kind to the NHLS by offering our staff accommodation within the hospitals where practical. The NHLS is grateful for this act of kindness. Further, we have encouraged some of our staff members, those who can, to work from home,” he says.

“In Gauteng, our testing sites remain ready to process specimens; however, the challenge the NHLS is faced with is the receiving of samples from the health facilities. This was due to the inaccessibility of some facilities in the cities of Johannesburg and Ekurhuleni due to the unrest,” he says. “The NHLS’ main challenge has been the collection of samples from the facilities. However, we are pleased to inform the public that as of 15 July 2021, the NHLS in Gauteng has been able to collect samples from the majority of health facilities.”

Medicines distribution also affected

Besides transport problems, medicines distribution has also been severely affected in the two provinces with looting and destruction of property at pharmacies. This has disrupted the government’s Central Chronic Medicine Dispensing and Distribution (CCMDD) programme — which allows public sector clients to collect medicines from more convenient places, such as private sector clinics rather than having to return to clinics for medicines refills.

“The most affected are those on the CCDMD programme collecting from Clicks outlets,” says Mandisa Dukashe, founder of the HIV Survivors and Partners Network. “They only received SMSes like everyone else saying the stores are closed with no further explanation of where to collect meds.”

Dukashe says during this difficult time, going to public clinics is the only solution. “We know people with chronic illnesses. Without treatment, the damage will be more [increased drug resistance, increased HIV infections and mortality]. Not that we don’t understand the burden that would cause to the system, but there is no other solution,” she says.

Bonginkosi Mthembu from Germiston, who receives his HIV medication from Clicks, says, “We are highly affected by this looting as now we have to go back to our doctors or clinics, even though we are not sick. And have to wait in those long queues just to collect our medication.

“Plan B will be for the medication to be delivered in our places of residence even though that might be a problem for others — as not everyone is working from home,” he says.

“As a result of protest action, Clicks has had to close all 110 of its stores in KwaZulu-Natal and 130 stores in Gauteng, with a total of 279 stores closed and 52 stores damaged so far nationwide. A hundred and six vaccination sites have been closed across the country,” says Clicks spokesperson Susann Caminada.

“The disruption of services means affected Clicks stores will be temporarily unable to administer vaccinations and provide medication to customers, along with public sector medicine pick-up points being temporarily unavailable. Contingency plans are being put in place to provide alternative arrangements for delivery of chronic medication and rescheduling of vaccinations, where possible,” she says. 

Caminada says the cost of the looting and damage to Clicks stores is still to be determined.

United Pharmaceutical Distributors (UPD) has confirmed that its warehouse in Mahogany Ridge in KZN was looted and the medicine supply chain disrupted. “Our business continuity plan has been implemented to bring in supplies and emergency medicines from our other regional sites, particularly clinical medicines for hospitals,” says Trevor McCoy, its managing executive.

On Wednesday, the South African Pharmacy Council released a statement saying that it had received reports from pharmacists and pharmacy associations that more than 90 pharmacies had been destroyed and looted, with KwaZulu-Natal being the hardest hit. “Among the looted items are Covid-19 vaccines and scheduled medicines, which when used without proper pharmacist counselling on storage and dosage may result in harm to one’s health,” the council said. “As such, we urge those who looted these medicines and health products to not use them or give to other persons but rather return them to their nearest pharmacy for proper disposal. We also caution members of the public to only source medicines from legitimate health establishments such as pharmacies.”

According to CEO of the Independent Community Pharmacists’ Association, Jackie Maimin, 51 independently owned pharmacies were looted, of which 18 were in Gauteng. “Disruption to pharmaceutical care has negatively affected the communities which have suffered damages due to looting of the pharmacies. These pharmacies have had to close down or limit their trading hours,” Maimin told Spotlight, adding that the disruption to the supply of medication is another factor that has to now be considered and there is a risk of treatment interruptions.

“Pharmacies which are closed are unable to service their communities [patients] and have had to redirect patients to open pharmacies. In the case of a patient having their prescription at one pharmacy [which has been damaged], access to the scripts are not available, adding pressure on the doctors who are already overburdened with the Covid-19 crisis to now reissue scripts.”

Medical oxygen

Nolundi Rawana, spokesperson for Afrox, which is the sole supplier of medical oxygen to South Africa’s health facilities, told Spotlight Afrox’ operations were also affected by this week’s riots and civil unrest. 

“The supply of medical oxygen to hospitals and clinics remains a priority,” she said. “Afrox is currently engaged in emergency planning to ensure deliveries can be safely undertaken and to find alternate routes to customers and hospitals as part of a flexible response to spontaneous civil unrest breaking out.” 

Rawana confirmed disruptions to some medical oxygen deliveries in Gauteng and KwaZulu-Natal but said contingency measures may include, among others, police escorting medical oxygen delivery trucks. “Afrox, however, will only operate and deliver where and when our assets and employees are safe.”

Emergency Medical Services

“We are currently responding to a high volume of distress calls in various parts of Gauteng. Road closures, the barricading of roads, attacks on paramedics and protests in various areas have made it difficult for paramedics and vehicles to enter communities and respond to calls,” says Kwara Kekana, spokesperson for the Gauteng Health Department.

“Our teams are on the ground responding to calls as best as they can in the current environment. There will, however, be delays in responding to calls as a direct result of the closures, protests and attacks on our staff and EMS vehicles.”

She said the team had to use an armoured ambulance in responding to calls to transfer patients and staff. “We plead with communities to stop attacks on paramedics and EMS vehicles so we can render services to those in urgent need of medical attention,” said Kekana. DM/MC

This article was produced by Spotlight — health journalism in the public interest.