Maverick Citizen

LIFE SHEDDING

Rolling blackouts and the daily horror story faced by healthcare workers

Rolling blackouts and the daily horror story faced by healthcare workers
A neonatal care unit. Photo: Photo: Denvor De Wee / Spotlight; Tintswalo hospital, Photo: Twitter; A patient waits at Tintswalo hospital, Photo: Twiiter

Healthcare workers face substantial stresses in the course of their daily duties. The added complications of rolling blackouts – from non-functioning life support machines to essential medications going bad and power surges causing expensive equipment to blow – have made life hellish for them.

‘We had to just keep her there and watch her bleed,’ said Nicholas Brink, a distressed community service doctor formerly working at Tintswalo district hospital in Mpumalanga. He was describing how in December 2022, without electricity, doctors were unable to properly assist a woman who had just had a miscarriage, and was bleeding profusely.

“Without a light source, power for a small suction machine and basic sterilised equipment, we were running out of options. For her, just waiting for the power to come back on wasn’t an option.”

This was just one example that flowed from Dr Brink in an hour-long, emotion-laden conversation about the impacts of rolling blackouts on health services. In urban areas it may be an inconvenience, but “for our patients it’s a matter of life and death” he said.

To try to understand the full impact of rolling blackouts on the right to health, Maverick Citizen asked a range of healthcare workers to detail how rolling blackouts are impacting on their practice, people’s health and access to healthcare services.

Stress and anxiety

They told us that a negative impact on individual health could come through stress and anxiety or through not being able to prepare food or water or store medicines safely. 

Simultaneously an impact on health services comes when clinics and hospitals cannot carry out core functions smoothly because of electricity cuts. On 16 January 2023, for example, the National Health Laboratory Service (NHLS) issued a memo to hospitals in Gauteng advising them that rolling blackouts were affecting networks in NHLS labs: “We are trying our best to ensure that the integrity of samples is maintained. Kindly note that this has a negative effect on turn around times.”

At the trouble-stricken Helen Joseph Hospital in Johannesburg doctors say that during rolling blackouts the “pumps can’t pump water, so no water. Lights come back and surge and break equipment. We have one third of our dialysis machines out of commission”.

This is what a range of health workers in different fields had to say:

Dr Nicholas Brink, former community service doctor, 2022, Tintswalo Hospital, Mpumalanga: 

“Load Shedding affects the whole continuum of health, from the vulnerable patient in the community, through to their efforts to access healthcare services and the quality of care they receive. 

“Because of the fragility of rural communities and rural health facilities, just a ‘small’ knock can have disastrous effects. Although it is difficult to prove causality, power cuts’ effect on the refrigeration of food and access to clean water would certainly increase the burden of infectious gastroenteritis on vulnerable populations, with diarrhoea being a leading cause of death in children under five.  

“Things like home oxygen machines and CPAP (Continuous Positive Airway Pressure) devices, which are more common after Covid-19, stop working during power cuts — often leading to unnecessary complications. Insulin, a critical drug for managing diabetes, requires refrigeration. Power cuts pose a serious challenge to patients, often with disastrous complications.”

“The area served by Tintswalo hospital is vast; people travel large distances at great cost to them and can’t get the services they need when they arrive, greatly impeding the screening and management of acute and chronic illnesses at a great cost to patient and state.

Life and death

“Access to cellphone signal is a matter of life and death and in rural areas load shedding often causes the whole network to go down. People can’t call an ambulance. Doctors can’t access the internet for critical information we’ve come to depend on, and can’t seek advice from specialists, in a setting with none on site. 

“Neonatal care is a good example of the vulnerability of the system. The unit relies on warming machines and CPAP machines. If the machines lose power momentarily, even in the few minutes it takes before they reboot, it can cause harm to babies. Prolonged loss of power is a disaster. We can certainly attribute some deaths to this.”

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Brink gives as an example an occasion in late December 2022 when there was no power for 10 hours after a transformer blew. “We had to take the kids off the warmers and CPAP and resort to pure oxygen and kangaroo care – using the mothers’ skin to keep the babies warm. Several babies needed to be transferred to other facilities, but only one was accepted,  accompanied by a doctor in a basic ambulance. One, who was otherwise doing well, weighed less than 1,000 grams and couldn’t be transferred.”

Finally Brink laments the emotional toll: “Load shedding is just an extra push on your already depleted reserves.”

Prof Rudo Mathivha, head of ICU, Chris Hani Baragwanath hospital, Johannesburg:

“There are many people in the community who are affected: diabetics on insulin that is going off; kids requiring home nebulization delivered by electricity-driven nebulizers; oxygen generators for oxygen-dependent people failing, infants having to be fed cold formula constituted from unsterilized unheated water; multitudes of citizens having food rot in their refrigerators and thus having to throw it out; fire hazards from having students/kids study by candlelight. 

“It’s true that  the majority of indigent people constantly live with the above amenities missing in their shacks but we cannot afford to have the whole country reduced to that level before we even get a chance to uplift them.”

Dr Ebrahim Variava, HOD Internal Medicine at Klerksdorp Tshepong Hospital Complex: 

“In the North West we have had lab challenges. This has been both processing samples and with the lab often offline centrally it is challenging getting investigations done or results. Both lead to a negative impact on the care provided.

“In addition, patients on home oxygen who have severe lung disease often don’t have sufficient backup cylinders, so with load shedding they become more ill and require admission just for oxygen.”

Dr Hannetjie Ferreira, Medical Officer, Tshepong hospital:

“I know of two X-ray machines that broke down over the weekend: one new machine at our 24-hour Community Health Centre, and also at the Tshepong Orthopaedic Outpatient Department. Monday at OOPD is the busiest day, so there are looooong queues at Xray dept.”

Dr Sham Moodley, Vice Chair of the Independent Community Pharmacy Association

“At a pharmacy level the stability of the fridge items are really difficult to manage. The products on the dispensary shelf are also now being subjected to extreme temperatures with no air-conditioning for long periods. We have to monitor temp in the pharmacy for compliance several times daily. Small pharmacies cannot afford the high-end units to generate power to keep the aircons going. This certainly is going to impact on medicine stability and patient care.” 

“The added cost of generators and inverters are not factored into the dispensing fee model of pharmacists – so there is certainly a struggle to keep up with the service levels versus costs related to load shedding. The industry is very computer dependent – the equipment is not coping with the unstable supply. It now requires constant replacement.”

Linda-Gail Becker, Professor of Medicine and Chief Operating Officer of the Desmond Tutu HIV Foundation (DTHF): 

All of our research sites must have electricity 24/7 so they all have backup generators. Generator diesel costs have escalated – this makes clinical research precarious in terms of sustainability.

“The DTHF has three big trial centres outside of hospitals where we must provide generator backup for possible electricity outages to ensure pharmacy temperatures and fridges are maintained for experimental and other drugs and vaccines. Normally these generators would kick in on the odd occasion. Now they are running daily and many times a day. These all require diesel and maintenance. 

“The cost just for this to our organisation was R370,000 in 2022. At current load shedding we predict the cost to go to R425,000 in 2023 and R445,000 in 2024. 

“This will go through the roof if we need to rely on generators only. The possibility that a generator fails may result in a fridge of experimental vaccines having to be discarded.” 

Dr Mark Human, South African Medical Association (SAMA), Gauteng Chair / Chair of SAMA’s Human Rights Law and Ethics committee: 

“The constant on/off with massive uncontrolled power surges creates a wear component on most appliances that you cannot even calculate! Anything with a compressor (think fridges/ aircons etc) will have a much higher failure rate.”

Prof Richard Tuft, Executive Director, Radiological Society of South Africa

“In the private sector most practices will have either their own or shared with landlord alternative power supplies. Most current leases require practices to have backup. However, the public sector will depend on backup of or exemption from loading shedding of the institution.”

Dr Binu Luke:

There are disruptions and delays in elective and emergency surgeries as a single backup generator is not enough to safely initiate elective surgery.”

Rural doctor in the Eastern Cape:

“Our metro call centre doesn’t have a functioning generator currently which means during load shedding we’re unable to contact emergency medical services to book ambulances. Even when we can book (if we know a cell number of someone well positioned), the dispatcher is unable to contact the ambulance drivers/paramedics since cellphone signal is also reliant on Eskom. I currently have an 11-year old girl with an acute abdomen needing transfer to Mthatha but can’t facilitate this.” DM/MC

The Rural Doctors Association of SA (RUDASA) is compiling the results of an online power supply survey to healthcare facilities. It can be filled in here: https://forms.gle/4koGmMBaPj5FrUxf7 Health workers with other experiences to share can write to [email protected] 

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