GAUTENG PUBLIC HEALTH CRISIS
‘Massive infection risk’ at Helen Joseph Hospital after water pressure plummets
Helen Joseph Hospital has been struck by low water pressure since Thursday, 1 June. The situation has improved slightly, but the emergency, surgical and medical wards still don’t have an adequate water supply.
Helen Joseph Hospital (HJH) in Johannesburg has been experiencing low water pressure since Thursday, 1 June. Affected areas include the emergency department, the intensive care unit, the theatre, outpatient clinics, the laboratory where blood tests are done, the administration block and all the wards on the upper floor of the hospital.
The hospital’s CEO, Dr Rodney Pheto, said there had been some improvement in the situation, with the water supply restored on the ground and second floors.
“The only departments that are currently affected now are the emergency department and all the medical ones and the surgical wards,” he said.
“Services are disrupted but not completely shut down because we cannot afford to shut down the services.”
‘Embarrassing and disrespectful’
A senior clinician at HJH, who asked not to be named, said the issue began on Thursday, 1 June. He described the situation as “embarrassing and disrespectful to people.
“We are actually quite lucky this time in some ways even though it is not a good situation. Our renal dialysis unit, kitchen, and theatres are actually spared because there is a partial supply to the hospital. However, there is definitely not enough.”
While water tankers were available, these provided only short-term relief.
“Occasionally a tanker might come and top up the tanks on the roof and there’ll be supply for an hour or so, but thereafter it gets used up and we are in trouble again,” he said.
At the time of writing, nearly all the hospital’s wards were without water. The hospital has nine medical wards, four surgical wards and two orthopaedic wards, each with roughly 30 patients. Each ward shares between three and four toilets.
“When there is no water where else will you go? You’ll still use the toilet. So, then those toilets with no flushing start to get full. Then we have to wait for either water restoration or, like today, a whole bunch of cleaners were getting gallons of water and bringing them up the elevators and trying to flush manually, which is really tough, especially if it’s sat overnight and now it’s solid and they have to plunge,” said the senior clinician.
Emergency department without water
A major problem is that emergency departments and wards are not getting water. There are between 30 and 40 patients in the emergency department and the water issues make it challenging to provide basic care. Patients with gastroenteritis were reportedly cleaning themselves with tissues or their own clothes.
Staff members have described the situation as “inhumane” and said it cannot be allowed to continue.
“In our area specifically, it means the taps aren’t working and toilets aren’t working, which means that all of our toilets are overflowing, both patient and staff toilets,” said a senior doctor, who asked not to be named.
“It is very difficult to do sterile procedures, to clean patients, to provide drinking water for patients and staff, to do handwashing. In terms of the risk of infection spreading, this is massive,” she said.
“Providing basic care for patients, cleaning, waste removal, and providing toilet services — it is essentially impossible without water.”
The water tankers dispatched by Johannesburg Water have not mitigated the situation in the emergency department.
“Our staff have been collecting water in plastic five-litre bottles from taps in some other areas of the hospital that are still working, and the hospital management has delivered a small amount of water for patient and staff use, but it comes to about a few hundred [millilitres] per staff member and per patient per day. So we haven’t really been getting adequate supplies of water apart from what staff are fetching themselves from other taps,” said the senior doctor.
Pheto said water tankers couldn’t reach the emergency department. Water had been transported to the department in buckets, and staff and patients were supplied with bottled water.
“It’s sort of a steep gradient, so it won’t be safe to park a water tank and that’s why they just parked right at the back of the hospital,” he said.
“This is an emergency response to the crisis that we are currently having. But we’re trying, by all means, to try and relieve the problem as we can.”
The lack of water led to toilets overflowing with bodily fluids, affecting staff and patients’ bathrooms. Staff had to resort to cleaning fluids such as vomit and blood off themselves with tissue and D-Germ — a hand disinfectant.
The senior clinician said: “For quick washing, using an alcohol-based wash is not a bad thing, it is actually quite useful. However, let’s say there’s debris on your hand or you got soiled on, then you actually need to do a proper wash with a proper soapy wash. There are also certain infections that are resistant to alcohol wash, and you actually need to do a proper soap wash with your hands.”
Using an alcohol-based solution for cleaning can work, but not necessarily in the emergency department.
“It is actually an even bigger problem because we have patients coming in with gastro, with diarrhoea and vomiting, or trauma patients with a lot of blood on them. So, it’s extremely difficult to clean these patients, it’s extremely difficult to change their linen, change their clothing, to do bed baths, and just hygiene in general,” said the senior doctor.
“We are continuing to provide the best care that we can. We are making do with staff collecting water from outside taps and other areas of the hospital. We are bringing our own water from home.
“We are continuing to do procedures, and trying to clean and do handwashing and so forth with alcohol hand rub and cleaning solutions. We are trying as much as we can to escalate to the management and make sure everybody is aware of the conditions and that patients are suffering.”
A key concern is that the lack of water poses an infection risk. “It’s a massive infection risk. I think that’s our biggest concern at the moment,” said the senior doctor.
“Especially with the cholera outbreaks that we are seeing in various places. We’ve had cholera patients admitted in the past. We have gastro patients currently. If anything like cholera happens to be in the hospital at the moment, it will spread like wildfire.”
Lack of communication
There has been little communication from hospital management.
“There’s been some communication; the communication that we get is essentially the same thing, which is, ‘We are looking for the problem and we don’t know what is causing it yet,’” said a senior doctor.
The communication from management was poor in general on various topics, and at times non-existent, said another doctor.
“The lack of communication is probably the biggest issue. Maybe the City of Joburg tells seniors in the hospital and no one knows what’s going on. The distribution of information has been poor,” he said.
Solutions put in place
While the cause of the low water pressure has not yet been identified, Johannesburg Water conducted investigations and found no problems with its water pressure.
“The issue could be internal. We have to look at all the pipes that are underground, but inside the hospital,” said Pheto.
Some of the nurses and support staff had to use buckets to get water from the taps on the lower floors.
“That is actually risky because it compromises the prevention of infection, prevention and control. So, the situation… I would like to admit that we are having a crisis, yes, but we’re dealing with it,” said Pheto.
The hospital has placed an order for portable toilets, but Pheto could not give a timeframe for when these would arrive. The portable toilets would only be used by staff members and escorts, while patients would continue using the hospital’s toilets, despite the water challenges.
“This is not ideal, especially for the hospital to have body fluids in one area. It’s a higher risk for infection and contamination,” said Pheto.
The hospital is also diverting Priority One patients who are emergency and critical, and Priority Two patients, to other facilities when necessary.
Although some doctors asked for the hospital’s emergency room to be closed until the water was restored, Pheto said this would not be possible.
“Unfortunately, that is something that we actually cannot afford to do because we will destabilise the other facilities. We’ve got services that run in the hospital that honestly we cannot close down,” he said.
Closing the ER or other parts of the hospital would overburden Charlotte Maxeke Johannesburg Academic Hospital, Leratong Hospital and South Rand Hospital, which was why patients were being diverted for a limited period of time, said Pheto.
“Previous measures would be to use water tankers to top up the hospital water tank, and usually that would help resolve some of it or buy some time or alleviate. But this time, because they can’t identify where the issue is, it is insufficient,” said one doctor.
The water tankers had prevented a catastrophic water failure but were not sufficient to address the challenges.
“I don’t personally think it was adequate. There’s still no water in the wards; I don’t know if patients are cleaning themselves since there is no water in the showers, let alone hot water,” said the senior clinician.
Diverting patients helps, but it does not solve all the problems. “Diverting patients works nicely if the patient is coming via ambulance, but if you are hurt down the road you don’t always have time to wait for an ambulance,” he said.
Permanent solutions in the pipeline
The hospital plans to increase the size of the pipe that is supplying water to the hospital and to boost the pressure supply. Pheto said there was a need to procure a second pipe so that there would be backup if one water supply pipe failed.
The hospital would also divert water from non-essential structures, such as the nursing college.
Gift of the Givers installed a borehole at the hospital that provides four or five green water tanks, but inadequate pressure hinders its supply to all parts of the hospital.
Read more in Daily Maverick: They know the drill: Gift of the Givers steps up to sink boreholes for battling Joburg hospitals
“The challenge is that they are on the ground floor, and there’s no way that this water can be pushed up,” said Pheto.
A doctor told Daily Maverick the Gift of the Givers borehole has always had a pretty low flow rate.
“Unlike Rahima Moosa [Mother and Child Hospital]’s boreholes, it’s not nearly enough to supply the rest of the hospital. [It] does at least allow for food to be prepared and for some small amounts of water to be provided for patients to drink from. Not enough for toilets, basins, laundry, etc.”
Pheto said that the hospital needed water flowing from a high-pressure area.
“The Gift of the Givers borehole has to be a backup plan, but only for the ground floor. The water coming out of the borehole will never actually even reach the first or the second floor. So, at the moment, it’s completely out of the question that we can rely on the water from the borehole,” he said.
The hospital remains open
“All of the services are running, not at 100% capacity, but all services are running,” said Pheto.
He urged people to honour outpatient appointments and said if patients were not stable enough to go to other facilities, they could still come to HJH.
Over the weekend, the majority of the cleaners were off work which is why the hospital looked so messy, said Pheto. However, the cleaners had been going the extra mile to mitigate the issues, for which the hospital management was thankful.
“They are collecting water from the ground floor and taking it to the wards, which is something that is outside their job description, but if you are facing a crisis, you’re expected to do more,” he said.
“We are working to resolve the problem as quickly as possible. The measures might appear to be temporary, but [we are] also working hard on long-term solutions to this problem.” DM