Doctors and other medical staff have expressed frustration and alarm at the devastating impact the cyber attack on South Africa’s National Health Laboratory Service (NHLS) is having on patient treatment and on potentially life-or-death decisions.
Critical medical procedures at two large government hospitals in Johannesburg have had to be postponed, which apart from the medical risk, also results in longer hospital stays, and an even greater bed shortage, they said.
Because of the cuber hack on 22 June, the NHLS is unable to upload test results on to the online system, reports TimesLIVE.
Results that previously could be obtained within several hours were now taking up to four days to be retrieved, because staff have to fetch them manually.
A senior doctor at Chris Hani Baragwanath Hospital said there had been severe consequences for patients. “This is one of the most serious threats to patient care we have had in a long time. When we have load shedding or water shortages, the problem is resolved in a day or two. What is happening here has been taking place for almost two weeks. The impact on patients is significant.
“We cannot make decisions about critically ill patients and patients with trauma. The doctor has to go to the lab and wait. In a hospital like Bara, you find so many doctors waiting for results that it is chaos.”
The Progressive Health Forum (PHF) said millions of blood and other pathology tests had been unable to be processed, and doctors were having to rely on their own clinical judgment to make decisions ordinarily guided by laboratory readings.
The PHF is a national network of academics, government workers, community activists and scientists now mobilising to help end the NHLS crisis.
“Doctors are suddenly blind,” said the forum’s convener, Dr Aslam Dasoo. “So if, for example, a woman with pre-eclampsia needs an emergency Caesarean to avoid her going into renal failure, it becomes a matter of life and death, because the illness eats up the platelets and her blood cannot clot. She could bleed to death unless you are able to cross-match the blood and order platelets for her. And while you wait for the information, the baby could become deprived of oxygen.
“Obstetricians have patients with foetal distress …and need to act while they are blinded. Yes, they can still make a good decision, but it will never be as precise as it could be, and by the time they act, the foetus could have cerebral palsy or neuro-encephalopathy.”
The crisis had not been well managed or prioritised with extra resources, he added. Interns and doctors had been turned into runners in many of the big government hospitals, where some of them were covering 30km-40km on very long shifts.
For example, one intern at Chris Hani Baragwanath Hospital racked up 34km during a single 12-hour shift.
Authentication solutions specialists Swivel Secure said high demand for patient information and often outdated systems were among the reasons why healthcare was now the biggest target for online attacks.
South Africa’s government departments and entities were sitting ducks for cyber-attacks because of years of under-investment in security systems, outdated technology and incompetent IT security staff, it said.
The NHLS said this week it was working on fixing its online system, and that it would be back online by mid-July.
A doctor in the radiology department at Charlotte Maxeke Johannesburg Academic Hospital said it was extremely difficult to work without blood-test results for cancer patients.
“For the cancer patients already on treatment, it is easier to postpone their treatment by three days when we know we are going to get the results. But for those who are just starting treatment, we have to get the results. We can’t do the treatment unless we’ve done the blood tests – that is just how it works.”
A nurse at Eshowe Hospital in KwaZulu-Natal said the delays had increased workloads tremendously.
“There are patients on dialysis you need to treat. You have patients who are diabetic. You need samples when treating those patients, otherwise you run the risk of losing them.
“Under normal circumstances, you will pick up that a patient is anaemic. But to even order any blood transfusion, you need to know the haemoglobin [HB] of that patient. How you detect the HB is through the lab. How will you give a blood transfusion without the lab results?”
National health spokesperson Foster Mohale conceded that the cyber attack had negatively affected the turnaround times of laboratory test results, but said all urgent results were being communicated telephonically to requesting clinicians.
He said there had been no reports of loss of life directly linked to the hack.
“Critical blood tests for sodium, potassium, glucose and other vital chemicals, as well as urgent tests for infections and other serious conditions, have been prioritised to ensure essential health services continue.
“Health facilities have point-of-care equipment such as i-STAT machines that can provide health-care professionals with diagnostic information [that is] key for patient care.”
On Wednesday, the NHLS said that all labs were functioning, but providing results remained a challenge.
“All urgent results are communicated telephonically. In addition, the NHLS has distributed a critical-test list to all health facilities,” said NHLS spokesperson Mzi Gcukumana. Critical tests are done where doctors have to make urgent decisions about gravely ill or seriously injured patients.
Gcukumana said a case had been opened with the police.
TimesLIVE article – Test-result delays cause chaos at hospitals (Restricted access)
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Cyber attacks create havoc in state hospitals in SA, and globally
Key health service units targeted by hackers