Medical care suffering as the taps run dry

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The running out of water in the Western Cape because of drought and in southern KwaZulu-Natal because of alleged sabotage of municipal facilities, has raised serious concerns for health facilities.

Rand Water has been fingered for violating the basic human rights of patients at the Sebokeng Hospital‚ after they instituted water restrictions without prior notification. The Times reports that this claim was made against Rand Water by the hospital’s CEO‚ Dr Zolela Ngcwabe‚ who accused the water supplier of acting in bad faith just days after the entity imposed a restriction on the municipality. “Formally‚ we were not informed that they (were) closing our water supply‚ so that we (could) have contingency plans. Water is a basic human right‚ and the rights of our patients and the community were deprived‚” Ngcwabe said.

She said the water cut-off had an effect on “the patients’ personal hygiene and hand washing. For us it is core‚ because both of them have an effect in terms of infection control‚ before and after eating”.

The report says her remarks follow the Emfuleni local municipality’s failure to settle a debt of more than R400m owed to Rand Water for a period of two years‚ which is now resulting in health facilities beginning to feel the pinch. The water supplier officially announced its decision to implement a 60% water restriction on Friday – even though the hospital was without water for the whole of last week – which not only affected the community of Sebokeng and surrounding areas‚ but also schools and clinics.

The municipality‚ according to Rand Water‚ has failed to honour agreements – made in several meetings between national treasury and the department of co-operative governance and traditional affairs – to settle the outstanding amount with the service provider.

“It was agreed that the municipality (would) resubmit a revised payment plan and honour its current account by the last day of the month‚ while negotiations on the settlement of the overdue amount were ongoing‚” said Rand Water media relations manager Justice Mohale.

“Rand Water has reduced by 60% its supply of bulk potable water to the Emfuleni local municipality. This decision is a credit-control action‚ to compel the municipality to meet its obligations to settle amounts due to Rand Water for water services rendered‚” Mohale added.

However‚ the report says, Ngcwabe accused the entity of not considering the well-being of vulnerable community members who needed quality primary healthcare. “Unavailability of water has had severe negative impact on the delivery of quality healthcare services‚ and also has a huge potential risk of spreading diseases. Patients’ care was compromised in all aspects‚ including the workers – if all of us can’t go to the toilet‚ all of us are affected‚” she added.

To date‚ the municipality owes the entity R431‚789‚101.

According to the hospital’s deputy director‚ Makibiti Madolo‚ the implications of these water restrictions is that patients would in the long run be diagnosed with diseases they initially didn’t have. “We are put in a compromised situation‚ where we may not know the effect of the closure of the water now‚ but we will see it maybe in the immediate future – that patients acquire diseases that they didn’t come with to the hospital. We are basically working against our own policy as a government‚ so we cannot as government set these priorities‚ then (allow) another parastatal (to) set objectives that negate the national mandate for public institutions‚” said Madolo.

She said that the way forward for the hospital would be to increase the number of boreholes‚ coupling them with Jojo tanks‚ and install an electronic monitoring system in the main tanks to check the water levels. The hospital would also put filters in the critical areas‚ such as the intensive care units‚ operating theatres and maternity wards.

The report says hospital has 800 beds and accommodates about 60‚000 patients every month.

The municipality was not immediately available for comment.

 

Hospitals in the Western Cape face disaster if the taps run dry – a prospect that is looming for the first half of 2018, reports The Times. Now‚ in a bid to stave off this crisis‚ the provincial government has started drilling for water at some state hospitals.

Long-term interventions were put in place some time ago but‚ “a large aspect of the short-term plan centres around the drilling and activation of boreholes at hospitals‚” said provincial health spokesperson Mark van der Heever. Hospitals in the province require 1.8m kilolitres of water per year to operate. He said the resulting “extra water” extracted from boreholes would augment the supply from the city.

The report says already drilling has begun at some hospitals‚ as well as the “re-activating” of existing boreholes at others – such as at Karl Bremer Hospital where the site is delivering 10‚000 litres of water per hour. At Tygerburg Hospital too‚ an old borehole is being activated‚ while water from the borehole at Khayelitsha Hospital is being tested for safety. The plan is being done in partnership with the Department of Transport and Public Works.

Van der Heever said that water was used at health facilities for “cleaning linen‚ floors‚ toilets‚ scrubbing‚ disinfecting equipment‚ bathing‚ drinking‚ and others”. Water from boreholes was tested at a laboratory for safety before use.

Caution‚ however‚ is needed, the report says. Chris Jack‚ a researcher at the Climate System Analysis Group at the University of Cape Town‚ said boreholes were helpful in times of a lack of municipal water supply. But‚ groundwater extraction “can have negative impacts such as land sinking‚ salt water intrusion in coastal areas like Cape Town‚ and a drop in water quality”.

The report says the department is aware of this‚ and according to van der Heever‚ is being careful “not to exhaust the resource”.

While plans unfold at hospitals‚ the drought could also increase the number of patients needing to be admitted. According to website of the National Drought Mitigation Centre in the US: “Health problems related to low water flows and poor quality water‚ health problems related to dust‚ reduced incomes‚ and fewer recreational activities” can be expected in any country where a drought unfolds.

 

In the Ugu district in KwaZulu-Natal, thirst is not what kills you when the taps run dry, it is sepsis, the body’s toxic response to an overwhelming infection. The body attacks itself in the immunological equivalent of a nuclear blast – at ground zero, everything dies, friend and foe alike.

Business Day reports that at the Murchison Hospital north of Port Shepstone, Day Zero arrived unannounced about two years ago. The exact date is unknown, because when the taps ran dry at Murchison, they had already run dry at Izingolweni and at Port Edward, and by the time supply to the hospital was restored, another area was about to go dry. Residents report that for the past two years, a reticulated water supply has been available for about half the day.

The report says Day Zero is not a sudden catastrophic implosion. It is, instead, a steady, random collapse of systems varying in severity as determined by myriad factors. In the Ugu district, populated by about 1m people, it manifested first at Murchison Hospital’s casualty ward, where the only reliable (though largely unregulated) water is supplied by tankers outsourced by Ugu District Municipality.

It means patients who arrive at the hospital with infectious hepatitis have not washed their hands for days, because water delivered by tanker is for drinking. It means medical personnel who suture arteries and close wounds on a Friday night (… gunshot chest, stab chest, gunshot chest …) cannot wash their hands between patients.

The report says faecal-oral transmission of infection is the most common, and the patients at Murchison Hospital are mostly ill with tuberculosis and opportunistic diarrhoeal infections prevalent where up to 80% of patients are HIV-positive.

It is critical to understand that when a district-level Day Zero toggles on and off, the conditions necessary to reverse the crisis diminish with each stoppage. When the taps are dry, flushing a toilet is a luxury; when they have been dry for days, the plumbing becomes blocked and the system collapses. The report says in most areas in the Ugu district, the taps have run dry for weeks over the past two years.

If you live east of Ugu’s great class divider, the R61, it means you’ll wash your hands from a rainwater tank, or use untreated artisanal groundwater. If you do neglect hand washing, you might become ill and rush to a doctor or the private clinic in Margate. But if you live across the road in the sprawling impoverished settlements, your best option is a pit latrine, though the common practice is to use any unoccupied area.

The report says for people who save their water for drinking and don’t wash their hands, getting sick means they will be going to the hospital in a crowded minibus taxi, which becomes a vector for disease on an epidemiological scale. Thus, instead of providing hope for the desperately ill, Murchison Hospital becomes an epicentre of disease.

When the hospital first informed the municipality of the water problem, the report says the complaint was dismissed and the hospital was told that it was using too much water. “What are we supposed to do?” a health worker (who cannot be named for fear of reprisals) said in response. “Must we use less water? At a hospital?”, the worker asked.

The report says this, then, is what Day Zero looks like, and these conditions, for want of data, is before the longer-term health effects, such as malnutrition and worms have been taken into account. World Health Organisation studies show that poor sanitation and hygiene result in stunted growth and impaired cognitive function, particularly for children under the age of five.

The report says it is probably impossible to quantify the outbreaks of disease related to the water-supply and sanitation crisis in Ugu. The whole district is an outbreak. When the water problem at the hospital was eventually escalated to the provincial government, Health MEC Dr Sibongiseni Dhlomo was report as saying at the time: “It’s not my problem. The hospital must speak to Ugu (district municipality).”

The report says the causes of the water crisis in Ugu are many and varied. There, as in Cape Town, this line of inquiry has already deteriorated into apportioning blame – and disingenuous prevarication. When asked how health workers are supposed to cope with the water problems at Ugu, Water and Sanitation Minister Nomvula Mokonyane blamed an unprotected strike by municipal workers as well as associated acts of sabotage. But the strike lasted only three weeks and came at the end of a periodic crisis that began years ago. And, now, after the strike ended more than a week ago, the water supply is as intermittent as before, while the municipality’s outsourced water tankers still ply their trade.

The report says the continuing water crisis in Ugu has prompted an investigation by the South African Human Rights Commission (SAHRC) following a call by human rights campaigner Afriforum. Afriforum has offered a R10,000 reward for information that would lead to the successful prosecution of people who sabotage the water supply system in the district.

“We suspect that the water supply network is being sabotaged so that individuals and groups can gain from possible contract work,” says Eugene van Aswegen, AfriForum’s coordinator for KwaZulu-Natal. “This, and the actions by the municipal workers, come down to a violation of human rights, because everyone has the right to access to water. This is the reason we decided to turn to the HRC,” van Aswegen says.

Water expert Anthony Turton likens the conditions in Ugu to “a form of water war”. It is a conflict in which hydraulic infrastructure is targeted to reach a specific objective, not directly driven by scarcity, but causing an induced scarcity as a weapon, he says. “The ANC has lost control on the ground, and the criminal justice system has failed to investigate, arrest or bring to trial any of the perpetrators. In short, the state has failed in its core duty.”

The report says Day Zero, a term popularised by Western Cape Premier Helen Zille regarding the Cape water crisis, has spurred municipal authorities into drastic action to manage the water crisis in that province, but its manifestation is not in the first instance about economic collapse, although that seems likely should the taps run dry.

The Times report
The Times report
Business Day report


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