As South Africa plummets towards a potential shift to stage eight load shedding, healthcare organisations warn of the drastic effects of rolling power cuts on an already crippled healthcare system, writes Medical Brief.
They say if the number of state hospital exempt from load shedding does not increase from the current 18%, the healthcare system could totally collapse.
In a BizNews report, Dr Mvuyisi Mzukwa, acting chairperson of SA Medical Association, (Sama) accused Health Minister Dr Joe Paahla of tardiness in tackling the hospital load shedding crisis.
“At this point you should be telling us what’s already done, sharing your plan – not being futuristic about something so crucial.”
Mzukwa said extracting data on how many patients have already died or been affected by load shedding would be difficult in such a secretive current political environment.
“Believe you me, people have died, but that information will be hidden, and nobody will be allowed to speak about this, even our members on the ground. We all saw what happened to Dr Tim de Maayer at Rahima Moosa Hospital when he blew the whistle on the state of public hospitals” he added.
Dr Caroline Corbett, president of the SA Anesthesiologists Association, SASSA, said regardless of Eskom load shedding, rural areas also suffered regular power outages due to cable theft and substation malfunction. This compromised patient care and resulted in patients overwhelming major hospitals.
"The major hospitals like Rahima Moosa and Bara or Charlotte Maxeke are under-resourced and poorly maintained, so the power crisis has a massive knock-on effect. For us in private, we’re losing equipment and running batteries flat – a four-hour power loss with delayed crossover is the absolute maximum our batteries can tolerate. The safety net is full of holes,” she said.
BusinessLIVE reports that independent pharmacies, public hospitals and the state’s key laboratories are scrambling to provide services as crippling power cuts leave users without electricity for up to 12 hours a day.
Their experience stands in stark contrast to private hospital groups, whose long-standing investments in power generating capacity mean they are among the few health-care providers buffered against the electricity crisis.
Eskom has imposed rolling blackouts every day so far this year, as it is unable to provide reliable electricity supply from its ageing coal-powered plants. The power cuts have intensified in the past six months, and Eskom has increased the frequency with which it imposes stage six load shedding, in which it sheds 6 000MW from the national grid.
Stage six load shedding has been catastrophic for independently owned pharmacies, which do not have the infrastructure to cope with long power outages, said Independent Community Pharmacy Association CEO Jackie Maiman. The association has 1 200 independently owned members and does not include retail chains Clicks and Dis-Chem.
“It’s an absolute disaster,” said Maiman. The power cuts disrupt air-conditioning and compromise the stability of medicines on the shelves, risking the safety of products that require refrigeration, and interrupt electronic claims processing and access to patient records, she said.
Private hospital groups Netcare, Mediclinic and Life Healthcare appear to be among the few health-care industry players able to sustain services with little disruption to patients.
Netcare hospital division MD Jacques du Plessis said the company invested in backup diesel generators and solar power 10 years ago, and while its diesel consumption has doubled from previous years, its operations continue as usual.
Life Healthcare’s SA CEO Adam Pyle said power outages have pushed up the running and maintenance costs of its back-up diesel generators and some hospital equipment, but patient care is not affected.
Mediclinic said the power outages disrupt surgeries at its day clinics but it is generally able to transfer these patients to hospital facilities on the same sites. All its SA hospitals have the necessary equipment to contend with load-shedding, it said.
Mediclinic spends about R1m a day on diesel during stage six load shedding to ensure sustained power for its SA hospitals, the group said.
The largely uninterrupted services provided by the large hospital groups stand in sharp contrast to the situation at many public hospitals.
Only 18 of the 37 public hospitals in Gauteng are exempt from load-shedding, and the rest are unable to fully maintain services during power cuts.
“Load-shedding does in many instances negatively impact on services at facilities. Some procedures have to be postponed, especially elective procedures so that priority is [given to] critical operations which cannot be delayed,” said Gauteng health spokesperson Motalatale Modiba.
Patient records remain accessible during power outages, because the provincial Health Department uses both paper and electronic patient records, he said.
Earlier this week, the National Health Laboratory Service (NHLS), which provides all the diagnostic tests done in the public sector, warned users in Gauteng that the power cuts pose a risk to the integrity of the samples it receives and are delaying turnaround times.
The laboratory service’s CEO, Kamy Chetty, said the organisation had appealed to the Department of Health to exempt it from load shedding, as many of its laboratories rely on hospital back-up generators.
“Load-shedding affects the turnaround times of tests, especially where there is complete power failure as the test has to be reconducted.
“This also impacts on the machinery as power surges are not good for our equipment. The Eastern Cape, which would normally have been able to maintain a turnaround time of 93% of samples, has dropped to approximately 86%,” she said.
Unions have warned that the power cuts are putting patients’ lives at risk and creating a difficult working environment.
SA’s biggest nursing union, the Democratic Nursing Organisation of SA, said members reported patients being turned away from health-care facilities during load-shedding.
Health Minister Dr Joe Phaahla recently admitted that generators could not meet increasing demands during load shedding in health facilities, leaving some hospitals with no choice but to switch off some critical areas and compromising patient care
Phaahla puts the backlog on elective surgeries in the public sector at between 170 000 and 180 000 cases.
He said the criteria for hospital load shedding exemption includes patient volumes, the nature of specialised services and the technological and medical equipment they have.
Government this week announced that the first of more than 100 privately-owned power plants being developed will connect to the grid by the end of 2023, according to BusinessLIVE.
The National Energy Crisis Committee, run by the Office of President Cyril Ramaphosa, expects record power outages to ease as measures put in place, including a new law to fast-track plant development, take effect, it said this week.
The committee, of which several Cabinet Ministers are members, told business and labour leaders on Monday that a range of interventions had been made as South Africans were enduring blackouts of as many as 12 hours a day.
“As these measures take effect, the supply of electricity will significantly improve,” the committee, known as Necom, said in a presentation.
The government has faced sharp criticism after power cuts were imposed on 205 days in 2022 and every day thus far in 2023, and Ramaphosa cancelled his trip to the World Economic Forum in Davos to hold crisis talks with Eskom, labour groups and business.
The measures that Necom said may ease the crisis include the following:
• The first of more than 100 privately owned power plants being developed will connect to the grid by the end of 2023. In total, the planned projects could produce 9 000MW, much of it for the companies’ own use.
• Emergency legislation is being developed to allow the faster approval and development of power plants.
• Contracts for the construction of plants that will produce 2 800MW of renewable energy for the grid have been signed and construction will soon begin.
• As much as 1 000MW may be imported this year from neighbouring countries and Eskom will buy 1 000MW of excess energy from private producers who already have facilities.
• Six of Eskom’s 14 coal-fired power plants have been “identified for particular focus” in a bid to get them to perform more reliably.
• Efforts to finish incomplete plants and maintenance of other major units are being made.
• The time to complete regulatory processes for new plants has been reduced.
Until then, healthcare facilities have to come up with contingency plans. Prophetically, a study published in the South African Medical Journal in December 2019 warned of the implications of future and increased power blackouts in the healthcare sector, and recommended measures and strategies to cope with these.
Revisiting the study, Medical Brief writes that authors, AE Laher, BJ van Aardt, AD Craythorne, M van Welie, DM Malinga and S Madi, all from the Department of Emergency Medicine, Faculty of Health Sciences, at the University of the Witwatersrand, said power failures and the lack of a robust contingency plan could prove catastrophic in any healthcare environment, with varied, far-reaching consequences.
In 2003, a 28% rise in both accidental and non-accidental deaths was recorded in the USA as a result of mass power outages, and in Ghana, for every day with a power outage lasting longer than two hours, hospital mortality was estimated to increase by 43%.
With Eskom’s increasing dependence on power outages to preserve the little electricity the country is able to generate, thanks to lack of maintenance of power stations, failure to successfully introduce new infrastructure, poor management and corruption, it bodes South Africans well to think ahead and implement alternatives and measures to counteract this, suggested the authors.
The healthcare system is already under extreme duress. In a 2017 survey of 19 developing countries, SA was ranked last on efficiency in healthcare-related expenditure, they pointed out.
While private facilities and secondary- and tertiary-level public hospitals have generator banks, smaller healthcare facilities including primary healthcare clinics, have often been left in the dark, although the government recently decided to exempt a number of public facilities from load shedding.
For those that are not on the list, the cost of alternative sources of power is substantial. Recently, a private hospital group reported an average monthly expenditure of R800 000 to run its generators.
Consequences of no power are many and varied, for example, increasing the risk of everything from food-borne diseases because of dirty utensils and food not being kept fresh to surgeries being postponed to critical devices failing to work.
Sewage and running water system maintenance is vital for healthcare facilities to prevent infection prevention, said the study authors. These are already struggling to meet the demands of public sanitation and water requirements, and during power outages, they become further dysfunctional, and in a prolonged power failure, reservoirs run dry.
Healthcare and theatre staff are often unable to sterilise surgical instruments and other essential items, potentially delaying emergency interventions and increasing risk of complications, and ultraviolet light sources, which help reduce the presence of resilient microbes in critical care areas, may also be dysfunctional during power outages.
Private healthcare regulations demand hospitals provide lighting in maternity delivery rooms, operating rooms, ward corridors and critical care areas during power failures, but currently, there is no legal requirement to provide backup power for maintaining thermal regulation.
However, temperature control during power failures presents a unique challenge: excessively high temperatures are linked to an increase in the proliferation and spread of infection, while excessively low temperatures might induce hypothermia and hypocoagulability.
Additionally, many medications, vaccines and blood products must be stored within specific temperature ranges, their efficacy and safety being compromised during prolonged and unpredictable power outages.
In tertiary hospitals, while most critical devices have built-in back-up battery power, this can be limited during prolonged power outages, and even fail. Although portable oxygen cylinders can be used when the central oxygen supply system is dysfunctional during outages, these are likely to fail during prolonged periods of power loss and ultimately affect patient outcomes.
The authors recommend a series of measures to counteract the debilitating and drastic effects of load shedding:
- Installing uninterruptable power supply (UPS) technology to run computers, label printers, fridges, blood gas analysers, etc.
- Storage and maintenance of fully charged back-up batteries for essential devices
- Stocking of an adequate supply of non-perishable foods
- Load shedding roster to activate additional clinical and administrative staff when required
- Point-of-care ultrasound and laboratory testing as an alternative to formal radiology and laboratory services
- Stringent maintenance and oversight of generators and back-up devices
- Connecting of sensitive and life-sustaining medical devices to red electrical power outlets that are capable of automatically switching between municipal and emergency generator power circuits
- Adequate fuel reserves at hand, with due consideration to cost and shelf-life (~6 – 12 months)
- Implementation of alternative energy sources (wind, solar)
- Consideration of biomimicry architecture and multi-storey ramps when designing new facilities
- Implementation of load shedding action plans and regular drills to test back-up power sources
- Storage of additional oxygen cylinders with regulators, bag-valve-mask resuscitators, oxygen tubing, portable pulse oximeters, manual sphygmomanometers and additional blankets per high-dependency bed
- Establishing of community-based shelters where technology-dependent patients are able to access adequate power supply for continuation of medical care
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