Healthcare workers are continuing to take strain from rolling power blackouts, with complications ranging from from non-functioning life support machines to essential medications going bad and power surges causing expensive equipment to blow.
“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 miscarried, 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 cited by Brink in an emotional 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.
Various healthcare workers told Maverick Citizen rolling blackouts were having a spiralling effect on their practices, people’s health and access to healthcare services.
Stress and anxiety
They said 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 Gauteng hospitals advising them that rolling blackouts were affecting networks in labs: “We are trying our best to ensure the integrity of samples is maintained. Kindly note this has a negative effect on turn around times.”
At the trouble-stricken Helen Joseph Hospital in Johannesburg doctors say during power outages, 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”.
Other health workers said:
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, 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 increase the burden of infectious gastroenteritis, 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 and can’t get the services they need when they arrive, 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 halts the whole network. 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 units rely on warming machines and CPAP machines. If the machines lose power momentarily, even in the few minutes it takes before they reboot, it can harm babies. Prolonged loss of power is a disaster. We can certainly attribute some deaths to this.”
Brink said in late December 2022 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 000g and couldn’t be transferred.”
Professor 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; children requiring home nebulisation from electricity-driven nebulisers; oxygen generators for oxygen-dependent people failing, infants having to be fed cold formula constituted from unsterilised unheated water; multitudes of citizens having food rot in their refrigerators and having to throw it out; fire hazards from having students/children 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:
“We have had lab challenges, both in processing samples and with the lab often offline centrally so it is challenging getting investigations done or results. Both lead to a negative impact on the care provided.
“In addition, patients on home oxygen with 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:
“Two X-ray machines 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 log queues at the X-ray dept.”
Dr Sham Moodley, Vice Chair of the Independent Community Pharmacy Association:
“At a pharmacy level the stability of the fridge items is 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 affects medicine stability and patient care.
“The added cost of generators and inverters is not factored into the dispensing fee model of pharmacists – so there is a struggle to maintain the service levels versus costs related to load shedding. The industry is very computer dependent. The equipment is not coping with the unstable supply and 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 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 run daily, 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.”
Professor 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.”
Rural doctor in the Eastern Cape:
“Our metro call centre doesn’t have a functioning generator, 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 as 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.”
From surgeries being delayed to equipment malfunctioning, the list is endless.
Specialist anaesthesiologist Dr Caroline Corbett, president of the SA Society of Anaesthesiologists, said a recent surgery involving a semi-deaf child receiving an implant and hearing device test had to be halted, reports Sunday Times.
The operation, scheduled to fall between power outages, reached a delicate stage when load shedding went from stage three to six, damaging equipment.
“The transition from mains to generator power is what destroyed the equipment as its internal hardware was not designed to tolerate load stresses or fluctuations of this magnitude,” Corbett said.
“In the anaesthesia, we work in a particularly technologically dependent space with monitoring, interventional, resuscitative, ventilation, record keeping, and drug delivery equipment all relying on a form of direct or indirect power supply.
“Most of this hardware also requires software and the repeated outages, disruptions in internet connectivity, ability to successfully reboot becomes not just difficult but in many cases, impossible.
“The large majority of our equipment is not locally manufactured and doesn’t factor in sustained periods of battery usage, especially beyond four hours.
“Alternatively, equipment fails, patient safety is significantly compromised … or the theatre service can no longer run and patients aren’t afforded access to care. This directly threatens every effort being made to address universal health care access.”
While many facilities and clinics have generators and UPS systems, medical disciplines such as surgery are affected.
Western Cape Health Department spokesperson Maret Lesch said emergency surgeries were being performed, but “elective surgeries are postponed, resulting in backlogs”.
Clinic services affected by prolonged outages involved electronic systems, test results, radiology, patient referrals and transfers, pharmacy scripts and dispensing medication.
“Many of our staff have to work extra hours to capture patient data and catch up on administrative tasks when the electricity is restored,” Lesch said.
Private hospital group Life Healthcare had an “unprecedented level of electricity outages” with 1 300 hours of them from January to September 2022.
“This was almost double the total hours of outages during the 2021 financial year,” CEO Adam Pyle said. “Our diesel consumption for the 2022 financial year was close to 1.3m litres compared with the almost 365 000 litres used in the 2021 financial year. That’s an almost 3.5 times increase.”
Pyle said prolonged use of generators pushed up costs, including maintenance.
“The energy crisis affects the public and private health-care sectors … We are absorbing the costs but if load shedding stays at these unprecedented levels these costs will ultimately result in the cost of health- care, both private and public, increasing,” he said.
University of Cape Town (UCT) public health specialist Professor Leslie London said “maintaining a cold chain for vaccines and other medicines is always a priority, and with longer power outages, it will become more difficult to ensure that vaccines do not become ineffective”.
London said clinics, the backbone of the proposed NHI, were a concern. “Preventive measures are not the mainstream of big hospital services, so it will be primary care and prevention that is hit most. It’s clear that power outages of the scale we are experiencing now will make maintenance of such services very difficult,” he said.
South African Medical Association spokesperson Nomonde Sussmann said GPs struggled to process electronic medical aid claims, online authorisations, bookings, obtain laboratory data, and power surges also damaged their equipment.
“Increased costs of alternative power sources like diesel, inverter and battery systems have escalated for all businesses, including private practices. Fridge line medications kept overnight in practices affect the efficacy of these medicines resulting in doctors having to dispose and incur the cost of replacement.”
Sussmann warned this would ultimately push up the cost of medical care or force some GPs to close their doors.
Sussmann said more load shedding could see hospital admissions increase as people using alternative sources of power like candles and paraffin were injured in accidents. There had also been a spike of gastrointestinal infections due to poor water quality, worsened by power outages.
National Health Department spokesperson Foster Mohale said the Health Ministry had not received reports from provinces indicating a huge load shedding impact: “That’s simply because we have committed to provide health facilities with resources to fuel and maintain alternative sources of energy.”
Meanwhile, for patients battling the curse of blackouts from their homes, the situation is just as dire. Every time load shedding is ramped up Steven Williams and his ailing brother Deon, who depends on oxygen to survive, feel a sense of panic.
The Johannesburg father has been caring for Deon since he was diagnosed with chronic obstructive pulmonary disease (COPD).
An inverter and three batteries to ensure an uninterrupted oxygen supply at home can no longer cope with the outages. Three weeks ago the 57-year-old was admitted to hospital after experiencing breathing difficulty.
“Because of the short breaks in-between load shedding the batteries don’t charge enough … if we have a four-hour load shedding my brother often has to use the manual oxygen cylinder,” said Steven.
“Since load shedding intensified he has spent more time in hospital as he often struggles to breathe at home. We are always on the edge … not knowing what might happen next. I sleep with one eye open to ensure the batteries don’t run flat.”
Sunday Times PressReader article – Blackouts put health care at critical risk (Open access)
See more from MedicalBrief archives:
72 hospitals now exempted from load shedding
Clarion call for hospital load shedding exemption
Bara coughs up R3.4m for generator diesel during 2022 load shedding
Load shedding: the doctor is out (of electricity)