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Legal action threat as hospitals struggle with load shedding

As healthcare workers continue to feel the brunt of ongoing load shedding, a union is threatening to take government to court over the widespread impact the power cuts are having in the sector, saying the matter was now one of “life or death”, writes MedicalBrief.

Patients are dying at state hospitals because of load shedding and doctors are forced “to make terrible choices over who lives and dies”, claims the Health and Allied Workers Indaba Trade Union (Haitu), which has called for government compensation for families affected by deaths resulting from load shedding.

The lack of energy was a matter of life or death, said Haitu president Rich Sicina, saying the union was concerned about the rapid deterioration of health standards from rolling blackouts and water shortages in all public health facilities, according to a report in The Citizen.

Only 77 hospitals were exempt from load shedding, out of 400 public healthcare facilities countrywide.

“It is a disgrace the government has allowed Eskom to collapse to this point, forcing healthcare workers to operate under such strenuous conditions,” said Sicina.

It was equally shameful that the government was so complacent about resolving load shedding, which had resulted in scores of unnecessary deaths in state hospitals.

Patients depend on equipment

“Every day Haitu receives reports from nurses about shocking conditions they are forced to endure because of water and power shortages. Nurses and doctors are forced to make terrible choices over who lives and dies.

“Not enough staff are available to resuscitate all the patients who depend on life-saving equipment like ventilators,” he said.

Public hospitals at risk

He said the “selfish government has responded to business by promising to compensate them for their financial losses, caused by load shedding” and the Health Department should record and make public the daily reports on the number of patients dying because of load shedding.

The union intends to file evidence in court later this month of the impact of load shedding on the healthcare system and how it is destroying public health.

Nurses, he said, are also fed up with relying on cellphone torchlights, unreliable generators and using cooler boxes to keep vaccines and other medicines at the correct temperatures.

A nurse who has worked in the maternity ward at the Alexander Health Centre and Clinic since 2021 told Health-e News the past few months have been among the hardest of her career, because load shedding often makes it impossible to offer the most basic service: checking blood pressure.

High blood pressure in a pregnant woman could indicate pre-eclampsia, a common cause of death among birthing women in SA. But if the backup generator doesn’t kick in during load shedding, the blood pressure machine does not work.

“The incubator doesn’t work. The suction machine also doesn’t work. It’s frustrating to tell patients to wait because we cannot access their medical records. Or to tell expectant mothers that we can’t check the health of their baby because the ultrasound is off. During an episiotomy, it is difficult to do the surgical cut and stitching because we can’t see. We have to suture all layers of the skin.”

Professor Lawrence Chauke, Clinical Head of Obstetrics and Gynaecology at Charlotte Maxeke Academic Hospital, said load shedding has huge negative outcomes on patient care. Although the hospital has been exempt from power cuts since last year, there are still challenges.

“Because other areas are undergoing load shedding, we have interruptions with the cellphone and internet network. Therefore, reaching out to on-call doctors who might be in other areas to refer, follow up, or ask for a different opinion, is difficult.”

Unless hospitals can also be exempt from the consequences of load shedding to other infrastructure, like cellphone towers and phone lines, patient care will still be compromised in one way or another, he added. Patients at public healthcare facilities rarely see the same doctor at all their visits.

“We can’t easily access the patient records on the system, which means we don’t know what treatment plan was recommended to the patient by another doctor and can’t easily continue. It does not matter that we are exempt: caring for patients is still compromised.”

Generators can’t power all machines

Hospitals prioritise certain machines, especially those in the ICU, to use the generator, he adds.

“You might find the generator powers only one machine. So patients sit for hours until the power returns because we can’t decide how to manage them.”

Another problem is how constant load shedding is damaging hospital machinery. Most of the machinery in the hospital, like the ultrasound machine, doesn’t come with a service agreement. If it breaks, the hospital has to wait until someone approves repairs, which could take weeks or months.

Most facilities have generators, but this does not help during stage six load shedding. Facilities can’t buy diesel in surplus and store it because it gets stolen. This places the facility at risk of randomly running out of diesel.

Load shedding ultimately worsens existing challenges within the public health system, resulting in a bigger burden for public healthcare users and HCWs.

Infection control concerns

The nurse said they scramble to preserve vaccines and medicines kept in fridges when the power goes off.

“We use cooler boxes filled with ice packs to keep vaccines and other medicines as cool as possible,” she said.

The fluctuating temperatures from the disruption in the power supply also often affect temperatures in the wards and places patients at a high risk of infections. “Operating with scissors under very high temperatures will, for certain, leave the patient with sepsis.”

Bongani Mazibuko, provincial secretary of the Democratic Nursing Organisation of South Africa (Denosa), said the strain of the power cuts on the staff, and the impact on their ability to work, was unacceptable.

“We can’t keep putting them through the strain and stress of caring for patients without the tools and structural support to do so. The severity of the impact of load shedding on patients and healthcare workers will be an additional crisis in our health system.”

Denosa says clinics should also be exempt from load shedding. Very few can operate during power cuts.

“HCWs cannot provide services with no lights and with no network. Denosa calls for all clinics to be exempt from load shedding and equipped with generators or other power supplies.”

Professor Francois Venter, head of Ezintsha at the University of the Witwatersrand, agreed that the government was responsible for many deaths.

He said sadly, however, it was hard to prove it.

“It is completely immoral that government hospitals do not have working generators or clean water, while government Ministers do,” he said.

‘Human rights violation’

DA Gauteng shadow MEC Health Jack Bloom said it was horrifying that medical staff had to choose who lived and who had to die.

“If people die of power failures it is a human rights violation. It’s shocking that only half of the hospitals were exempted from load shedding,” he said, calling it medical negligence.

Meanwhile, spokesperson for the Eastern Cape’s provincial health department Yonela Dekeda has confirmed that the generator at Kareedouw Hospital has been broken for weeks, but denied babies were being delivered by torchlight.

The generator packed up more than a month ago, leaving the hospital without backup power during load shedding, but the department says this is not important, because “it’s a a small hospital and the lack of a generator has no bearing on patients’ care”.

The facility, also known as BJ Vorster Hospital, serves thousands of families in the KouKamma Municipality, including those from settlements in the Tsitsikamma and Storms River areas, writes Joseph Chirume for GroundUp.

Kareedouw, 120km from Gqeberha, is extremely hot in summer, and residents fear that prolonged load shedding, coupled with the high temperatures, may affect services at the hospital.

“Nurses are using cellphones to light the corridors when there’s load shedding because the generator is not working,” said a resident.

A local businessman said the generator had not been operating for more than a month. “I have witnessed technicians working on it on numerous occasions. We fear that the children’s’ section and lifesaving medical processes could be affected if there is prolonged load shedding,” he said.

Russell Rensburg of the Rural Health Advocacy Project said hospitals should all have functioning generators as backup. “It’s unacceptable that both management and provincial authorities have not addressed the situation.”

When GroundUp visited, there was no load shedding and the lights were on. We tried to speak to the hospital’s chief executive officer but he was at a funeral. None of the staff wanted to talk on the record about the generator.

DA shadow Minister for Health Jane Cowley wrote to Eastern Cape Health MEC Nomakhosazana Meth at the end of January. complaining that the generator was not working.

“The generator malfunctioned at the start of the year, endangering patients’ lives whenever load shedding is being implemented. Three weeks have passed, but it has still not been repaired.

“Nurses are now forced to bring torches with them to work, while critical lifesaving procedures must be scheduled according to the latest load shedding schedules. How is it possible that babies are being delivered by torchlight?”

Dekeda confirmed that the generator was not working, but denied nurses were using torches.

“The backup generator is currently not operational and the department has prioritised the repairs. The fault assessment has been done and the repairs are in process.

“The department has procured emergency lights in the interim to provide basic lighting during load shedding. All of our medical equipment is battery backed-up and charged during the time when there is power.”

Dekeda said said that medical care was offered even when there was no power. “BJ is a small hospital with no theatre and ICU patients requiring more medical care are normally referred to Humansdorp Hospital (about 50km away). That the generator is not working has no bearing on patients’ care.

“The hospital uses gas stoves in the kitchen and also has a mobile lamp that is battery backed-up.”

 

GroundUp article – This hospital’s generator has been broken for weeks, but the Eastern Cape health department says it doesn’t matter (Creative Commons Licence)

 

The Citizen article – ‘Govt must pay for deaths’: Staff can’t resuscitate all patients when lights go out (Restricted access)

 

Health-e News article – Strained energy grid strains healthcare workers (Creative Commons Licence)

 

See more from MedicalBrief archives:

 

72 hospitals now exempted from load shedding

 

Bara coughs up R3.4m for generator diesel during 2022 load shedding

 

Eskom load shedding limiting Gauteng surgery schedules — DA

 

Healthcare workers tell of the devastating toll of rolling power cuts

 

 

 

 

 

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