Tuesday, 28 September, 2021
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Unrest abates but effects on health care will be far reaching

While the violence and looting that wracked KwaZulu-Natal and parts of Gauteng last week has abated, the health effects are likely to be far reaching, warn experts.

As reported in MedicalBrief last week, severe staff and pharmaceutical shortages, temporary closures of health facilities or services – including dozens of hospitals and clinics – and treating patients for protest-related injuries have piled extra pressure on the health sector. At least 121 pharmacies were looted in KwaZulu-Natal and Gauteng, 51 of them independently owned.

Estimates are difficult because damage is till being quantified but in Durban’s economic zone alone, around R1.5bn in stock has been lost, with R15bn in damages to property. Business Leadership SA estimates that 50,000 informal traders and 40,000 businesses of allkinds have likely been impacted by the violence and looting, and warns that as many as 150,000 jobs are at risk, meaning as many as 1.5m homes are without incomes. A preliminary estimate of the claims that insurer SA Special Risk Insurance Association (Sasria) will have to deal with varies from R7bn to R30bn.

At least 70 optometrist practices were looted. A dialysis centre in Durban  and another in Johannesburg were also targeted, with facilities were looted of TV sets, laptops and computers. Ambulances, including some with patients, were also targeted.

Health regulatory bodies the availability of controlled substances and looted medicines may endanger the health of community members who may consume them without supervision and guidance from healthcare professionals.

“We would like to urge the public not to utilise any medicines that are not accessed through authorised health care institutions. You may report such illegal activity to SAHPRA or to law enforcement agencies,” the South African African Health Products Regulatory Authority (SAHPRA), Health Professions Council of South Africa (HPCSA), Office of Health Standards Compliance (OHSC), South African Nursing Council (SANC) and South African Pharmacy Council (SAPC) said in a joint statement.

“We appeal to citizens looting and destroying the healthcare infrastructure and disrupting the provision of health care to consider the long-term consequences of their actions on the health of communities. Without health care services, the requisite medicines and vaccines, we will have unnecessary deaths and cause further pandemonium, including severe damage to the economy," the bodies said.

They said that with the help of the Health Department, they were working closely to ensure the provision of essential medicine, including chronic medication and vaccines, were restored.

Dr Prudence Buthelezi, general secretary of the National Health Care Professionals Association, said many health care professionals had put duty above personal interest. “Some of them have returned to work on empty stomachs because the shelves are empty and they are needed at the hospitals because they understand the oath they have taken. But it is difficult,” she said.

So volatile was the situation in KwaZulu-Natal this week, with roads blocked and vehicles and trucks being torched, that many medics resorted to camping at their workplaces. National Education, Health and Allied Workers' Union (Nehawu) spokesperson Zola Saphetha said: “Some who used their own transport have suffered, too, as some had their cars damaged.”

KwaZulu-Natal Health MEC Nomagugu Simelane said direct threats were received by staff at various hospitals and clinics including Edendale, Osindisweni, Mahatma Gandhi Memorial Hospital and KwaDabeka community health centre. In Queenwood, Durban, looters targeted the SA National Blood Service, where items stolen included test tubes and equipment meant for blood collection.

Independent Community Pharmacy Association CEO Jackie Maimin said the looting of Cipla — a manufacturer of generic medication in Durban — would have serious repercussions for medicine stock in the province. “The pharmacies in KwaZulu-Natal have not received a delivery since Monday, a big manufacturer has been knocked out and so too have our wholesalers which distribute 75-80% of all pharmaceuticals in the province. We are very concerned about stock there.”

She about 70 pharmacies were attempting to reopen for short periods to dispense emergency medicines. “We are supplying smaller quantities so that there is enough for everybody to get their medication.”

The worst is yet to come

Medical staff are concerned the worst is yet to come. “We are not even halfway through our Covid-19 vaccination rollout programme but what we saw unfolding this week was disastrous,” said a Gauteng doctor. “We watched as people, some not even in their masks, collected and spread Covid-19 without a care in the world. If we think Covid-19 has been bad, if we think hospitals have been strained, wait and see the true repercussions of it within a few weeks.”

Hit by the dual crises of Covid-19 and civil unrest, funeral practitioners in Gauteng and KwaZulu-Natal have raised the alarm that they will soon run out of coffins.  Monageng Legae, the spokesperson for the South African Funeral Practitioners’ Association, said that they are experiencing a shortage of coffins because their supply chain for the two provinces has been interrupted by the civil unrest.

KZN’s Simelane warned that if a community loses a clinic or a hospital now, it won’t be rebuilt because there is no money.

Simelane said many hospitals were running out of food and would soon have an oxygen crisis if nothing changes. She said specialist services, X-rays and some surgeries were no longer available and expressed concern over pregnant women as well as Covid-19 patients getting the care they need. She added that the looming fuel crisis will also have a dire effect on emergency medical services.

There had been a big increase in people needing urgent medical help after being stabbed, shot, burnt or run over by vehicles. “The blockading of provincial and local routes has had a severe chain reaction, with potentially dire consequences for our compatriots. It has had a direct bearing on the prospects of recovery for those who are sick or injured, and for those who need to go into life-saving medical procedures.

Simelane said many facilities were unable to perform X-rays and no referrals to specialist care were being made because patient transport had collapsed.

“Direct threats have also been received by staff at various hospitals and clinics including Edendale, Osindisweni, Mahatma Gandhi Memorial Hospital, and KwaDabeka Community Health Centre. The majority of clinics that are run by eThekwini Municipality have had to be closed due to the unrest,” Simelane said.

Doctors Without Borders on expressed their deep concern over the impact of civil unrest in Gauteng and KwaZulu-Natal on healthcare services. “The unrest also prevents the provision of essential healthcare delivery by blocking patients, medical staff and critical supplies from reaching facilities.

They said there had been disruptions in every district of KwaZulu-Natal, where staff cannot work because of public transport stoppages, road closures and the suspension of private ambulance services. “Emergency departments, which are already stretched by a surge in Covid-19 cases, are overwhelmed due to staff shortages and a huge influx of trauma cases linked to the violence, forcing doctors to choose who receives life-saving treatment, and who does not,” their statement continued.

The Doctors Without Borders team was blocked from assisting with the Covid-19 response in the province, according to the statement, and a decade-old HIV/TB programme had to be abandoned after the team was threatened.

Earlier in the week spokespeople for Netcare and Life Healthcare in the province confirmed that their facilities were still open but under pressure because of staff shortages and the interruption of contracted services as a result of the civil unrest.

South Africa’s National Health Laboratory Service (NHLS), which does Covid-19 testing for the public health sector, has warned that its operations in Gauteng and KwaZulu-Natal have been affected by civil unrest in the two provinces.

KwaZulu-Natal has been particularly hard-hit, said NHLS spokesperson Mzi Gcukumana. He said testing was not possible at the moment for the province, and patients who are sick are not coming forward for testing, putting more communities at risk of contracting Covid-19.

While South Africa is still calculating the tally of the vaccine stock and medicines stolen in last week’s unrest in KwaZulu-Natal and Gauteng, there is still much uncertainty about plans to restore medicine security.

Shafrudeen Amod, a pharmacist in Durban, says with big retail pharmacies closed many independent community pharmacists are now left to deal with patients running out of medication for both communicable and non-communicable diseases, with crucial support and communication lacking from the government and the Pharmacy Council.

“It’s all good and well to make statements about stolen medicine, rightfully so, but now what? What are the plans? Instead, we now sit with a legal and moral abandonment of patients and pharmacists,” Amod says.

“We understand that medicine was stolen, but that is not the biggest priority. It is those people who are alive now and to keep them alive by providing them with their prescription medicine. We are all waiting for guidance. What do we do to facilitate access to prescriptions?” He warns we may end up in a situation where people want to bulk buy and then, what steps are there with rationing?

Amod says at the moment the big retail pharmacies tell their patients to go to their nearest pharmacy and get community pharmacists to call them regarding prescriptions. “We don’t have time to do that. How legal is that? Will it be acceptable for the Pharmacy Council and medical aids to do that when there are no physical prescriptions?” he asks.

“A chain reaction is now in place where patients are being deprived of access to proper pharmaceutical care. Innovative mechanisms should be put into place until services normalise.”

One such temporary measure, he says, is to issue the pharmacies with temporary Section 22(a) permits. Section 22(a) of the Medicines and Related Substances Control Act provides for a concession granted to an organisation or person rendering a health service (the right as authorised by the director-general of health) to acquire, possess, use or supply any Schedule 1-4 substance.

“It will provide us with a temporary solution if certain pharmacists were issued with these permits, particularly in the hard-hit areas. It means that they can continue with diabetes, hypertension, and ARVs without patients having to consult a doctor first and especially since most of the prescriptions records were destroyed,” says Amod. Most chronic medicines are Schedule 3 to Schedule 4 medicines.

“We need to implement mechanisms to ensure continuity of supply of medicines.”

In Gauteng, Right ePharmacy in a statement announced that it will permanently close all ATM pharmacies in the province. Three of their four sites were destroyed in last week’s unrest. The ATM pharmacies, as they were known, are pharmacy dispensing units which “served almost 55,000 patients and dispensed more than 710,000 chronic medicine prescriptions”.

Government says vaccination efforts not seriously impeded

The situation may still appear uncertain for medicine security but at least South Africa’s vaccination efforts have not been floored by the riots, writes Spotlight. The deputy director-general in the health department, Dr Nicholas Crisp, during an interview on eNCA on Monday said the country had its best performance yet, with more than 223,000 vaccine doses administered in 24 hours.

“Things have been picking up nicely and once KwaZulu-Natal is completely in the swing of things, and Gauteng, I’m sure the figures will pick up even more,” he said.

Tlala said that the Covid-19 vaccine follows a supply line, moving from a storage facility to the vaccination site in short intervals and as such, the impact on the roll-out will not necessarily be the lack of vaccines, but fewer vaccination sites.

Crisp says most of the losses were in the private sector in KwaZulu-Natal.

“We did lose some of these [vaccines] allocated to the distribution network of the private sector.

“Fortunately, there wasn’t that much in the portions of the supply chain that were damaged, so it has not been too great a loss. And the public sector vaccines are spread over a large number of facilities and we are protected so, fortunately, we have not lost a lot by way of vaccines but we have lost a lot of opportunities to vaccinate people.”

Crisp quantifies it as between 40,000 and 50,000 vaccine opportunities lost per day in the two provinces last week, which amounts to about 300,000 vaccine opportunities during the unrest. DM/MC

 

Full New24 story: Health bodies urge public not use looted medication (Open access)

 

Full TimesLive story: Looting deals body blow to health care and flood of Covid-19 cases will follow (Restricted access)

 

Full Daily Maverick story: A desperate plea to protect healthcare facilities, staff and patients (Open access)

 

Health and Unrest: Counting the cost and getting people their medicines

 

From the MedicalBrief archives:

 

Violence and looting cripple healthcare across Gauteng and KZN

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