A dramatic drop in water pressure and a shortage is having serious repercussions at Helen Joseph Hospital (HJH) in Johannesburg, affecting critical areas like the emergency department, ICU, the theatres, outpatient clinics, the laboratory, administration block and all wards on the upper floor of the hospital.
CEO Dr Rodney Pheto said on Tuesday that the water supply had been restored on the ground and second floors, but the emergency department, and all surgical and medical wards, were still in a dire situation.
“Services are disrupted but we cannot afford to shut down,” he said.
‘Embarrassing and disrespectful’
A senior clinician said the issue had been ongoing since 1 June, and was “embarrassing and disrespectful to people”.
While water tankers were available, these provided only short-term relief. “Occasionally, a tanker will top up the tanks on the roof and there’ll be supply for an hour or so, but thereafter it gets used up and we are in trouble again,” he said.
At the time of writing, nearly all wards were without water. There are nine medical wards, four surgical, and two orthopaedic wards, each with roughly 30 patients. Each ward shares between three and four toilets.
Emergency department without water
A major problem is that emergency departments and wards are not getting water. There are between 30 and 40 patients in the emergency department – patients with gastroenteritis were reportedly cleaning themselves with tissues or their own clothes.
Staff have described the situation as “inhumane”.
“In our area specifically, it means the taps aren’t working and toilets aren’t working – so all of our toilets, for patients and staff, are overflowing,” said a senior doctor. “It is very difficult to do sterile procedures, to clean patients, to provide drinking water, to wash hands. In terms of the risk of infection spreading, this is massive.”
The water tankers dispatched by Johannesburg Water have not mitigated the situation in the emergency department.
“Staff have been collecting water in plastic five-litre bottles from taps in some other areas of the hospital that are still working, and management has delivered a small amount for patient and staff use, but it comes to about a few hundred (millilitres) each per day.”
Pheto said water tankers couldn’t reach the emergency ward. Water had been transported to the department in buckets, and staff and patients were supplied with bottled water.
Improvised cleaning
The lack of water has seen toilets overflowing with bodily fluids, affecting staff and patients’ bathrooms. Staff have resorted to cleaning vomit and blood off themselves with tissue and D-Germ, a hand disinfectant.
A senior clinician said: “For quick washing, using an alcohol-based wash is not a bad thing… however, if there’s debris on your hand, or faeces, then you actually need to do a proper wash with soap. There are also certain infections that are resistant to alcohol wash, and you must do a proper soap wash of your hands.”
Using an alcohol-based solution for cleaning can work, but not necessarily in the emergency department.
“It is an even bigger problem because we have patients coming in with gastro, with diarrhoea and vomiting, or trauma patients with a lot of blood on them. So, it’s extremely difficult to clean these patients, it’s extremely difficult to change their linen, change their clothing, to do bed baths, and just hygiene in general,” said the senior doctor, who added that they were bringing their own water from their homes.
The doctors’ biggest concern right now was the massive infection risk.
“Especially with the cholera outbreaks … we’ve had cholera patients and have gastro patients …if anything like cholera happens to be in the hospital right now, it will spread like wildfire.”
Lack of communication
There has been little communication from management. “What we get is essentially the same thing, ‘We are looking for the problem and we don’t know what is causing it yet’,” said a senior doctor.
Johannesburg Water conducted investigations and found no problems with its water pressure, saying the issue could be internal.
The hospital has placed an order for portable toilets, but Pheto could not give a timeframe for when these would arrive. These would only be used by staff and escorts, while patients would continue using the hospital’s toilets, despite the challenges.
“This is not ideal,” he said.
The hospital is also diverting Priority One patients who are emergency and critical, and Priority Two patients, to other facilities when necessary.
Although some doctors asked for the hospital’s emergency room to be closed temporarily, Pheto said this was not possible.
“We actually cannot afford to do because we will destabilise other facilities. We’ve got services that run in the hospital that honestly we cannot close down.”
Closing the ER or other departments would overburden Charlotte Maxeke Johannesburg Academic Hospital, Leratong Hospital and South Rand Hospital, he added.
“Previous measures would be to use water tankers to top up the hospital water tank, and usually that would help resolve some of it or buy some time or alleviate. But this time, because they can’t identify where the issue is, it is insufficient,” said one doctor.
The water tankers had prevented a catastrophic water failure but were not sufficient to address the challenges.
“I don’t personally think it was adequate. There’s still no water in the wards; I don’t know if patients are cleaning themselves since there is no water in the showers, let alone hot water,” said the senior clinician.
Permanent solutions in pipeline
The hospital plans to increase the size of the pipe supplying water to the hospital, and to boost the pressure. Pheto said there was a need to procure a second pipe for backup if one water supply pipe failed.
The hospital would also divert water from non-essential structures, such as the nursing college.
Gift of the Givers installed a borehole at the hospital that provides four or five green water tanks, but inadequate pressure hinders its supply to all parts of the hospital.
A doctor told Daily Maverick the Gift of the Givers borehole has always had a pretty low flow rate.
“Unlike Rahima Moosa (Mother and Child Hospital)’s boreholes, it’s not nearly enough to supply the rest of the hospital. (It) does at least allow for food to be prepared and for some small amounts of water to be provided for patients to drink – not enough for toilets, basins and laundry, though”
Pheto said the hospital needed water flowing from a high-pressure area.
“The Gift of the Givers borehole has to be a backup plan, but only for the ground floor. The water coming from that will never actually even reach the first or the second floor. So, at the moment, it’s completely out of the question that we can rely on that water.”
See more from MedicalBrief archives:
Water supply problems compound issues at Helen Joseph Hospital
Helen Joseph doctors’ plea for action as hospital in ‘dire straits’
Helen Joseph allegedly a fire hazard before 2010 World Cup, and still is