Blackouts put health care at critical risk

Having a steady supply of oxygen is a matter of life and death for Deon Williams, above

● 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, 61, 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.”

Patients, hospitals and clinics — even with backup power — aren’t immune to SA’s energy crisis. Specialist anaesthesiologist Dr Caroline Corbett, president of the SA Society of Anaesthesiologists, explained how a recent surgery involving a semideaf child receiving an implant and hearing device test was halted.

The operation, scheduled to fall between power outages, reached a delicate stage when load-shedding went from stage 3 to 6, 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 experienced 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 1.3-million 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 Prof 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 such as 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 such as 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.

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.”