Private and public hospitals’ efforts to render lifesaving services to their patients have been dealt yet another blow with the implementation of a new round of Stage 6 rolling blackouts. And with indications that things could get worse in the foreseeable future, hospitals and the Department of Health are scurrying to find solutions to a life-threatening crisis. Chris Bateman reports for Medbrief Africa.
“Hello darkness my old friend” – NOT our song, say hospitals
An ambitious two-year plan to provide solar power to prioritised State hospitals facing increasingly critical power outages is underway, with wind-energy harnessed in appropriate provinces.
The CSIR is conducting an analysis of power-critical areas in hospitals providing 24-hour care and emergency services before the solar roll out begins. Funding has been ring fenced by National Treasury to ensure the success of the project.
Meanwhile disaster management chiefs, the national health department, Eskom, and municipalities are trying to solve the existing hospital power supply ‘Rubik’s Cube’ crisis and reduce the multiple and potentially fatal impacts of ever-increasing load shedding on patients.
As of early this January, 79 of the country’s 420 public hospitals (18%, excluding 3000 state clinics), had been rendered exempt from load shedding, while private hospital groups continue to negotiate individually with municipal electricity suppliers. Most of the now exempt State hospitals already had direct and dedicated Eskom power supply lines, unlike hundreds of their counterparts that are locked into neighbourhood and municipally controlled power supply networks.
Solar is cheaper and far quicker than laying dedicated power lines to hospitals where patients are identified as most vulnerable. Both options would protect the national grid because most hospitals are connected to their surrounding suburban power supply network, rendering power outage exemption counterproductive. Without stand-alone, dedicated hospital power supply, the risk is that too many load-shedding exempted facilities, (and thus connected neighbouring suburbs), would collapse the national power grid.
The complexity of keeping, prioritised hospitals on full power while ensuring sufficient fuel supplies for a minimum of four-hour diesel generator backup – for them and less fortunate facilities, emerged this week in interviews with the country’s health infrastructure Chief Director, Ayanda Dakela, and Dr Wayne Smith, a leading disaster management practitioner.
Dakela said it was not necessarily the bigger hospitals like Chris Hani Baragwanath that had pre-existing, dedicated Eskom lines.
“It varies from big hospitals to the smaller ones. Most however, are supplied with power by local government, so isolating those 79 in our first phase was the easy part. Phase Two will be where we talk directly to local government to help exempt hospitals – which is time-costly. Laying dedicated lines is not only expensive but subject to zoning and environmental impact assessments, so solar – and wind turbines in parts of the Eastern Cape for example with strong wind – is far quicker and more cost effective,” he said.
Dakela said fortunately the load shedding hospital crisis came to a head just before their financial year planning was completed.
Dr Wayne Smith, Director of Disaster Management for the Western Cape, and leading advisor to his provincial peers, says, “it’s not that the hospitals use a lot of power – it’s that they’re embedded in the community with the power supply configured that way. The other knock-on effect is that a lot of switch overs are done by municipal staff who must go to the junction boxes to do the switch overs- it’s not all automated from a single board. We’re trying to create dedicated feeder lines to isolate the most essential hospitals from the grid but that has cost implications. We’ve placed several applications for this based on triaging the most vulnerable hospitals. The risk assessments still need to be done by Eskom. I can assure you it’s not a case of Eskom or municipalities being reluctant to provide load shedding exemption – most people just don’t understand the knock-on effect on the national grid,”: he explained.
Meanwhile two leading doctor organisation chiefs have singled out the exemptions from load shedding that MPs enjoy, juxtaposing this with ill and critically ill patients in hospitals. South African Medical Association acting chairperson, Dr Mvuyisi Mzukwa said he knew of MPs in his hometown of Durban who enjoyed this privilege, albeit benefitting the communities who happen to live around them.
Dr Caroline Corbett, President of the influential South African Society of Anesthesiologists, SASSA, said it was “terrifying that your hospital may regularly be without power and that we come to accept this as the norm.
“How are we supposed to provide sustainable health care in a setting like that, with all the numerous pre-existing challenges and Covid-induced backlogs?”
She urged the authorities to recognise the cross pollination that exists between the public and private sector (where 85% of anesthesiologists work) and to treat the health care system as a single unit.
Dr Mzukwa, also a private practitioner, said it was facile to say 80% of the public was supported by public sector health facilities when a huge proportion of lower income patients consulted GP’s and specialists out of pure frustration at the dysfunctional public health system.
He said smaller practices were hardest hit by power outages as they had to purchase back up generators, constantly fix power surge damaged or ruined equipment and cancel or postpone elective surgeries due to growing backlogs and the heightened risk factor.
Corbett added; “uninterrupted power should be non-negotiable. Healthcare is an essential priority. Unfortunately, in the president’s address this week, it did not appear as a priority – it was not even mentioned. That’s very sad for healthcare activists like myself. Power outages speak to every aspect of budget and care. If we can’t have a healthy nation, how do we function? We’ve just been decimated by COVID-19, and our power supply is now completely inequitable and very unreliable.”
She illustrated this by saying a recently completely SASSA survey of members showed that in certain areas of KwaZulu Natal and the Eastern Cape, respondents did not even realise they had load shedding because they so seldom had regular power supply.
“That’s frightening,” she said.
So far, no patient death has been publicly linked to load shedding, but, says Mzukwa, that’s either a function of poor data collection or, “simply a matter of time.”
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