South Africa: In-Depth - What South Africa's Power Cuts Mean for Health Facilities

Most people in South Africa will be familiar with that moment of sudden silence when the lights go out and you realise that load shedding has just started. Load shedding or power cuts to call a spade a spade, has become an inconvenience most people simply have no choice but to endure.

Something fewer people will have experienced is that moment when the power kicks out, and rather than your house, it is a hospital room or theatre that is plunged into darkness. As stated in a 2019 paper in the South African Medical Journal, power failures and the lack of a robust contingency plan could prove catastrophic in any healthcare environment, with varied and far-reaching consequences.

The consequences of power cuts in healthcare facilities can indeed be "varied and far-reaching" including losing power in theatre, various types of electrical equipment not working, food spoiling, refrigerated medicines becoming too warm, or computer systems becoming temporarily unusable.

Power cuts can also result in increased admissions. A paper looking at the effect of load shedding on paediatric hospital admissions in Cape Town found a 10% increase in hospital admissions for days where load shedding was experienced on the same day, or no more than two days prior, compared to when there was no load shedding in the past two days.

Backup power

Dr Tony Behrman, CEO of Qualicare (Independent General Practitioner Network), says all government hospitals are supposed to have an Uninterrupted Power Supply (UPS) and Critical generator backup power supply and they must be able to run non-elective procedures during power cuts.

"The response time for an alternate power source, like a UPS in the event of a power failure, needs to be faster than 0.5 seconds for all medical equipment in ICUs, theatres, and recovery areas where there are high-risk patients. This sort of response speed can only be met using a UPS," he says. "Unfortunately, most UPSs only function for a limited time before they need re-energising, and as a result, hospitals are required to invest in multiple UPS battery back-ups, each of which must deliver power for a minimum regulated 20 minutes as per SANS 10142. This power source is, however, only a temporary bridge that ensures enough time for the compulsory alternate source of power from a Critical generator to supply the hospital."

In short, if things work as they should, you'll hardly notice when the power kicks out, and the hospital switches first to UPS and then to the generator.

Behrman says these generators must be able to function for at least 24 hours or for a minimum of three hours to complete surgery and evacuate the building, and the day theatres, if required.

Many of the private hospitals, Behrman says, have voluntarily further invested in large Base Load generators (you often see them outside the hospitals in a dedicated outdoor area).

"They can run for many days on end depending on the supply of generator diesel available," he says. "In times of severe power outages, however, there may be severe rationing of diesel, which may result in fuel being diverted to hospitals of differing priorities by the state."

Management responsibility

"The major challenge for many South African facilities is that they fail to ensure that their backup generator is well-serviced and up to date," says Sibongiseni Delihlazo, spokesperson for the Democratic Nursing Organisation of South Africa (Denosa). "Because it may take up some time before they experience power outages, some managers tend to neglect this area of ensuring the generators are well-serviced. When the power outage hits, some are caught unprepared, which compromises the healthcare workers. While some institutions neglect this area, others tend to be let down by their own bureaucracy where it takes time before fuel is bought, for instance."

One problem, according to Delihlazo, is that many institutions neglect to put together health and safety committees on which workers and managers are represented. He argues that failing to establish these committees can result in blind spots regarding potential problems with backup power.

He says it would be difficult to get accurate statistics on power-related incidents at hospitals since some incidents won't be reported. "This is where our concern is - that it has not been reported does not mean it has not happened."

Concern about rural areas

Delihlazo is particularly concerned about rural areas. He says municipalities with good infrastructure typically spare healthcare facilities from power cuts, but this is not always the case in municipalities with poor infrastructure. "It would be appreciated, that as new facilities are built, they take this into account, because it may be that facilities built before times of load shedding may have overlooked this critical area because load shedding was never there," he says.

And, as Delihlazo points out, healthcare workers have no choice but to find solutions when the lights do not go back on as they are supposed to.

"In cases where there is a power outage, they will do their level best if they were in the middle of a procedure so that a patient could survive especially when it is obvious that the patient's life could be compromised if they don't intervene and electricity won't come back," he says, describing how sometimes mobile phones are used to provide light in emergencies.

"This is why we would often appeal to institutions especially those in the rural areas that they must please ensure that their back-up generators are serviced during load shedding," he says, adding that the alternative is to refer a patient to the nearest facility that is in working order - but the challenge with that, he says, in rural areas is the shortage of ambulances or the time it takes to repair broken equipment.

Power cuts in the Western Cape

Asked about the province's approach, Western Cape Department of Health spokesperson Mark van der Heever says they have regular engagements with electricity suppliers to ensure hospitals are spared from power cuts as far as possible.

"This is possible most of the time and when not possible these hospitals have generators. All 24-hour health facilities have backup plans in place in the event of power cuts. This can range from fixed generators to mobile generators," he says, adding that eight-hour health facilities are supported with mobile generators.

He says all hospitals have generators to ensure emergency services can continue. "Certain non-essential areas of the hospital such as the administration area might be without electricity, but this is done to re-route the generator power to the emergency and trauma and theatre areas for emergency operations. Electricity is re-routed from non-essential parts of the hospital such as Admin to trauma, emergency theatre and areas where critically ill patients are and those connected to oxygen points," he says.

"Oxygen points are connected to both the hospital's power grid and the generators to ensure uninterrupted oxygen supply," he says explaining that the generators automatically kick in once the power is off.

Power cuts and vaccinations in KZN

Power cuts can also impact South Africa's COVID-19 vaccination programme since vaccines have to be kept in fridges below certain temperatures and because data capturing should ideally be done electronically rather than on paper.

Dr Rishigen Viranna, Democratic Alliance (DA) spokesperson for health in KwaZulu-Natal, says load shedding and the poor state of municipal facilities have been identified as two of the biggest challenges to the roll-out of government's COVID-19 vaccination programme in the province.

His comments follow a two-day oversight inspection by the KwaZulu-Natal Legislature's Health Portfolio Committee to the Amajuba and uThukela health districts.

In a statement, Viranna said they had major concerns around the findings within Estcourt, Loskop, and Dannhauser in particular, where the failure by local municipalities to maintain their own properties has been flagged as one of the biggest impediments to the speedy rollout of the vaccine.

"At Dannhauser Community Health Clinic (CHC), the committee found the vaccination roll-out severely affected by load shedding. While the clinic has a generator, the vaccination area was not connected to it. This resulted in at least a four-hour delay despite many elderly people having arrived at 7 AM to receive their vaccine.

No electricity supply and/or load shedding also means that Department of Health staff based at vaccination sites must use a manual data capturing process. Not only is this extremely time-consuming but staff also do not have the proper training for this," the statement reads.

The KwaZulu-Natal Department of Health declined Spotlight's request for comment.

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