Relying on cellphone torchlights, unreliable generators and using cooler boxes to keep vaccines and other medicines at the correct temperatures are just some of the stresses healthcare workers face due to the electricity crisis gripping South Africa. And they are fed up.

*Ziyanda Somlatha, a nurse, has worked in the maternity ward at the Alexander Health Centre and Clinic since 2021.  The past few months have been among the hardest of her career because load-shedding often makes it impossible to offer the most basic service: checking blood pressure.  

High blood pressure in a pregnant woman could indicate pre-eclampsia,  a common cause of death among birthing women in SA. But if the backup generator doesn’t kick in during load-shedding, the blood pressure machine does not work. But that’s not all.

“The incubator doesn’t work. The suction machine also doesn’t work. It’s frustrating to tell patients to wait because we cannot access their medical records. Or to tell expectant mothers that we can’t check the health of their baby because the ultrasound is off. During an episiotomy, it is difficult to do the surgical cut and stitching because we can’t see. We have to suture all layers of the skin.”

Following an outcry last year, the National Health Department negotiated with Eskom to exempt certain hospitals from the load-shedding schedule. Nationally, 77 out of roughly 400 hospitals are exempt.

Healthcare workers can’t do their jobs

Professor Lawrence Chauke, Clinical Head of Obstetrics and Gynaecology at Charlotte Maxeke Academic Hospital, says load-shedding has huge negative outcomes on patient care. Although the hospital has been exempt from power cuts since last year, there are still challenges.

“Because other areas are undergoing load-shedding, we have interruptions with the cellphone and internet network. Therefore, reaching out to on-call doctors who might be in other areas to refer, follow up, or ask for a different opinion, is difficult.”

Unless hospitals can also be exempt from the consequences of load-shedding to other infrastructure, like cellphone towers and phone lines, patient care will still be compromised in one way or another. Patients at public healthcare facilities rarely see the same doctor at all their visits. 

“We can’t easily access the patient records on the system, which means we don’t know what treatment plan was recommended to the patient by another doctor and can’t easily continue. It does not matter that we are exempt because caring for patients is still compromised,” says Chauke.

Generators can’t power all machines

Chauke says hospitals prioritise certain machines, especially those in the intensive care unit (ICU), to use the generator.

 “You might find that the generator powers only one machine while the rest aren’t. Patients sit for hours until the power returns because we couldn’t decide how to manage them.”  

Another problem is how constant load-shedding is damaging hospital machinery. Chauke says most of the machinery in the hospital, like the ultrasound machine, doesn’t come with a service agreement. If it breaks, the hospital will have to wait until someone approves repairs, which could take weeks or months.

“Access to healthcare is then further compromised,” he says.

Most facilities have generators, but this does not help during stage 6 load-shedding. Facilities can’t buy diesel in surplus and store it because it gets stolen. This places the facility at risk of randomly running out of diesel.

Load-shedding ultimately worsens existing challenges within the public health system, resulting in a bigger burden for public healthcare users and HCWs.

Infection control concerns

Somlatha says they scramble to preserve vaccines and medicines kept in fridges. These could spoil during power cuts because the fridges turn off. “We use cooler boxes filled with ice packs to keep vaccines and other medicines as cool as possible,” she says.

Chauke added that the fluctuating temperatures due to the disruption in the power supply could impact temperatures in the wards and place patients at a high risk of infections. “Operating with scissors under very high temperatures will, for certain, leave the patient with sepsis.”

Bongani Mazibuko, Provincial Secretary of the Democratic Nursing Organisation of South Africa, says the strain power cuts put on HCWs, and the impact on their ability to work is unacceptable.

“We can’t keep putting HCW through the strain and stress of caring for patients without the tools and structural support to do so. The severity in the impact of load-shedding on patients and HCWs will be an additional crisis in our health system.”

DENOSA says clinics should also be exempt from load-shedding. Very few can operate during power cuts.

“HCWs cannot provide services with no lights and with no network. DENOSA calls for all clinics to be exempt from load-shedding and equipped with generators or other power supplies.”  – Health-e News