CORRESPONDENCE

Loadshedding and healthcare: Salt in the wound?

To the Editor: South Africa (SA)'s energy crisis is a longstanding problem. With no permanent solution in sight, the worsening power cuts continue to detrimentally impact the quality of public healthcare across the nation.^[1-2] At present, the country is experiencing the highest numbers of loadshedding hours since its inception -averaging over 1 500 hours in 2022.^[3] As the effects of the COVID-19 pandemic remain apparent, it is questionable whether we can handle another crisis.

Currently, only 72 hospitals are exempt from loadshedding nationwide!^[4] This is frightening, as state-run hospitals nationwide care for >80% of the population.^[5] Of most concern is the impact on intensive care units, which utilise electronic machinery to keep patients alive.^[5-7] Multiple technologies involved in critical care are unable to function without power, which leaves numerous healthcare workers forced to do these tasks manually.^[6] In an already short-staffed system, where there is only 1 doctor per 3 198 citizens,^[8-this proves deadly. The pandemic saw the lives of over 1 300 SA healthcare professionals lost - replacements for whom have proven difficult to come by.^[9] Loss of massive aid from technology, even for minutes, leaves opportunity for worker exhaustion and patient mismanagement.

Another major blow affects surgical departments, where doctors have had to resort to torches during surgery.^[10] Poor lighting in procedures is associated with a higher error rate and increased postoperative complications.^[11] More importantly, the inability to carry out emergency procedures and scans causes untimely deaths and emotional trauma for all involved.^[12] In less urgent instances, multiple procedures must be delayed or cancelled, resulting in an increase in the backlog - which was already an issue post-COVID.^[13,14] Such circumstances lengthen hospital stay, which puts patients at risk of acquiring serious nosocomial infections.^[15]

The only 'solution' in place is that of backup generators, which also provide a challenge, as these are poorly maintained and prone to failure.^[16] Moreover, the cost of diesel is proving difficult to maintain, since hospitals spend millions of rands to function when cuts occur.^[17] It has been stated that other power sources are being investigated, as generators are not meant to be utilised for long periods.^[18] The Health Professionals Council of SA has voiced a plea that all healthcare facilities be exempt from loadshedding,^[19] but this has not yet occurred.^[4]

With no effective solution in sight, the morale of healthcare workers is on the decline. Aside from the lingering 'side-effects' of the COVID-19 pandemic, the exacerbation of power cuts brings an already dilapidated system to its knees. If not addressed, this problem is one that will further place patients' lives at risk, and doctors and nurses may not be able to work under such challenging conditions much longer.

Thandeka Dakalo Malange

Second-year medical intern, Livingstone Hospital Complex, Eastern Cape, South Africa malangethandeka@gmail.com

References

1. Cele S, Burkhardt P. Energy crisis will get worse, analyst warns as load shedding cuts Ramaphosa trip short. News24, 2022. https://www.news24.com/fin24/economy/energy-crisis-will-get-worse-analyst-warns-as-load-shedding-cuts-ramaphosa-trip-short-20220919 (accessed 17 January 2023).         [ Links ]

2. Niselow T. Sunday read: Load shedding through the years and how Eskom has struggled to keep the lights on. News24, 2019. https://www.news24.com/fin24/Economy/Eskom/sunday-read-load-shedding-through-the-years-and-how-eskom-has-struggled-to-keep-the-lights-on-20190324 (accessed 17 January 2023).         [ Links ]

3. BUSINESSTECH. South Africa's horror year of load shedding - here's how it compares. BUSINESSTECH, 2022. https://businesstech.co.za/news/energy/630667/south-africas-horror-year-of-loadshedding-heres-how-it-compares/ (accessed 17 January 2023).         [ Links ]

4. BUSINESSTECH. 72 hospitals now exempt from load shedding in South Africa. BUSINESSTECH, 2022. https://businesstech.co.za/news/government/636531/72-hospitals-now-exempt-from-load-shedding-in-south-africa/ (accessed 17 January 2023).         [ Links ]

5. Laher AE, van Aardt BJ, Craythorne AD, van Welie M, Malinga DM, Madi S. 'Getting out of the dark': Implications of load shedding on healthcare in South Africa and strategies to enhance preparedness. S Afr Med J 2019;109(12):899-901. https://doi.org/10.7196/SAMJ.2019.v109i12.14322        [ Links ]

6. Mukwevho N. 'Load shedding is a matter of life and death' - nurses union. Health-E News, 2022. https://health-e.org.za/2022/07/08/load-shedding-is-a-matter-of-life-and-death-nurses-union/ (accessed 17 January 2022).         [ Links ]

7. Ismail A. The health dangers of load shedding. News24, 2015. https://www.news24.com/health24/news/public-health/how-load-shedding-can-kill-you-2015020 (accessed 17 January 2022).         [ Links ]

8. Clarke M. Critical shortage of doctors in SA - less than 1 doctor for every 1 000 patients. Democratic Alliance, 2022. https://www.da.org.za/2022/05/critical-shortage-of-doctors-in-sa-less-than-1-doctor-for-every-1-000-patients (accessed 17 January 2022).         [ Links ]

9. Heywood M. More than 1 300 healthcare workers in South Africa have died of COVID-19. Daily Maverick, 2021. https://www.dailymaverick.co.za/article/2021-09-07-more-than-1300-healthcare-workers-in-south-africa-have-died-of-covid- (accessed 17 January 2022).         [ Links ]

10. Gous N. Doctors use patient's cellphone torch during surgery in KZN Hospital. TimesLIVE, 2019. https://www.timeslive.co.za/news/south-africa/2019-07-10-doctors-use-patients-cellphone-torch-during-surgery-in-kzn-hospital/ (accessed 17 January 2022).         [ Links ]

11. Forrester JA, Boyd NJ, Fitzgerald JE, et al. Impact of surgical lighting on intraoperative safety in low-resource settings: A cross-sectional survey of surgical providers. World J Surg 2017;41(12):3055-3065. https://doi.org/10.1007/s00268-017-4293-z        [ Links ]

12. Copelyn J. Torchlight tragedy: Inside a Joburg emergency room during load-shedding. Mail & Guardian, 2022. https://mg.co.za/top-six/2022-09-22-torchlight-tragedy-inside-a-joburg-emergency-room-during-load-shedding/ (accessed 17 January 2022).         [ Links ]

13. October A. Solutions to SA's chronic surgical delays. City Press, 2022. https://www.news24.com/citypress/news/solutions-to-sas-chronic-surgical-delays-20220' (accessed 17 January 2022).         [ Links ]

14. Chu KM, Marco J, Bougard H, et al. Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals. S Afr Med J 2021;111(7):685-688. http://doi.org/10.7196%2FSAMJ.2021.v111i7.15686        [ Links ]

15. Nair A, Steinberg WJ, Habib T, Saeed H, Raubenheimer JE. Prevalence of healthcare-associated infection at a tertiary hospital in the Northern Cape Province, South Africa. S Afr Family Pract 2018;23;60(5):a4922. https://doi.org/10.4102/safp.v60i5.4922        [ Links ]

16. Mahamba C. Gauteng hospitals and clinics had 181 generator failures this year because they ran out of diesel. IOL, 2022. https://www.iol.co.za/the-star/news/gauteng-hospitals-and-clinics-had-181-generator-failures-this-year-because-they-ran-out-of-diesel-07456132-0839-41aa-ad78-1c344144e98b (accessed 17 January 2022).         [ Links ]

17. Patrick A. Diesel for generators has cost Baragwanath Hospital R3.4m in less than seven months. BusinessDay, 2022. https://www.businesslive.co.za/bd/national/2022-07-20-diesel-for-generators-has-cost-baragwanath-hospital-r34m-in-less-than-seven-months/ (accessed 17 January 2022).         [ Links ]

18. BUSINESSTECH. Government in talks to exempt critical hospitals from load shedding. BUSINESSTECH, 2022. https://businesstech.co.za/news/government/628538/government-in-talks-to-exempt-critical-hospitals-from-load-shedding/ (accessed 17 January 2022).         [ Links ]

19. Fokazi S. Hospitals 'buckling under pressure ofload-shedding, patients' lives at risk'. TimesLIVE. 2022. https://www.timeslive.co.za/news/south-africa/2022-09-22-hospitals-buckling-under-pressure-of-load-shedding-patients-lives-at-ris (accessed 17 January 2022).         [ Links ]