KwaZulu-Natal hospital crisis: epidemics strike after taps run dry on Day Zero
In the Ugu district in KwaZulu-Natal, thirst is not what kills you when the taps run dry, it is sepsis, the body’s toxic response to an overwhelming infection. The body attacks itself in the immunological equivalent of a nuclear blast — at ground zero, everything dies, friend and foe alike. Bear this analogy in mind when contemplating Day Zero.
At the Murchison Hospital north of Port Shepstone, Day Zero arrived unannounced about two years ago. The exact date is unknown, because when the taps ran dry at Murchison, they had already run dry at Izingolweni and at Port Edward, and by the time supply to the hospital was restored, another area was about to go dry.
Residents report that for the past two years, a reticulated water supply has been available for about half the time.
Day Zero is not a sudden catastrophic implosion. It is, instead, a steady, random collapse of systems varying in severity as determined by myriad factors.
In the Ugu district, populated by about 1-million people, it manifested first at Murchison Hospital’s casualty ward, where the only reliable (though largely unregulated) water is supplied by tankers outsourced by Ugu District Municipality.
When the taps are dry, flushing a toilet is a luxury; when they have been dry for days, the plumbing becomes blocked and the system collapses
It means patients who arrive at the hospital with infectious hepatitis have not washed their hands for days, because water delivered by tanker is for drinking. It means medical personnel who suture arteries and close wounds on a Friday night (… gunshot chest, stab chest, gunshot chest …) cannot wash their hands between patients.
Try washing your hands one at a time while holding a water bottle, says one doctor.
Faecal-oral transmission of infection is the most common, and the patients at Murchison Hospital are mostly ill with tuberculosis and opportunistic diarrhoeal infections prevalent where up to 80% of patients are HIV-positive.
It is critical to understand that when a district-level Day Zero toggles on and off, the conditions necessary to reverse the crisis diminish with each stoppage.
When the taps are dry, flushing a toilet is a luxury; when they have been dry for days, the plumbing becomes blocked and the system collapses.
In most areas in the Ugu district, the taps have run dry for weeks over the past two years.
If you live east of Ugu’s great class divider, the R61, it means you’ll wash your hands from a rainwater tank, or use untreated artisanal groundwater.
If you do neglect hand washing, you might become ill and rush to a doctor or the private clinic in Margate. But if you live across the road in the sprawling impoverished settlements, your best option is a pit latrine, though the common practice is to use any unoccupied area.
For people who save their water for drinking and don’t wash their hands, getting sick means they will be going to the hospital in a crowded minibus taxi, which becomes a vector for disease on an epidemiological scale. Thus, instead of providing hope for the desperately ill, Murchison Hospital becomes an epicentre of disease.
When the hospital first informed the municipality of the water problem, the complaint was dismissed and the hospital was told that it was using too much water.
"What are we supposed to do?" a health worker (who cannot be named for fear of reprisals) said in response.
"Must we use less water? At a hospital?", the worker asked.
This, then, is what Day Zero looks like, and these conditions, for want of data, is before the longer-term health effects, such as malnutrition and worms have been taken into account. World Health Organization studies show that poor sanitation and hygiene result in stunted growth and impaired cognitive function, particularly for children under the age of five.
It is probably impossible to quantify the outbreaks of disease related to the water-supply and sanitation crisis in Ugu. The whole district is an outbreak.
When the water problem at the hospital was eventually escalated to the provincial government, the South Coast Herald reported Health MEC Dr Sibongiseni Dhlomo as saying at the time: "It’s not my problem. The hospital must speak to Ugu [District Municipality]."
The causes of the water crisis in Ugu are many and varied. There, as in Cape Town, this line of inquiry has already deteriorated into apportioning blame — and disingenuous prevarication.
When asked how health workers are supposed to cope with the water problems at Ugu, Water and Sanitation Minister Nomvula Mokonyane blamed an unprotected strike by municipal workers as well as associated acts of sabotage.
But the strike lasted only three weeks and came at the end of a periodic crisis that began years ago. And, now, after the strike ended more than a week ago, the water supply is as intermittent as before, while the municipality’s outsourced water tankers still ply their trade.
Ironically, at an average of about 700mm a year the rainfall on KwaZulu-Natal’s South Coast is one of the highest in the country, while the province’s dams are more than 47% full.
The province does experience droughts, though, the most recent of which (2015–16) precipitated the breakdown of water and sanitation infrastructure, made worse by severe flooding early in 2017.
A paper presented to the Water Services Commission warned as long ago as 2008 about this probability, reading that water authorities (under the direct authority of the Department of Water and Sanitation) and service providers (under municipal authority) faced "numerous challenges" in providing sustainable services because of backlogs, scarcity of skills, ageing and deteriorating infrastructure, nonalignment of political will with technical priorities, and an inability to achieve cost efficiencies.
The province allocated R220m for drought relief to farmers in 2016, including for water harvesting and the maintenance of dams, but Times Live reported in August that a forensic investigation was launched into the way R200m of the allocation was spent.
"We’re busy with the investigation on money allocated for drought relief‚ which has been embezzled‚" said Agriculture and Rural Development MEC Themba Mthembu.
"We allocated money to fight drought, but there were complaints whether that translated to any impact on the ground‚" Mthembu said.
The report is expected at the end of 2017.
The continuing water crisis in Ugu has prompted an investigation by the South African Human Rights Commission (HRC) following a call by human rights campaigner Afriforum. Afriforum has offered a R10,000 reward for information that would lead to the successful prosecution of people who sabotage the water supply system in the district.
"We suspect that the water supply network is being sabotaged so that individuals and groups can gain from possible contract work," says Eugene van Aswegen, AfriForum’s coordinator for KwaZulu-Natal.
"This, and the actions by the municipal workers, come down to a violation of human rights, because everyone has the right to access to water. This is the reason we decided to turn to the HRC," Van Aswegen says.
Water expert Anthony Turton likens the conditions in Ugu to "a form of water war". It is a conflict in which hydraulic infrastructure is targeted to reach a specific objective, not directly driven by scarcity, but causing an induced scarcity as a weapon, he says.
"The ANC has lost control on the ground, and the criminal justice system has failed to investigate, arrest or bring to trial any of the perpetrators. In short, the state has failed in its core duty."
Day Zero, a term popularised by Western Cape Premier Helen Zille regarding the Cape water crisis, has spurred municipal authorities into drastic action to manage the water crisis in that province, but its manifestation is not in the first instance about economic collapse, although that seems likely should the taps run dry.
Day Zero is in the first place the salient date of a disease-borne humanitarian disaster.