Joburg is crumbling. Here’s how it affects hospitals

• Without electricity, doctors in the emergency department couldn’t use machines that monitor patients’ vital signs. Ventilators couldn’t be hooked up either, and even making phone calls to ask other facilities for help was near impossible.
• Hospitals use lots of water to clean equipment, wash laundry and keep the facility itself clean, but the Lenasia South District Hospital has had to make do without these services — a result of the city’s ageing water infrastructure combined with frequent load-shedding.

At night, Palesa Mgazi*, a doctor at Lenasia South District Hospital in the south of Joburg, regularly puts patients on drips in complete darkness.

There’s no beeping from machines that check vital signs in the emergency department where she works — because they don’t work without electricity.

She has to think on her feet — and fast.

Many patients coming through the doors need to be hooked up to machines that monitor their body temperature, pulse rate, blood pressure and oxygen levels. Others need to be put onto a ventilator (a machine that breathes for them).

But during late November’s load-shedding — or days in that month when there was simply no power — she couldn’t use such equipment, because there was no diesel to fuel the backup generators.

And Lenasia South District Hospital is not on the list of hospitals that are exempted from load-shedding, according to the national health department’s spokesperson, Foster Mohale.

Ventilators are the biggest challenge. The machines have about half an hour’s battery life after the power goes out, Mgazi says.

After that, doctors have to simulate the patient’s breathing manually, using a process called bag mask ventilation.

To do this, a health worker holds a mask connected to an air-filled bag over the patient’s mouth and squeezes the bag rhythmically to pump oxygen into their airways.

Mgazi spoke to Bhekisisa on her way back from work after a night shift.

She was exhausted. 

“We only have two doctors in the emergency unit at a time,” she explained, “so if one has to ‘bag’ a patient, there’s only one doctor left [to do everything else]. I don’t know what we’ll do if, one day, two patients need ventilation [at the same time].”  

While the patient is being helped to breathe, someone has to contact bigger hospitals nearby to find out whether there are beds available for those who need more advanced treatment than what Lenasia can offer.

Easier said than done, Mgazi notes: the doctor on call would have to go to a place where there’s a cellphone signal, which mostly disappears at the hospital during power outages, as does the use of the facility’s landlines, according to Mgazi.

All this with no guarantee that there will be any water, which hospitals use lots of to clean equipment, wash laundry and keep the facility itself clean.

What’s behind the chaos?

Four layers of government collapse, according to sources at the hospital.

1. The fire

A fire which broke out at a Lenasia substation on November 4 plunged parts of Lenasia South into darkness for days. But while technicians were working to fix the damage, a large circuit breaker blew up because equipment at a supporting substation had been vandalised, explains a City Power statement.

Power was only fully restored to Lenasia South on November 8, according to Nickolaus Bauer, deputy director of communications in the office of the Joburg mayoral committee that deals with infrastructure issues.

But residents of Lenasia South faced renewed power outages later in the month, when the substation tripped. Bauer says this was due to an overhead line fault on the Eskom infrastructure serving the substation.

This second power outage left the Lenasia South hospital without electricity for a day, say hospital staff Bhekisisa spoke to.  

2. The failing power utility

By December 2, South Africa had had 179 days with scheduled outages this year, with each day having more outages on average than in previous years. As a result, by September, South Africa had already experienced more load-shedding in 2022 than in any other year.

Eskom CEO André de Ruyter said earlier in the year that the country’s energy problems are a result of poor maintenance and sabotage of power stations.

Following public pressure from health workers at state facilities, 77 hospitals around the country are now exempt from load-shedding.

In Gauteng, the list of facilities includes Charlotte Maxeke Johannesburg Academic Hospital and Helen Joseph Hospital. Health workers at those facilities told Bhekisisa that power cuts have indeed ceased since the government’s announcement.

Along with the rest of the country, the Lenasia South hospital had stage 4 load-shedding during parts of November, which sometimes left the hospital without power for up to 7½ hours a day.

3. The fuel

The hospital has two backup generators, which are supposed to support the facility during scheduled blackouts. When the Lenasia South substation first broke down on November 4, these generators provided electricity to the hospital.

But for most of November, there was no diesel to run them, says a hospital worker who wants to remain anonymous. This left the hospital without power during load-shedding and also for part of the period when the substation tripped.

The reason?

The Gauteng health department hadn’t paid the people in charge of making sure there’s enough fuel for the generators, according to the source.

But in response to questions from Bhekisisa, Mogeru Morewane, the chief director of the Joburg health district, says the diesel delivery issue happened because load-shedding and other outages had created a high demand for generator fuel.

As a result of all this, Lenasia South District Hospital didn’t have electricity for some hours in November, she says. 

4. The pipes

Joburg’s water woes have been another challenge.

In the last week of November, Mgazi says, the hospital faced water outages every second day for a few hours at a time, though there were trickles of water in some parts of the hospital. 

Morewane confirms that the facility had water supply issues in November, which she says was due to scheduled water outages in the Lenasia area by Joburg Water.

To fix the problem, Joburg Water brought in water tankers to fill the water reservoirs, she says.

According to Benoît le Roy, who heads the South African Water Chamber, Joburg has not invested enough in the upkeep of the city’s water infrastructure.

“Load-shedding also exacerbates the problem,” says Le Roy. Reservoirs need to be at least 60% full to keep users’ taps from running dry. “Electric pumps are used to fill the reservoirs to reasonable levels. With load-shedding, the pumps don’t run long enough to keep up the water levels.”

For hospitals, water outages are a nightmare, says another doctor at the hospital. “Toilets don’t flush, so patients can’t even use the bathroom.”

Mgazi concludes: “We can’t clean anything without water, so there’s just blood on the floors in the emergency room.” — Additional reporting by Joan van Dyk

* Not her real name. Our sources didn’t want to be identified because of fear of losing their jobs, as government hospital workers aren’t allowed to speak to the media without permission from the provincial government.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.