A torchlight tragedy: Inside a Joburg emergency room during load-shedding

• In July, load-shedding left Charlotte Maxeke Johannesburg Academic Hospital without a CT scanner, a machine that allows doctors to get a 3D image of a patient’s brain.
• As a result, doctors in the emergency unit couldn’t assess a patient with a serious brain injury.
• This is a common problem in public hospitals, sources say, because the machine takes huge amounts of electricity to operate and can sometimes fail when its source of power changes from the Eskom grid to the backup electricity.

In the emergency room at Charlotte Maxeke Johannesburg Academic Hospital in July, a doctor was holding his patient’s eyelids open with one hand and moving a penlight across the man’s face with the other.

The patient, in his early 20s, was unconscious. Dried blood covered his hair and face.

He’d been rushed to the trauma unit after falling from a significant height and the doctor was trying to establish whether he was brain-dead.

Both of his pupils constricted as the light passed over them.

It was a sign that the man’s brain was functioning, at least partially.

There was potentially still time to operate and save him, says David Kerr*, a medical student who was on the young man’s treatment team.

“We needed to act fast.”

Kerr and his supervisor rushed to make a booking for the CT scanner, a sophisticated X-ray machine that could help the doctors to figure out exactly where the brain damage was, and whether it could be fixed in surgery.

This patient’s situation was so urgent that he would likely be pushed to the front of the queue, Kerr remembers thinking.

But the administrator in charge of scheduling appointments for the CT scanner had bad news — load-shedding had started.

The lights were still on because most of the hospital was supported by a series of generators.

But the CT scanner wasn’t working. The machine uses an enormous amount of energy. To scan 7,904 patients over a one-year period, it requires the same amount of power as 14 households in the Cape Town suburb of Delft.

A confused back and forth ensued between Kerr’s supervisor and the administrators: was there any way to switch the machine on?

But they warned him: “There’s nothing we can do.”

An additional senior source at Charlotte Maxeke confirmed that the hospital had been left without a CT scanner due to load-shedding in July. Though Kerr doesn’t know why the generator wasn’t able to support it, there are several potential explanations.

A radiologist at a different Joburg government health facility told Bhekisisa that CT scanners are often offline during load-shedding because they use so much power. Another common problem with these complex machines is that they can fail when their source of electricity changes from the Eskom grid to the backup power supply, says Tony Behrman, a Cape Town-based hospital management expert.

Helpless, Kerr and his supervisor returned to their unconscious patient. They would have to monitor him for hours until the power was back.

About an hour later, Kerr’s supervisor repeated the torchlight test. This time, the patient’s right pupil responded, but the left eye just stared back, blank and fixed.

“We all really wanted to help him,” recalls Kerr, “but there was just nothing we could do. It was heartbreaking.”

By the time the power came back on — three hours after the patient had been booked into the hospital — neither of the man’s pupils moved.

But there was still a small chance that the hospital’s brain surgeons could save him. So the doctors pushed the man into the scanner.

The machine revealed a brain bleed so severe that the neurosurgery department decided that if there had been a window to save him, it had passed.   

Soon thereafter, the patient was declared brain-dead.

When the trauma specialist in charge of the emergency unit heard that hours had passed before the patient got a CT scan, he was furious.

“You let this patient die,” he screamed at the team. “You killed him.”

But his anger dissipated as soon as he heard the word “load-shedding”. He apologised. 

And that’s the moment that stood out for Kerr, because if it had been the doctors’ mistake that delayed treatment for the dying man, it would have been a serious offence.

The fact that it was the government’s failure meant the incident was uncontroversial.

Kerr concludes: “We just carried on with the day.”

* David Kerr is a pseudonym. The medical student requested anonymity for fear that he would be victimised for speaking out. His identity is known to Bhekisisa.

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