‘It makes me feel like I am failing my patient’: doctors on load-shedding

A new survey has revealed that load-shedding is affecting doctors' mental wellbeing and threatening patients' safety.

The Medical Protection Society (MPS) survey of more than 660 doctors across South Africa paints a stark picture of the impact the ongoing energy crisis still has on the healthcare system.

Respondents have raised concerns about delayed tests, surgeries and prescriptions, failing or unreliable systems, machinery, phone lines and treating patients in the dark when inverters or generators fail. 

Some also feel extremely vulnerable as their alarm systems and electronic safety gates fail during power outages.

According to the survey, 86% of healthcare practitioners are saying load-shedding is posing a significant threat to patient safety, and 75% said it is affecting their mental wellbeing.

Also, nearly 80% believe the government could do more to prevent all healthcare facilities from being affected by load-shedding, and of those doctors who are considering leaving South Africa to practise in another country, 90% cited load-shedding as an influence on their decision.

The effect of not being able to provide safe patient care on a doctor’s mental wellbeing cannot be overstated.

—  Dr Volker Hitzeroth, medico-legal consultant at MPS

Former chairperson of the South African Medical Association Dr Angelique Coetzee agrees that load-shedding is lowering doctors’ morale.

“It makes them feel helpless and hopeless, because they are getting behind schedule — particularly in theatres if there are no generators, especially in the public sector hospitals.

“It's that hopelessness where you know that you have this list that you need to go through, but there is no electricity," Coetzee said.

An environment of frequent power cuts is not conducive to patients or doctors, she said.

"Certain medication needs to be stored at a certain temperature, and if that is not happening, you don't know if it is affected.

"If you walk into a ward and the temperature is high because there is no air-conditioning, the doctor is standing there sweating. You can also get some bacterial infections because the temperature regulation is not up to standard.

"All of that would make you as a doctor extremely unhappy to work."

Coetzee described load-shedding as a man-made pandemic. 

MPS, which protects the professional interests of more than 30,000 healthcare professionals in South Africa, said more needs to be done so healthcare practitioners can focus on treating patients without worrying about the safety and financial drawbacks of load-shedding.

A medico-legal consultant at MPS, Dr Volker Hitzeroth, said power outage challenges for healthcare practitioners who have to care for patients are compounded.

“The effect of not being able to provide safe patient care on a doctor’s mental wellbeing cannot be overstated. When patient safety is at risk, doctors also feel vulnerable to complaints, regulatory investigations, claims in clinical negligence and even criminal charges.

"This pressure, in addition to the financial burden placed on healthcare facilities to function sufficiently during power outages, is clearly taking its toll and may be tipping the balance for those who are already struggling to cope due to many other challenges doctors face daily,” Hitzeroth said.

Hitzeroth said when mental wellbeing is poor, it is worrying for the individual practitioner but can also jeopardise patient care.

“With load-shedding predicted to continue well into 2024 at the very least, more needs to be done to enable healthcare practitioners to focus on treating patients without worrying about the safety, medico-legal and financial implications of load-shedding.

"If the damaging effects of load-shedding on healthcare facilities are not properly addressed, I fear South Africa may face an exodus of healthcare practitioners at a time when we can ill afford it,” said Hitzeroth.

Doctors who participated in the MPS survey commented anonymously. One shared: “Our practice runs on EMR and is paperless. The cost of running back-up generators increases the pressure on us to make a decent turnover. When the system fails, I cannot access patient files or generate scripts, which hinders work flow. We also cannot do any procedures or access images such as X-rays. It makes me feel like I am failing my patients.”

Another said load-shedding creates a perpetual anxiety when caring for patients.

“Load-shedding affected my electrical supply and equipment I could use. In our area, when there is load-shedding, there is also no water, can’t flush toilets, wash equipment, wash hands. At times no signal, still a problem affecting my phone lines, frustrating. I had to spend a huge amount on a generator, then inverter, backup water tank and water pump working on solar during a gastro epidemic to just be able to breathe.” 

One doctor lamented having no access to a X-ray facility during load-shedding, nor computer access to check test results. 

“At times the generator packs up and you have to sit in darkness and treat patients.”

Load-shedding is causing havoc, said another. “Patients are rebooked every day. You work under pressure.”

Dealing with the enforced power cuts at work and socially was a strain for this doctor: “Load-shedding affects mental health because of how it affects us outside the workplace as well as inside it. Driving is a lot less safe, and road rage and accidents are on the increase. That sense of frustration and impatience with current national infrastructure can't be left behind when you enter the workplace, it spills over, and that, combined with staffing shortages and difficult bosses, makes people increasingly short tempered, thus communication and patient safety suffers.”

Another doctor feels that the government should do better to prevent load-shedding at hospitals. 

“Even if we use a generator it does not supply everything. So with anaesthetic machines, we have issues with low air pressure during load-shedding, which is dangerous to the patient and can cause fear and uncertainty.”