Healthcare services will continue to feel the effects of the riots, violence and looting in KwaZulu-Natal and some parts of Gauteng, even as efforts to rebuild get under way.
“The vulnerable population, poor communities, refugees and other marginalised populations will bear the brunt of these violent protests,” says Brenda Kubheka, managing director and cofounder of Health IQ Consulting, which provides risk management and clinical ethics services to the health sector.
“Accessing medical facilities will be more challenging and perhaps more expensive when people travel long distances to access care. Food supplies will impact how patients take medications, which may lead to disruption in compliance or taking medication in ways contrary to the advice given by medical professionals.”
Kubheka, who is a member of the Gauteng Covid-19 bed management committee, among other things, suggests that the riots will hit the health sector hard. Tshowa Kabala, her research assistant, agrees. The two say, “These include the travel disruption for personnel, damage to infrastructure, disruption in the supply chain, and transportation impacting service delivery and access to care. Deliveries of medicines, personal protective equipment and other supplies affected health establishments, and some facilities were affected by staff shortages due to blocked roads and safety concerns.”
Health facilities in KwaZulu-Natal were inundated with trauma patients during the riots, forcing officials to review the allocation of staff to deal with the unexpected demand for services.
The riots stopped Johanna Duba, 39, from Tembisa in Gauteng, from accessing the healthcare services she needed. Duba was 36 weeks pregnant at the time. “It affected me badly because there are lots of stages in pregnancy, and sometimes my body needs medical attention,” she says.
Duba was unable to attend a doctor’s appointment on 12 July. She resorted to calling the clinic. “My feet were in pain, and I called the healthcare centre for advice on what I should do to get better,” says Duba. It didn’t help much though because “local pharmacies were closed”. On the morning of 4 August, Duba gave birth to a girl.
Expressing concern over the gender disparities in accessing healthcare, Kubheka and Kabala say, “Women and young girls suffer [doubly] during unrest because of hindered access to reproductive health services caused by the impact of turmoil on transportation, availability and access to health services.”
Nonkululeko Boikhutso, clinical services director at the Nelson Mandela Children’s Hospital and a lecturer at the Wits School of Public Health, was frank in her assessment of the effects of the riots on the health sector. “In health, unfortunately, the cost is always a life lost which can never be replaced,” she says.
Not spared from the looting was the South African National Blood Service (SANBS). Khensani Mahlangu, communications officer for the SANBS, says four of its sites – fixed donor centres in Umlazi and Pine Crest and branches in Queensmead Mall and New Germany – were targeted, vandalised and looted.
“KwaZulu-Natal operations … have … temporarily closed,” says Mahlangu. Operational teams could only take stock of the damage once safety and calm was restored. “As a result of the specific business centres which have been closed within the province, we are unable to continue operations as normal, and we anticipate that the prolonged closures will have a negative impact on our ability to collect, test and dispatch blood efficiently – resulting in pressure across our business and eventually affecting recipients of blood and blood products.”
The riots have worsened problems faced by the SANBS. “The winter months and school holiday periods are typically challenging for us in terms of collections. The added pressures of the third wave and level four lockdown have also kept us out of corporates where a substantial amount of our blood is collected. The support of our donors has fortunately allowed us to maintain sufficient blood stocks. However, we know that the shelf life of our blood products is limited, and a prolonged interruption of our operations could have dire consequences for our recipients,” says Mahlangu.
Covid-19 vaccination centres in parts of Gauteng and KwaZulu-Natal were also forced to close. Along with slowing the vaccine roll out, Kubheka and Kabala worry that the riots may have been super-spreader events. “The lockdown has socioeconomic implications, and the vaccination programme is critical for achieving population immunity and economic recovery. Delays in vaccination will render more people prone to severe Covid-19 disease, putting additional strain on the health system.”
Boikhutso says, “Vaccination will help contain the virus in the long run and if we do not have enough people vaccinated, it simply means that we will continue to see these peaks and deaths among our people.”
Unable to access medication
After soldiers were dispatched to hotspots in the provinces, the situation stabilised, and KwaZulu-Natal and Gauteng were able to resume vaccination programmes. This return to calm also meant chronic medication could again be collected.
Savy Mafindo Matimura, 54, and Tendai Matimura, 62, who live in Hyde Park, could not collect their chronic medication at Edenvale Hospital. Savy has high blood pressure, and her husband, Tendai, is asthmatic.
Savy had an appointment to collect their medication on 12 July. “When we were near Alex, there was smoke all over and people running up and down. Cars were hooting … I decided to come back because there was no way to get to Edenvale Hospital.”
Before Savy was put on high blood pressure medication, she suffered a stroke. She spent five days without her medicine, eventually getting it on 20 July, along with her husband’s. “I am not that happy because I have days I didn’t take medication. I have to take it every single day, [as does] my husband.”
Kubheka and Kabala say chronic medication needs to be taken consistently as disruptions can exacerbate the disease progression. Patients on HIV treatment may end up developing resistance to medicines.
“Independent pharmacies have also been looted and destroyed and many have closed due to uncertainty and the protection of their staff and assets. Therefore, accessing medication will be a lot more challenging for individuals. They may need to find alternative health service providers who may be far from home or where they usually access medical services. This may come at a high cost and make it even more challenging to navigate the public health system, mainly if proactive communication about alternatives is not provided.”