Whooping cough is no fun. I was vaccinated as a child, but immunity wanes over time and I was worryingly ill. It is a highly contagious and serious bacterial infection that is nasty for everyone, but can be deadly for babies and the elderly.
Large-scale vaccination over the past few decades made it an uncommon disease, but what was alarming to me is that several doctors I spoke to were not surprised. They all said they have seen a rise in the number of cases recently.
Vaccines are an important cog in a large and complex public health machine. After some investigation, it seems as though a whole new crisis is bubbling up under our feet. There is a resurgence of “old” illnesses hitherto kept under control by the combination of modern sanitation and modern and reliable healthcare systems.
The present cholera outbreak in three provinces, in which 23 people have died, is another example of this. Apparently linked to a dodgy quarter-billion-rand tender, the outbreak has attracted outrage. That’s to be expected. These people died in circumstances the UN described in a press release as “avoidable and tragic”, as close to an admonishment as you are likely to see.
In fact, the UN, Unicef and the World Health Organisation have been working in Hammanskraal for five months, since the first case in the present outbreak, and have been trying to help the department of health get on top of a crisis they saw coming.
In SA right now there are also outbreaks of measles, mumps, diphtheria and chickenpox. Along with cholera, these are all preventable.
Where there is cholera, says Dr Anthony Turton of the University of the Free State, it is likely we will also start to see a rise in cases of hepatitis A that may not necessarily be attributed to the dirty water and nonfunctional sanitation systems that caused it. But in SA right now there are also outbreaks of measles, mumps, diphtheria and chickenpox. Along with cholera, these are all preventable.
A cholera outbreak is an indication of so much more than just a health crisis. There will be a kneejerk response to focus on waterborne diseases, but it is simplistic to do this. It speaks more widely of the degradation of a collection of interconnected and interdependent systems — water, sanitation and health — all amid a crisis of education and poverty in a population with many people compromised by a poor diet.
As with all big systems, the causes are complex, but load-shedding is a major factor. It’s worth noting that rumours swirl about who the new Eskom CEO might be, and that electricity minister Kgosientsho Ramokgopa has formally been given powers to plan our energy future. Let’s not be naïve though — the procurement of whatever plans Ramokgopa might come up with still lies with the department of mineral resources & energy.
The reason for this — that energy procurement remains a fundraising tool for the ANC or individuals associated with it, or just standard-grade inertia — doesn’t really matter. The fact is that what change does come will come slowly. It seems likely that load-shedding will be a part of SA life for at least another five years. Infuriating as this may be, we need to make peace with it.
A lack of electricity over long periods means sanitation systems start to fail and clean water is not pumped to where it needs to be. That is a vicious cycle of cause and effect, the effect of which has been illustrated in Hammanskraal.
Next up is the difficulty in storing and transporting vaccines, which generally need to be kept below 7°C. More cases of preventable diseases suggest this system is also starting to buckle. There are good arguments to be made for an adjustment to the state’s vaccine schedule to protect the population further from diphtheria, measles and mumps, but that works only from a broader public health perspective if the shots are made widely available — and for that you need electricity.
Once people are sick and have made it to a health facility, they now receive diminished — and diminishing — levels of care. Healthcare networks require electricity to function properly. It is necessary for communications and the refrigeration of vaccines, and more importantly they require clean water and sanitation. This is the basic infrastructure required to practise even the most basic medicine.
A final layer to this is the vastly inefficient manner in which public health is organised in SA — via provincial set-ups that do their own thing and serve their own needs at the expense of patients. The list of crises that have beset the Gauteng health department, from the Life Esidimeni tragedy to the Rahima Moosa scandal, tell the tale. Add the government’s inexplicable refusal to allow the private sector to train nurses and it’s a full stack.
When a patient requires care because they were not vaccinated as a child, or because they have been exposed to disease due to nonfunctional sanitation networks, they are sick as a result of one broken system and are presenting themselves to another for treatment. It’s dystopian.
The issue of trust comes up whenever I speak to an expert. If you are poor and live in Hammanskraal and you obviously don’t trust the water in the tap, what exactly are you supposed to do? How do you wash your hands? How do you boil your water for drinking and cooking when there is no electricity, and paraffin is increasingly costly? For most people there is no workaround in which you drink bottled water and rely on an inverter. They are wholly exposed to the system failure.
None of this is easy to fix. Those in authority will blame load-shedding and Covid, but that’s only a part of the truth. This is a picture of a series of serious system weaknesses. Alarms should be sounding on all fronts. SA is going to get sicker.
• Parker is Business Day editor-in-chief.
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