According to medical professionals, transferring patients to Jubilee Hospital resulted in a larger area of infection and longer exposure to electrolyte imbalances, which may have compromised the immune systems of those who later died from dehydration. They argue that hospitalisation was unnecessary and that establishing cholera treatment centres in affected communities and following WHO management protocols, would provide timely access to treatment.

By Gugulethu Masilela

A former military medical officer claims that if the Gauteng health department had followed internationally recognised cholera protocols, the tragic loss of 23 lives and the rampant spread of infections in Hammanskraal could have been avoided.

“By moving the patients to Jubilee Hospital, officials increased the infection radius and exposed patients to longer periods of electrolyte imbalances, and this may have weakened the immune system of many patients who later died of dehydration,” the retired senior officer at the South African Military Health Services (SAMHS) of the South African National Defence Force (SANDF) charged.

He said there was no need for the hospitalisation of patients, “because to provide timely access to treatment, you need to establish cholera treatment centres in the affected communities. This is done outside of a hospital setting and it is based on management protocols as provided by the  World Health Organisation (WHO),”  he explained.

Another medical practitioner also agreed that the ferrying of patients to hospital premises contravened the cholera protocols of the WHO, thereby exacerbating both the mortality and infection rates.

“We could have done better by establishing treatment centres in the community as this could have provided us a critical intervention on a larger scale,” he said.

Upon conducting a cursory examination of the WHO’s website, the Telegram was able to corroborate both claims.

What the two doctors have brought up is stated explicitly on the WHO Africa Regional website: “In order to provide timely access to treatment, cholera treatment centres should be established in affected populations. These centres should be located at strategic points to maximise the number of affected individuals that can be treated outside of a hospital setting and based on management protocols defined by and agreed to by all parties.

“Response plans must provide for coordination between treatment centres, healthcare centres, and levels of care in the communities in which they are located and should include the dissemination of proper hygiene practices and public health measures.”

During a cholera outbreak, it is crucial to have quick access to treatment according to the protocols. Communities should have access to oral rehydration, and larger treatment centres should be available to provide intravenous fluids and round-the-clock care. If treated promptly and appropriately, the mortality rate should not exceed 1%.

“Cholera is a disease that responds satisfactorily to medical treatment. The first treatment goal is to replace fluids that have been lost by diarrhoea and vomiting. Up to 80% of cases can be treated through early administration of oral rehydration salts,” the organisation explains.

According to the WHO, it is not advisable to administer antibiotics on a large scale because “it has no effect on the spread of cholera and contributes to the production of bacterial resistance.”

Besides contravening the protocols established by the WHO, the transfer of patients to the embattled Jubilee Hospital posed additional challenges related to the capacity and infrastructure of the hospital. In 2019, the Democratic Alliance, the main opposition party in the country, referred to Jubilee as “the worst hospital in Gauteng.”

It has been four years, but the hospital is still wrestling with the same old allegations. The ghosts of the past have come back to haunt them yet again, as the Sowetan has just uncovered that the hospital is struggling to keep up with the surge of patients…” the casualty ward, commonly known as ward 17, was so overcrowded that more than 45 patients sat on benches waiting to get help.”

The newspaper quoted a nurse at the hospital saying: “And some bleed the whole night until the point of going mad…I have never seen anything like this in my life.” 

The Gauteng Department of Health has refuted the allegations and said they have managed the outbreak in accordance with the necessary treatment standards. According to Doctor Tshwale, the spokesperson, they have adhered to all protocols, including those recommended by the WHO.

“The department has a fully equipped clinic in Kanana village for the Hammanskraal people. The clinic’s mission is to treat patients with gastrointestinal disorders and cholera symptoms before they are sent to a hospital. We have distinct wards for cholera-infected patients, and we have also transported some patients to nearby hospitals to avoid over-crowding,”  said Tshwale.