12 June 2023 - NW2076
Hlengwa, Ms MD to ask the Minister of Health
With regard to the recent cholera outbreak in Hammanskraal, Gauteng, that has claimed 10 lives and saw the hospitalisation of more than 37 residents in a critical condition, and noting that the City of Tshwane has come out to caution the residents against drinking tap water while the Free State has confirmed six cases of cholera with 76 residents in the province being sent for testing, what (a) kind of support has the national Government afforded the City and the residents of Hammanskraal and surrounding areas during this time and (b) has the national Government done to contain the outbreak?
(a) Support the national Government afforded the City and the residents of Hammanskraal and surrounding areas
The national, provincial and respective district outbreak response teams were activated to coordinate the response to the outbreak. Ward-based Outreach Teams (WBOTs) were also activated to facilitate community-based interventions. The teams assisted with conducting contact tracing, active case finding linked to diagnosed cases within the community and visiting families of all the identified patients.
Two wards that were used for Covid at Jubilee Hospital were re-opened to serve as special wards for Cholera and Patients Under Investigation (PUI). This provided an additional capacity of 60 beds.
Surrounding hospitals were activated to receive stable patients who were referred to make space for diarrhoeal patients. Steve Biko Academic Hospital (SBAH) and Dr George Mukhari Academic Hospital accepted the referrals. Jubilee Hospital does not have Specialists since it is a District Hospital. A Gastro-Enterologist was mobilised from DGMAH to do ward rounds at Jubilee Hospital. This assisted to improve clinical management and outcomes of admitted patients. National Health Laboratory Services allocated a dedicated team within their DGMAH laboratory to deal with Jubilee Hospitals’ specimens to improve Turn Around Times (TAT).
Field Epidemiologists were activated from the World Health Organization (WHO) and Government. His team has expanded to include Specialists in Infection Prevention and Control (IPC), Case Management, Risk Communication and Community Engagement (RCCE). Community health workers were trained on hygiene packs and deployed to distribute the packs to the community, conduct health education and community surveillance. There is ongoing training of health care workers through webinars and refresher courses.
A field hospital was established in Kanana, Hammanskraal, to address the late presentation of sick patients which is a major contributor to the mortality. The field hospital started operating on 26 May 2023 and has since seen more than 100 patients. The utilization of the field hospital is constantly monitored.
A Task Team was established with all role-players involved in water quality monitoring; this includes the Department of Water and Sanitation, The City of Tshwane –Water Services and Environmental Health, the Department of Health (National and Province). Responsibility of testing of water has been distributed between role-players to avoid duplication and waste of resources. The Department of Water and Sanitation has engaged the Water Research Commission (WRC) and the Council for Scientific and Industrial Research (CSIR) to provide quality assurance for water quality testing.
The Department of Social Development obtained the list of deceased individuals from Jubilee Hospital to provide psychosocial support and social relief to their families. This was done in collaboration with local Councillors. By 30 May 2023, the Social Workers had visited 19 families to provide counselling and social relief.
Risk Communication and Community Engagement activities have been intensified to (1) ensure that everyone at risk for cholera is informed about how to reduce the risk of spreading the disease, take personal protective and preventive measures, and go to the health facility if they become severely ill (2) debunk rumours and misinformation by providing accurate information about how to recognise symptoms of cholera, how it is transmitted and what to do to encourage prevention and early treatment-seeking behaviour, and how to care for family members with diarrhoea, and (3) to facilitate community engagement and feedback through community radio and outreach activities, to ensure uptake of available services to prevent the spread of cholera.
(b) The Deputy Minister of Water and Sanitation, Deputy Minister of Health, MEC for Health in Gauteng, and MMCs from the City of Tshwane convened at Jubilee Hospital and agreed on the establishment of the Technical Coordination Committee lead by the Director-General for Health. This Committee consists of senior managers from the departments of Health, Water and Sanitation, Social Development and the City of Tshwane. The function of the Committee is to oversee the public health response, water quality monitoring, psycho-social support and social relief for distressed families, and Risk Communication and Community Engagement (RCCE)
As a health sector, all provinces through Heads of Health (Technical Committee of the National Health Council), were alerted of the outbreak and a physical meeting convened to ensure readiness of all the provinces. Cholera Incident Management Teams have been activated at national, provincial and district level and attended by multisectoral and multi-disciplinary stakeholders. Meetings are held to monitor the intervention strategies as well as the outbreak.
Risk Communication and Community Engagement is conducted at various media platforms for the South African community. The country is on high alert through the Provincial Departments of Health, National Health Laboratory Services. The department is continuously updating the public and stakeholders, especially focusing on high-risk areas with densely populated informal settlements, areas with unreliable water supply and sanitation.