Power outages in Ethiopian Hospitals

Fitsum Tilahun (MD)

The disaster of power outage in a hospital, especially a tertiary level hospital like Tikur Anbessa (Black Lion) is beyond comprehension and yet that was what happened two days ago: a power cut and a dysfunctional generator that lasted for seven agonizing hours.

You can expect a lot of bad things to happen when you go to any Hospital in Ethiopia. Most of you have been there and you know what I mean. Mistreatment starting from the gate keeper to the attending doctors, long waits for laboratories, appointments, and lack of basic diagnostic facilities, the list is long.

But what you don’t expect is to see your new born baby die from hypothermia (extremely low body temperature), or see your patient who is in life support machine die because of power outage. Emergency life saving surgeries can’t be done, and Tikur Anbessa is the one place in Ethiopia where the most critical of patients are admitted.

Patients on critical condition put on mechanical ventilation (life support) can’t survive more than few minutes with their machine off let alone for seven hours. Frozen lab samples, pathology specimens stored on a freezer will be discarded. You can’t imagine what the patients went through to give that sample and in some instance it is a sample that can’t be done again. Even routine care can’t be done with lights off for the 800 plus hospitalized patients and basic diagnostic services will not be available.

Unfortunately, this did not happen for the first time. Seven patients at Tikur Anbessa’s Intensive Care Unit (ICU) have died in 2005 because of power outage. I was a medical student back then and I was reading in the central medical library when the power went off. I was hoping that it will get back soon so I waited long but the power didn’t come back and I went to my dorm and slept. I was so upset because I couldn’t get ready for my exam, but what I didn’t know by then was just two floors above the library patients were dying.

Fast forward seven years

After exhausting rhetoric about the high energy supplying dams and power export to our neighbors, the big irony remains our own people die because of lack of it.

You often hear about Tikur Anbessa hospital because it is the biggest and is located at the heart of Addis Ababa. The problem is worse in the other hospitals. Most of them carry old and dysfunctional generators that are never tested before disaster strikes. And when you go out of Addis Ababa it gets increasingly worse.
I worked in Dodola Hospital, some 185km south east of Addis Ababa, for two years. My colleagues and I were the first physicians to the hospital. But for the two years I worked there, we had no transformer installed to support the hospital’s electric needs or the budget to run the 10 liters/hr gas consuming backup generator. It was impossible to run the x-ray machines or the Operation Room. And yet this was a hospital inaugurated in 2010, basically to coincide with election time by then. This problem was shared among the 42 other hospitals in the region. Their medical directors and CEO’s used to raise these problems during quarterly regional meetings.

Many of the hospitals go operational before they qualify to meet the basic standards, and the contractors simply hand them over without being checked by the regional health bureau. In our case the contractor didn’t install the proper electric line for high power transmission. The hospital had to spend more than 100,000 birr to get the line ready but the contactor was not made to pay for that or for any of the other many structural problems the hospital had even from the beginning.

The list for the problems goes on and on but I want to highlight that this power outage is not just a one day incident, but a result of the chronic inefficient bureaucracy, corruption, absence of accountability, and most importantly the low value that we have for human life

The media is silent

When seven patients died back in 2005, only Addis Adma, a private Amharic weekly, made news about it; there was no mention of the incident on the national media and no one was held responsible. A few days later life resumed as usual in the hospital with no charges against anyone. Even Addis Admas didn’t make a follow up story on the issue. But since then, no guidelines have changed, and no new equipments bought.

May be we are so accustomed to daily tragedies that we have acclimatized to the bad things happening as facts of life rather than something that can be changed.

We can’t put all the blame on the media for the loss of accountability, for example, but even with this limited space a lot can be achieved if we really value life; whether you are in jail for political reasons or in a hospital bed, life counts the same and we should give same focus on such things. If we are looking only for headlines, well then, we shouldn’t bother preaching about human right, free speech and the opening of political space.

Radio FANA, the biggest radio station with outreaches throughout the country, broadcasted just a few lines of the news about a seven hrs power outage at the Tikur Anbessa hospital. Who is responsible? Any patient died? What happened to the frozen samples? What happened to the patients who were turned back? This is not news; it’s not even a good tweet.

Ethiopian Electric Power Corporation (EPCO) and the issues with the media are a national headache and I won’t indulge to give solutions about that, so I focus on what the hospitals can do. They need to have more autonomy to operate by themselves, and we should decrease the bureaucratic burden involved in purchasing maintenance supplies.

Routine drilling should be carried out on emergency preparedness such as checking whether the backup generators are working or not. Whether a given hospital’s team follows standard procedures upon such events matter most to the patients who trusted us with their lives.

For now kudos to the staff at the Tikur Anbessa hospital, who rose to the that terrifying moment and worked to save lives, the seven nerve racking hours of the power outage elapsed without claiming lives even at the ICU.