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31 May 2023 | Story Prof Anthony Turton | Photo Supplied
Prof Anthony Turton
Prof Anthony Turton is a water expert from the Centre for Environmental Management at the University of the Free State.


Opinion article by Prof Anthony Turton, Centre for Environmental Management, University of the Free State.


This week, our national sewage crisis really began to bite. A media storm has erupted over the cholera outbreak in Hammanskraal, while some families are now grieving for their dead relatives. It is important that we start this story by remembering the dead, because they were breadwinners in families, all doing their best to survive the tribulations of our times. They died unnecessarily, the victims of the slow onset disaster I spoke of in 2008 at a conference titled ‘Science Real and Relevant’.

At that conference, reference was made to three water quality challenges that we, in the dwindling aquatic sciences community, were all too aware of, but unable to speak about. We noted trends that data sets were showing us, and we felt a growing sense of alarm about the consequences of the trajectories on the graphs. We noted that our systems were failing rapidly, with much of our hard infrastructure in the water sector approaching the end of its useful design life. We noted with alarm the loss of skills, as the ravages of purging took its toll on our science, engineering, and technology core.  We noted the loss of dilution capacity in all our rivers after the first National Water Resource Strategy (NWRS), mandated by the National Water Act (NWA), indicated that we had allocated 98% of all the water in all our rivers and dams, as far back as 2002. We noted the migration of plumes of uranium moving into the headwaters of both the Vaal and Crocodile Rivers, both tributaries of the Orange and Limpopo respectively, driven by uncontrolled decant of acid mine water, as the gold mining industry started to collapse.

From these sets of data, a simple conclusion was drawn – SA was heading for a slow onset disaster unless we could convince our political leadership that we need to do things differently.

Here are some facts in the wake of the cholera crisis.

Fact 1 – The South African economy ran out of water in 2002 when the NWRS revealed that we had already allocated 98% of all the water we have legally available in terms of the NWA. This means that we cannot convince investors to have confidence in our future. We face an investment drought as a direct result of this startling but irrefutable fact.

Fact 2 – We produce more than 5 billion litres of sewage daily, all of which is discharged into our rivers and dams, only about 10% of which is treated to a standard that makes it safe for direct human contact.

Fact 3 – The Green and Blue Drop Reporting System was suspended by Nomvula Mokonyane when the data was showing trends in the failure of our sewage treatment works. This is like a pilot in a commercial airliner switching off the radar screen because the information being revealed was becoming uncomfortable to the poorly trained, but rapidly promoted cockpit crew. This is the undeniable genesis of the deaths we are seeing today.

Fact 4 – Because of Facts 1 and 2 combined, our tsunami of sewage can no longer be diluted in our rivers. In fact, more than 60% of all our large dams are now eutrophic, with highly enriched water breeding toxic cyanobacteria, all thriving off the warming water and growing flow of nutrients from sewage. In simple truth, we have lost our dilution capacity, and our rivers have been turned into hazardous sewers breeding harmful pathogens, including the flesh-eating bacteria that cost RW Johnson his leg. This means that cholera is only one of the risks we are facing from raw sewage in our rivers. For example, Hepatitis A is a waterborne pathogen directly related to sewage-contaminated rivers, but this is being reported separately in our slow onset disaster, so the penny has yet to drop.

Fact 5 – The current Minister of Water and Sanitation, Mr Senzo Mchunu, was brave enough to reinstate the Green and Blue Drop Reporting System, which has now shown that more than 90% of our wastewater treatment works are dysfunctional. He is a brave man in so doing, and I want to publicly support him as he tries to rebuild the trust that was destroyed by a previous minister.

So, this is where we are today. People are dying as a direct consequence of decisions made by a former minister, who clearly failed in her custodial role. She must ultimately be held to account for her dereliction of duty and blatant betrayal of public trust. Just this week, a spokesperson for the Presidency noted that his office was unable to intervene in another crisis, because the cooperative governance clause in our constitution prevented one sphere of government from intervening in the activities of another sphere. We must challenge this constitutional weakness and seek clarification from the appropriate court. How can a constitutional clause be so irrational as to prevent one part of government from intervening in another to avert a catastrophe? How many more lives must be lost to the absurdity of legal protection for those in power, while their activities are clearly not in the best interest of society as a whole? Surely a constitutional democracy is about empowering the citizens by protecting them against the consequences of failed service delivery.

From the depths of despair in the families of those whose lives have been lost to an entirely preventable illness, let us find the strength to rally as one and shout out, ‘enough is enough’. Our noble constitution grants all citizens rights to a better life in an environment that is safe from harm. Let us restore that dream by demanding that our sewage flows be brought under control. Surely this is the basis of modern civilization, irrespective of political persuasion or ideological preference.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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