‘The infrastructure can’t cope’: South African healthcare workers struggle to deal with third wave
Dr Angelique Coetzee is a GP in the South African capital Pretoria, where she has run a family clinic for the past 33 years.
But she has never known anything like COVID-19.
She said: “If you have never been in such a situation, you can’t imagine what it is like. We’ve been dealing with 30 or 40 positive cases every day. The pressure is extreme.
“If you look at a country like Australia where they have a few cases, well I would see their national caseload in a couple of days. Can you imagine?”
When we first spoke in June, Dr Coetzee seemed on the verge of tears.
She said: “If I speak to you now, that means someone with COVID will not been seen – and there is no point trying to message. I don’t have time to answer.”
Dr Angelique Coetzee is a GP in the South African capital Pretoria
South Africa has found itself in the grips of a Delta variant-driven “third wave” of infection.
The caseload has been brutal, outstripping the first two waves by a factor of three.
The country’s acting health minister says this surge has now peaked in the province of Gauteng, where the cities of Pretoria and Johannesburg are situated but Dr Coetzee says her personal and professional burden has barely changed.
She said: “We have been seeing fewer patients on a daily basis this week but the weather is colder and COVID-19 patients are turning up with pneumonia so we are seeing sicker patients than we have been during the last three or four weeks.”
South Africa’s beleaguered public-run health system has struggled to cope with wave after wave of the virus.
Lacking sufficient beds and qualified staff, city hospitals used casualty departments as holding centres where patients wait for space to free up – sometimes for days.
South Africa’s healthcare system has been struggling with staff shortages during the pandemic
“This is the third wave we have experienced, comes less than six months (after the second) and the infrastructure can’t cope,” said Dr Coetzee.
“Most patients need oxygen and I try to admit them to hospital but because of (capacity) problems I have had to treat them at home. We have been waiting for 24 to 48 hours before we could get them cylinders, dealing with the stress of trying to manage patients without oxygen with the knowledge that if we don’t make a plan they are going to die. All this while the surgery is full, full, full. It is so very stressful.”
The extreme working patterns and the mental pressures that come with it have been felt in unexpected ways.
“I have had colleagues who have had motor vehicle accidents. One was so tired after work that he drove his car into a tree,” she said.
“The second one was hit at a crossroads – and a lady doctor reversed into a garage door because she had forgotten to open it. The most bizarre things that happen in a short space of time but it shows you the pressure they are under.”
Community groups have been running ad-hoc clinics in South Africa during the pandemic
Dr Coetzee has been operating on the very edge within a healthcare system that was been put under severe strain.
There are no support workers or home visits or specialist consultations for most people in South Africa.
Instead, GP’s like Dr Coetzee try to do it all.
“You become distant after a while but you try to carry on and on. I think that is the only way to survive it,” she said.
Yanga Booi is a 32-year-old nurse working at the intensive care unit at Thelle Mogoerane Regional Hospital in Vosloorus, on the outskirts of Johannesburg.
He says the hospital is poorly equipped and the staff have been insufficiently prepared during the pandemic.
He said: “The health system in South Africa did a complete spin when the pandemic hit our shores. We were put in the spotlight and given this false sense of heroism, but it wasn’t the right sort of attention because when we went to work, the hospital was in a worse state that than it was before.
“We were ill-prepared from the beginning, and we are still not prepared.”
The third wave has come as rioting and looting has taken place across the country
The hospital in Vosloorus provides beds and treatment but Booi says COVID testing at the facility is not reliable and patients are not properly isolated.
“We cannot be sure who has COVID because we get so many false negatives. It’s like we wait for people to get sick or drop dead, then look into the COVID thing,” he said.
“I remember admitting a patient who was negative on admission and so we didn’t isolate him. A few days later he died and we found out that he was positive.
“It’s a sad situation because the hospital does not have an isolated ICU ward for COVID patients. It’s a general ICU with isolation rooms and we admit COVID patients to it – some people have it and others don’t. We cannot be sure.”
Mr Booi says dozens of his colleagues have paid a terrible price over the course of three separate waves of infection in South Africa.
He said: “It is unfortunate that we have had to watch our colleagues dying from this… countless members of staff have gone, it’s not just nurses, it’s the doctors, it’s the clerks, it’s the porters.”
The 32-year old, who took up the profession when he was offered a government bursary, says he was “deeply afraid” when the pandemic arrived.
Yet 17 months later he has noticed a change in himself and others.
Yanga Booi said the country was ill-prepared for the pandemic
He said: “The loss of life has caused us to grow a thick skin, just like when we came into the profession. Our first experiences with death were terrifying but then we got accustomed to people dying and that is what has happened with COVID.
“We are used to the virus we know it is here to stay and we must find ways to keep going.”
Dr Shabir Mahdi is dean of the faculty of health sciences at Witwatersrand University in Johannesburg and is a source of expertise and fearless criticism in a country that has struggled in all aspects of its pandemic response.
Dr Mahdi says the ferocity of South Africa’s third wave of infection came as a “huge surprise”.
He said: “The current resurgence far exceeds what we have experienced either in the first or second wave in the number of documented cases. In fact, the numbers of new cases diagnosed on a daily basis is three times what it was at the time of the peak of the first and second wave.”
Dr Shabir Mahdi said the third wave in the country came as a ‘huge surprise’
However, this eminent viriologist is unsparing in his criticism of the government’s response.
While the magnitude of the Delta-fuelled third instalment could not have been predicted, he says health officials knew another wave was coming at the beginning of South Africa’s winter season.
He said: “In a province like Gauteng where 25% of the population live, our hospitals are completely overwhelmed but at the same time, we have beds that are literally vacant in the same hospitals and we can’t actually use those beds because some official in some government department forgot that you actually need to have health care workers available to actually staff those beds.”
Canadian Prime Minister Justin Trudeau has announced his resignation.
The 53-year-old said he will step down as leader of the country’s ruling Liberal Party, which he has led since 2013.
He says it will allow his party to choose a new leader as he suspends parliament until March due to political deadlock.
Chrystia Freeland, seen on the day she quit as finance minister and deputy prime minister in December. Pic: Spencer Colby/The Canadian Press via AP
Follow live: Justin Trudeau announces resignation
Speaking to reporters in front of his residence at Rideau Cottage, in the country’s capital, Ottawa, he said “internal battles” mean that he “cannot be the best option” in the next election.
“I don’t easily back down faced with a fight, especially a very important one for our party and the country. But I do this job because the interests of Canadians and the well-being of democracy is something that I hold dear.
“A new prime minister and leader of the Liberal Party will carry its values and ideals into that next election. I am excited to see that process unfold in the months ahead.”
Mr Trudeau, who has been prime minister since 2015, faced calls to quit from a chorus of his MPs amid poor showings in opinion polls.
He came under further pressure after his finance minister, Chrystia Freeland, resigned in December over clashes on policy.
The disagreements included how to handle possible US tariffs imposed by Donald Trump‘s incoming administration.
Justin Trudeau and Donald Trump in Italy in 2017. Pic: AP
Mr Trudeau’s resignation comes as the polls show his party is likely to suffer a heavy defeat to the official opposition Conservatives in an election that must be held by late October.
The Liberals must now name an interim leader to take over as prime minister ahead of a special leadership convention.
Mr Trudeau came to power 10 years ago following a decade of Conservative Party rule and was initially praised for returning the country to its liberal past.
But he has become deeply unpopular with voters in recent years over a range of issues, including the soaring cost of food and housing and surging immigration.
He is the eldest son of Pierre Trudeau, one of Canada’s most famous prime ministers, who led the country from 1968 to 1979 and from 1980 to 1984.
The political upheaval comes at a difficult moment for Canada internationally.
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US President-elect Donald Trump has threatened to impose 25% tariffs on all Canadian goods if Ottawa does not stem what Mr Trump calls a flow of migrants and drugs into the US.
Many fewer of each cross into the US from Canada than from Mexico, which Mr Trump has also threatened.
In a social media post on Christmas Day, Mr Trump even suggested the US could take control of Canada, as well as Greenland and the Panama Canal.
Canada is a major exporter of oil and natural gas to the US, which also relies on its northern neighbour for steel, aluminium and autos.
Few one-time golden boys manage to retain their lustre long into political office.
Barack Obama just about held on to his, leaving the US presidency with his approval rating high despite his party’s 2016 loss to Donald Trump.
But Emmanuel Macron is faltering in France and Justin Trudeau steps down as head of Canada’s liberal party with his popularity in shreds. So much for Western liberal values.
In the high tides of inflation and immigration, those who were their supposed flag-bearers are no longer what electorates want.
Follow live: Justin Trudeau announces resignation
For Mr Trudeau, it is a dramatic reckoning. His approval ratings have dropped from 65% at their highest in September 2016 to 22% now, according to the “Trudeau Tracker” from Canada’s non-profit Angus Reid Institute.
The sudden departure of his finance minister and key political ally Chrystia Freeland last month dealt his leadership a body blow, just as Canada readies itself for a potential trade war with the US which, she argued in a bracing resignation letter, his government was not taking seriously enough.
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“Parliament has been paralysed for months,” Trudeau says
The man Mr Trump recently trolled as “Governor of the ‘Great State of Canada’ or ’51st (US) state'”, Mr Trudeau was as close to Canadian political royalty as it gets.
The son of the country’s 15th prime minister, Pierre Trudeau, he was famously toasted by US president Richard Nixon as “the future prime minister of Canada” when he joined his father on a state visit as a toddler.
Aged five, he met the late Queen for the first time. “Thank you for making me feel so old”, she remarked drily at a re-meet in Malta almost 40 years later.
He has led Canada’s liberal party since 2013 and served as the country’s 23rd prime minister for almost a decade.
Mr Trudeau won a resounding electoral victory in 2015 and secured the premiership through two subsequent elections, though as head of a minority government.
Mr Trudeau, his wife and children celebrate after he won the Federal Liberal leadership in 2013 in Ottawa. Pic: AP/The Canadian Press/Adrian Wyld
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He made significant inroads against poverty in Canada, worked hard on nation to nation reconciliation with Canada’s indigenous communities, secured an effective trade deal with the US and Mexico in 2016 and managed to keep the public mostly on-side through the COVID-19 pandemic.
But he was a polarising figure. Holidays in exotic climes like a trip to the Bahamas in 2016 to an island belonging to the Aga Khan made him seem elitist and out of touch.
There was embarrassment when blackface images surfaced from his early years as a teacher, for which he apologised profusely.
His supposed liberal credentials smacked of double standards when he invoked emergency powers to crush truckers’ protests in 2022.
But it was the economic aftermath of the pandemic, with Canada suffering an acute housing shortage, immigration leaping under his premiership and the cost of living hitting households across the board which really piled on the pressure.
In those, Canada is not unique. But the opposition conservatives and the public at large clearly want change, and Mr Trudeau has responded.
He has announced his intention to resign as party leader and prime minister after the Liberals selects their next leader.
Mr Trudeau’s legacy may shine brighter with a little hindsight. But now is not that moment.
The question is whether his conservative opposition will fare any better in an increasingly combative geopolitical environment if, as seems likely, a candidate of their choosing wins a federal election due at some point this year.
Donkey karts loaded with wrapped parcels of unknown goods weave around the large puddles of water left in the dried riverbed.
Young men quickly hop over laid bricks to bridge the puddles followed by women treading carefully with babies on their backs.
The Limpopo River’s seasonal dryness is a natural pathway for those moving into South Africa from Zimbabwe illegally.
A sandy narrow beach undisturbed by border patrols with crossers chatting peacefully under trees on both banks as men furiously load and unload smuggled goods on the roadside.
Against the anti-immigration rage and xenophobia boiling over in South Africa’s urban centres, the tranquillity and ease of the border jumping is astonishingly calm.
People crossing the dried Limpopo River to get from Zimbabwe to South Africa
“You can’t stop someone who is suffering. They have to find any means to come find food,” one man tells us anonymously as he crosses illegally.
At 55 years old, he remembers the 3,500-volt electric fence called the “snake of fire” installed here by the Apartheid regime.
Hundreds of women and children escaping conflict in the late 1980s and early 1990s were electrocuted.
A woman near the border
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Today, people fleeing drought and economic strife are smuggled across or walking through border blindspots like this one.
“Now, it’s easy,” he says. “There is no border authority here.”
He crosses regularly and always illegally. While he laughs at the lack of border agents, he says he has been stopped by soldiers in the past.
“They send us back but then the next day you try to come back and it is fine.”
Part of the dilapidated border fence that separates South Africa with Zimbabwe
We find a few soldiers on our way back to the main road. They look confused by our presence but unphased. It is hard to believe they are unaware of the streams of people and goods moving across the dried riverbed just a few hundred metres away.
Border ‘fence’ trampled and full of holes
We drive along the border fence to get to the official border post into Zimbabwe, Beitbridge.
“Fence” is a generous term for the knee-height barbed wire laid across 25 miles of South Africa’s northern edges in 2020. Some sections are completely trampled, and others are gaping with holes.
The concrete fortress is a drastic change to the soft, sandy riverbed. Queues dismantle and reassemble as eager crowds rush from one building to another as instructions change.
Zimbabweans can live, work and study in South Africa on a Zimbabwean exemption permit, but many like Precious, a mother-of-three, cannot even afford a passport.
Precious, a mother-of-three, staying at a shelter in Musina, South Africa
Shelters for women and trafficked children in Musina
When we meet her at a women’s shelter in the border town of Musina, she says she only has $30 (£23.90) to find work in South Africa and that a passport costs $50 (£39.80).
“My husband is disabled and can’t work or do anything. I’m the only one doing everything – school, food, everything. I’m the one who has to take care of the kids and that situation makes me come here to find something,” she says tearfully before breaking down.
The shelter next door is home to trafficked children that were rescued. Other shelters are full of men looking for work.
Musina is a stagnant sanctuary for Zimbabweans searching for a better life who become paralysed here – a sign of the declining state of Zimbabwe and the growing hostility deeper in South Africa.
In Johannesburg, South Africa’s economic centre, illegal immigrants are facing raids and deportations organised by the Ministry of Home Affairs at the behest of popular discontent.
The heavy-handed escalation in the interior sits in stark contrast to the lax border control.
Derelict buildings in Johannesburg where migrants are living
“I wonder how serious our government is about dealing with immigration,” says Nomzamo Zondo, human rights attorney and executive director of the Socio-Economic Rights Institute of South Africa (SERI), as we walk through Johannesburg’s derelict inner city.
“I think part of it is that the South Africa we want to build is one that wants to welcome its neighbours and doesn’t forget the people that welcomed us when we didn’t have a home – and that is why I think they are so poor at maintaining the borders.”
She adds: “But then the call has to be one that says once you are here, how do we make sure you are regularised here, that you know who you are, and contribute to the economy at this point in time.”
More makeshift migrant accommodation in Johannesburg
Climate of anti-migrant hate
In 1994 as South Africa’s first democratically elected president, Nelson Mandela ordered that all electric fences be taken down.
His dream for South Africa to become a pan-African haven for civilians of neighbouring countries that provided sanctuary for fighters in the anti-Apartheid movement was criticised by local constituents back then.
Sky correspondent Yousra Elbagir speaks to migrants inside a government van
Now in a climate of increasing anti-migrant hate, that vision is rejected outright.
“I think that is the highest level of sell-out. When South Africans were in exile, they were in camps and they were restricted to go to other parts of those countries,” says Bungani Thusi, a member of anti-immigrant movement Operation Dudula, at a protest in Soweto.
Anti-immigrant protesters from the group Operation Dudula at a demonstration in Soweto
He is wearing faux military fatigues and has the upright position of an officer heading into battle.
“Why do you allow foreigners to go all over South Africa and run businesses and make girlfriends?” he adds, with all the seriousness of protest.
“South Africans can’t even have their own girlfriends because the foreigners have taken over the girlfriend space.”
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