‘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.”
World
In the idyllic Cognac region of southern France, Trump’s tariffs threaten a centuries-old way of life
The impact of Trump’s tariffs is reaching deep into every economy.
We travelled into the French rural heartland, heading for Cognac – the home of French brandy.
It is only half the size of Surrey but its exports to America are worth €1bn a year and that trade is now severely threatened.
The first buds are out on the vines of Amy Pasquet’s vineyard.
An American, she has married into the industry and with her French husband owns JLP Cognac.
She knows more than most the bond brandy has formed between their two countries that goes back to the war.
Tariffs latest: Follow live updates
Ms Pasquet said: “A lot of the African-American soldiers had really loved their experience here and had brought back the cognac. And I think that stayed because this African-American community truly is a community and they want to drink like their grandfather did.”
The ties remain with rappers like Jay Z’s love for cognac.
However, Ms Pasquet adds: “There’s also this other community of people who have been drinking bourbon for a long time, love bourbon, but find the prices just outrageous today. So they want to try something different.”
Amy Pasquet owns JLP Cognac with her husband
JLP’s products were served at New York’s prestigious Met Gala.
They were preparing to launch new product lines in the US. But now that’s in doubt.
It is hard being an American in France now, Ms Pasquet says.
Her French neighbours are appalled by what US President Donald Trump is doing.
She continues: “They’re like, okay, America’s forgotten how close France and America are as far as (their) relationship is concerned. And I think that’s hurtful on both sides. I think it’s important to remember that the US is many things, and not just this one person, and there are millions of inhabitants that didn’t vote for him.”
A fresh challenge for a centuries-old tradition
Making cognac takes years, using techniques that go back centuries. In another vineyard we met Pierre Louis Giboin whose family have been doing it for more than 200 years.
In a cellar dating back to the French Revolution, barrels of oak sit under thick cobwebs, ageing the brandy.
The walls are lined with a unique black mould that thrives off the vapours of cognac.
They have seen threats come and go over those centuries, wars, weather, pestilence. But never from a country they regard as one of their oldest allies and best of customers.
Read more:
What China could do next as Trump’s tariff war
How tariffs will affect your money
Could Trump’s tariffs tip the world into recession?
Pierre Louis Giboin’s cellar dates back to the French revolution
Mr Trump’s tariffs, says Mr Giboin, now threaten a way of life.
“It’s at the end of like very good times in the Cognac region. It’s been like 10 years when everything’s been perfect, we have good harvest, we sell really easily all the stock, but now I mean it’s the end.”
Ms Pasquet and Mr Giboin are unusual.
Most cognac makers sell their produce through the drink’s four big houses, Hennessy, Remy Martin, Martell and Courvoisier.
Some have been told the amounts they can sell have been drastically reduced.
Independents though like them must find new markets if the tariff threat persists.
Confusion away from the chaos
Outside in the dappled light of a Cognac evening Mr Giboin and I toast glasses of pineau – the diluted form of cognac drunk as an aperitif.
In this idyllic corner of France, a world away from Washington, Mr Trump’s trade war on Europe simply makes no sense.
“He’s like angry against the whole world and the way he talks like that Europe the EU was made against the US to cheat on the US. It’s just crazy to think like this,” Mr Giboin says.
It’s not just what Mr Trump’s done. It’s how Europe now strikes back that concerns the French. And it’s not just in Cognac where they’re concerned
France exports more than €2bn worth of wine to America.
In the heart of the Bordeaux wine region, Sylvie Courselle’s family have been making wine since the 1940s at their Chateau Thieuley vineyard.
It’s bottling season but they can’t prepare the wine headed for America while everything is up in the air.
Showing me the unused reels of US labels for her wine she told me she was losing sleep over the uncertainty.
Later she was meeting with her American distributors.
Gerry Keogh sells Ms Courselle’s wine across the US.
He says the entire industry is reeling
Sylvie Courselle with distributers
The Chateau Thieuley vineyard in the Bordeaux wine region
“I think it’s like anything. You don’t really believe it’s happening. And even when you’re in the midst of it, it was kind of like 9/11.
“You’re like… This is actually happening. It’s unbelievable. And when you start seeing the repercussions from the stock market, et cetera, and how it’s impacting every level, it’s quite shocking.”
They know the crisis is far from over and could now escalate.
“We feel stuck in the middle of this commercial war and we don’t have the weapons to fight, I think,” Ms Courselle said.
It is, she says, very stressful.
Gerry Keogh
The histories of America and France have been intertwined for centuries through revolutions against tyranny and two wars fighting for liberty.
America used to call France its oldest ally, but under Donald Trump its now seen here as turning on France and the rest of Europe in a reckless and unjustified trade war.
It is all doing enormous harm to relations between the US and its European allies.
How Europe now decides to retaliate will help determine the extent of that damage.
World
In the idyllic Cognac region of southern France, Trump’s tariffs threaten a centuries-old way of life
The impact of Trump’s tariffs is reaching deep into every economy.
We travelled into the French rural heartland, heading for Cognac – the home of French brandy.
It is only half the size of Surrey but its exports to America are worth €1bn a year and that trade is now severely threatened.
The first buds are out on the vines of Amy Pasquet’s vineyard.
An American, she has married into the industry and with her French husband owns JLP Cognac.
She knows more than most the bond brandy has formed between their two countries that goes back to the war.
Tariffs latest: Follow live updates
Ms Pasquet said: “A lot of the African-American soldiers had really loved their experience here and had brought back the cognac. And I think that stayed because this African-American community truly is a community. and they want to drink like their grandfather did.”
The ties remain with rappers like Jay Z’s love for cognac.
However, Ms Pasquet adds: “There’s also this other community of people who have been drinking bourbon for a long time, love bourbon, but find the prices just outrageous today. So they want to try something different.”
Amy Pasquet owns JLP Cognac with her husband
JLP’s products were served at New York’s prestigious Met Gala.
They were preparing to launch new product lines in the US. But now that’s in doubt.
It is hard being an American in France now, Ms Pasquet says.
Her French neighbours are appalled by what US President Donald Trump is doing.
She continues: “They’re like, okay, America’s forgotten how close France and America are as far as (their) relationship is concerned. And I think that’s hurtful on both sides. I think it’s important to remember that the US is many things, and not just this one person, and there are millions of inhabitants that didn’t vote for him.”
A fresh challenge for a centuries-old tradition
Making cognac takes years, using techniques that go back centuries. In another vineyard we met Pierre Louis Giboin whose family have been doing it for more than 200 years.
In a cellar dating back to the French Revolution, barrels of oak sit under thick cobwebs, ageing the brandy.
The walls are lined with a unique black mould that thrives off the vapours of cognac.
They have seen threats come and go over those centuries, wars, weather, pestilence. But never from a country they regard as one of their oldest allies and best of customers.
Read more:
What China could do next as Trump’s tariff war
How tariffs will affect your money
Could Trump’s tariffs tip the world into recession?
Pierre Louis Giboin’s cellar dates back to the French revolution
Mr Trump’s tariffs, says Mr Giboin, now threaten a way of life.
“It’s at the end of like very good times in the Cognac region. It’s been like 10 years when everything’s been perfect, we have good harvest, we sell really easily all the stock, but now I mean it’s the end.”
Ms Pasquet and Mr Giboin are unusual.
Most cognac makers sell their produce through the drink’s four big houses, Hennessy, Remy Martin, Martell and Courvoisier.
Some have been told the amounts they can sell have been drastically reduced.
Independents though like them must find new markets if the tariff threat persists.
Confusion away from the chaos
Outside in the dappled light of a Cognac evening Mr Giboin and I toast glasses of pineau – the diluted form of cognac drunk as an aperitif.
In this idyllic corner of France, a world away from Washington, Mr Trump’s trade war on Europe simply makes no sense.
“He’s like angry against the whole world and the way he talks like that Europe the EU was made against the US to cheat on the US. It’s just crazy to think like this,” Mr Giboin says.
It’s not just what Mr Trump’s done. It’s how Europe now strikes back that concerns the French. And it’s not just in Cognac where they’re concerned
France exports more than €2bn worth of wine to America.
In the heart of the Bordeaux wine region, Sylvie Courselle’s family have been making wine since the 1940s at their Chateau Thieuley vineyard.
It’s bottling season but they can’t prepare the wine headed for America while everything is up in the air.
Showing me the unused reels of US labels for her wine she told me she was losing sleep over the uncertainty.
Later she was meeting with her American distributors.
Gerry Keogh sells Ms Courselle’s wine across the US.
He says the entire industry is reeling
Sylvie Courselle with distributers
The Chateau Thieuley vineyard in the Bordeaux wine region
“I think it’s like anything. You don’t really believe it’s happening. And even when you’re in the midst of it, it was kind of like 9/11.
“You’re like… This is actually happening. It’s unbelievable. And when you start seeing the repercussions from the stock market, et cetera, and how it’s impacting every level, it’s quite shocking.”
They know the crisis is far from over and could now escalate.
“We feel stuck in the middle of this commercial war and we don’t have the weapons to fight, I think,” Ms Courselle said.
It is, she says, very stressful.
Gerry Keogh
The histories of America and France have been intertwined for centuries through revolutions against tyranny and two wars fighting for liberty.
America used to call France its oldest ally, but under Mr Trump it is now being as turned on, as France, along with the rest of Europe, finds itself in what many would argue is a reckless and unjustified trade war.
It is all doing enormous harm to relations between the US and its European allies.
How Europe now decides to retaliate will help determine the extent of that damage.
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