‘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.”
The ceasefire clock is ticking down and everyone in Gaza knows it.
In the calm, people have been flooding to hospitals looking for treatment – almost overwhelming doctors.
At a hospital in southern Gaza, a Sky News team filmed as patient after patient was brought in for treatment, many of them children, with undiagnosed illnesses.
Follow the Israel-Hamas war live, as more hostages are released
The hospital’s corridors were crammed, with the injured placed on rickety beds.
In one doctor’s room, mother after mother entered with their ill children, desperate for help.
There is a real fear of a major spread of disease among the civilians, who are largely homeless and barely finding enough food to survive.
Hygiene fears grow in Gaza
The head of the safety unit of the Ministry of Health in Gaza told Sky News the basic lack of hygiene and lack of clean water is making problems worse.
“There are many different types of diseases, such as skin diseases between the refugees, especially gut diseases and diarrhoea,” Estamily A’adeni explained.
“As you may know most of the displaced people have a basic lack of hygiene because of their evacuation, and lack of water hygiene, this is why we see an increase in some cases such as skin disease, respiratory illness, and children in particular are suffering from diarrhoea,” he added.
Mothers in a doctor’s room in Gaza
Estamily A’adeni in Gaza
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Aid deliveries have continued both to the south and the north of the Gaza Strip, and the quantity of it coming in has increased.
But aid agencies have consistently said it is hopelessly inadequate.
People are increasingly desperate, and they know that when the war resumes life will get even worse.
Hundreds of thousands have already moved south, and they face the very real prospect of having to move again.
Of course, the current ceasefire has been entirely dependent on the release of hostages in Gaza, and the release of Palestinian prisoners in Israeli jails.
At the permanent vigil for hostages at a square in Tel Aviv, it’s clear that people are desperate for them to be returned.
At the same time though, there is widespread support for a resumption of the war on Hamas. And this is a conundrum for the Israeli government and the military – and Hamas of course always knew it would be.
This complex process has so far been remarkably successful, with negotiators staying in constant touch with both Israel and Hamas.
The vigil site itself is dominated by an enormous, fully dressed dinner table with place settings for all the hostages. Silhouetted pictures of people are hung over the back of chairs to symbolise that they’re still missing.
Vigil in Tel Aviv
Chairs without the pictures represent the hostages who have been released and are now in hospital or back with their families in Israel.
Hundreds of people wander around the square looking at installations – including bound and blindfolded toy dolls that represent the children being held.
A few gazebos have been set up by survivors of the various kibbutzim attacked by Hamas on 7 October. Pictures of the dead and missing from the individual kibbutz adorn the gazebos, and people come to mourn and chat with friends and relatives.
In the crowd I met Sandra Cohen. I asked her if she, like others here, believed the war against Hamas had to restart, and I asked her about the complexities of the IDF’s tactics – how to attack Hamas and get the hostages out.
“They have a dilemma because getting them out and having a full destruction of the tunnels could put them in harm’s way, so they take it day by day and they do it slowly, obviously they have drones that watch and see what’s happening, but they do want to get them back alive, and we just have to wait and see what happens.”
Former United States secretary of state Henry Kissinger has died aged 100.
He passed away at his home in Connecticut on Wednesday, according to a statement from Kissinger Associates Inc.
The veteran politician had major influence on American foreign policy under Presidents Richard Nixon and Gerald Ford.
Born in Germany in 1923, Mr Kissinger fled the Nazi regime with his family as a teenager and settled in the US in 1938.
During eight years as a national security adviser and secretary of state, Dr Kissinger was involved in major foreign policy events including the first example of “shuttle diplomacy” seeking peace in the Middle East, secret negotiations with China to defrost relations between the burgeoning superpowers and the instigation of the Paris peace talks seeking an end to the Vietnam conflict.
Dr Kissinger with President Gerald Ford and Chairman Mao Zedong in Beijing in 1975
Analysis: A ‘top diplomat’ for some, a ‘war criminal’ for others
In 1973 he was jointly awarded the Nobel Peace Prize for his efforts to negotiate an end to the Vietnam War.
However, Dr Kissinger, along with President Nixon, also bore the brunt of criticism from the US’s allies following the fall of Saigon to North Vietnamese forces in 1975 as the remaining US personnel fled what is now known as Ho Chi Minh City.
Henry Kissinger meeting President Xi Jinping in Beijing earlier this year. Pic: AP
His influence over US diplomacy – which continued long after he left office – has not been without controversy, and some activists called for him to be prosecuted for war crimes.
He remained active in politics, even after his 100th birthday in May, attending meetings in the White House, publishing a book on leadership styles, and testifying before a Senate committee about the nuclear threat posed by North Korea.
In July 2023 he made a surprise visit to Beijing to meet Chinese President Xi Jinping.
During his early life, after becoming a naturalised US citizen in 1943, Dr Kissinger joined the US Army the same year and was awarded a Bronze Star.
He would go on to serve with US counter intelligence in occupied Germany.
Dr Kissinger earned his bachelor’s, master’s, and PhD degrees at Harvard University, where he taught international relations for almost 20 years before President Nixon appointed him national security advisor in 1969.
Henry Kissinger with Richard Nixon and Israeli prime minister Golda Meir
He is survived by his wife of nearly 50 years, Nancy Maginnes Kissinger, two children by his first marriage, David and Elizabeth, and five grandchildren.
According to the statement from Kissinger Associates: “He will be interred at a private family service. At a later date, there will be a memorial service in New York City.”
Senator and former presidential candidate Mitt Romney paid tribute to Dr Kissinger on X describing him as a “great one” and saying: “Fortunate indeed is America for his lifetime of diplomacy, wisdom, and love of freedom.”
Winston Lord, former US ambassador to China and Dr Kissinger’s one time special assistant said: “The world has lost a tireless advocate for peace.
“America has lost a towering champion for the national interest. I have lost a cherished friend and mentor.
“Henry blended the European sense of tragedy and the American immigrant’s sense of hope.”
Cindy McCain, the wife of late Senator John McCain said: “Henry Kissinger was ever present in my late husband’s life.
“While John was a POW and in the later years as a Senator & statesman.
“The McCain family will miss his wit, charm, and intelligence terribly.”
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