‘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.”
A group of people tried to steal a Banksy mural from a battle-scarred wall in Ukraine, the governor of the region has said.
They managed to slice off a section of board and plaster bearing the image of a woman in a gas mask and dressing gown holding a fire extinguisher.
But they were spotted at the scene in the city of Hostomel, near Kyiv, and the mural was retrieved, Oleksiy Kuleba said in a statement.
He added that the image was still intact and the police were protecting it.
“These images are, after all, symbols of our struggle against the enemy… we’ll do everything to preserve these works of street art as a symbol of our victory,” he said.
Police shared images of the yellow wall in Hostomel, with had a large patch cut all the way back to the brickwork.
They said a number of people were arrested at the scene.
Banksy confirmed he had painted the mural and six others last month in places which had suffered particularly heavy fighting after Russia invaded Ukraine in late February.
One shows a female gymnast balancing on a damaged building, while another depicts a man resembling Russian President Vladimir Putin being flipped during a judo match with a little boy, and another shows two children using a metal tank trap as a seesaw.
Banksy’s work can sell for millions of pounds on the art market.
Sajid Javid has announced he will not stand in the next general election, saying being an MP had been “the privilege of [his] life”.
The former chancellor, who has held a number of senior roles in government alongside his Bromsgrove seat, is the most high-profile Tory MP to decide to step down at the next national vote, expected in 2024.
It comes amid reports the Conservative Party has told its MPs to decide about their future by Monday, with a number of younger members already confirming their exits.
He has also made the announcement on the day Labour secured an historic majority in the City of Chester by-election, with stark warnings that such a swing nationally could cause the Tories big problems the next time the country goes to the polls.
Politics live: Sunak ‘on borrowed time’ after Tory vote collapses in by-election
In a letter to his party chairman posted on Twitter, Mr Javid said it was “a decision I have wrestled with for some time”, but one that had been “accelerated” due to the party deadline.
“Being the local MP and serving in government has been the privilege of my life and I am immensely grateful for the opportunity to serve,” he said.
“I always sought to make decisions in the national interest, and in line with my values, and I can only hope my best was sufficient.”
He pledged the decision would not impact his work as an MP during his remaining time in office, adding: “I will of course continue to support my friend the prime minister and the people of Bromsgrove in any way I can.”
Prime Minister Rishi Sunak said he was “sad to see my good friend… stepping back from politics”, tweeting: “He’s been a proud champion of enterprise and opportunity during his time in government and on the backbenches – particularly for the people of Bromsgrove.”
Ending with a Star Wars quote, the PM added: “May the Force be with you, Saj.”
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After resigning from government over Boris Johnson’s conduct earlier this year, he made a cutting speech in the Commons
Mr Javid first came into parliament in 2010 at the start of the coalition government, and got his first job on the front bench in 2012 as economic secretary to the Treasury.
Over the past 12 years he has held some of the highest offices of state, including home secretary and chancellor of the Exchequer.
Mr Javid quit the latter role in 2020 – less than three months into the job – after the then-Prime Minister Boris Johnson and his senior adviser Dominic Cummings insisted he sack his aides and replace them with ones chosen by Downing Street.
He returned to Mr Johnson’s top team as health secretary in June 2021 after Matt Hancock resigned after being caught on CCTV kissing one of his aides and breaking his own COVID guidance.
But he was the first minister to resign in the wave of exits that led to Mr Johnson’s downfall over the summer, followed minutes later by then-Chancellor and now Prime Minister Rishi Sunak.
Mr Javid twice ran for the leadership of his party, but lost out to Mr Johnson and his successor, Liz Truss.
The host of a conference in Kyiv alerted guests that air raid sirens were sounding, before assuring them they were safe and the event would carry on as planned.
It is a small example of how people across Ukraine are learning to cope with the unpredictability of war while carrying on with their lives in a test of endurance that has been likened – in its spirit – to what the UK lived through during the Blitz in the Second World War.
Stepping onto the stage at the Kyiv Security Forum, amid the air raid warning, was Vitali Klitschko, the city’s major.
He is overseeing support for residents at a crucial moment following several waves of Russian missile strikes against energy infrastructure since early October.
Last week, they knocked out the lights, heat and water supplies for much of the capital for up to two days – a brutal taste of how bad conditions could become, if more attacks cause even graver damage as winter bites.
Mr Klitschko said he wanted to speak bluntly about the risk, telling his audience that the people of Kyiv need to be prepared for various scenarios “even the worse one” – with power out for a prolonged period of time.
He offered this advice: “Stock up on water, non-perishable food and warm clothes. Also anyone with friends or relatives who live in rural areas away from the city should talk with them and be prepared to move out there if necessary, should conditions worsen.”
Power cuts have increased in frequency in recent weeks
Asked afterwards by Sky News whether he was worried that Russia could freeze residents in the city to death with its missile strikes, he said the priority was to be prepared.
“The main goal of Russians, we know, they tried to destroy our infrastructure, critical infrastructure, they want to freeze us. But we have to be prepared for any case, also for [a] worst case scenario,” he said, speaking in English.
“That is why everyone in the city government has to know what we have to do in a critical situation, how we can help the people because it will be [a] catastrophe if the Russians totally destroyed our infrastructure. It will be [a] humanitarian catastrophe.”
A local food market in Kyiv
At the same time, he underlined the determination of residents to endure: “It’s our cities, our homes. We don’t want to leave. The Russians try to bring depression on our citizens… I talked to our citizens. They are very angry and ready to stay and ready to fight.”
As for whether what Kyiv residents were having to endure could be likened to the Blitz spirit, the mayor said: “It is [a] pretty similar situation [to the] Second World War in London.”
That spirit of defiance was on display at a local food market, where shoppers bustled from stall to stall almost as normal – despite the knowledge Russia could launch a new missile strike at any moment.
Halyna and Georgii Bohun said they have not left Kyiv since the first day of the full-scale invasion on 24 February.
They likened their country’s experience – in terms of carrying on despite the dangers – to what people in the UK felt during the Blitz.
“We were thinking: if they survived after such bombardment, we will also survive,” Halyna, 60, a pharmacy worker, said.
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Her husband even compared Ukraine’s President Volodymyr Zelenskyy to Winston Churchill.
“Sometimes they even use similar words, even their minds are similar,” said Georgii, 73, a retired energy industry worker.
The pair said they had enjoyed a lull in missile strikes over the past week, but were ready for worse to come.
“We are not afraid,” said Halyna. “What will be will be. But we are for freedom and only for our country’s victory.”
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