‘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.”
As people take a break for the Easter holiday, in the Gaza Strip there is no respite from the 18-month-long war with Israel.
Gaza has a tiny Christian community of Greek Orthodox Christians, Catholics, Evangelicals, and Anglicans.
For Ramez al-Souri, the pain is unimaginable. His three children were killed by an Israeli airstrike, on an annex of Gaza’s Saint Porphyrius Greek Orthodox Church.
Palestinian health officials say the attack on 19 October 2023 killed 18 people inside the building.
“My home has changed completely because there are no smiles, no laughter, no joy,” Mr Al-Souri says.
“I lost my flower – my daughter Julie – and my boys Suhail and Majd. They were salt of the Earth.”
Shrouded in darkness
Julia was 12 years old, Suhial 14 and Majd 11.
It is a loss that never leaves Mr Al-Souri, and one shared by almost every family in Gaza.
Walking through the cemetery, he gently places a small bouquet of flowers on his children’s grave. Gunfire crackles in the distance. The neighbourhood is full of rubble and destruction.
“This Easter is no different than the last,” Mr Al-Souri says.
“We are tending to our wounds.
“We continue to hope for an end to this war and suffering, for the darkness over Gaza to finally lift.”
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No end in sight
But there is no sign of light for more than two million people trapped inside Gaza.
Israel’s Prime Minister Benjamin Netanyahu gave a special address to the nation on Saturday night and vowed to continue the war until Hamas is destroyed.
Mr Netanyahu said Israel has “no choice” but to keep fighting “for our very own existence until victory.”
Israel is calling for Hamas to disarm and to release 10 Israeli hostages in exchange for a 45-day ceasefire.
There are 59 hostages still inside Gaza. It is believed 24 of them are still alive.
Hamas has rejected the proposal. It argues Israel reneged on the first ceasefire deal by refusing to move to phase two of the agreement and withdraw Israeli troops from the Gaza Strip.
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Netanyahu: ‘I will not give in’
A disaster on the ground
Since the ceasefire collapsed on 2 March, Israel’s bombing campaign has intensified.
Palestinian health officials say more than 1,700 people have been killed in the last month, and more than 90 people in the last 24 hours.
The humanitarian situation is a disaster. At the few remaining soup kitchens in Gaza, children scramble for food. They carry pots for their family and push forward trying to secure a bowl of lentils or rice.
Israel has blocked aid trucks from entering for the last seven weeks. It says it is to put pressure on Hamas.
But the pressure is being felt by civilians, creating what aid groups say is the most severe crisis Gaza has ever faced.
Israel has cut off vital supplies of food and medicine, but insists it is not using starvation as a weapon of war. It rejects any suggestion Gaza does not have enough food and accuses Hamas of stealing it.
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Gazans struggle to find bodies under rubble
‘We’re craving food’
Seven members of the Al-Asheh family are displaced and live in a tent in Deir al-Balah.
Twelve-year-old Ahmed says before the war he didn’t like lentils, now it is all he eats.
“Before the war, we used to have fruits, chicken, vegetables, everything was available. We were never hungry,” Ahmed explains.
“Now, we’re craving food, chicken – anything. The only thing we can eat now is what the soup kitchen provides.”
Food is increasingly hard to come by in Gaza
It is clear that ceasefire talks are going nowhere, and Israel has tightened its blockade and deepened its war.
More than 400,000 Palestinians have recently been displaced yet again as Israel has expanded a buffer zone inside Gaza, levelling houses to create a “security zone”.
For Palestinians, this constitutes a “land grab”.
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Israeli forces encircle Rafah
‘A symbol of the world’s conscience’
Israel has also established another military corridor in southern Gaza, calling it Morag corridor.
The corridor is north of Rafah and has cut Gaza’s second-largest city off from the rest of the territory. Israel says it has now taken control of 30% of the Gaza Strip and insists it will not withdraw.
For Palestinians, the future has never looked more bleak. They are blockaded, displaced, struggling for food, water, basic sanitation and in constant search of safety.
“Gaza is calling on the world to stand by it,” Mr Al-Souri says.
“Gaza stands as a symbol of the world’s moral conscience.”
London-born teenager Carlo Acutis is about to become the first millennial saint, almost 20 years after his death.
The teenager, whose Italian family moved to Milan months after his birth in 1991, dedicated his short life to Catholicism, and died of leukaemia in 2006 aged 15.
Having passed all the posthumous trials necessary for sainthood, he will be canonised on 27 April in St Peter’s Square in Vatican City.
But what does it take to become a saint and how did Carlo achieve it?
Here’s everything you need to know.
What does it mean to be a saint?
All Christians are called to be saints, but only a select few throughout history have been officially recognised as one.
A saint is defined in Catholicism as people in heaven who lived heroically virtuous lives, offered their life for others, or were martyred for the faith, and who are worthy of imitation.
How do you become a saint – and how did Carlo do it?
There are four steps on the path to becoming a saint:
Stage 1 – Servant of God
A postulator – essentially a cheerleader advocating for the candidate – gathers testimony and documentation and presents the case to the Vatican’s Congregation for the Causes of Saints.
This process usually begins at least five years after the death of the person in question.
Carlo was dedicated to the church throughout his short life, receiving first communion at the age of seven and regularly attending daily Mass, praying the rosary and participating in eucharistic adoration.
But it was through mixing his faith with technology that Carlo had the most impact, informally becoming known as “God’s influencer” as he used his computer skills to spread the Catholic faith.
He started publishing newsletters for his local churches, taking care of his parish website and later of a Vatican-based academy.
He became particularly interested in something called Eucharistic miracles.
These are events deemed miracles which take place around the Eucharist, which is the traditional name the Christian church gives to the re-enactment of the Last Supper.
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It’s the moment when the faithful are given a small piece of bread and a sip of wine, called the Holy Communion. They believe that, through the consumption of the bread and wine, Jesus Christ enters those who take part.
Carlo started logging miracles on a website, which eventually went viral and has since been translated into many of the world’s most widely spoken languages.
Stage 2 – Venerable
If worthy, the case is forwarded to the Pope, who signs a decree confirming the candidate’s “heroic virtues”. The person is now called “venerable”.
Carlo was named venerable in 2018 after the church recognised his virtuous life, and his body was taken to a shrine in Assisi’s Santuario della Spogliazione, a major site linked to St Francis’ life.
Stage 3 – Beatification
Carlo Acutis lies in state ahead of being beatified in 2020.
File pic: AP/Gregorio Borgia
You become beatified – the declaration by the Pope that a dead person is in a state of bliss – when a miracle in your name is identified and formally declared a miracle by the Pope.
The Roman Catholic Church teaches that only God performs miracles, but that saints who are believed to be with God in heaven intercede on behalf of people who pray to them.
Typically, miracles are the medically inexplicable healing of a person.
The Pope tends to accept it as such when witnesses “verify” someone was healed after prayer and doctors/clergy conclude that it had no medical explanation, was instant and lasting.
If verified, the candidate is beatified and becomes “blessed”.
Carlo’s first supposed miracle was the healing of a boy called Mattheus Vianna, who was born in 2009 in Brazil with a serious birth defect that left him unable to keep food in his stomach.
As a young boy, he was forced to live on vitamins and protein shakes but regularly vomited after meals and was unable to put on weight.
Mattheus, according to his priest, touched one of Carlo’s relics in church and said “stop vomiting” – an act which is said to have cured him.
In February 2014, his family ordered further tests and he was found to be fully cured, the priest said.
In 2019, the claimed miracle was acknowledged by the Vatican and confirmed by Pope Francis a few months later, paving the way for Carlo to become beatified in 2020.
Stage 4 – Sainthood
A second miracle is required in order to reach sainthood.
If verified, the candidate can be canonised and made a saint. A formal canonisation ceremony at the Vatican follows.
Figures of Carlo on sale at a souvenir store ahead of his canonisation. Pic: Christoph Sator/picture-alliance/dpa/AP Images
The second miracle in Carlo’s name was the reported healing of a Costa Rican girl studying in Italy who suffered a major head trauma.
Her mother said she prayed at Carlo’s tomb after the incident, invoking his spirit and leading to her daughter’s full recovery.
Pope Francis attributed the second miracle to Carlo after a meeting with the head of the Vatican’s saint-making department, Cardinal Marcello Semeraro, in May 2024.
Sainthood is rare – but not as much as it used to be
It isn’t known exactly how many sainthoods have been handed out in the Catholic church’s history, though estimates tend to sit at around 10,000.
For hundreds of years, they were selected through public acclaim, until Pope John XV led the first canonisation in the year 993, making Bishop Ulrich of Augsburg a saint.
Canonisation has been more common in recent years, though, with the late Pope John Paul II, who was the Pope from 1978 until his death in 2005, declaring 482 saints during his tenure – more than all of his predecessors.
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That record was overtaken just two months into Pope Francis’ tenure, as he canonised more than 800 15th-century martyrs, the so-called “Martyrs of Otranto,” who were beheaded for refusing to convert to Islam.
Since then, the Pope has gone on to grant a number of other high-profile sainthoods, including his predecessors Pope John Paul II and John XXIII, married couple Louis and Zelie Martin, who lived in France during the 19th century, and Mother Teresa.
He’ll take to St Peter’s Square on 27 April at 9.30am UK time – in conjunction with the celebration of the Holy Year’s jubilee for teens – and canonise the first ever millennial saint.
World
Why Putin has suddenly offered an ‘Easter truce’ in Ukraine – and the interesting way it’s being presented
Well it is something, but it’s by no means everything – a ceasefire for 30 hours, not 30 days.
This feels like a diplomatic dance, rather than a military, or moral, manoeuvre.
An Easter truce – announced by Vladimir Putin on Saturday – is significant in the sense that, if it holds, it’ll be the first actual cessation of hostilities since the war began.
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And it’s significant in the sense that it’s the first actual concession made by Moscow since Donald Trump initiated peace negotiations two months ago.
But – and there’s always a “but” when it comes to the Kremlin – how much of a concession is it really? And how much difference will it make militarily?
It’s nowhere near what the White House has been asking for, and it’s nowhere near what Ukraine has previously consented to.
The American president’s first proposal was a full 30-day ceasefire. Kyiv agreed but Moscow didn’t, not without conditions.
Then there was the attempted maritime truce. Again, Moscow’s agreement came with strings attached, in the form of sanctions relief, so it never got off the ground.
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Ukraine: Michael Clarke Q&A
So why suddenly suggest a truce now?
America had made no secret of its growing frustration at the lack of progress in peace negotiations.
Trump threatened to “take a pass” on attempts to reach an agreement on Friday after his secretary of state said the US might “walk away”.
I don’t think that in itself would be a problem for Russia, given its military dominance. But I think it could be a problem if Trump blames Putin for the lack of progress, and then pulls the plug on their thaw in relations as well.
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So this feels like Putin is giving Trump just enough to keep him on side, without actually making any major concession.
And the way it’s being presented is interesting too – at Russia’s initiative, on humanitarian grounds, Ukraine must “follow our example”.
He’s trying to cast himself as the peacemaker in the eyes of the US president – as the one who gives solutions, not problems – which appears contrary to Trump’s opinion of Volodymyr Zelenskyy.
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