‘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
Russia calls meeting with UK ambassador after Lord Cameron says Ukraine ‘has right’ to strike inside Russia with UK weapons
Russia has warned that Ukrainian strikes on its territory with UK-supplied weapons could bring retaliatory attacks against British military facilities and equipment on Ukrainian soil or elsewhere.
During a trip to Kyiv last week, Foreign Secretary Lord Cameron said Ukraine “absolutely has the right” to strike back at targets inside Russia using British-supplied weapons.
Russia’s foreign ministry said the UK’s ambassador to Moscow had been “summoned” to make him “reflect on the inevitable catastrophic consequences of such hostile steps by London”.
The UK’s Foreign Office, however, contested the claim saying the ambassador had not been “summoned” but he had just taken part in a diplomatic meeting with ministry officials.
British ambassador Nigel Casey was called in for a formal protest, the Russian foreign ministry claimed, as it said Lord Cameron’s remarks recognised that Britain – which has given Ukraine billions of pounds worth of weapons to defend itself in the war against Russia – was now de-facto a part of the conflict.
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Keep up with all the latest news from the UK and around the world by following Sky News
“Casey was warned that in response to Ukrainian attacks on Russian territory with British weapons, any British military facilities and equipment on the territory of Ukraine and abroad could be targeted,” the foreign ministry said.
“The ambassador was called upon to reflect on the inevitable catastrophic consequences of such hostile steps by London and immediately refute the belligerent provocative statements of the head of the Foreign Office in the most decisive and unambiguous way.”
A UK Foreign Office spokesperson said in a statement: “The British Ambassador was not summoned. He met Russian Ministry of Foreign Affairs officials for a diplomatic meeting.
“The Ambassador reiterated the UK’s support for Ukraine in the face of unprovoked Russian aggression, and restated the UK’s position on providing support to Ukraine.”
During Lord Cameron’s visit to Ukraine last week, the foreign secretary reiterated Britain’s unwavering support for Ukraine, whose troops have been fighting Russia’s invasion since the Kremlin launched its “special military operation” in February 2022.
“Ukraine has that right. Just as Russia is striking inside Ukraine, you can quite understand why Ukraine feels the need to make sure it’s defending itself,” Lord Cameron said.
Senior Israeli officials have been threatening a major military operation into the city of Rafah and surrounding areas in southern Gaza for weeks.
On Sunday, Israeli defence minister Yoav Gallant warned it could take place “imminently” as talks on a ceasefire with Hamas fizzled-out in Cairo.
Now, they have taken a major step towards it.
War latest: Families flee Rafah as IDF orders 100,000 to evacuate
On Monday morning, the Israel Defence Forces (IDF) released a statement instructing people in southeastern Gaza to advance towards an “expanded humanitarian area” to the north, centred around the city of Khan Younis, and a coastal community called Al-Mawasi.
The IDF said it “includes field hospitals, tents and increased amounts of food, water, medication and additional supplies”.
The claim will be greeted with scepticism by international aid agencies that have argued the Israelis have failed to do enough to facilitate such aid.
Civilians are being told to move to an ‘expanded humanitarian area’ to the north
The UN’s refugee agency in Gaza, UNRWA, immediately questioned the operation on X.
UNRWA said an offensive “would mean more civilian suffering and deaths” and that “the consequences would be devastating for 1.4 million people”.
The vast majority of people living in southern Gaza have already been displaced by the fighting further north.
And in what represents a significant juncture, the Israelis are instructing them to return to areas that have already badly damaged in this conflict.
Israel has been dropping evacuation leaflets from the air. Pic: AP
Khan Younis was placed under siege by the IDF in January and many neighbourhoods have been partially – or completely – destroyed.
However, there are no doubts about the Israelis’ intent.
Leaflets are now being dropped in southeastern Gaza, stating: “Anyone in the area puts themselves and their family members in danger. For your safety, evacuate immediately….”
Aerial strikes have caused havoc – but there are fears a ground attack would be even worse. Pic: Reuters
With this operation, Israel would test the very limits of support that it receives from Western countries like the US, the UK and members of the European Union.
Last week, US secretary of state Antony Blinken suggested an incursion into Rafah was a step too far, warning the Israelis had yet to produce “a clear, credible plan to protect civilians”.
Until it does, Mr Blinken said Washington “cannot and will not support a major military operation” in the area.
Read more:
Peace looks distant as ever after Israel refuses ceasefire terms
Inside Gaza protest’s last stand
Now, Israel’s chief ally and military backer will have to formulate a response, one which requires them to evaluate the nature and extent of this complicated relationship.
But it seems Israeli Prime Minister Benjamin Netanyahu and his war cabinet have made up their minds.
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