‘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
Donald Trump refuses to rule out military force over Panama Canal and Greenland – as he warns NATO to spend more
US president-elect Donald Trump has refused to rule out military or economic action to seize the Panama Canal and Greenland – as he said he believes NATO spending should be increased to 5% per member state.
Speaking at Mar-a-Lago, Florida, Mr Trump made a series of sweeping claims on what his policies could look like when he takes office on 20 January.
He said he believes NATO spending should be increased to 5% per member state, while he also declared US control of Greenland and the Panama Canal as vital to American national security.
The 78-year-old Republican also spoke of relations with Canada, as well as addressing his position on the Middle East and the war in Ukraine.
Sky News takes a look at some of the key claims brought up during the conference.
NATO
Mr Trump claimed “nobody knows more about NATO than I do”, before adding: “If it weren’t for me, NATO wouldn’t exist right now.
“I raised from countries that weren’t paying their bills, over $680bn. I saved NATO, but NATO is taking advantage of us.”
The president-elect also said members of NATO should be contributing 5% of their GDPs (gross domestic product) to defence spending – the previous target has been 2%.
Donald Trump speaking at Mar-a-Lago. Pic: Reuters
Greenland and Panama Canal
Asked if he can reassure the world he won’t resort to military action or economic coercion in trying to get control of the areas, he said: “No, I can’t assure you on either of those two.”
“But, I can say this, we need them for economic security.”
He didn’t add any further detail around Greenland – which he has recently suggested the US should own or control – but he said the Panama Canal “was built for our military”.
He said the canal was “vital” to the country and China was “operating” it.
Mr Trump criticised the late Jimmy Carter for his role in signing over the Panama Canal to Panama during his presidency, saying it’s “a disgrace what took place” and “Jimmy Carter gave it to them for one dollar.”
Canada
A day after Canadian Prime Minister Justin Trudeau announced he was stepping down, Mr Trump said he believed the US’ northern neighbour should become the 51st US state.
He mocked Mr Trudeau by calling him “governor” rather than prime minister.
He argued the US and Canada combined would amount to an “economic force” that would “really be something”.
“There isn’t a snowball’s chance in hell that Canada would become part of the United States,” Mr Trudeau responded.
Israel-Hamas war
Israel has been waging a 15-month war on the militant group ruling Gaza, Hamas, since they launched an unprecedented attack on southern Israel on 7 October which saw 1,200 people massacred and about 250 taken hostage, many of whom remain in captivity.
Mr Trump said: “If those hostages aren’t back by the time I get into office, all hell will break out in the Middle East.”
Nearly 46,000 Palestinians have been killed in Israel’s assault on Gaza, according to Hamas-run health officials in the enclave.
Analysis: Trump’s warning risks becoming less threatening
Ukraine war
Referring to Russia’s ongoing full-scale war against its smaller neighbour, Mr Trump said a “big part of the problem” was Russian President Vladimir Putin had said for many years he did not want Ukraine involved with NATO.
“Somewhere along the line [outgoing President Joe] Biden said you can join NATO,” he said.
“Well, then Russia has NATO right on their doorstep.
“When I heard the way Biden was negotiating I said ‘you are going to end up in a war’ and it turned out to be a war.”
Asked if he would commit to keep supporting Ukraine during negotiations with Moscow, Mr Trump quipped: “Well, I wouldn’t tell you if that were the case.”
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Offshore drilling
Mr Trump repeated one of his favourite phrases from the campaign trail, “drill, baby, drill”.
On Monday, outgoing President Biden moved to ban new offshore oil and gas developments along most US coastlines.
But Mr Trump, who has vowed to boost domestic energy production, said he will undo it.
“We’re going to be drilling a lot of other locations,” he said.
The public articulation by Donald Trump of a new desired target for NATO allies to spend 5% of national income on defence will surely plunge governments across Europe into crisis mode – not least here in the UK.
Britain presents itself to the world and in particular to the United States as the biggest defence spender in Europe and NATO’s most powerful European military.
Yet Sir Keir Starmer has not even managed to set out a timeline for what he describes as a “path to 2.5%” of GDP being invested in his armed forces, up from just over 2% today.
If the prime minister merely sticks to this pledge, he risks being viewed by the new administration as woefully unambitious and not credible on defence.
Then there is the extraordinary threat by Mr Trump to seize Greenland by force if necessary, even though this valuable piece of territory belongs to a fellow NATO ally in the form of Denmark.
The move – were it to happen – would demonstrate the limitations of the alliance’s Article 5 founding principle.
It is supposed to guarantee that all allies would come to the defence of any member state which is under armed attack.
But what about if the aggressor is also meant to be an ally?
The president-elect also appeared to dash any hope of Ukraine being offered membership to the alliance anytime soon – a core request of President Volodymyr Zelenskyy.
Instead, Mr Trump sounded sympathetic to Vladimir Putin’s absolute opposition to such a move.
He said he would meet the Russian president after taking office – reiterating a promise to end the war in Ukraine, though again without spelling out how.
The outbursts came in a lengthy press conference on Tuesday that marked the starting shot in what could be a make-or-break test for NATO – an alliance of transatlantic friends that rose from the ashes of the Second World War.
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European members of NATO, as well as Canada, already took a battering the last time Mr Trump was in the White House – and rightly so.
The US had for far too long largely bankrolled the security of Europe, while the majority of its allies – including the UK – reaped the so-called “peace dividend” that followed the collapse of the Soviet Union and the end of the Cold War, swapping expenditure on defence for peacetime priorities such as economic growth, healthcare and education.
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From 2019: Was this the most awkward NATO summit ever?
Mr Trump made clear during his first term his displeasure about what he saw as Washington being ripped off and vowed to make Europe take its fair share of the burden.
He even warned member states that the US would not come to the aid of an ally that was not hitting at the very least a minimum NATO spending targeting of 2% of GDP – something they had previously pledged to do by 2024 but were slow to deliver on.
Such language electrified allies in a way that even Putin’s initial 2014 invasion of Ukraine, with the annexation of Crimea and attacks in the east of the country, had not.
Yet, with the threat from Russia growing in the wake of its full-scale war in Ukraine in 2022, coupled with conflict in the Middle East and the challenge posed by China, it has become clear that this heightened level of expenditure by allies was still far short of what is required to rebuild militaries across Europe that have been hollowed out over decades.
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Mark Rutte, the new secretary general of NATO, set the stage for what is expected to be another push to ramp up investment when he delivered a landmark speech last month in which he called on allies to return to a “war mindset” and “turbocharge” defence spending.
He said this was to counter growing threats, but observers said it was also a pre-emptive response to the anticipated demands of the next Trump administration.
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‘Ukraine needs more arms, less talking’
Either way, it poses a huge challenge for all allies, in particular for Sir Keir Starmer.
He and Rachel Reeves face a choice: change course when it comes to their top priorities of economic growth, hospital waiting lists and new housing and instead invest more in defence or defy what will doubtless be growing demands from the United States to spend billions of pounds more on the UK armed forces – and maybe even leave the country in a position whereby the US would not come to its aid if attacked.
The Rapid Support Forces (RSF) and its allied militias are committing genocide in Sudan while waging war against the army for control of the country, Joe Biden’s US administration has determined – two weeks before leaving office.
In a statement sharing the designation on Tuesday, US secretary of state Antony Blinken said the RSF and its aligned militias had “systematically murdered men and boys – even infants – on an ethnic basis” and “deliberately targeted women and girls from certain ethnic groups for rape and other forms of brutal sexual violence”.
He announced that Washington would impose sanctions on RSF leader Mohamed Hamdan “Hemedti” Dagalo and seven RSF-owned companies located in the United Arab Emirates (UAE).
Mohamed Hamdan ‘Hemedti’ Dagalo. File pic: AP
The UAE is credibly accused of backing and arming the RSF – something it has strenuously denied.
When reached for comment by Reuters, the RSF rejected these measures and said: “America previously punished the great African freedom fighter Nelson Mandela, which was wrong.
“Today, it is rewarding those who started the war by punishing (RSF leader) general Mohamed Hamdan Dagalo, which is also wrong.”
The RSF has been fighting Sudan’s army for territorial control of the country since war erupted in the capital, Khartoum, in April 2023.
The ensuing devastation has been described as the worst humanitarian crisis ever recorded – with over 11 million people forced out of their homes, tens of thousands dead, and 30 million in need of humanitarian assistance.
Sudan, Africa
In December 2023, Mr Blinken announced that both warring parties had committed war crimes, but that the RSF in particular had committed crimes against humanity and ethnic cleansing.
He mentioned this precedent in this latest announcement, adding: “Today’s action is part of our continued efforts to promote accountability for all warring parties whose actions fuel this conflict.
“The United States does not support either side of this war, and these actions against Hemedti and the RSF do not signify support or favour for the SAF (Sudanese Armed Forces).
“Both belligerents bear responsibility for the violence and suffering in Sudan and lack the legitimacy to govern a future peaceful Sudan.”
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Sudan’s history faces erasure
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This comes twenty years after then US secretary of state Colin Powell described the conflict in Darfur, western Sudan, as a genocide in 2004.
Back then, RSF leader Hemedti was heading up a lesser-known Janjaweed militia that was carrying out state-sanctioned atrocities against civilians.
He was not held accountable then, and many wonder if this latest designation will have any impact on the actions of forces on the ground.
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