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COVID-19: South Africa’s healthcare workers struggle under pressure of third wave | World News

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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
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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
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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
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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
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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
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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
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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.”

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Italy: Close associate of ex-PM Silvio Berlusconi cleared of negotiating with mafia after bombings | World News

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A close associate of ex-Italian PM Silvio Berlusconi and three former police investigators have had their convictions overturned, in a case where the state was accused of colluding with the mafia during its 1990s bombing campaign.

Former senator Marcello Dell’Utri, along with Mario Mori, Antonio Subranni and Giuseppe De Donno, have now been acquitted by a judge at an appeals court in Palermo. They had all maintained their innocence.

Dell’Utri was accused of brokering a deal to stop the attacks, in return for scaling back crackdowns by authorities and loosening strict conditions for top bosses behind bars.

Marcello Dell'Utri is a former senator
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Marcello Dell’Utri is a former Italian senator

Dell’Utri, who had been a politician for Berlusconi’s right-wing Forza Italia party, was convicted in 2018 of acting as a liaison between state institutions and Cosa Nostra bosses in Sicily.

He had been sentenced to 12 years behind bars for undermining the state, as were former generals Mori and Subranni, while ex-colonel De Donno received an eight-year jail term.

But the judge in Palermo, Angelo Pellino, has ruled the charges did not constitute a crime, suggesting state officials could contact mobsters if deemed necessary.

However, he upheld guilty verdicts against two mobsters, including Leoluca Bagarella, a convicted killer for the Corleone mafia family.

Dell’Utri told Italy’s Adnkronos news agency: “This acquittal is a turning point, not only for me but for Italian justice. This trial was monstrous.”

The prosecution case claimed state representatives had negotiated with the mob following a string of mafia bombings that killed 23 people, including prominent anti-mafia magistrates Giovanni Falcone and Paolo Borsellino.

Silvio Berlusconi casts his ballot at the 2000 elections. Pic: AP
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Silvio Berlusconi pictured in 2000. Pic: AP

According to prosecutors, talks between the mafia and the Italian state began after judge Falcone, his wife and three bodyguards were killed by a device under a motorway in May 1992.

The state’s willingness to enter negotiations after Falcone’s murder encouraged further bombings, it was alleged.

The prosecution said those attacks included the one that killed Mr Borsellino two months later because he had opposed the negotiations.

Judge Giovanni Falcone was killed in a bomb blast in May 1992. Pic: AP
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Judge Giovanni Falcone was killed in a bomb blast in May 1992. Pic: AP

The following year, Cosa Nostra carried out unprecedented mainland attacks on cultural and church targets, including Florence’s Uffizi Gallery.

Ten people were killed in Milan and Florence. After 1993, the attacks abruptly stopped.

The prosecutors said they would review Thursday’s ruling to decide if they would appeal the decision to the Supreme Court.

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La Palma eruption: Lava spread raises fears of more damage on Spanish island as it rises 50 feet in places | World News

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The advance of lava from a volcanic eruption in Spain’s Canary Islands has slowed, rising in some places up to 50 feet as it thickens.

One giant river of lava on the island of La Palma slowed to 13 feet (4m) per hour on Wednesday – on Monday, a day after the eruption, it was moving at 2,300 feet (700m) per hour.

A second stream of lava has virtually ground to a halt.

As it slows, it has raised concerns that the molten rock may fan out across the land and destroy more homes.

vScreen grab from a video taken by a night drone shows a volcano erupting and tongues of lava in La Palma, Spain September 22, 2021. Spanish Emergency Military Unit (UME)/
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The advance of the lava has slowed significantly

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Correspondent broadcasts live as volcano erupts

It now covers 410 acres and has entombed 350 homes.

There have been no casualties reported from the eruption but damage to property, infrastructure, and farmland is expected to be extensive.

Almost 7,000 people were evacuated after scientists monitoring the volcano warned of the eruption.

The lava slowing has allowed more residents of towns in its path to grab belongings under police escort.

Officials had initially expressed fears about what would happen when the lava – with temperatures exceeding 1,000 degrees Celcius – reached the Atlantic ocean, as it could cause explosions, trigger landslides and produce clouds of toxic gas.

However, the head of the National Geographic Institute in the Canary Islands, Maria Jose Blanco, said some lava streams won’t reach the ocean until the weekend, and others may never reach it at all.

Thick ash has covered the island
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Thick ash has covered the island

Meanwhile, molten lava, ash and smoke continue to pour from the volcano’s mouth, shooting up to nearly 14,000 feet high, the Canary Islands Volcanology Institute said, raising concerns about whether airspace above the island could remain open.

Readings taken of the air found no threat to health, authorities said.

Joel Francisco, 38, said he and his elderly parents left their home with only a handful of belongings and important documents.

Now the flow appears to have slowed, he hopes to return, if police allow.

“We don’t know how long we have to wait until we can return to our homes because the roads are closed,” he told The Associated Press.

“Some people have it worse off, their houses are gone.”

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Video of La Palma eruptions burning buildings and destroying homes

The Canary Islands Volcanology Institute said the eruption and its aftermath could last for up to 84 days.

This means residents could still be at risk of earthquakes, lava flows, toxic gases, volcanic ash, and acid rain.

However, tourists visiting the island have been largely undeterred, with many continuing to land for previously planned holidays.

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Ukraine leader pledges ‘strong response’ after shots fired at aide’s car in assassination attempt | World News

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Ukrainian president Volodymyr Zelenskiy has warned the “response will be strong” after one of his top aides survived an assassination attempt.

At least 10 bullets struck Serhiy Shefir’s car, the top aide and close personal friend of Mr Zelenskiy, outside of Kiev on Wednesday.

The driver of his black Audi was badly wounded and taken to hospital, but Mr Shefir escaped uninjured.

It is not known who carried out the shooting and the gunman is still at large.

Markers are attached next to bullet holes in a car of Serhiy Shefir, Ukrainian President Volodymyr Zelenskiy's principal aide, following an assault outside the capital Kyiv, Ukraine September 22, 2021. REUTERS/Serhii Nuzhnenko
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Markers are attached next to the bullet holes in the car of Serhiy Shefir following the attack

Mr Zelenskiy issued a warning to the attacker from New York, where he is taking part in the UN General Assembly.

He said he did not know who was responsible for the attack, but pledged “a strong response”.

“These could be internal or external forces. But I don’t consider them to be strong because sending me a ‘hello’ by firing from a forest into the automobile of my friend is weakness,” he said.

“This [attack] will not affect the strength of our team.

“This does not affect the path toward change that I have chosen with my team, for taking our economy out of the shadows, for the fight against criminal elements with large, influential financial groups – on the contrary, because the people of Ukraine gave us a mandate for change.”

Mr Zelenskiy addressed the 76th Session of the U.N. General Assembly in New York City this week while the assassination attempt took place 12 miles south of Kiev
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Volodymyr Zelenskiy, who was in New York at the time of the attack, has pledged ‘a strong response’

Mr Shefir praised his driver for acting “heroically” by accelerating away from the gunman as the “shots rang out”.

He added: “We had to speed up a little, it was scary.”

Mr Shefir also said he believed he had been targeted in an attempt to intimidate the “highest echelon of power”, but added this would not work.

He said: “One has to understand that our president [Zelenskiy] is very strong-willed, he has a spine and cannot be intimidated.”

The Kremlin has denied any Russian involvement.

Kremlin spokesman Dmitry Peskov added any suggestion of a link with Russia showed “the signs of an excessively excited emotional state”.

He said: “Unfortunately nowadays, whatever happens in Ukraine, none of the current politicians is able to rule out the Russian trace.”

Mr Shefir praised his driver for acting "heroically" by accelerating away from the gunman
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Serhiy Shefir praised his driver for acting ‘heroically’ by accelerating away from the gunman. File pic

Ukraine has seen a huge rise in violence since its conflict with Russia began in 2014 when the Crimean peninsula was annexed.

Several military and political officers have been targeted in assassination attempts since then, with seven deaths taking place between 2016 and 2017 alone in the Ukrainian capital Kiev.

The attack came just days before Ukrainian politicians were set to debate Mr Zelenskiy’s bill on cracking down on the country’s powerful oligarchs, who dominate the economic and political landscape.

On Thursday, a day after the shooting, Ukraine’s parliament passed a law which bans oligarchs from financing political parties or taking part in privatisations.

It must now be approved by the president to come into force.

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