When Prof Lungile Pepeta died at Life St George’s Hospital on Friday, the collective hearts of his city and his province broke. Nurses were crying. Shocked doctors, battle-weary from three months in the Covid-19 trenches, shared the sad news with one another in hushed tones. As reports of his death spread around town, and from Port Elizabeth to his hometown in Bizana, there were tears and anger, but above all, shock and despair.

Covid-19 has dealt the Eastern Cape a devastating blow. It took away a doctor who fiercely advocated for the health of the province’s children, a man who bravely fought to open a medical school for rural doctors, an advocate who fearlessly battled and offended many politicians in his mission to achieve excellence in public health care.

The gentle giant from Bizana was no more – and he left behind an almost impossible dream: to create a dedicated children’s hospital for his province, staffed by an army of hand-picked specialists.

A beloved doctor blessed with the sharpest of minds and the biggest of hearts, Pepeta completed his MBChB at the University of the Transkei, now the Walter Sisulu University, in 1997, and obtained a diploma in child health care in 1999. He qualified as a paediatrician in 2003 and worked in Komani before returning to study at Wits and the Chris Hani Baragwanath Hospital to qualify as a pediatric cardiologist in 2008. 

In 2009 he moved to Port Elizabeth, where he set up the first paediatric cardiology unit at the city’s provincial hospital. Children who were born with congenital heart disease, a condition with an abnormally high incidence in the province, no longer had to go the Red Cross Memorial Hospital in Cape Town for open-heart surgery – instead, their heart problems could be sorted out with a two-hour procedure, often even shorter, and an overnight hospital stay. At the time of his death, Pepeta was completing a PhD in paediatrics from Stellenbosch University.

In 2010 he was appointed head of the paediatrics department at Dora Nginza Hospital in PE’s Zwide township.

In 2012, when severe staff shortages in Nelson Mandela Bay threatened the collapse of the public health system in the metro, Pepeta, along with veteran cardiologist Dr Basil Brown and surgeon Dr Sats Pillay, took the department on in a press conference organised in contravention of departmental regulations. They were threatened with disciplinary charges and dismissal. Pointing at his warning letter, Pepeta laughed his trademark laugh: “Let them try,” he said.

In 2014, after the hospital was flagged for its extremely high death rate among babies and children, Pepeta publicly criticised the Eastern Cape health department’s failure to provide his unit with R5-million worth of life-saving equipment. At the time, 27 of every 1,000 babies born at the hospital died before they were a week old – this was nearly three times the national average of 10 per 1,000 recorded in 2004/2005. 

Ruffling many feathers, Pepeta began a campaign to get the private sector to donate money for equipment. “Our children need a fighting chance,” he would repeat over and over, pointing to broken machines and expensive equipment that had been rendered unusable through neglect and a lack of maintenance. He lamented what he described as the most basic of failures – no scales to weigh children and babies.

As his running battles with the department over access to expensive medicine and equipment for the smooth running of the hospital continued, he always had nothing but kind words for his little patients. “Askies, askies,” he would apologise when they cried. 

Doctors who trained under him remembered his enthusiasm and pride as he encouraged them to further their studies.

Dr Samkelo Jiyana trained under Pepeta as a paediatric cardiologist: “I met Prof Pepeta when I was a paediatric registrar and he was the head of paediatrics at Dora Nginza Hospital.  

“In the corridors of the department of health at Bhisho, and indeed among his colleagues in the rest of the Eastern Cape, he was known as the Lion of the West. He definitely had no problem roaring to make sure the state’s services were on par with those at private healthcare facilities. 

“It was these efforts that made the department of paediatrics at Dora Nginza Hospital a place where doctors fought to come and work and train. His department became the Harvard of Dora Nginza.

“Prof Pepeta instilled in us a fire that made me, when I had to face the final exam last year, confident enough to know I stood a chance of making it. I am a paediatric cardiologist because of him. 

“We became a family and you would not be surprised to find us discussing the finer details of a child’s heart images in the wee hours of the morning. No one and nothing could come between us. Dr Luzuko Bobotyana, who now waits in the wings as a paediatric cardiology fellow, can attest to this.

His brain was always busy with new plans – whether for the children of the Eastern Cape or for anywhere else in South Africa. He wanted to establish a big children’s hospital in the province. That was his greatest dream. He was our gentle giant, but also a person on whose shoulder you could cry. 

“To me, it looked like Prof Pepeta had seen a synopsis of his life before living it. The speed and broadness with which he approached everything he did, bears witness to this. When he became executive dean of the faculty of health sciences at Nelson Mandela University, he just ran with it. It became his life. I remember him detailing the intricacies of hydroponics over lunch with his colleagues. Or him reciting the Xitsonga, Tshivenda and Afrikaans names to us in preparation for the graduation.”

Dr Adele Greyling was trained by Pepeta and went on to become the first paediatric cardiologist in Africa to specialise in heart rhythm disturbances in children.

“I am broken,” she said. “He was so much larger than life. He got so much done in his short life. He was my mentor. He was a wonderful doctor and completely dedicated to his patients. He had so much passion for paediatric cardiology. We did things in our unit that everybody told us was impossible. He was ready to change the world with the medical school. I don’t know if they will ever find someone who can replace him.

“He had a fierce love for his family and he carried his friends through difficult times. His tenacity had no equal. He meant so much for all of us. It will take a very long time to accept that we have lost him,” said Greyling.

“It makes me very sad to think of the unit that he started at Dora Nginza Hospital. It was part of his legacy, but maladministration drove it into the ground. We cannot ignore how important it was to him.”

Pepeta planned to teach disease prevention and health promotion alongside treatment options and rehabilitation medicine. He had been impressed by the primary healthcare system he saw on a visit to Cuba that year, and wanted to do something to address the sharp differences between the South African and Cuban systems. In Cuba, he pointed out there were 80% general practitioners and 20% specialists – while in South Africa it was the other way around.

The equipment in the cath lab where Pepeta started his groundbreaking unit broke in October 2018 and has still not been fixed. This led to Greyling leaving the public sector and the metro was left without a permanent cardiologist.

Apart from training new specialists, he also travelled countrywide to recruit others for Dora Nginza Hospital.

Dr Johani Vermeulen moved from Pretoria to Nelson Mandela Bay to start a paediatric oncology unit after she was convinced to do so by Pepeta.

“His children were his life. He was so proud of his strong son and he adored his daughter. He treated her like a princess. I think he was all things to everyone. He had this ability to see the treasure in other people and always wanted to help others chase their dreams as if they were his own.

His brain was always busy with new plans – whether for the children of the Eastern Cape or for anywhere else in South Africa. He wanted to establish a big children’s hospital in the province. That was his greatest dream. He was our gentle giant, but also a person on whose shoulder you could cry. 

“I wish he could somehow see the outpouring of tributes for his life. He was so serious about making a difference – and he did. We will celebrate his life through the hurt. I also want to say thank you for his unwavering loyalty and belief in my dreams and in our oncology unit. For his friendship and those brotherly hugs. Those shoulders carried so much and his heart had space for so many,” she said.

The head of the department of obstetrics and gynaecology at Dora Nginza Hospital, Dr Mfundo Mabenge, said Pepeta was a great man and had been a great friend.

“We worked side by side and often called ourselves a mother and child pair, as I was heading obstetrics and he was heading paediatrics. We started together as heads of department at the hospital and we influenced each other to develop a strong academic environment. 

“We started training registrars together and last year he encouraged me to train superspecialists, which I started doing. Lungile was an unselfish individual. We were appointed together in 2016 as professors and later Prof Zukiswa Zingela (Psychiatrics) and Prof Fikile Nomvete (Internal Medicine) joined us. We were often called the terrible quadruplets because of our support for each other and the hard work we did to train registrars. 

“We have lost an incredible man, an academic and a father who loved his children and his wife,” said Mabenge.

Students and colleagues also remembered his fondness for taking pictures, and the hours he would spend at each graduation ceremony making sure he had a photo with everyone. Every educational goal reached was celebrated with a Facebook post sometimes punctuated with a “Halala!”

Pepeta took up the job as the executive dean of health sciences at Nelson Mandela University in January 2017, with the first order of business being to set up the country’s newest medical school. He left behind a newly established paediatric oncology unit and a paediatric surgical unit, and shortly after his departure, Dr Pinky Zozi opened a paediatric high care unit at the hospital.

Last year, as they were preparing for the medical school’s final accreditation visit by the Health Professions Council, he explained that he planned to make the facility something unique for South Africa.

“My plan is to train rural doctors who can return to their rural villages, and city doctors for urban communities, and be the doctors that people need,” he said in an interview in October 2019. 

Pepeta planned to teach disease prevention and health promotion alongside treatment options and rehabilitation medicine. He had been impressed by the primary healthcare system he saw on a visit to Cuba that year, and wanted to do something to address the sharp differences between the South African and Cuban systems. In Cuba, he pointed out there were 80% general practitioners and 20% specialists – while in South Africa it was the other way around.

He also left behind a body of research into congenital heart disease and was always actively campaigning for more proactive approaches to combating rheumatic fever, especially in rural areas, as this could damage the heart.

This was a call that another registrar trained by him, Dr Zongezile Masonwabe Makrexeni, heeded and together the pair produced a number of journal articles. 

“I have no words,” Makrexeni said. “I am shattered.”

“God gave us Prof Bongani Mayosi and he gave us Prof Lungile Pepeta. And he took both of them from us.”

The death of his close friend Mayosi, a high profile cardiologist, researcher and the dean of the University of Cape Town’s faculty of health sciences, came as a blow to Pepeta, who was planning to make stress management part of the medical school’s curriculum. 

He was fond of quoting Mayosi, who he regarded as his mentor, as saying: “If you have reached your dream, then do something else.”

Shortly before his death, he was elected as the new chairperson for the South African Council for Medical Schemes. The previous chairperson, Dr Clarence Mini, also succumbed to the virus. 

Students and colleagues also remembered his fondness for taking pictures, and the hours he would spend at each graduation ceremony making sure he had a photo with everyone. Every educational goal reached was celebrated with a Facebook post sometimes punctuated with a “Halala!”

Pepeta was fond of sending messages with exclamation marks. On 28 June, in one of his last Facebook posts, he took a picture of himself and his team in full protective gear about to perform an emergency procedure on a baby. “We shall soldier on Covid-19 or not!!!” he posted. And a WhatsApp message sent on 18 July showed, “I had a dip in the past three days! Feeling a bit better! Still in High Care! This virus wins the medal of all!!!”

He was a fierce proponent of lockdown measures and started a Facebook group to educate people on Covid-19, as he firmly believed that this would be key in fighting the disease. Pepeta was also one of the first and loudest voices to raise the alarm when it became clear that the public health facilities in Nelson Mandela Bay were cracking under pressure. 

He was first hospitalised with Covid-19 at the end of June, and then again in July. On Friday 7 August, he died of virus-related complications.

Shortly before his death, he was elected as the new chairperson for the South African Council of Medical Aids. The previous chairperson, Dr Clarence Mini, also succumbed to the virus. 

On Saturday, Health MEC Sindiswa Gomba and Eastern Cape Premier Oscar Mabuyane paid tribute to Pepeta, among many others.

Prof Sibongile Muthwa, vice-chancellor of Nelson Mandela University, said Pepeta was an embodiment of servant leadership. 

“It is these fine credentials and his unwavering commitment to finding sustainable solutions for the health sector that makes this an immense loss… his humility and heart for ordinary people will be sorely missed.”

Uwile uth’omkhulu.

A giant tree has fallen. DM/MC