Similar to many other lower- and middle-income countries, South Africa has a deep-seated history of inequality. Beginning in 1652 when the first Dutch colonisers reached our shores and extending to today’s post-apartheid racial divide and socioeconomic exclusion, there has always been an extreme wealth disparity between economic classes. Centuries of deliberate laws and brutality have designed the country that we live in — wrought with an institutionalised form of discrimination that seeps into the water that feeds all South Africans.

The gross economic inequality that is pervasive can be illustrated in the GINI Index, which describes South Africa as the most unequal country in the world. University of Cape Town (UCT) Professor Elelwani Ramugondo argues, convincingly, that this inequality is an “ongoing and dehumanising consequence of colonialism, racism and a global capitalist neo-liberal agenda”.

LaShyra Nolen, Student Body President at Harvard Medical School, describes Covid-19 as “the great exacerbator”. Covid-19 has laid bare the efficacious colonial and apartheid effort. Similarly to the US, we have seen how Covid-19 has highlighted the disparities between social groups. Workers providing “essential services” are often unable to work from home, thus bearing the brunt of infections the world over. In South Africa, these workers are overwhelmingly not white, leaving poorer black communities particularly vulnerable to the effects of the virus.

This is further aggravated by a two-tiered health system which preserves access to ICU and early supportive care for the wealthy, and the overcrowded living circumstances affecting poor South Africans making social distancing exceptionally difficult.

This reality demands bold responses. In an attempt to usher forward justice, there has been a flurry of activity in South Africa. Nolen framed the pursuit of social justice as an ever-increasing proximity towards community. This is an effective framework, but it is incomplete. Fundamentally, we need to understand that injustice affects people differently according to their identity, therefore social justice must be intersectional.

The UN conceptualises social justice as “the fair and compassionate distribution of the fruits of economic growth”. This must be our goal — to ensure that all people, regardless of where they live or who they are, are equally able to enjoy the freedoms and pleasures that modern life is able to bestow on us.

Occupational consciousness, theorised by Ramugondo, provides a compelling lens for the pursuit of social justice. It refers to the continuous process of becoming aware of the dynamics of hegemony and the realisation that the existence of these hegemonies is sustained by what each person does every day. This helps provide a common language through which people can view and describe their “individual and collective everyday doing” to resist and oppose the ideas and systems that oppress our communities.

Thus, “everyday doing” becomes liberating and powerful — especially when in proximity to our communities. This is how we create intersectional justice — together and with intention.

Medical schools are not exempt from the burdens and oppressions detailed above. If social justice is to be realised, the onus is on medical schools to move towards a praxis of justice. This process is, however, arduously slow. Anyone within the academy will confirm this and lament on their own experiences of this truth.

In contrast, young people are often characterised as agents of boundless energy and capacity. Herein lies a potential strength to combat the slowness of change in medical schools — students embracing occupational consciousness and working together towards a common cause.

Take UCT’s Faculty of Health Sciences for example — the faculty with the largest research output and grant income at the top university in Africa. Students here have long congregated in societies, each playing a different role in enhancing and supplementing their official curricula. These societies have various foci and mechanisms of action, but all are conceptualised, administered and led solely by students, with each group of students modifying their priorities based on their needs and passions.

These organised groups, especially those centred around communities, have immense potential to ingrain in medical students the importance of social justice. Here, Nolen’s comments of promoting and prioritising “investment in research and community engagement projects that directly promote the healing of black communities” becomes particularly relevant.

The UCT student society with the most members is the Students Health and Welfare Centres Organisation, also known as Shawco — the largest student-run non-profit in Africa. Shawco hosts between six and eight free mobile clinics every week in some of the most under-resourced areas of Cape Town. These clinics, which provide free primary healthcare and screening, are run entirely by students (the majority of the volunteer base) alongside volunteer health professionals.

Being a Shawco volunteer or leader exposes health sciences students to the deep injustices in communities and provides them with a platform to actively work towards social justice while improving their medical knowledge and clinical skills. This exposure to the barriers to health faced by disadvantaged communities promotes students to be agents of change — socially conscious health practitioners who desire to centre communities in their conceptualisation of healthcare. 

The UCT Surgical Society is aimed at promoting surgery as a viable and exciting career option, giving students as much knowledge, experience and skill as possible during our undergraduate training. In addition to its normal activities, it actively works towards improving social justice.

For example, the society helped organise a programme that connects students to the provincial Covid-19 hotline or to wards in hospitals that require extra hands, helping the health system cope with the Covid peaks. Additionally, its fundraising initiatives have raised over a quarter of a million rand for Operation Smile South Africa and The Children’s Hospital Trust over the past few years.

The horrific truth of racism and its effects have been well documented by people of colour around the world for centuries. Despite this, the repercussions have often gone unnoticed or deliberately ignored by dominating structures and the people supporting them.

We marvel at the work of protesters old and new, the writers who fuel the resistance and the bodies who support the work and are grateful that, especially in our context, the cries from #RhodesMustFall, #FeesMustFall and #BlackLivesMatter have reverberated over recent years.

To support this work and amplify these voices, and as a response to the most recent episodes of police brutality and racial disparities in health in South Africa and abroad, UCT Health Sciences societies co-hosted a collaborative podcast series examining oppression and the ways it affects health in South Africa, a student-driven step towards social justice. We hope this serves our fellow health professionals and students well.

The healthcare space must change significantly before community work is celebrated as much as research is. However, the status quo is dynamic and medical students have an important role to play in advancing this agenda. Students should not wait to be taught about social justice from their medical schools, but rather use opportunities like student societies to help prioritise equity in the healthcare space and their communities.

Likewise, educators should not wait for students to practice social justice before it is taught. Medical schools should work towards a future where social determinants of health and social justice principles are inextricably woven into the mainstream curriculum. Doctors are so much more than scientists and we should be challenged to see ourselves in that way.

Integrating social justice and equity into the current and future health system begins with medical students, educators and doctors. If not us, then who? If not now, then when? DM

Regan Boden is a fourth-year medical student at the University of Cape Town. He is the incoming vice-president of the UCT Surgical Society and a research student at UCT’s Global Surgery Unit.

Robyn Kamau is a fifth-year medical student at UCT and interested in women’s health and endocrinology. She is vice-president of Shawco Health 2019/2020 and a research student at UCT’s Global Surgery Unit.

Imraan Majiet is a fourth-year medical student at UCT and a research student at UCT’s Global Surgery Unit, with interests in health systems, vaccinology, epidemiology and global health. As UCT Surgical Society deputy head of career development, he is heavily involved in the student-run society’s events.

Sana Salduker is a final-year medical student at UCT and president of Shawco Health — one of the largest student-run non-profits in Africa.