Maverick Citizen


Limpopo Health MEC Dr Phophi Ramathuba’s xenophobic, dehumanising diatribe against Zimbabwean patient

Limpopo Health MEC Dr Phophi Ramathuba’s xenophobic, dehumanising diatribe against Zimbabwean patient
Limpopo MEC for Health Phophi Ramathuba. (Photo: Gallo Images / Sowetan / Sandile Ndlovu)

MEC Phophi Ramathuba’s dehumanising rant to a Zimbabwean patient is a distraction from the root issue: that the ANC never acted on the implementation of strategic frameworks to regulate cross-border healthcare agreements back in 1994.

It’s become an all too familiar script now for politicians to deflect to a so-called burden of illegal foreign nationals draining resources in the country to cover up for the government’s failure to do its job effectively.

On Tuesday night, it was the turn of Limpopo MEC for Health Phophi Ramathuba, whose interaction with a patient in a Bela-Bela hospital posted on Twitter went viral. In the video clip, Ramathuba is seen in black scrubs at a patient’s bedside. She launched into the rant when the patient said she speaks Shona.

Ramathuba said to the woman: “You are supposed to be with [Zimbabwean President Emmerson] Mnangagwa; you know he doesn’t give me money to operate. And I’m operating with my limited budget. When you guys are sick, I’m hearing that you just say, let’s cross the Limpopo River, there’s an MEC there who’s running a charity department.”

She continued with what has been widely slammed as a “dehumanising diatribe” and “cruel bullying lecture” in front of other patients in the ward and an entourage that accompanied her on the hospital visit. Some of them are recorded laughing at Ramathuba’s quips at the woman’s expense or agreeing with her as she goes on about population statistics and a recent trip to Canada. 

“You know,” she said, “before they give me a visa I had to prove that if I fell sick in Canada, I would be able to cater for myself.”  

She also said in the clip: “People have got problems with [Home Affairs] Minister [Aaron] Motsoaledi; they say he is xenophobic, that he is anti-Zimbabwe. He’s not anti-anybody; it’s because he was working in health and he knows the pain.”

Ramathuba, without looking at the patient again, then placed her hand on the woman’s leg and said: “Sorry sisi, but you won’t be discharged until you settle your bill. 

“You must charge her,” she concluded, with a thumb pointing backwards at the patient.

The post spreading on social media in an increasingly polarised South Africa, and with enlarging inequality and an intensified scramble for fewer and fewer resources, has predictably split the room. 

Some on social media have expressed outrage, calling the MEC a “healthcare worker who has lost her compass” and calling for her dismissal, saying “her [Hippocratic] oath is to do no harm but here she is being harmful”.

Phophi Ramathuba, a Health MEC out of touch and out of place

‘A stunning display of hubris’

The Progressive Health Forum said: “The MEC’s failure to resign or to be shown the door after this disgraceful conduct will mark the government’s tolerance of prejudice and its embrace of populism.”

The forum called her behaviour a “stunning display of hubris” and added that Ramathuba’s behaviour had already had a knock-on effect. 

“There are now reports of undocumented foreigners being denied urgent care, which is unconstitutional and contradicts ethical norms. Unlike politicians, health professionals may not make a discriminatory distinction based on a person’s origin, circumstances or behaviour.”

The looming election season has seen politicians work all angles to blame illegal foreigners for South Africa’s ills and woes, and some people have attributed Ramathuba’s comments and posting of the video clip to political expediency.

Limpopo health MEC locks up doctors in hospital quarantine

Janet Munakamwe, the chairperson of the African Diaspora Workers’ Network (ADWN) and a member of Kopanang Africa Against Xenophobia, said: “We condemn what the MEC did and these are the issues we have been raising for years about political rhetoric to gain political mileage. This video is evidence of institutionalised xenophobia that is happening every day in this country in all institutions.”

Munakamwe said South African politicians had failed to confront their Zimbabwean counterparts on the issues of political, economic and social instability which have forced Zimbabweans to leave their country. And in the case of Ramathuba, she said, the MEC had chosen not to use her leverage to speak to her Zimbabwean health counterparts, but instead to scapegoat a patient in a hospital bed. 

SPOTLIGHT: For these patients, the future is not a game – it is a matter of life and death (Part 1)

Sibusisiwe Ndlela, an attorney at SECTION27, said: “Migrant persons (including refugees, asylum seekers, undocumented and stateless persons) are entitled to access healthcare services in this country as is already set out in the Constitution.”

She added that the National Health Act sets out that the state and clinics and community health centres must provide free services in certain cases and that the Uniform Patient Fee Schedule provides classifications for patients together with the fees payable by them when going to hospital. The categories are: full-paying patients, subsidised patients, and patients who qualify for free services.

“There are fees that apply to users, including migrants. What is important to highlight is that for vulnerable categories of persons, user fees are exclusionary. And a denial of access to healthcare services has tangible consequences,” she said.

Ngqabutho Mabhena, the chairperson of the Zimbabwe Community in South Africa, said a summit on migration in the SADC region needed to be held to address the collapsing economies in southern Africa which had made xenophobia the pressure point it now is in South Africa.

Mabhena said: “The ANC is in an alliance with Zanu-PF and it needs to ask itself if this alliance benefits South Africa. More Zimbabweans will continue to flock to South Africa as Zanu-PF is unable to rebuild the economy.

“What we saw in Ramathuba’s video is only what was recorded this time, but this is what we are seeing and hearing every day and it is what triggers attacks by ordinary people.” 

The Economic Freedom Fighters called for Ramathuba’s removal and added: “The Afrophobic attack by Ramathuba on a bedridden patient is cruel and malicious … It reveal[s] a shocking hatred for a fellow human being by someone tasked with protecting and saving human life.” 

The Democratic Alliance joined the chorus for Ramathuba’s axing and warned that “populist comments do nothing but incite violence and hatred”.

Visit Daily Maverick’s home page for more news, analysis and investigations

‘A spirited discussion’

But others on Twitter have supported the MEC and called for “deportation, not service provision for illegal immigrants” and applauded the MEC for “finally realising the problem”. 

The South African Human Rights Commission (SAHRC) stopped short of calling out Ramathuba’s behaviour, describing the interaction as “a spirited discussion about their nationality and use of public health services”.

Wisani Baloyi of the SAHRC said that Ramathuba “raising these conversations with hospital patients is misplaced”. 

He added: “The commission wants to draw the attention of everyone to Section 21 of the Bill of Rights that stipulates that only citizens have the right to enter, remain and reside in the Republic. The issues being raised by the MEC are valid. However, this conversation that the MEC initiated with the patient should be held within the structures of government. It is quite critical that the South African government raises these concerns with its SADC counterparts.”

On Wednesday, the MEC appeared on several media platforms and defended her actions as protecting the rural health catch-up programme for elective surgeries in Limpopo from being “hijacked by illegal foreign nationals”.

Her spokesperson, Neil Shikwambana, also sidestepped questions of the MEC’s thoughts about being named a bully and for failing to uphold her Hippocratic Oath as a trained medical doctor. 

He confirmed that the video was taken during Ramathuba’s visit to a project called Rural Health Matters, which is aimed at clearing surgical backlogs in the province.

He told Maverick Citizen: “This [the patient] is a Zimbabwean illegal foreign national. There is nothing xenophobic about what the MEC said, because she is in no way against foreigners getting medical care in South Africa, but what she is advancing is that people cannot just cross borders illegally with an intention to receive medical care in this country … it strains the public healthcare system. Where in the world have you heard of a foreigner who is in the country illegally receiving elective surgery?”

Shikwambana could not give a specific number of illegal migrants that Ramathuba referred to as the people “draining the Limpopo healthcare system”, only saying it was “a huge number”.

Asked how Ramathuba had contributed to creating a national framework to address the impact of healthcare needs of people who move across national boundaries, he said: “It is not about a framework … but about illegal immigrants and the strain they put on the healthcare system.”

Governing party’s failure

But it is the governing party’s failure over the past 28 years to put in place frameworks and regional agreements defining the nature and limits of public healthcare provided to people moving across the SADC region that has hollowed out an already depleted healthcare system.

Professor Alex van den Heever of the Wits School of Governance was a member of the government’s strategic management teams set up in 1994 to develop policy in this regard. 

He said: “If you don’t put in place a framework, you are going to have people crossing the border to use South Africa’s public healthcare services — it’s predictable. So, to protect the public health services you enter into regional agreements, including payment for services, on what would happen under such circumstances. 

“If you set up those mechanisms, the fiscal harm is mitigated substantially. But nothing has been done since 1994. And, since the mid-2000s, no systemic problem has been solved, because another objective took root in government and that was the objective to loot.”

Van den Heever added: “Ramathuba’s rant is basically a distraction that’s used to create a xenophobic response as if that’s the cause of the problem. The cause of the problem is the government failing to create a coherent strategy and plans for solving difficult problems.”

He said that what’s needed now includes mapping the movement of people to better define catchment populations, a better organisation of financial systems, and the deployment and employment by the government of leaders with integrity and competence.

He added: “The failure of those departments is because of the government’s failure to act and lead — not because of migrants.” DM/MC


Comments - Please in order to comment.

  • Sue Malcomess says:

    It’s heartbreaking to think this is someone who is supposed to be leading the country. To me the problem is the fact that the Government have failed dismally in controlling immigration. The problem is the Department of Home Affairs. The Government is trying to put the genie back into the bottle and it can’t be done.

  • Katharine Ambrose says:

    Another loud mouthed ANC apparatchik showing her lack of knowledge and compassion for someone at their weakest while she is surrounded by her hangers on. Disgusting arrogant display.

  • Chris Verster says:

    Why is the HPCSA so quiet in this regard? According to their register, she is a registered practitioner and according to the HPCSA Ethical Guidelines doctors should always regard concern for the best interests or well-being of their patients as their primary professional duty. Furthermore, it states that they should also be mindful that they are in a position of power over their patients and avoid abusing their position.

    To verbally attack a hospitalized patient in this way with a bunch of laughing acolytes surrounding them, is unprofessional conduct and simply unbecoming any healthcare provider – no matter at what level you work.

    Clearly there is a problem with illegal immigrants and the cost of providing health care to them, but this should be addressed at political level between departments and governments – not by bullying a patient in a hospital bed.

    • Charles Young says:

      For the HPCSA to respond, somebody has to make a formal complaint.

    • Tods The Toed says:

      A doctor’s duty of care is to treat the patient to the best of their knowledge without harming them. There is no fiduciary responsibility to care. That’s why we have bad (rude etc) and caring doctors(spent time with you and not just prescribe drugs). This patient got treated and her rant, whilst inappropriate, does not constitute an ethical misdemeanour. There are no grounds to report her to the HPCSA.

  • Dennis Bailey says:

    That a poverty-stricken sick person should lie in bed listening to such a rant is a betrayal of any oath, even the oath to be human. You are an insult to your profession, doctor.

  • Helga Puttick says:

    This is reprehensible behaviour of a medical doctor towards a patient. Dr Ramathuba should be disciplined by the HPCSA without delay.

  • Cunningham Ngcukana says:

    Her comments made to a patient who was in a hospital bed was very distasteful and dehumanising irrespective of the nature of the operation. She was talking to
    the wrong person at a wrong place. Immigration issues ought not to be addressed with patients when forums to deal with those issues exist between countries and at the level of EFF. Her comments promote vigilantism and must be condemned with the contempt it deserves. Failure by her ANC government to deal with porous borders and to manage immigration and to deal with the conflict in Zimbabwe decisively cannot be at the door of hospital patients by a politician. It is outright populism and political thuggery driving Operation Dudula agenda at a wrong place.

  • Caroline White says:

    Zimbabwe is falling apart. Mugabe started it snd Mnangabwe is no better. RSA has the best healthcare system in southern Africa. It’s hardly surprising that Zimbabweans, without adequate healthcare services, should seek treatment in South Africa. What we need to do is NOT stoke the fires of xenophobia but seek an agreement for SADC countries to contribute to their citizens’ healthcare.

  • Roelf Pretorius says:

    I agree with the HRC – the Constitution does only speak of citizens that have the right to enter and reside in the Republic. And I also agree with prof. van den Heever that such problems can be substantially mitigated on an SADC level. But it is also true that, for SA to be able to give proper services to its people, the leaking borders HAVE to be plugged, no matter what the cost. It is not just about health services; it is also about water, sanitation, electricity, roads, law enforcement . . . these undocumented immigrants are compromising EVERYTHING. But most of all, if they enter illegally, they most probably do not intend to obey the law – I here can’t help to think of the illegal Zama-Zamas who did that mass rape a few weeks ago. So either the ANC has to start doing a governments’ job, which is first of all seeing that South Africans are safe, or they have to get out of the way and call an early election so we can put someone in place that will do it. And because the patient is an illegal immigrant, the medical practitioner had every right to confront the patient; it is time the illegals get the message that SA is not there to loot any more, that that time is past now. They will not get the message unless they are told in very clear, direct terms. It is time both DA & EFF come to the party on this.

  • Sydney Kaye says:

    It is true that ranting at the patient was inappropriate, but does it make any difference to the horrified comments that (1) this read t am emergency and (2) that the patient was not resident , legal or illegal, but had come over the border specically for this operation. There is case law that a patient in need of emergency treatment must be treated at no cost, but not once the situation is no longer an emergency. Border control is at fault not the patient who knew she could get away with it, but the substance of what the NEC said was correct.

    • Helen Lachenicht says:

      I remember the border situation being questioned soon after 1994 and the ANC answered, “they helped us …. we will help them” ?

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