Zimbabwean mother’s deadly ordeal highlights migrant healthcare crisis after SA hospital demands upfront payment

Her name was Nokuthula Mguni. Mother of three daughters – Ayanda, Amanda, and Shiloh. She spent most of her adult life working so that they could have a better one. She put two of her girls through university; Shiloh is preparing to start high school. Her smile could light up a room, and her laughter would echo across an entire floor.

She dressed to kill. “You don’t have to look like your problems,” she would say to anyone who would listen. Her favourite story about coming to live and work in South Africa (SA) was that the only thing she left behind was a sandal, lost while crossing the river.

She arrived with nothing but ambition and nerve.

She died at four in the morning on 16 April at Charlotte Maxeke Hospital in Johannesburg.

She was a Zimbabwe Exemption Permit holder. A foreigner, yes. But also a woman who had spent 15 years building a life in this country, paying taxes, raising her daughters, and contributing to the community around her. She was about to become a grandmother. She had earned every inch of the life she had made.

None of it counted when she needed help most.

I want to believe that she was not aware of how she was treated in the last hours of her life. I hope her final thoughts were of the extraordinary contribution she had made – that her daughters were graduates, that Shiloh had inherited her resilience and her commitment to hard work, that she had achieved everything she had set out to do.

What happened to Nokuthula Mguni that night was illegal. It remains so regardless of her immigration status, her permit type, or the colour of her passport.

I pray that the pain had dulled her senses before she was left lying across a metal bench in an emergency waiting room for hours – her body propped up between two hard seats – because the hospital would not admit her without an upfront payment of R5,000.

I pray she lost consciousness before she heard the fight we had with the administrators. I hope the drugs they eventually gave her knocked her out before she understood that she had been left there to die, not because her condition was untreatable, but because she was a foreigner.

Plainly unlawful

When Shiloh called me that Saturday afternoon, I knew it was serious. Her mother was asking for R220 – money needed to obtain a letter from the doctor to request an ambulance, because she was too weak to walk and could no longer speak.

I offered to collect her myself. I picked up a friend to help carry her, withdrew cash and drove to her flat in Hillbrow. We carried her to the lift and descended 12 floors with Shiloh and a kind neighbour who had been helping to look after her.

The trip to Charlotte Maxeke took less than five minutes. We carried her into the emergency room. My friend went to find a wheelchair. I handed money to the neighbour, promised Nokie she would be taken care of, and drove Shiloh to McDonald’s on Empire Road to get her fed and settled before taking her home.

We had barely reached the car when my phone rang. They would not admit her without a R5,000 upfront payment. She was a foreigner. Could I come back and assist?

Getting back into that hospital is its own ordeal. Since a fire in April 2021, the public car park has been closed. Visitors are funnelled through a single road converted into a handful of parking bays. When those bays are full, it is nearly impossible to pass through without damaging your vehicle. I clipped both mirrors leaving the first time.

When I asked one of three security guards – sitting under a tree on chairs – to check for oncoming traffic, he flatly refused. I photographed him and went directly to the head of security, who at least had the decency to apologise and agree to wait while I went inside to sort out the payment request.

More than two hours had passed. Nokie was still spread across the metal bench. Her sister Zoisha had arrived and was waiting at the administration counter.

Foreign nationals ‘required to pay’

I asked the administrator to explain why an emergency patient was being forced to pay before receiving treatment. She told me that all foreign nationals were required to pay, and that if I kept pushing, she could insist on R50,000 upfront. A small crowd of staff gathered, visibly irritated that I was demanding a rational explanation for what was plainly unlawful.

The moment I reached for my phone to photograph the payment notice, the administrator slammed the shutter down and stormed out demanding I delete the pictures. A burly security guard joined her. I was surrounded by four people.

I was physically compelled to unlock my phone while she deleted the photographs herself.

I am generally calm, but I am not built to yield to male aggression. The guard backed off. His supervisor arrived. We went downstairs to deal with my initial complaint. Despite an initial denial, the guard was made to apologise.

We went back to the emergency room. Another confrontation, another attempt to intimidate, and again – in front of his superiors – an apology. A different administrator processed the payment of R4,000. Nokie was still lying on the bench.

This is not a matter of policy interpretation. Under South African law, no public hospital may refuse emergency treatment on the grounds of nationality or inability to pay upfront. What happened to Nokuthula Mguni that night was illegal. It remains so regardless of her immigration status, her permit type, or the colour of her passport.

Deserved better

I left the hospital with a terrible sense of dread and went home to look up the process and cost of repatriating a body to Zimbabwe. On Monday afternoon, I received a text confirming she was in theatre. She was in recovery. On Wednesday morning, she went back in. She had developed a severe infection and needed a second operation.

She died on the table at four in the morning on Thursday. The sepsis had spread through her entire upper body. Despite the heroic efforts of her surgical team, they could not save her.

My brother accompanied the family to the hospital. My mother had died at the same hospital a few years earlier, so we understood the process. Mostly, we wanted to protect Nokie’s family and make sure they were not subjected to any further cruelty.

We held her memorial at Kings and Queens mortuary in Doornfontein on Thursday, 23 April. The room was packed. Her daughters had come to Johannesburg to accompany their mother on her final journey home.

A magnificent three-tiered casket, paid for by her friends and family, stood at the front. She had loved flowers; there was a beautiful bouquet laid across the lid. The photograph on display showed her smiling, full of life – wearing a branded T-shirt from the company she had served faithfully for 15 years.

It was a service befitting her dignity, her strength, and every single thing she had achieved. Everyone broke into song as we carried her casket to the hearse. The drizzle turned into a downpour. Someone said the ancestors were welcoming her home. It reminded me of the day they buried Nelson Mandela in Qunu. My heart was sore, but my spirit was soothed.

Nokuthula Mguni crossed a river to build a life in this country. She built it. She earned it. She deserved far better than to be left to lay on a metal bench for hours because a piece of paper said she was from somewhere else.

I knew my rights. I knew what was happening was illegal. I said so, loudly and repeatedly.

It made no difference. She died anyway. That is the truth I am living with. And it is a truth this country should be ashamed of. DM

The Gauteng Department of Health did not respond to requests for comment.

Faizel Cook is a former journalist and a media practitioner.