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Medical xenophobia: It’s time to level the power imbalance in healthcare facilities


Dr Shakira Choonara is an award-winning public health practitioner and activist, and was the 2017 Woman of the Year in Health in South Africa. This piece is written in her personal capacity and represents her personal views only, not those of any entity or organisation.

Let’s talk about the deep irony of discrimination and the intersectionality between class and migration. On the one hand, black patients who are foreign are stigmatised and denied access to care. On the other hand, foreign healthcare professionals are valued, considered a scarce skill and sought out to supplement the shortage of healthcare professionals.

I am extremely angry, but not shocked, by the utterances of Limpopo Health MEC, Phophi Ramathuba. So many things ran through my mind as I watched the video. Having watched her arrogantly berating a patient, I cannot even bear to call her by her title.

The recording shows that Ramathuba is well aware of the statistics of foreign nationals in the country and the budget allocation. Yet she blatantly disregards her training, the Hippocratic Oath, the National Health Act and the Constitution.

I say I am not surprised because, for too long, patients across the world are subject to unequal power dynamics in the healthcare system. In much of our work on the ground, among teenage mothers and even among adolescents, we find that one of the major deterrents to accessing healthcare is the healthcare provider “shouting” at them for falling pregnant or wanting contraceptives.

Irrespective of the progressive legislation, which makes provision for the “access to healthcare services” for “everyone” — including foreign nationals in South Africa — health facilities continue to demand identity documents and, in many cases, patients are turned away.

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Stigma and discrimination are rife and affect whether patients receive treatment.

These are longstanding systemic issues, the way patients are treated or unfortunately mistreated in our healthcare systems. The only difference is that Ramathuba was caught on camera. The video of her abuse of a patient is an indicator of the growing lack of humanity in our healthcare systems, the misuse of position and power — not allowing the patient to speak or respond.

Even worse is that it’s not Ramathuba alone who is berating the patient; all of the public servants and representatives around her — cheering her on and laughing — also need to be held to account.

Imagine being ill and subjected to this. My heart goes out to patients who have to endure this.

Now let’s shift to the deep irony of discrimination and the intersectionality between class and migration. On the one hand, patients are stigmatised and denied access to care; on the other hand, foreign healthcare professionals are valued in the South African healthcare workforce — they are considered a scarce skill and necessary to supplement the shortage of healthcare professionals.

Are some migrants more equal than others in the eyes of such officials?

Where to from here?

Officials such as Ramathuba should direct their frustrations at the relevant structures within the Department of Health, Department of Home Affairs and the Department of Cooperation and International Affairs — not at patients.

Being a member of the African National Congress, her frustrations with the healthcare system should feed into policies and actions of the ruling party.

Officials who demonstrate gross neglect of our Constitution and legislation must be dismissed, and this should not be through long, costly investigations.

Patients should come forward and report these abuses.

I am fully cognisant that reporting processes at the facility are not always clear, but we do have structures in place, such as the Health Ombud, whose website states that the following can be reported to the Call Centre:

  • Inappropriate treatment or care.
  • Inappropriate behaviour by a healthcare facility.
  • Poor quality healthcare service provided by a healthcare establishment.
  • Unsatisfactory management of a complaint by a healthcare establishment.

I am convinced that National Health Insurance has unfortunately not moved beyond populist rhetoric of certain political parties. The NHI, which is said to fall under the global commitment to universal health coverage, means exactly that: universal health for all, irrespective of nationality. DM/MC


Comments - Please in order to comment.

  • Miles Japhet says:

    NHI is a pipe dream under the ANC. It simply is not workable with a broken economy and will see a further flight of skills.

  • Katharine Ambrose says:

    NHI is just a pretty dream. The ANC wants to control everything. Their touch is a death knell for every SOE. So it will turn into a nightmare in their hands.

  • Barrie Lewis says:

    Where to go from here? Instead I’m glad I belong to the Blue Zone movement, where ten times as many people reach vibrant old age. In our eighth decade we take no medication and see our GP perhaps once a year. We’ve been reminded time and again that wellness is 80% lifestyle. Giving up sugar and refined grains for ever, turning to sourdough bread from 100% meal and getting more protein from legumes has been a life-changer. Literally. We’ve saved well over a million rand by giving up medical aid.

    New research shows that even type 2 diabetes can be put completely into remission without the use of medication; just a change of lifestyle.

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