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

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.

[embed]https://twitter.com/zimlive/status/1562138134208552960?s=20&t=GVsyPUEfu2oAQvrUiFbHag[/embed]

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”.

[embed]https://www.dailymaverick.co.za/article/2020-04-15-phophi-ramathuba-a-health-mec-out-of-touch-and-out-of-place/[/embed]

‘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.

[embed]https://www.dailymaverick.co.za/article/2020-04-03-limpopo-health-mec-locks-up-doctors-in-hospital-quarantine/[/embed]

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. 

[embed]https://www.dailymaverick.co.za/article/2018-09-05-spotlight-for-these-patients-the-future-is-not-a-game-it-is-a-matter-of-life-and-death-part-1/[/embed]

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