‘All we can do is make her comfortable. She doesn’t have long to live." Those words struck like thunder, rattling my chest. My wife’s grandmother — our beloved “Ma” — was critically ill. My wife stood frozen, tears tracing lines down her cheeks, eyes locked in disbelief.
In the ICU at Rondebosch Medical Centre, Ma lay still on a snow-white bed, her once-sparkling face pale and gaunt. The steady hiss of oxygen and the metronome of monitors filled the sterile room. Our mission felt grim and clear: comfort her and brace for goodbye.
Could we get her to Mooi River, KwaZulu-Natal — her home, her chosen final resting place? Would she make it to see her grandson Kurt get married in a couple of days in Cape Town?
Against the odds, Ma clung to life. Family trickled in, one by one, to whisper their farewells and press fragile hands in prayer. Even under death’s shadow, hope refused to die.
Then, a miracle.
Weeks later — when we had feared a coffin — Ma was wheeled out of the ICU, a faint smile gracing her lips. A month later, she was back in Mooi River. Doctors called it “a miracle”. The woman who once lay bound to beeping machines now walked free, eyes glinting with defiant vitality.
That moment — Ma’s recovery — felt like liberation. But it also reminded me that survival isn’t the same as freedom.
She says now: “If the doctor had told me I wouldn’t make it, I’d have given up.”
While Ma may have left the hospital, our nation, izwe lethu, South Africa, is still under observation.
From ICU to the world stage
In 1993, South Africa was declared clinically unviable. The prognosis: civil war. The evidence: political bloodshed, state-sponsored violence and an economy gasping for air. Chris Hani’s assassination nearly sent the nation into cardiac arrest. Rwanda’s genocide the following year showed just how close we came to that cliff.
And yet, against every prediction, we didn’t flatline.
South Africa staggered out of the ICU, carried by leaders forged in fire: Nelson Mandela, Desmond Tutu and others; and a fragile national conscience that chose reconciliation over revenge.
But here’s the truth: we never really left the hospital.
The triple curse of poverty, unemployment and inequality kept us on life support. Add to that our chronic condition — corruption — and a dependency complex fed by donor aid and state patronage.
The miracle was real. But recovery demands more than survival — it demands strength, honesty and a new way of walking.
The danger of crutches
Just as Ma needed a wheelchair, we needed foreign aid, BEE and affirmative action. These supports mattered. They still do.
But crutches become a problem when we mistake them for legs.
Then Donald Trump came swinging. He didn’t just remove the crutches — he kicked them out with the grace of a bouncer clearing a toddler’s ward.
Potentially revoking Agoa. Undermining Pepfar. Gutting goodwill. The fight against HIV/Aids in South Africa faced a severe threat when the Trump administration implemented a temporary freeze on foreign aid — including Pepfar funding — placing an estimated 15,000 healthcare jobs at risk and disrupting vital HIV services.
Clinics in dozens of high-burden districts were forced to scale back, jeopardising continuity of care for millions.
A partial reprieve came when US Secretary of State Marco Rubio signed a waiver permitting the resumption of select “life-saving and humanitarian” Pepfar-supported activities.
At one point, Pepfar contributed approximately 17% to South Africa’s R44.4-billion HIV counselling and testing campaign, according to Health Minister Dr Aaron Motsoaledi.
But the future of this support remains uncertain. The waiver may be temporary — and with Trump’s erratic foreign policy, no one can confidently predict what comes next.
Yet perhaps this isn’t the beginning of a breakdown — perhaps it’s the beginning of standing up.
My now three-year-old son once stood up when he was younger because he thought I was supporting him. He’s been running ever since.
Standing on our own two feet
This isn’t a call for isolationism. It’s a call for maturity. Dignity. Reciprocity. Uganda faced its Aids crisis head-on — without the crutch of donor dollars. It reduced HIV from 15% to 5% by 2007, focusing on behaviour change, not just pills.
South Africa started with ABC — Abstain, Be faithful, Condomise — but somewhere along the way, we swapped wisdom for dependence. We lost the plot and chased cure over character.
As Professor Francois Bekker put it, “the crisis is an opportunity — to rethink healthcare, reimagine delivery and rebuild resilience”.
From begging bowl to trading partner
Agoa was never just a gift — it was a gateway. It opened markets, lowered trade barriers and gave South African manufacturers access to the world’s biggest consumer economy. In many sectors, it boosted exports, encouraged foreign investment and created jobs. On paper, a triumph. But we must resist the temptation to overstate its impact.
A November 2023 report from the Brookings Institution estimated that the loss of Agoa would cause South Africa’s total exports to the US to decline by just 2.7%, with a GDP impact of only 0.06%.
While Agoa unlocked opportunity, it also flung the barn doors wide open to SA receiving dumped chicken from the US, devastating our poultry industry. For every 10,000 tonnes of imported poultry, approximately 1,000 jobs were lost. The South African Poultry Association has long warned that the industry was bleeding not just from cheap imports, but from a policy that treated trade volume as a win, regardless of local consequences.
Beyond their economic and humanitarian veneer, Agoa and Pepfar have also functioned as instruments of soft power — tools used by the US to shape African policy and assert geopolitical influence. In return for aid and access, our sovereignty has often been quietly eroded.
We were trading — but at what cost?
Agoa enabled multinationals to dodge tariffs while investing in South Africa with minimal local ownership. What we got wasn’t empowerment, it was participation without power. Jobs were created, yes — but without influence. Labour without leverage. We had access to global markets, but little agency in shaping the rules.
Today, the US demands 50% American ownership of TikTok in the name of sovereignty. Why shouldn’t South Africa demand the same dignity in its own economy?
The end of Agoa doesn’t have to be a death knell. It can be a doorway, a chance to rebuild smarter — trading like equals, not beggars. It could force us to invest in our own value chains, grow intra-African trade and craft policies that serve South Africans first.
We need less gatekeeping. More gate-building. Depending on Washington — or Beijing, or Brussels — is like accepting Trump’s prescription of drinking bleach to kill the Covid-19 virus.
We’ve survived. Now we must thrive. From handouts to handshakes, from dependency to dignity, from crutches to courage.
Let’s walk out of the hospital. Let’s finally walk with dignity. As Madiba said, it’s in our hands. DM