There's more to being a good doctor than just academic qualifications, says outgoing Health Ombudsman Malegapuru William Mokgaba.
“A good doctor requires empathy and a deep understanding that every single patient craves a hundred percent care. Such empathy is not something that can be taught or learned from books. It is something people are born with. It derives from a person’s nature and values.”
For those reasons, among numerous others, Makgoba has earned a deep respect over the past five decades, writes Biénne Huisman in Spotlight.
Growing up in Limpopo, Makgoba used to rest under marula trees, minding his father’s ducks, sheep and goats – a happy childhood, filled with a sense of belonging.
When he was 11, his father, Morithi Makgoba, entered a diabetic coma. His life was saved at a hospital 20km away. It was an early encounter with medicine and the healthcare system, which would become his son’s life’s work.
Apart from a passion for medicine, the need for equal opportunity would also become a driving force in his life. At boarding school, when he was 14, a teacher suggested he skip a grade.
Makgoba, squirming away from special treatment, asked that all of his classmates write a test to check for such eligibility. This, he says, resulted in five pupils, including himself, attaining 85% or more, and being pushed a year ahead.
In the more than 50 years since then, Makgoba – now Professor Emeritus and retired vice-chancellor of the University of KwaZulu-Natal (UKZN) – has helped shape South African health policy, notably through his critique of Aids denialism in the 2000s, and later through his appeal as Medical Research Council (MRC) president to provide antiretroviral drugs to people with HIV.
This saw him clash with some of the country’s most powerful politicians, including then-President Thabo Mbeki, of whom he said at the time:.
“The sad part is, (Mbeki) is trying to politicise scientific facts, and that’s what the Nazis did.”
Makgoba’s trademark forthright manner manifested in his job as South Africa’s first Health Ombud, a position he assumed in 2016 and which saw him release stinging public reports. His tenure ends next month.
A revelation
For seven years, Makgoba has led a Pretoria-based staff of 30 who investigated patient complaints against health practitioners, hospitals and clinics across the private and public sectors. The office, since inception has processed some 10 800 complaints.
“This was a revelation of the health system,” he adds. “How it interacts with politics, and how political power and lack of accountability can result in human rights abuses to the extent that vulnerable people, like mental health patients, could be treated the way they were treated, resulting in deaths and so forth. I mean, people in power denying that their actions could have been responsible for what happened. It was a failure of basic common sense. That was really just horrible as an investigation.”
The ongoing inquest into the deaths of the Life Esidimeni mental healthcare patients, which started in 2021, has had many delays, with the latest postponement granted to the lawyers of former Gauteng Health MEC, Qedani Mahlangu. Proceedings will resume on 2 May.
He also highlights his office’s recent investigation into the Rahima Moosa Mother and Child Hospital in Johannesburg. The damning report, released in March, on the conditions there included shocking revelations about how the health and dignity of patients were compromised.
“It was a litany of deficiencies. Here you have an 80-year-old hospital that has been totally neglected. It used to be an excellent hospital that won awards. It’s a hospital that deals with obstetrics but doesn’t even have a blood bank.
“One of the most common causes of maternal death is blood loss. People lose a lot of blood giving birth. The hospital is overcrowded and run down – horrendous and unhygienic, with women who have just delivered or pregnant women sleeping on floors.”
Side-stepping Mandela
The 70-year-old scholar speaks openly about his political non-affiliation. During his studies at the University of Natal Medical School, he says he was inspired by Steve Biko and the Black Consciousness Movement. However, he felt that belonging to a political party would curtail his scientific freedom and thinking.
Makgoba recalls that he even side-stepped an invitation from Nelson Mandela to join the ANC.
He met Mandela at Luthuli House in Johannesburg in 1990. At the time, Makgoba was living abroad and Mandela asked him to consider returning home.
“He said I should think about returning, think about joining his new movement, his philosophy of reconciliation. And he put me in a corner because he wanted to know whether I was a member of the ANC. I said no. And he said, well, I’ll take you downstairs so you can join. And I said, no thank you. Fortunately, as we were talking, his PA knocked on the door and said there’s somebody who wants to see you. That’s how I escaped.
“I mean, the pressure to be told by such an important person to become a member of a party! The fact is I don’t belong to any political party. It has something to do with my independence, my freedom of thinking, my training.”
Varied career
At the height of apartheid in 1981, Makgoba won a scholarship to study toward a PhD at the University of Oxford, where in 1983, he completed his thesis in human immunogenetics.
He would continue doing research in England and the US, focusing mainly on genes and cell surface proteins involved in the immune response.
From 1986 to 1988 at the National Cancer Institute of the US, he was part of a team of researchers headed by Dr Stephen Shaw. At the time, immunology was preoccupied with T-cell receptors and T-cell recognition; thus how these cells remember and learn, tailoring specific immune responses, somewhat similar to human memory or the nervous system.
“Dr Shaw believed there must be something that makes the cells communicate with each other and tell each other before a specific response is triggered. He came up with a theory of cell adhesion molecules, especially in T-cells. It opened up something new about how T-cells may be useful in surveying for cancers in the body because they have these structures allowing them to crawl around and sniff other cells and say, there is something here that’s not normal, etc.
“It was a fashionable field, a popular field, and opened a whole area of biology. To this day, those papers are still being quoted.”
Accolades and outrage
In 1993, Makgoba accepted the position of Deputy Vice-Chancellor at the University of Witwatersrand (Wits). Here, his drive for higher education transformation caused clashes, with some colleagues describing him as “an unapologetic radical” and in 1995, his detractors lodged a 297-page dossier of complaints against him.
Makgoba responded by describing his detractors as an “inbred elite” and racist.
While his views on transformation earned him accolades, they sparked outrage too.
Over the years, controversy followed him around South African campuses and committees – skirmishes he brushes off. Today, he says peers saw his writing on “decolonisation and Africanisation” as a threat instead of a push for positive change. “Instead of being embracing, they grew defensive.”
After Wits, he joined the MRC, and in 2002 became vice-chancellor of UKZN.
What’s next?
His obvious passion and decades of experience suggest he will remain engaged in ongoing healthcare reforms, although it is not clear in what capacity.
He says he is busy writing a book on his life and experiences.
See more from MedicalBrief archives:
Callous disregard at ‘dirty’, ‘filthy’, ‘unsafe’ Rahima Moosa – Ombud
FF+ concern over loss of Makgoba as Health Ombud
Makgoba report: 94 silent deaths and still counting
Makgoba report: Heads start to roll