Dr Phophi Ramathuba: Nasty but not wrong

William Saunderson-Meyer writes on illegal immigration and the effect on SA's hospitals


Limpopo Health MEC Dr Phophi Ramathuba’s recently videoed tongue-lashing of a hapless Zimbabwean patient for free-riding on “her” hospital services has ignited outrage. 

It undoubtedly was bullying of the worst kind. Ramathuba, who has a history of throwing her weight around, should not only be fired from the provincial cabinet but should also be severely disciplined by the Health Professions Council. Neither will happen. 

Far too many people in the African National Congress agree with her sentiments, if not her manner of expressing them. It’s telling that the video of her appalling behaviour was not taken secretly and then anonymously uploaded to a social media site. It was shot by government officials and it was they who proudly posted it to the Health Department’s official site.

As for the HPCSA acting, forget it. It’s an ANC lapdog, not a professional standards body. It has consistently failed to stir itself against doctors within the ruling party who have trampled on medical ethics. ___STEADY_PAYWALL___

Take for example the Life Esidemeni scandal, where the corruption and incompetence of Gauteng Health’s top leadership led to the deaths of at least 144 psychiatric patients. Despite much prodding and pushing to bring them to book, the HPCSA has done the minimum it can get away with.

A bad bedside manner aside, Ramathuba’s outburst has a positive aspect to it. It signals an end to the protracted suppression by the ANC and a politically correct media of a frank and robust discussion as to whether millions of people should freely and illegally flock to an imagined South African Eldorado from shitholes elsewhere on the continent. 

So, as a start, let’s not mince words. Forget the euphemisms of “undocumented visitor” and “economic migrant”.

They’re “illegal foreigners” and the descriptor has nothing to do with prejudice or abuse. It’s a straightforward legal term. That’s how they are defined in South Africa’s Immigration Act of 2002, which replaced the Aliens Act of 1991, with its connotation of extraterrestrial, other-worldly beings.

Right now, illegal immigration is one of the most emotive issues in the Western world. It pits the cherished beliefs of privileged leftwing elites against the growing anger — fanned by expediently populist politicians — of the people whose interests they claim to have at heart, the working classes and the unemployed.

Their embattled ideology — that foreign nationals crossing borders, despite not having the requisite documentation and despite not being asylum seekers, nor in imminent physical danger from conflict — should be met with warmth, forgiveness and public benefits. The mechanism used by these self-defined progressives to kill debate on the issue is to vilify any reservations over illegal foreigners as xenophobia.

On the contrary, it is this suppression of debate that fuels the frustration of ordinary citizens feeling displaced in their own land. And it’s the pieties of those who are not at the sharp end of the illegal influx that gives firebrands the flammables with which to stoke violence against the kwerekwere outsiders.

This is an issue on which the African National Congress has swung 180 degrees. Before 1994’s first democratic election and until recently, the party’s song sheet has been one of brotherly love, especially to those bordering nations that paid a high price for harbouring ANC exiles.

Consequently, fences were dismantled or allowed to fall into ruin. The enforcement of immigration regulations — except, ironically, for skilled workers and investors trying to enter the country legally — was effectively abandoned. 

There’s another perverse irony arising from the ANC’s historical obligations to our neighbours. It’s because of the political and diplomatic succour that the ANC government has given to the likes of FRELIMO in Mozambique and, especially, ZANU-PF in Zimbabwe, that these despotic regimes have survived. The ensuing oppression and economic collapse are major push factors for their poor and hungry citizens to opt for a fugitive life in South Africa.

This is not an either-or situation, as it is dishonestly sometimes posed to be. Yes, there are compelling economic reasons to facilitate migration by skilled workers, just as there are compelling moral reasons to embrace political refugees and asylum seekers. But the caveat is that both streams of people need to be legally regulated and their volumes managed.

Ramathuba is undoubtedly a nasty piece of work, but on this issue, she is also right. It is not acceptable that in some state hospitals, around 80% of all babies delivered are to mothers who have entered South Africa to take advantage, without paying a cent, solely to access our superior medical services.

Nor are all these foreign patients indigent. Nurses and doctors on the frontline, as well as the local patients they displace, are well aware that many who could afford to pay, are just taking advantage of the beneficence of the South African public health system. 

Hence the grassroots anger. This in turn offers a political opportunity that is being shamelessly exploited by the likes of Patriotic Alliance leader Gayton McKenzie, who this week said he would personally switch off the oxygen machines of foreign nationals, if it were necessary in order to save South African lives.

The SA Medical Association’s response, which is representative of many progressive organisations and individuals, is that healthcare is an absolute, fundamental human right. “Discrimination of any kind in the healthcare sector is unacceptable,” SAMA states.

Healthcare is, of course, a human right, but it is not an absolute right. As our Constitutional Court has ruled, it’s a right qualified by the constraints of budgets and resources, and the competing demands of others in need of medical attention. 

That’s a universally recognised reality. No country in the world allows untrammelled access to its medical resources by foreigners, especially not to the detriment of the local population. Since access to medical care is a life or death issue, to do so would be to invite popular revolt. 

The heated dispute over Ramathuba’s outburst over illegal foreigners’ is just the beginning of it. She’s hit a sore spot and the hurt is only going to get worse. 

This is going to be a major political issue going forward, with the usual scrambling by the political hyenas for advantage. South Africa is about to embark on a madly ambitious, ideologically driven plan, which will see our expensive but efficient private health sector phased out in favour of a “free” National Health Insurance. 

The NHI will be shambolic and unaffordable. It’s also bad news for the 9m people belonging to medical schemes — of whom about a million are ANC-voting public servants — who can currently shield themselves from the foreign free-riders abusing state healthcare facilities.

This black middle-class, all medical scheme members, is going to become very, very voluble when it has to compete with masses of illegals clamouring for care. Unlike the disenchantment of the disadvantaged, it will be difficult for the progressives to disparage and dismiss this powerful political constituency.

So, what will the progressives do? On the evidence of past hypocrisy, they’ll join the ANC leadership in seeking their medical care overseas. Though probably not in Russia, China and Cuba.

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