South Africa: foreign patient detained over medical bill

South African authorities are investigating a case of xenophobic attack in which as senior health official verbally lashed out at a foreign national languishing on a hospital bed, accusing her and other foreigners of burdening the country’s health system.

In a video that has since gone viral on social media, Dr Phophi Ramathuba is seen berating a Zimbabwean woman – a road traffic accident victim – who was awaiting surgery at a government hospital in the town of Bela-Bela in the South African province of Limpopo, which borders Zimbabwe, Botswana and Mozambique. Dr Ramathuba is the provincial health minister, a post known locally as Member of Executive Council (MEC) for Health.

'Our Health System Not A Charity'

"You are killing my health system," Dr Ramathuba says in the video of the 23 August incident, which was first posted on Limpopo’s Health department Facebook page.

Leaning over the unidentified female patient’s bed, the medical doctor-turned-politician says that Zimbabwe’s President Emmerson Mnangagwa does not contribute to South Africa’s health budget, and that her country’s health system is not a "charity."

"You speak Shona? Then how do you find yourself in Bela-Bela when you are supposed to be with Mnangagwa… you’re killing my health system," Dr Ramathuba says in the video, referring to the language spoken by a majority of Zimbabweans.

"You are supposed to be with Mnangagwa, you know he doesn’t give me money to operate on you guys, and I’m operating with my limited budget. That is why when my people want health services, they can’t get [them]. And that is endangering the community... this is unfair!"

She ordered that the patient be detained after receiving the necessary critical medical attention until she had settled the medical bill in full.

Incident decried As Xenophobic, Unlawful

The incident sparked widespread controversy in both South Africa and Zimbabwe, with some supporting the sentiments expressed by the provincial health minister and others branding Dr Ramathuba as xenophobic, unethical and insensitive.

Lloyd Kuveya, Assistant Director at the Centre for Human Rights at the University of Pretoria in South Africa, told FairPlanet that Dr Ramathuba’s conduct was untoward and disagreeable.

"The MEC should not have made such statements to a patient who has been admitted and seeking medical attention," Kuveya told FairPlanet. "She ought to be communicating at a policy level with her peers and not to descend onto the hospital floor laying down policies. Her statements also have the effect of fueling xenophobia."

The human rights practitioner added that it was not policy in South Africa to detain anyone for failing to meet their medical bills - neither citizens nor foreign nationals. 

He said that while foreigners are required to pay for anything above basic medical services – such as the surgical operation this particular patient required – detaining them was unlawful.

"Migrants still enjoy rights in South Africa, except for those rights linked to citizenship, such as the right to vote," Kuveya pointed out. "In fact, according to SA Constitution, no person can be detained got failure to meet contractual obligations."

The chairperson of the Zimbabwe Exiles Forum (ZEF), Advocate Gabriel Shumba also criticised the order for the detention of the patient. 

"To my knowledge, it is not official policy," Shumba told FairPlanet in an interview. "It is absurd to detain a person for failure to pay because not only does that amount to kidnapping and an infringement of freedom of movement, but that act also denies the person the opportunity to do something to settle the debt. 

"It is thus irrational in that you continue feeding and housing the patient at further cost, instead of asking them to do something to settle that debt."

He added that the most holistic approach would be for bilateral and multi-national engagements to come up with sustainable solutions to socio-economic problems afflicting the entire region.

'A Victim of Politics'

Dr Angelique Coetzee from the Solidarity Doctors Network said the patient was a victim of politics between South Africa and Zimbabwe.

"This patient is a victim of the drama between the two countries," Dr Coetzee told The Times newspaper.

"Even if they cross the border illegally to get health services, it’s not their fault," she added. [The MEC] wasn’t supposed to embarrass her like that in front of people. It was unethical, unprofessional and out of line. She should have addressed that at a different level," 

Incident Divides South Africans

South Africa’s opposition political parties, the Democratic Alliance (DA) and the Economic Freedom Fighters (EFF) are demanding Dr Ramathuba’s sacking for humiliating the patient, while members of the youth league of the ruling African National Congress party defended the minister for her "frank engagement" with the patient. 

Dr Ramathuba herself has rejected criticism that her comments were xenophobic. She insists that Limpopo province faces an "influx of foreign nationals who are overwhelming, choking the province’s health system resulting in doctors often working under pressure."

Dr Mike Ramothwala, from the same Limpopo department of health, took to Twitter to endorse the MEC’s statements, saying: "The last statistics showed that 80 percent of women giving birth at Musina hospital are illegal Zimbabweans and SA women sometimes didn’t find beds to give birth on. We are trying to fix our healthcare system but we can never do it unless what our MEC is saying is addressed."

Hospitals in Shambles Back Home

In the aftermath of this fallout, some Zimbabweans abroad started crowd funding to settle the patient’s medical bill, with a private hospital in Harare offering to settle it on its own.

With the country’s health system in shambles, many Zimbabweans seek medical care in South Africa, where the services are largely free and also of much better quality.

Back home, nurses and doctors - who frequently strike for better pay and improved working conditions – complain that the hospitals are poorly equipped, with drugs and other consumables being in critical short supply.

Image by fernando zhiminaicela.