Dr Nomalungelo Nyathi is ready for the time when the average South African can access quality healthcare despite their financial circumstances.

“​​I believe that we can have a healthcare system that is functional, efficient and effective in ensuring that our people get excellent care when they are not well. I want to be a part of creating that truth in South Africa and other parts of Africa,” she says.

Durban-born Nyathi is the managing executive: clinical and risk advisory at AfroCentric Group, where she develops health risk management strategies, products and solutions. “We’re living through a time when it is clear that the way we have been doing healthcare so far is not the best way, which means we must recreate a new way. I’m grateful to have the opportunities that allow me to have an impact,” she continues.

After qualifying as a doctor from the University of Cape Town, Nyathi worked as a clinician in the public sector. It became clear to her while still in the early stages of her career that her interest was not in treating patients, but in influencing the systems that govern the ways in which care is delivered. Since leaving clinical medicine, Nyathi has mainly worked to manage funding solutions and the care aspects in private healthcare for Medscheme. This has allowed her to gain a pragmatic perspective on both the public and private healthcare sectors. Nyathi now runs a division that is looking at solutions to make healthcare affordable for medical schemes and form actuarial models to build networks of providers that will help patients manage their chronic diseases.

The lack of access to healthcare in South Africa is one thing, but being a woman trying to address this challenge is another. The barriers to entry provide just one instance of this problem. Nyathi says that she has observed an underlying assumption that women cannot be as sharp and effective as men in leadership roles. This is incorrect. Leadership frameworks and language around leadership need to change so that intentional opportunities can be afforded to women looking to grow in the industry.

“Our sector still has very few women in leadership positions. The tragedy is not just in the low numbers, but in the richness and power of the contribution women must make in business for us to get to where we need to be as a country. The voices, perspectives and skills of women are not a luxury for business and healthcare leadership — they are necessary if we are to win and thrive collectively,” says Nyathi.

Despite having to face the implications that come with women’s suppression in the industry, like imposter syndrome, Nyathi notes that it is going to take some resilience for her to fully see her vision through. “I want to play a more Pan-African role in the healthcare system of our continent in the future. South Africa has so much that can help other African countries accelerate their health system journeys. I have learnt a lot in my career thus far and I would like to use what I have to build the health systems in other countries.”

I want to play a more Pan-African role in the healthcare system of our continent in the future. South Africa has so much that can help other African countries accelerate their health system journeys. I have learnt a lot in my career thus far and I would like to use what I have to build the health systems in other countries.

The highly accomplished Dr Sadna Balton is talking about what most of us take for granted — the ability to communicate.
For the most part, we go through life not appreciating how natural it is for us to be able to speak, to hear and to be understood. Balton sees the ability to communicate as a basic human right.

She is a champion for those who struggle to be heard, and treats children with a range of disorders that span cerebral palsy, autism, Down’s syndrome and developmental delay. “Healthcare is not just about saving lives. It’s about wellbeing, quality of life and function. It’s about getting people back into their jobs, little ones back into school.”

Balton’s commitment to preserving human dignity expands beyond the hospital. A keen advocate for community upliftment projects, she pioneered the Care-giver Child Programme, which enables caregivers to access learning about early childhood development. Treatment with adult patients, too, is extensive, with research into the variety of factors that may impede hearing or motor co-ordination.

No biography of Balton’s would be complete without her shout-out to “Bara”. Formative to her experience as a caregiver is her relationship to Chris Hani Baragwanath Academic Hospital, with which she has become synonymous. Since entering a department of just six people in 1991, she has successfully grown the department to a staff of 40 professionals in the fields of speech therapy.

The department of speech therapy and audiology at Baragwanath is the largest and most successful of its kind in the country. Her years in its service have created a rich tapestry of events. “There are so many special Bara memories — those of us who have been at Bara for a while often say that it has a heart and soul of its own…” Care is not just for patients, though, she observes. It is also for each other. Birthdays, weddings, graduations: all are celebrated, with a devotion that “borders on family”.

There are the little moments too, where small things seem huge. Notably, Baragwanath was the first state-funded cochlear implant site, where a modest feat — the implanting of 100 cochlear implants — felt “momentous”. This was in fact an unprecedented milestone in the local public sector.

Recently, Balton opened herself up to scrutiny when she openly shared her journey of recovery from Covid-19 online. She immediately felt the effect of a strong stigma associated with the virus, which piqued her interest as a doctor.

She was able to reflect on this culture of silence in a public forum, where she reported revealing instances of people speaking up, opening up a broader conversation about public health, stigma and mental health. “We need to keep telling our stories to change perceptions.”

Her advice for young women considering a profession in public health is: “Stay true to yourself. Don’t be afraid to fight for what you want. Nurture people. This path is a collective journey.”

“Providing access to communication is our primary goal.”

Bloemfontein-based midwife, Sebabtso Tsaoane, wants to see a South Africa where all women have access to sexual reproductive healthcare.

After having been diagnosed with endometriosis and undergoing a laparoscopy, Tsaoane started to have conversations about sexual reproductive health with other women around her — this is when she realised that many women suffer from serious ailments in silence. Then a nursing student, Tsaoane decided to start her NGO — Black Woman Arise Women’s Health Foundation — with the intention to demystify sexual reproductive health for women.

“It does not help to only empower women politically, economically and in other areas, and neglect to empower them in the area of their health. Sexual reproductive health has a significant impact on a woman’s physical and mental health, and this affects how women show up in the world. For example, many young girls miss school because of period poverty and older women tend to miss work days due to health challenges caused by endometriosis, fibroids and polycystic ovary syndrome, to name but a few. Women’s bodies have been politicised and policed for the longest time — we now need to be empowered to make informed decisions regarding our bodies and health. Especially as this can affect generations to come,” says Tsaoane.

There are a number of cultural and religious beliefs, as well as socioeconomic factors, that can prevent black women from looking after their sexual reproductive health in comparison to women of other races. “There is a lot that women are not informed about and I feel that conversations where women are being educated and engaged need to come into more focus,” she says.

At the same time, Tsaoane notes that nurses and midwives are not as celebrated as other medical professionals and she would like to see this come to an end. “I do hope I get to see a time when women in my field are more respected and receive more recognition. Nurses and midwives put their lives on the line to protect and heal those in their care, sometimes under extremely unfavourable circumstances,” she explains.

Originally from Sediba-Skema in Thaba Nchu, Tsaoane moved to Bloemfontein to pursue a degree in psychology. She changed her course to nursing after realising how many years it would take to complete a psychology degree. This is a decision she still believes she was led to by fate. When her late father became ill, she was able to take care of him as she was doing her clinic hours at the same hospital where he was admitted. This hospital is also where Tsaoane was introduced to midwifery and where her passion for advocating women’s reproductive rights was sparked. She is completing her master’s in nursing with a focus on sexual reproductive health, while also working as a midwife and running a food business. “Beyond excelling in the field as it is, I would love to see more of us embracing the entrepreneurial model of nursing and midwifery in different forms. I would love to see more nurses and midwife bosses. This will also allow children to see that there are countless career opportunities within the profession,” she says.

I do hope I get to see a time when women in my field are more respected and receive more recognition. Nurses and midwives put their lives on the line to protect and heal those in their care, sometimes under extremely unfavourable circumstances.

Flavia Senkubuge is a medical doctor, a specialist in public health medicine and a global public health advocate based at the University of Pretoria’s school of health systems and public health. Along with being chair of health policy and management, she is also the current president of the Colleges of Medicine South Africa (CMSA), one of the most prestigious bodies of medicine in Africa.

Being raised in an environment where she says women had a voice and were successful in their own right shaped the woman she is today, and her definition of success is about making a difference in the world. “I remember as a young girl being raised around women who were teachers, doctors, nurses, housewives and farmers, but each one of them had one thing in common, the drive to make a difference,” says Senkubuge.

This is clear in the multiple roles she holds that all seem to reflect the intersectionality of her interests and values. Senkubuge is the first black woman and the third woman to be president of the CMSA in 65 years. As well as being the current chair of the World Health Organisation’s African Advisory Council on Research and Development — where she is responsible for advising on matters concerning health research and development in Africa — she is also the vice-president of the African Federation of Public Health Association, an organisation concerned with promoting public health in Africa. As the president of Women in Global Health South Africa, Senkubuge is involved with achieving gender equality within global health leadership.

Senkubuge says her work is rooted in the African philosophy of ubuntu and that at heart she is a philanthropist who is passionate about mentoring young people. She says she wants to be able to make a difference not only in one person’s health, but also for the entire population. “By having a seat at the table and therefore contributing to global health policy, I am able to impact and make a difference to population health globally, and that is what drives me.”

When asked about some of the challenges she has faced in her career, she cites ageism, minimisation and invisibility, adding that she shares this with many other career women. Senkubuge believes that the most important thing that needs to change is health injustice, especially during the Covid-19 pandemic. “There needs to be a realisation of our interconnectedness as people. Once we realise that ‘I am because we are — or ubuntu — it will become easier to advocate and implement many of the desires we have for the health system in South Africa and globally. Our global health systems have to be based on values and driven by social solidarity.”

There needs to be a realisation of our interconnectedness as people. Once we realise that ‘I am because we are’ — or ubuntu — it will become easier to advocate and implement many of the desires we have for the health system in South Africa and globally.

When you fall ill, it’s often at the most inconvenient time. Dr Lerato Masemola’s patients really appreciate that her Thari Health clinic is open until 7pm or even 8pm, so they can visit after work or when they’ve put the kids to bed.

Masemola opens her clinic in the mornings, takes the early afternoon off to be with her children, aged 14 and 12, then reopens at 5pm. She lives close by, so it’s not a big deal, she says, but it’s a big deal for sick or anxious people who can get an appointment when they need one. Thari Health is open seven days a week, and Masemola also visits patients in two nearby frail care centres if they can’t get to her clinic.
She began her career studying as a specialist in forensic medicine, “but I missed the human interconnection and decided cutting up dead bodies wasn’t what I wanted to do, so I went back to clinical medicine”, she says.

She also studied emergency response medicine, which is when she realised that the hours when medical services are available are hugely important. “People would come into the emergency unit at 2am with tonsillitis because they couldn’t get a doctor’s appointment, so I’ll work until 8pm depending on how busy it is.”

As well as providing general practitioner services for everyone from babies to geriatrics, her thriving practice also offers aesthetic treatments, including micro-needling, thread lifts, chemical peels and targeted therapies to treat acne, pigmentation, scarring and stretch marks.
She added these at her patients’ request, because when she recommended that they visit a dermatologist to treat acne scars, for example, they wanted her to care for them because they like and trust her.

As a doctor first, however, her treatments focus on what people need or on restoring what they have lost rather than shaping a new body or face for them. “It’s the medical side rather than the pretty side; I don’t want people to look like Barbie, I want them to look like themselves. But if you’ve smashed your face on the tarmac, you don’t look like yourself.”

When someone comes in after an accident and she can restore their face to a point where they smile at the mirror and feel hope rather than despair, it’s “unbelievably rewarding”, she says.

Last year, she benefited from her own experience when she mangled her face in a serious bike accident. The process left bad scars that she has minimised with treatments including platelet placements, skin booster injections and peels to reduce pigmentation in the scar tissue. She’s determined to get back on her bike, however. “My husband and kids cycle and I’m not going to be left out.”

That ties in with her philosophy of gratitude, treating every day as a lesson and not giving up. “I had this big fall, but I’m a mother, a doctor and a wife — if I fall on the ground and then fall apart, what good does that serve me? I approach life as a lesson: if you fail, you get up.

I love hanging around with 100-year-olds who give you life advice that’s pure and brutal.

Outspoken Dr Margaret Mojapelo has survived the “fight of her life” against Covid, and is now planning a fresh battle to trigger major changes in healthcare provision across the country.

She has two ambitious goals: bolstering public-private partnerships so world-class medical centres can treat uninsured patients through government subsidies; and creating a national mentorship scheme that encourages youngsters to train for a medical career and stick with it for life.

At 62, Mojapelo has the experience to believe these are essential, and the clout to hopefully make the government listen. She’s delighted by the appointment of her former mentor Joe Phaahla as the health minister and her former classmate, Dr Sibongiseni Dhlomo, as his deputy. They can expect a phone call from Mojapelo very soon.

The doctor, affectionately known as Dr Maggz, is the founder of Mediwell, a medical centre in Dainfern with ambitions to expand across Africa. Although Dainfern is an upmarket estate, Mediwell’s database of 10 000 patients includes taxi drivers, waiters and domestic workers from the Fourways area. She runs the centre — with her daughter Dr Malebo Mokotedi — as a multidisciplinary private practice with facilities including dental, physiotherapy, X-ray and haematology services, as well as a theatre. “It works so well because it’s a one-stop facility. It’s the model of the future because Covid has taught us that individual practices that are prevalent in South Africa are very vulnerable if you get Covid,” she says.

Most of Mediwell’s 40 employees are female, and it is so well respected that job vacancies attract hundreds of applicants. This has inspired Mojapelo to work on a recruitment database for other practices that need staff. As a huge believer in harnessing technology to improve healthcare, she’s also embedding a digital platform called Pocket Couch into their services to match patients with therapists for virtual consultations, now that mental health issues have been exacerbated by the pandemic.

One scheme Mojapelo has long been trying to launch is a package offering essential consultations and check-ups for R350 to employed people who do not have health insurance. It would be free to the patient, with government paying the fee. This would give workers high-quality care and save them having to take the whole day off to attend a public hospital. But government support has not been forthcoming. “It’s a model for universal healthcare. I don’t like the idea of the NHI [National Health Insurance], but I want people who are employed but uninsured to have access to affordable healthcare at world-class facilities,” she says.

Another goal is to massively expand Mediwell’s mentoring scheme, where aspiring healthcare workers can come to learn. This needs rolling out to high schools and universities in partnership with government and private healthcare centres, Mojapelo believes. The youth need to be motivated and inspired by what can be achieved in the profession, but if they only see public hospitals, they’ll be deterred from a career in healthcare, she fears.

The doctor has also established a digital Healthcare Workers Heroes Memorial on YouTube to honour health practitioners who died in the line of duty from Covid. The video ends with a spine-chilling list of more than 700 professors, doctors and nurses — putting names to the statistics.

In South Africa, we are specialists in mediocrity. You must look at best practices and evolve.

Mandisa Dukashe is HIV-positive and is leading the fight for a 0% HIV transmission future. Through her NGO, HIV Survivors and Partners Network, she has partnered with the U = U campaign. “What U = U means is undetectable = untransmittable. It’s a global movement started by the Prevention Access Campaign from the US in 2016,” she says.

The data behind the U = U campaign was formulated several years before the campaign began and has since spread to more than 60 countries. “There were four studies that were done involving thousands and thousands of HIV discordant partners that proved when someone who is HIV-positive is on treatment and virally suppressed, that person cannot transmit HIV. When the viral load is undetectable, it is untransmittable to the HIV-negative partner,” Dukashe explains.

She and her husband researched the concept further and by 2014, they were satisfied with the findings. After a decade of protected sex, they conceived and Dukashe’s first daughter was born HIV-negative.

Dukashe, who has 10 years’ experience as a nurse, works with HIV-positive healthcare workers, as well as HIV-positive community members. In 2018 she founded HIV Survivors and Partners Network, establishing ties with the Prevention Access Campaign. Trusting in the U = U theory before it was launched as a campaign was meaningful for Dukashe and her husband, a practicing nurse.

“We wanted to prove science was going to work for us. In 2014, I gave birth to my daughter, and my husband was HIV-negative. In 2021, my husband is still HIV-negative because of U = U,” she says.

Dukashe knew that U = U would change health management strategies toward HIV in South Africa. Her work with U = U focuses on starting treatment and viral suppression — areas where South Africa’s performance is poor. “According to the 1990 targets, we did not do well on starting people on treatment and viral suppression,” she says.

In South Africa, 70% of HIV-positive people start treatment and 64% are virally suppressed — although the U = U campaign has done better on both fronts. “In our support groups, we’re sitting on 97% viral suppression and everyone is on treatment,” Dukashe says.

Dukashe’s journey has been captured in her autobiography, As I Rise Above, published last year. In it she writes about her experiences as a young girl with an absent mom, raised by her grandmother, and about the rape by a trusted family member. “I was the first at home with a matric and graduating with a degree is another story. I thought my HIV status was meant to destroy me, only to find out it was meant to propel and put me where I am today,” Dukashe says.

Her story shares truths on how young women enter transactional relationships with older men, hoping to secure a stable future. “If it was not for the inequalities and the lack of opportunities as a young girl, I would not have chosen to get married at 19 and I would not have contracted HIV in the process. Economic empowerment for women and girls is important because when you’re not empowered, the chances of you moving away are lower. The person who is providing for you is the same person who is violating your rights and abusing you,” she says.

Dukashe will graduate with a master’s in public health at the end of the year and is pursuing a PhD in public health next year. “I want to be that academic in Africa who’s not only a researcher, but who is also living the U = U campaign. When they are quoting who brought this to Africa, who actually called on different governments in the region to adopt this, my name will be mentioned,” she says.

U = U can end the HIV epidemic.

Dr Abongile Qamata is a clinician who recently made the switch to a medical adviser at the Afrocentric Group. After working as a clinician for seven years, she felt the need for a change within her field. “At Afrocentric, I’m in the health policy and medical advisory unit and I’m leading the alternatives to hospitalisation strategy, which provides other options to the traditional bricks-and-mortar hospitals,” she says. Qamata’s mother and brother have both been teachers for more than 20 years and she took this as a lesson to not pigeonhole herself in the same career for a lifetime. “I qualified at 21 as a medical doctor and I couldn’t imagine working for another 40 years doing the same thing. People should diversify and apply themselves in multiple career streams. We can’t be doing things the same way our parents did,” she says.

Qamata’s shift to an advisory role has exposed her to different elements in the medical field, particularly “managed care”. She believes that patients with acute symptoms are best cared for at home, and Afrocentric has partnered with a number of organisations, including Cure Medical, to help facilitate this care. “Cure Medical does remote patient monitoring. Their technology makes sure that data is monitored minute by minute, rather than the conventional three- to four-hour check-ins that nurses do in hospitals. If your doctor logs on in the afternoon, they can see everything that happened in the morning and overnight,” she says. Admitting patients at home also allows doctors and caregivers to garner a holistic approach to caregiving as they can see how the living conditions of patients might contribute to their conditions. “You’re able to see into their life, which you can’t see when they are a hospital patient in isolation lying on a hospital bed,” she says.

Qualifying as a doctor at 21, Qamata has 15 years of experience in the medical field. She performed well at school and had to interrogate whether her strong academics pushed her towards medicine or if this was something she wanted. “When I applied to university, I realised I didn’t want to do anything else. I am very passionate about health promotion and disease prevention, and I think we as clinicians have a responsibility to empower people to look after their health and not just keep coming back,” Qamata says. Her passion for health promotion saw her enrol for a master’s in public health and nutrition at the University of Stellenbosch, where she is currently finalising her thesis for submission at the end of the year. Her research focuses on noncommunicable diseases and how lifestyle and nutrition can influence contracting and living with these, specifically in the management of metabolic syndrome.

The narrative of young people with strong academic performances being channelled into medicine made Qamata sceptical of her own potential at times while growing up. Despite this, she advises young women to dare greatly — advice she believes would have been helpful to her while at school. “I was very reserved and did not put myself out there as much as I should have. I was smart, young and had a lot of potential, but I didn’t tap into it as much as I should have and as much as I could have. Looking back, I would tell my younger self: ‘Girl, you have a lot going for you, so dare and dare greatly,’” she says.

Young women and girls, you have so much potential that you need to exploit. Hard work and potential need to come together and, when they do, they make magic.