Building health infrastructure – and Brand Phophi
By Ufrieda Ho
It’s a health budget day in Limpopo, and MEC Dr Phophi Ramathuba is set to address a packed council sitting in Lebowakgomo on how R18 billion will be divided up for health needs in the province.
It’s Ramathuba’s second year in the role, and it’s a balancing act for a department that only came out of administration by national treasury less than two years ago.
Some in the gallery on the late summer day are clutching bottled water, and dressed like they’ve copped an invite to the glitz party of the year. Ramathuba herself has chosen a siren-red two-piece suit. It’s matched with red high heels. Shoes are her weakness, Ramathuba has been reported as saying.
Her outfit shows off her slimmed-down figure. In recent months she’s become her own poster child for the ‘Pfuka – move for your health’ campaign, which she introduced in the province. Her office manager and spokesperson joke that they’re expected to join in on the daily 30 minutes of heart-rate-raising exercise before the desk-job part of their work day begins. It’s all about putting into action a health campaign the MEC has been punting: getting people to take responsibility for their own health and well-being.
On budget day, her staff are busy shuffling her between interviews. They’re running over time; the schedule has bottlenecked. In the end, they give Spotlight literally five minutes with the MEC, despite requests for interview time and face-to-face interaction having been confirmed weeks in advance. The MEC’s spokesperson offers Spotlight the option to wait till early evening, in the hope that Ramathuba’s schedule will ease up. That, or emailing further questions.
Even as she talks, Ramathuba is distracted; she apologises while she make a phone call on one of her two phones. She has to check in with cousins who have arrived as VIPs for the budget address, she says.
Her staff say she operates at full tilt most work days. But they don’t want to get into any personal details about what makes their chief tick. They do say that when the MEC gets angry, it’s over something like a hospital or clinic that hasn’t done something it’s supposed to have ticked off. They also steer away from controversial questions, adding quickly that budget day is a ‘happy’ day. It is certainly a day bizarrely infused with pomp and ceremony.
Far from the sham glam and the clock-watching in the council chambers, though, are real concerns. Healthcare workers have been on strike, days before Ramathuba’s budget speech. For them, time has been about waiting for unpaid bonuses, and their strike has begun to affect services at Polokwane Hospital. It’s the latest in a seemingly constant stream of bad news reports about health in the province.
There are severe staff shortages, and a glaring loss of experienced senior staff at facilities – many have been seduced by better pay and working conditions in private hospitals. There are regular reports of theft of medicines; shortages of essential equipment so dire, babies are said to have to share incubators; and ambulances are reduced to mortuary vans because they take forever to arrive, if they arrive at all.
There’s also mismanagement and corruption at some facilities. Ramathuba’s own unannounced spot visits at some of the province’s hospitals during her tenure have revealed incidents such as patients going without proper meals, even when allocated provisions have been available.
She’s also had to put out fires over corruption and scandal.
In the days before the budget speech, the Democratic Alliance has flagged an outstanding financial debt owed to Cuba for the Cuban doctors programme that runs into millions. Cuban doctors are firmly entrenched in Limpopo – this, even as their inability to understand local languages and local conditions is a cause of deep frustration for local patients.
There’s also been a scandal involving a bogus hospital laundry contract for 32 hospitals in the province. It resulted in the Economic Freedom Fighters (EFF – the official opposition in the province) laying charges against Ramathuba, even though it was a scandal she inherited. In response, Ramathuba took the decision to insource hospital laundries by introducing laundry mini-hubs. The final design and planning for these are expected to be completed this financial year.
Corruption and inefficiencies in the system cost lives, especially in a province where the Department of Health says more than 80 per cent of the population is rural, and fully reliant on public healthcare. When local clinics prove to be hopelessly under-resourced, people are referred to facilities in bigger towns. For rural people this means travelling long distances, at significant expense, to access treatment. Often they travel the night before their appointment, sleeping on hospital benches to secure a place in the queue to be seen by a doctor. Even then, sometimes people are simply turned away before they receive any help.
Ramathuba should have first-hand understanding of the challenges of under-resourced rural areas. She grew up in Vhembe, to parents who were teachers. She had a lifelong dream to become a doctor. After she graduated from what was then Medunsa she worked at the coalface of healthcare, starting out as an intern at Makopane Hospital. Ramathuba eventually worked up to the position of chief executive of Voortrekker Hospital, before joining the political ranks.
She also holds a master’s degree in medical pharmacology, through the University of Pretoria, and has qualifications in advanced health management as well as other business and leadership qualifications.
She prides herself on being an activist, though. In her budget address she invoked Biko, Fanon and Marx, even as she spoke about fighting mental health, the success of a cataract-removal programme, HIV-testing targets and increased treatment budgets to R1.3 billion (including R479 million for ARV drugs), and even the impact of continued water shortages across Limpopo on making quality healthcare a reality.
Revolutionary ideals and old struggle heroes still matter to Ramathuba, she says. They keep her in touch with why she became a doctor in the first place – Marxist ideals such as working for all, and sacrificing for the common good. She took to heart a call from the Limpopo Aids Council, in October 2016, for senior government officials to ‘adopt’ child-headed families in their constituencies; Ramathuba donates to and supports four households in need in Vhembe, a press release from her office stated.
And she believes in a bit of humour. She has a good giggle when she’s reminded that when she delivered her budget speech, her cheeky joke about the mental health of some members of the legislature didn’t go unnoticed.
Ramathuba demonstrated skill in being able to make her speech engaging and interactive – not just through the odd joke, but also by introducing some of her personal guests on the day. They include young graduate doctors, part of Ramathuba’s troop of ‘super-specialists’.
She also introduced a nurse she met on Facebook. Angela Motsusi defeated the depression that took over her life when she was diagnosed HIV-positive in 2011. Motsusi is now an HIV/Aids ambassador, and was singled out by Ramathuba as an inspiration. In turn, Motsusi later posted selfies taken in the legislature building, saying how honoured she felt to be Ramathuba’s special guest and calling the MEC “a humble leader”.
Ramathuba has a modern touch in the way she stays connected. She uses social media effectively, and taps into issues in a relevant way. Her #blessersmustfall campaign speaks directly to young people whose worlds may only seem real when they’re hashtagged. She’s even approved flavoured and coloured condoms as part of state issue stock, because she says young people prefer them.
On her Facebook page, she has just under 5000 ‘friends’; and there’s a mix of curated personal posts and professional content. Interestingly, the page includes comments of all kinds, from the odd post slamming Jacob Zuma’s salary being unequal to the job he’s doing, to a photograph of someone bringing to Ramathuba’s attention the spin of British PR company Bell Pottinger in creating the phrase ‘white monopoly capital’, seemingly to divert attention from the controversial Gupta family’s relationship with Zuma.
That she’s allowed her page to be uncensored speaks volumes. That she also manages to cram in posts of PR campaigns for the department (everything from malaria prevention to combating depression, fighting nyaope use, and even ‘insecticide pastors’) is a touch of social-media genius.
In one of her Facebook picture she’s in traditional Xitsonga dress. It garners comments such as “looking gorgeous”, and “just beautiful honourable”. She’s also seen, in official pictures promoting a vaccination campaign, in a doctor’s white jacket. There are pictures of Ramathuba holding Limpopo’s Christmas and New Year babies, as well as images of her in meetings tackling a malaria outbreak; she reposts reports about crises in troubled Vuwani, which made headlines when schools there were torched and burnt to the ground in 2016.
There are also pictures of Ramathuba and her two daughters at an ANC rally. Ramathuba gave birth to her first daughter over a decade ago – at a public hospital. It earned her significant kudos, for trusting her own state-run institutions. Though what her choices for healthcare in the province are now is unclear – Spotlight’s emailed questions to her team went unanswered.
Ramathuba does maintain popular appeal. She’s been given monikers such as ‘Dr Fix-It’ and ‘DiPhoplar’, and Limpopo TAC welcomed her appointment. It’s not so much Ramathuba being able to wave a magic wand over entrenched problems in the province; it’s more to do with her approach: staying connected, being seen to be taking the concerns of civil society organisations seriously – and even sucking up criticism from detractors.
It would be easy to for her to scoff, and retreat behind her position and title as MEC; but that would be an empty tactic. Ramathuba seems to understand this, and it’s working for her .