Mbombo: From domestic worker to MEC

By Biénne Huisman

Western Cape Health MEC Nomafrench Mbombo’s office is on the 21st floor, with views over Cape Town. Seated at a large desk, her eyes flit over a television screen on the far wall. For a moment her features cloud over.

It’s August 8, the day Health Minister Zweli Mkhize introduced the National Health Insurance (NHI) Bill in Parliament.

“This,” sighs Mbombo, gesturing at NHI headlines floating across the TV screen.

Western Cape MEC for Health Nomafrench
Mbombo. Photo by Joyrene Kramer.

She has been outspoken about opposing the bill. While supporting universal health coverage goals in South Africa, she says nationalisation is not a viable means for achieving that.

“Centralised government decision-making in healthcare has shortcomings. This was already evident in the testing phases of the NHI. Strong provincial health systems are key,” she says.

Mbombo’s beliefs are underpinned by her nursing and academic career spanning the country’s three coastal provinces: the Eastern Cape, KwaZulu-Natal and the Western Cape.

Here in the Western Cape, her unique challenges include crime-related injuries such as gunshot and stab wounds. Gang shootings are on the rise on the Cape Flats, with more than 70 patients treated for gun injuries at Groote Schuur Hospital each month this year.

“Surgeons have done the costing,” says Mbombo. “It costs about R25,000 per person who presents with a gunshot, especially multiple gunshots. And this does not include EMS [emergency medical services] transport and recovery time afterwards. Our health budget is going to crime.”

Surgeons and paramedics are so busy saving the lives of people caught in the crosshairs of crime that the waiting time for other patients with less immediate life-threatening problems has skyrocketed.

“A pregnant mother who might have called an ambulance, or an elderly person who has difficulty breathing are probably categorised as ‘priority two’, but due to priority-one injuries, such as gunshot wounds, they now have to wait,” says Mbombo.

Another problem is paramedics having to wait for police escorts to enter “red zones” – the most dangerous areas. Mbombo has joined paramedics when they need to get to these areas.

“I went with an EMS team to Mitchells Plain, it was 10pm, [and] I observed firsthand the delays the ambulance faced getting to a 5-year-old boy.”

She says most incidents take place on payday weekend at the end of the month.

Mbombo, the first black woman in former premier Helen Zille’s cabinet, is not scared to pack a punch. Perhaps this is due to her formative years in Mdantsane township outside East London, which is famous for its boxing culture. Mdantsane is home to boxing legends Welcome Ncita and the late Nkosana “Happy Boy” Mgxaji. Mbombo keeps a boxing bag and gloves ready at her double-storey home in West Beach, near Blouberg Beach, in Cape Town.

Growing up, her father was unemployed and her mother worked at a fish and chips café. From a young age Mbombo assumed the role of the family’s caretaker.

“We had such a big family. I only realised in about Standard 9 [Grade 7] that I was one of just three siblings. I always assumed that all of my cousins were siblings.

“I mean, my mother would leave home by 4am and come back at 10pm. So you didn’t see your actual parents; you were being cared for by anyone in the council house. Then, when I was older, I ended up having responsibilities to look after the younger ones too.”

Mbombo was also the family “nerd”; the one who read newspapers and listened to the radio. “I used to write letters on behalf of the community,” she recalls. “They would ask: ‘Can you please write me a letter for a grant? Can you write a letter to the school?’”

After matriculating, Mbombo was determined to become a healthcare professional. “Generally, for our generation growing up in the township, the thing you always wanted to be is a nurse, sometimes a doctor.”

She applied to several universities for bursaries – without success.

“It was common that after matric you must find work so you can help take care of the others. When I didn’t get a bursary I became a domestic worker.”

Mbombo was fired three times; the third was spectacular. “With the third job, my employer would go out with her children, leaving me to clean the house. Usually, she would return at around 3pm,” says Mbombo, who stares out the window and starts to chuckle.

“It’s common,” she continues, “when you have not been exposed to things, to start exploring.  I used to explore that whole house. I would wear the madam’s clothes and stilettos, and take tea from her best China cups. On that day – it was a Monday – I was wearing the madam’s best dress and reading their Sunday newspapers on the sofa. Well, imagine my surprise when she arrived home early. She was angry. She scolded me and said: ‘You don’t belong here.’”

These cutting words became deeply significant. “I will always remember those words,” says Mbombo. “I realised that, yes, I don’t belong in that domestic worker job … that God has different plans for me.”

Some months later, while roaming East London’s streets unemployed, Mbombo bumped into a neighbour. A nursing sister, who had good news.

“I was window shopping, looking at a dress and thinking: ‘I will buy this dress one day.’ And then this woman said to me: ‘Nomafrench, did you apply?’ I said, ‘No, what’s happening?’ It turns out they had introduced a nursing degree at [the University of] Fort Hare, where you didn’t have to pay for anything. Actually, they paid you; you got a salary while studying.”

The next day Mbombo applied. Competition was tight as the course had capacity for only 40 students, from all over the country, but her results were good and she was accepted.

“I was 18. It was a four-and-a-half year course. So, yes, that’s how it all started,” says the MEC as she leans back in her chair.

She recounts her first job – as a maternity nurse – at Frere Hospital in East London. “I ended up having lots of these low birth weight babies. In addition, HIV was rearing its head.”

After three years at the hospital, Mbombo went on to complete a master’s degree at the University of KwaZulu-Natal. Her research focused on homecare for children from informal settlements living with HIV/Aids. She was then headhunted by the University of the Western Cape (UWC), where she obtained a PhD. “By the time I was pursuing my PhD, I was combining my professional midwifery experience with aspects related to gender,” she says.

“I had learned that health is about more than just physical illness, it’s about empowerment too.” She was promoted to associate professor in sexual and reproductive health and rights.

After 15 years at the UWC, Mbombo needed a new challenge. She was considering going to Bangladesh to do humanitarian work, when she received an invitation to a Democratic Alliance (DA) meeting of black professionals.

“I must just tell you,” she says, “behind the scenes I was an ANC person. I went to this dinner. There were lots of us: accountants, academics, whatever. We didn’t know each other. What they said was this: ‘We invited you because we know you are disinterested. We want you to dissect our policies – as the DA – and tell us what is wrong so that we can fix it in order to attract people like you.”

The seduction was successful, and Mbombo joined the DA in 2013. “I realised that in order for there to be constitutional democracy in South Africa, you need to have a strong opposition,” she says.

In May 2014, she became a member of the provincial legislature. Soon after, she received a call “out of the blue”. It was Helen Zille, who was then the premier. “I was at a mall when I got the call,” recalls Mbombo. “It was noisy. I heard, ‘Hi, Nomafrench. I’m Helen Zille. How are you?’ I said, ‘Hi, how are you?’ And she said, ‘Would you please be my minister of sports and culture?’ I wasn’t expecting that. In December I got a call from her again and she said, ‘Can you do me a favour, please?’ I said, ‘Yes, prem.’ And she said, ‘On the first day of January I’m announcing a cabinet change…’ I was like, ‘Oh, okay, so you’re firing me?’ And she said, ‘No, silly, can you please be my minister of health?’”

Today, Mbombo is in her second term as the Western Cape MEC of Health. Meanwhile, she is also the federal leader of the DA’s Women’s Network. On Women’s Day, August 9, in Port Elizabeth, she delivered a speech titled Women Shall Rise and Break Their Silence.

“We remain at the top of the unemployment chain. Women who are employed face the painful reality of being manipulated into giving sexual favours in return for keeping their jobs,” she says, adding that in many communities young women are forced to sleep with teachers to get better marks.

Mbombo shares her house with her two daughters. One is a student at the University of Cape Town, the other has a job in public relations. “We are the three musketeers,” she says, explaining that she raised her daughters alone, as she is “happily widowed”. Her husband, originally from Port Elizabeth, passed away in 2003.

“The bottom line,” concludes Mbombo, “is to fix South Africa… in a large part, for the future of my children.”

Hospital horrors

Lotti Rutter & Leonora Mathe, Treatment Action Campaign

The hospital is full. Two young girls lie on trolleys in the main hallway. They are

An elderly patient with severe pain waits in the corridor at Kwamhlanga
hospital inMpumalanga
without being attended to. The patient’s face has been blurred
to protect their identity.

wrapped in pink blankets; drips come out of their arms and hang on the walls. One looks in severe agony. She calls out for a nurse again and again. Their mother tells us that they arrived at the hospital seven hours ago and have yet to leave the hallway. Laughter comes from the nurses’ break room. It is situated directly opposite their trolleys, but no-one ever emerges to help.

An old man with only one leg sits next to them. His drip is attached to the same set of hooks. He stands in pain. He struggles with his crutches, his drip and his file in order to slowly move down the dusty passage to the toilet. The toilet will not flush, and is dirty after people have tried. A poster haphazardly taped to the wall in the bathroom informs patients that they should “always wash their hands”. Yet the soap dispenser is empty, and there are no taps to provide water. The floor is filthy.

Overcrowding, dirty facilities, bad services and poor attitudes. This is what awaits public healthcare users at Prince Mshiyeni Hospital in Umlazi, the largest township close to Durban.

Treatment Action Campaign branches monitor the state of health care at hundreds of clinics and hospitals across the country. They are the people who need the public healthcare system to work, so they are the first to notice when it does not. Prince Mshiyeni Hospital is not alone in its dysfunction. In recent weeks, a TAC fact-finding mission has showcased the crisis in several public hospitals.

We visited hospitals in KwaZulu-Natal, Limpopo, Mpumalanga and Gauteng. And the situation in each is as dire as it is in the next.

In Limpopo, at Malamulele Hospital, people begin queuing at the old and run-down facility from 5.30am. The corridors are full. At each turn, brightly dressed women fill the hallways. Around 200 people are waiting to be attended to by only two doctors. The waiting is unbearably long. We are told that there has been no constant water supply at the hospital for three years. Patients are unable to wash themselves, and there is only a small amount of container water available for using the toilets. As we walk through the wards during visiting hours, the patients have no privacy. There are no doors or curtains. The wards smell, and the bed linen is dirty.

In Tshilidzini Hospital, more than 75 patients wait for their files. Each time a shrill voice screams out a name, the chain of people patiently moves one seat across. People have been waiting in this queue for over five hours. A few people waiting are already wearing Tshilidzini hospital gowns. One is a young man with an open wound on the back of his neck – the wound and stitches are uncovered, and he uses a wad of toilet paper to stop it seeping. And the file room is only the beginning; once they leave, patients are faced with more long queues to be attended to by a doctor.

In Elim Hospital, patients wait for files for around five hours. After collecting their files, they enter the hospital and join a long queue to be seen by a doctor. In a corridor around 100 metres long, patients on back-to-back benches fill the entire space, waiting to be seen. Those with bad coughs sit with everyone else – in a corridor with windows on just one end. As we walk around, at each turn a new queue appears. More faces are raised in hope at the sight of us. In the main hallway, a man is sitting on a trolley, under a blanket. A drip comes out of his arm. He tells us he was admitted six hours ago, but nurses have yet to find a bed for him to be moved to.

In Mpumalanga, at KwaMhlanga Hospital, the corridors are full. One old gogo

Welcome to Prince Mshiyeni Hospital. Expect long waits,
bad service and dirty facilities.

(elderly lady) lies on a trolley in the corridor, in severe pain. She struggles to move, and has not yet been attended to. People in wheelchairs are stacked together, each man’s knees squashed into the chair in front of him. Hundreds of people wait to be seen. Their eyes follow us as we pass through the corridors. One man sits in casualty with a home-made sling on his arm. After being attacked by thugs, he had attempted to access services at the hospital. An X-ray had been taken the night before – yet only a day later, his file has been lost. He is told to go and submit an affidavit at the police station, and return. He has no money, and has received no painkillers. The young man sitting next to him has been waiting for five hours. A baseball cap covers a bloody stain on the back of his head.

In the most well-resourced province, Gauteng, the recently refurbished Thelle Mogoerane Hospital still suffers the same level of neglect as before. Casualty is overcrowded, and the queues last for hours. People sleep in the corridors. Patients bleeding and in critical condition sit with everyone else. A psychiatric patient is seen wandering around the wards. We are told that for days, patients have been fed porridge for every meal. One woman shows us an X-ray of her broken jaw. She had been sent home with just a Panado for the pain. Another woman told us that post-labour, the doctors had sewn her vagina shut – when she returned to question them, they told her she must have been born that way. Another woman explained how, during labour, doctors took another woman into her space in theatre. Eventually, after waiting the whole day to be seen, she gave birth to her baby. The baby was green, and died six days later.

Poor management, budgetary constraints and a lack of care for the needs of patients plague these public facilities. And it is the people who suffer. In order to expose these crises, and hear from the people who need to use these services, TAC will be holding public hearings and showcasing people’s stories in the run-up to World AIDS Day.

As we leave Prince Mshiyeni Hospital through the abandoned trolleys, a woman sits sobbing in a wheelchair. Under a blanket her feet are badly swollen, and she struggles to breathe. We can see the fear in her eyes. She has just been discharged. A nurse leaving the hospital passes by; we try to engage with her to re-admit the woman, but she informs us as she rushes away that she will let the security guard know he must look for the woman’s friend. After TAC intervenes, she is re-admitted. Upon being examined, she is diagnosed with pneumonia and cryptococcal meningitis. She is moved to a cold and overcrowded ICU ward, beds mere centimetres apart. She has not been allowed to keep her blanket, and is visibly shaking when we visit.

When we eventually leave the facility, the young girls cocooned in pink are still where we found them in the dirty corridor, hopeless, still waiting for help.

A litany of atrocities at Prince Mshiyeni Hospital
- A wheelchair lies abandoned on the pavement, and trolleys are scattered across the casualty entrance of the hospital. Dirty rags line the floors as we enter. We are greeted by dust, dirt, and dirty chip packets.

- Family members push patients up and down the hall on trolleys. One patient looks in severe pain, lying on her side on a trolley; she rests her head on a water bottle that acts as a pillow.

- A diabetes patient waits to collect chronic medicines. Last month she waited through the day until 11pm, only to have to return the next day. Before speaking to us today, she has already waited for over eight hours.

- Paper files lie on the unattended counter for anyone to look at. One woman waited for eight hours until they located her file.

- At 4.30pm, more than 100 people still need to be seen. Every corridor of the hospital has more and more patients, sitting, waiting to be attended to.

- One small room has at least 25 beds haphazardly squashed into it. Another has only a few centimetres between each bed. It seems that psychiatric patients have been put next to other patients.

- A woman with her leg in a cast had come to the hospital in agony seven hours prior, in an ambulance. The previous month they had cast her leg without having taken an X-ray. At 4.30pm she is told the X-ray department has closed, and she should return the next day. The doctor has not seen her. As she leaves the hospital in a wheelchair, she is still in agony. In her opinion, coming to this hospital is a waste of time.

- Three people struggle to get an unconscious person – who has been discharged – into the back of a car. They use a piece of material to get the person off the trolley, and eventually, onto the back seat. During this 20-minute challenge, cleaners look on.

- An old man, looking gaunt and sick, leaves the hospital. A pulled-down TB mask rests on his neck.

- A hungry man eventually leaves the hospital by getting a lift with strangers. He has been there for eight hours. He has no money for food or for a taxi.

- A white van emblazoned with a “21st Century Funerals” logo stands outside the accident and emergency entrance. A trolley is carried out of the back and taken inside the hospital. A while later the driver returns, pushing a corpse in a body bag past patients entering the hospital in order to load it into the back of the van.

TAC survey highlights poor infection control in clinics

By Marcus Low

Tuberculosis (TB) infection control measures in some South African public sector clinics fall woefully short. This is according to an infection control survey that was published by the Treatment Action Campaign (TAC) ahead of World TB Day (23 March 2017).

While the survey has some limitations, and is by no means an exhaustive survey of clinics in South Africa, it nevertheless provides compelling evidence that we have an infection control problem at a number of public sector clinics. Given that poor infection control at clinics may be a significant contributor to TB transmission in South Africa, this is a red flag that should be taken seriously.

How was the survey conducted?

TAC branch members across seven of South Africa’s nine provinces were trained on a TB infection control questionnaire. Delegations from TAC branches then went to their local clinics to fill in the questionnaire. They reported their findings back to the TAC national office where the findings were captured.

The questionnaire contained seven questions relating to TB infection control measures that should be in place at clinics. Each question was simply given a “yes” or “no” answer. It was designed in such a way that “yes” answers in each case indicated correct infection control procedures. In other words, the more “yes” answers a clinic got, the better.

What did the survey find?

As part of their media release, TAC published an Excel file with the data they collected. This file contains details of the 158 clinics that were surveyed and how each of seven questions were answered in relation to these clinics. Below we present some additional analysis we conducted of the data provided by TAC. (For those interested in exploring the data, we have done some data cleaning and saved it as a CSV file that can be downloaded here.)

While TAC rated each clinic red, orange, or green – the data can also be represented as a score out of 7 for each clinic – where each yes answer adds 1 point to the score. Thus clinics that score 7/7 are rated green, 5/7 or 6/7 are rated orange, and 4/7 or less are rated red.

Scores by province

ProvinceNumber of clinics surveyedMean score out of 7
Western Cape 15 4.67
Eastern Cape253.52
Free State193.16

The above table shows the mean score of the clinics surveyed in each province. We should stress though that these are not representative samples and the findings cannot be generalised to entire provinces. The mean scores in some provinces are also so close together that we should not read anything into the fact that e.g. Mpumalanga is above Gauteng, or that Free State is above Limpopo. It does seem significant however that the clinics that were surveyed in the Western Cape tended to do substantially better than clinics surveyed in other provinces.

No clinics in the North West province and the Northern Cape were surveyed. Of the seven provinces surveyed, Mpumalanga is somewhat over-represented with 39 out of the 158 clinics – most other provinces had around 20 clinics surveyed.

Results by question

This table shows the total NO and YES answers to the seven questions. In each case YES indicates correct infection control measures. Only question 1 and 3 received more than 50% YES answers. Question 5 received exactly 50% YES answers.

QuestionsAnswered NOAnswered YES
1. Are the windows open?22136
2. Is there enough room in the waiting area?9266
3. Are there posters telling you to cover your mouth when coughing or sneezing?6494
4. Are you seen within 30 minutes of arriving at the clinic?10157
5. Are people in the clinic waiting area asked if they have TB symptoms? 7979
6. Are people who are coughing separated from those who are not?10553
7. Are people who cough a lot or who may have TB given tissues or TB masks?11642

The TB infection control measure on which clinics did the best was keeping the windows open in the waiting area. Second best was having posters up on the walls telling people to cover their mouths when coughing or sneezing. However, apart from opening windows and having posters on the walls most clinics did very poorly at TB infection control.

It is also notable that on the cross-cutting question as to whether people are seen within 30 minutes, only 57 of the 158 clinics got “yes” answers. Long waiting times becomes a more important risk factor when other infection control measures are not in place because people are exposed for longer periods. The mean score in clinics with less than 30-minute waiting times was 5.1 compared to only 2.3 in clinics with longer waiting times – in other words, the clinics where people waited longer tended to be clinics where the risk of TB infection were already substantially higher.

How much did clinic scores vary?

Only 15 of the 158 clinics in the survey got “green” ratings. 31 were rated “orange” and 112 were rated “red”. The mean rating for all clinics surveyed was 3.34/7 and the median was 3/7.