Being a good doctor requires empathy, says outgoing health ombud Prof Malegapuru Makgoba

As a young boy surrounded by hills in Limpopo, Malegapuru William Makgoba says he used to rest in the shade of marula trees, minding his father’s ducks, sheep and goats, while pondering the wonders of nature. His childhood was happy with a sense of benevolence and belonging.

At the age of 11, he saw his father, Morithi Makgoba, enter a diabetic coma in their home district of Sekhukhune. He recalls that his father’s life was saved at a hospital 20km away. It was an early encounter with medicine and the healthcare system, which would become his life’s work.

Apart from a passion for medicine, the need for equal opportunity would also become a driving force in his life. When he was 14 years old at boarding school, a teacher suggested that he skip a grade. Makgoba, squirming away from special treatment, asked that all his classmates write a test to check for such eligibility. This, he says, resulted in five pupils, including himself, attaining 85% or more, and being pushed a year ahead.

In the more than five decades since then, Makgoba — now professor emeritus and retired vice-chancellor of the University of KwaZulu-Natal — would come to shape South African health policy, notably through his critique of Aids denialism in the 2000s, and later through his appeal as Medical Research Council president to provide antiretroviral drugs to people living with HIV. This saw him in conflict with some of the country’s most powerful politicians.

A profile interview in the American scholarly journal Science in 2000 quotes Makgoba as lambasting then-president Thabo Mbeki. “The sad part is, [Mbeki] is trying to politicise scientific facts, and that’s what the Nazis did,” he said at the time.

Makgoba’s trademark forthright manner manifested in his job as South Africa’s first health ombud, a position he assumed in 2016 and which saw him release stinging public reports. His tenure draws to an end next month.

A revelation

For the past seven years, Makgoba has led a Pretoria-based staff of 30 who investigated patient complaints against health practitioners, hospitals, and clinics across the private and public sectors. And while his ombud office email did not work at the time of this interview, he calmly implies this is a temporary glitch. He says his office processed some 10,800 complaints since its inception.

Reflecting on his tenure, he recalls some of the most jarring incidents. He singles out the Life Esidimeni tragedy, which saw an estimated 144 psychiatric patients die due to starvation and neglect in 2016 after they were transferred to under-resourced NGOs and psychiatric facilities in Gauteng. His initial report on the affair is here.

“This for me was a revelation of the health system,” says Makgoba. “How it interacts with politics, and how political power and lack of accountability can result in human rights abuses to the extent that vulnerable people, such as mental health patients, could be treated the way they were treated, resulting in deaths and so forth. I mean, people in power denying that their actions could have been responsible for what happened. It was a failure of basic common sense. That was really just horrible as an investigation.”

The ongoing judicial inquest into the deaths of the Life Esidimeni mental healthcare users, which started in 2021, has had many delays with the latest postponement granted to the lawyers of former Gauteng health MEC, Qedani Mahlangu. Proceedings are set to resume on May 2.

He also highlights his office’s recent investigation into the Rahima Moosa Mother and Child Hospital in Johannesburg. The damning report on the conditions at the hospital included shocking revelations about how the health and dignity of patients were compromised. Makgoba released the report in March.

To Spotlight he says, “It was just a litany of deficiencies. Here you have an 80-year-old hospital that has really been neglected over the years. It used to be an excellent hospital that won awards. I mean, it’s a hospital that deals with obstetrics but which doesn’t even have a blood bank. One of the most common causes of maternal death is blood loss. People lose a lot of blood giving birth. It’s overcrowded and run down — just horrendous and unhygienic, with women who have just delivered or pregnant women sleeping on the floors.”

Side-stepping Mandela

The 70-year-old scholar speaks openly about his political non-affiliation.

During his studies at the University of Natal Medical School, he says he was inspired by Steve Biko and the Black Consciousness Movement. However, he felt that belonging to a political party would curtail his scientific freedom and thinking.

Makgoba chuckles, recalling how he even sidestepped an invitation from former president Nelson Mandela to join the ANC.

He says he met with Mandela at Luthuli House in Johannesburg in 1990. At the time, Makgoba was living abroad and Mandela asked him to consider returning home.

“He [Mandela] said I should think about returning to South Africa, that I should think about joining his new movement, his philosophy of reconciliation. And of course, he put me in a corner because he wanted to know whether I was a member of the ANC. And I said no. And he said, 'Well, I’ll take you downstairs so you can join.' And I said no thank you.

“Fortunately, as we were talking, his PA knocked on the door and said, 'There’s somebody who wants to see you.' That’s how I escaped. I mean, the pressure to be told by such an important person to become a member of a party! The fact is I don’t belong to any political party. It has something to do with my independence, my freedom of thinking, my training.”

A long and varied career

During the interview over Zoom, Makgoba’s office walls appear bare behind him. He says that he keeps relics of his long and varied career at his home in Schoonoord in Sekhukhune, explaining that he feels no need to “intimidate people with certificates of his education on his office walls”.

At the height of apartheid in 1981, Makgoba won a prestigious scholarship to study towards a PhD at the University of Oxford in the UK, where in 1983 he completed his thesis in human immunogenetics. At the time, Makgoba’s supervisor, Prof Andrew McMichael, said this about him: “Overall, he [Makgoba] was one of the most broadly able and interesting students I have seen. A good scientist, but with a mission to do something special for his people.”

Makgoba would continue doing research in England and in the US, focusing mainly on genes and cell surface proteins involved in the immune response.

From 1986 to 1988 at the National Cancer Institute in Maryland in the US, he was part of a team of researchers headed by Dr Stephen Shaw. Makgoba explains that at the time, immunology was preoccupied with T-cell receptors (a protein on the surface of T cells — the white blood cells that drive the immune response) and T-cell recognition; thus how these cells remember and learn, tailoring specific immune responses, somewhat similar to human memory or the nervous system.

“Dr Steven Shaw had a view that there must be something that makes the cells communicate with each other and tell each other before a specific response is triggered, and he came up with a theory of cell adhesion molecules, especially in T-cells. It opened up something new about how T-cells may be useful in surveying for cancers in the body because they have these structures that allow them to move around and crawl and sniff other cells and say, there is something here that’s not normal, and so forth. It was a fashionable field, a popular field, a competitive field to be in. It opened a whole area of biology and even up to this day, those papers are still being quoted.”

Accolades and outrage

In 1993, Makgoba accepted the position of deputy vice-chancellor at the University of Witwatersrand (Wits). Here, his drive for higher education transformation caused clashes, with some of his Wits colleagues describing him as “an unapologetic radical” and in 1995, his detractors lodged a 297-page dossier of complaints against him. Makgoba responded by describing his detractors as an “inbred elite” and racist.

Indeed, while Makgoba’s views on transformation earned him accolades, they sparked outrage too. Over the years, controversy followed him around South African campuses and committees — skirmishes that he brushes off.

Looking back, Makgoba says peers saw his writing on “decolonisation and Africanisation” as a threat instead of a push for positive change.

“Instead of being embracing, they grew defensive,” he says.

After Wits, he joined the South African Medical Research Council , and in 2002 he became vice-chancellor of the University of Natal (later the University of KwaZulu-Natal or UKZN). Here, signing graduation certificates was a highlight, he says. Makgoba recalls being on holiday one Christmas at the Livingstone Hotel on the Zambezi, where an old English couple recognised him as the man who graduated their daughter.

“When you cap people [tapping a student’s head during graduation], pictures are taken,” says Makgoba. “I think they took this picture and framed it and it was somewhere in their lounge or whatever. And they came up to me and said, 'But we know you because your picture hangs in our house.' And I said I’m not sure. They said, 'Well, you capped our daughter.' And they bought me a bottle of champagne — Moët & Chandon.”

What’s next?

With his time as health ombud coming to an end, going forward, Makgoba says he is busy writing a book on his life and experiences. His obvious passion and decades of experience suggest he will remain engaged in South Africa’s ongoing healthcare reforms, though it is not clear in what capacity.

On South Africa’s proposed National Health Insurance system, he says: “This is a very excellent concept but for it to work, poor infrastructure needs to be addressed — poor leadership, inadequate human resources and poor governance in health need to be addressed.”

Wrapping up our interview, Makgoba says that being a good doctor requires empathy and a deep understanding that every single patient craves 100% care. Such empathy is not something that can be taught or learnt from books, he says. It is something people are born with. It derives from a person’s nature and values.

— This article was first published by Spotlight