'My biggest disappointment in my time as a health minister so far was in 2009 when a front-page headline screamed that I was causing a scandal for taking my son to Steve Biko Academic Hospital [in Pretoria]," Aaron Motsoaledi, South Africa's health minister, explains over the phone late on Wednesday afternoon. He pauses.
"The reporter said: 'You're pushing people aside to get priority treatment. You're rich and have a medical aid. You're supposed to use a private hospital.'"
Motsoaledi's son was three years old at the time. He had a temperature of 40°C and was taken to Steve Biko hospital in a state ambulance.
His grannies, who were taking care of him, initially took him to a private hospital. But, four days after his admission, no diagnosis had been made and the boy's condition remained serious.
"I asked that he be transferred to Steve Biko," Motsoaledi says.
"Within four hours of his arrival he was diagnosed with serious sinus problems and successfully operated on.
"You know why? Because a professor diagnosed him and that's what professors are there for. Professors are based in academic hospitals, not at private hospitals."
These are the stories you usually don't hear about public hospitals, the minister says. "People always believe it to be the other way around: that the blunders are made in the public healthcare system and repaired in the private system. But I work in healthcare. I live and experience these cases every day – also in my personal life. And I know that what happens in healthcare in this country isn't always clear-cut."
About a month ago, Motsoaledi underwent major surgery at Steve Biko Hospital. He returned to work this week.
"I don't subscribe to that school of thought that I can't use a public hospital. I will never do that. I phoned that journalist who reported on my son's admission and asked her: 'Which clause in our Constitution says rich people must go to private hospitals and poor people to public ones?'"
A week after Motsoaledi was discharged, his wife was admitted for eye surgery at the same hospital. In 2012, one of his daughters had her molars removed at Polokwane Provincial Hospital in her hometown.
"By the way, there is a maxillofacial specialist at that hospital … Yes, in Polokwane, in Limpopo," says Motsoaledi.
Utilising public hospitals sends a message
In 2010, one of his daughters, who is now a fourth-year medical student at the Medical University of South Africa (Medunsa), booked herself into a private hospital, also for a dental issue. She phoned her father to inform him she was going to use his medical aid.
He told her: "If you're going to use my medical aid you had better cancel your booking at the private hospital and use it instead at Medunsa's training hospital [Dr George Mukhari Hospital]."
For Motsoaledi, the message his daughter would be sending if she used a private hospital was unacceptable.
"She was studying at a teaching hospital where her professors were working as doctors, but when she's sick, she goes somewhere else to be taken care of? That sends the wrong idea," he maintains.
What was his daughter's reaction?
He hesitates, then chuckles. "She had no choice. She's my child."
Motsoaledi acknowledges that state hospitals are "far from perfect". But he's quick to add that the public facilities are home to some of the best academics in the country.
"The weakness is that we haven't been giving the state specialists enough management support and equipment to do their jobs. However, I can assure you that all my National Health Insurance plans are geared towards overturning this. I want to give the professors their power back. That is my promise," he insists.
Public facilities not necessarily for the poor
He also wants to change the perception that public facilities are reserved for the poor.
"I'm not saying private healthcare must not be used by South Africans. I'm saying it can't be the primary mode of healthcare delivery to any population, let alone South Africa's, because it's simply unaffordable.
"We should also never forget that every single doctor trained in this country, including the privates, was trained by government doctors in state hospitals. And many of them, particularly specialists, still work there."
The minister remains continually irked by the bad reputation – "sometimes totally unfair" – gained over the years by the public healthcare sector, and he maintains that the state is often not credited for medical achievements it has supported.
To bolster this view he refers to Dr Ridwan Mia, the plastic surgeon who's been lauded internationally for giving young burn victim Pippie Kruger a life-saving skin transplant.
Motsoaledi explains: "The overwhelming perception out there is that Dr Mia is a private specialist because some of his patients come from private hospitals. And, of course, that Dr Mia must be a private specialist for one simple reason: he's good at what he does.
"Yet Dr Mia is a full-time employee at a state hospital, Helen Joseph, and at a public university, Wits.
"This is just one such case of many that I have to support my view that South Africa has the expertise in the state healthcare sector – but we need to provide this expertise with far better resources. And if we begin to manage our public hospitals well this expertise will thrive … The current state of our public healthcare system is not irreversible."
Fighting a battle of perception
Motsoaledi is fighting this battle of perception on several fronts. One of the toughest of those is in his own government.
The minister acknowledges that very few of his Cabinet colleagues use public hospitals.
"Don't think I am hiding from this difficult issue. I say it in Cabinet meetings, and I make no apology. I tell them: 'I'll be happy if all of you use public healthcare.'"
Although opposition parties and ANC leaders mostly use private care, they have lauded Motsoaledi for receiving medical attention at public facilities. But concerns have been raised that he and his family get "preferential treatment".
The Democratic Alliance's health spokesperson, Jack Bloom, has said that 1?629 patients were waiting for surgery at Steve Biko at the time that the minister was admitted for an operation, and that such surgery was needed more by someone who couldn't afford private healthcare.
Motsoaledi is adamant that his medical aid paid for all costs.
"People think everything at a public hospital is free, but that's not the case. If you have a medical aid you are charged for services and the money that the hospital gets for the services is revenue for the hospital."
He adds: "But let's talk further about this 'special treatment' issue … Look, I'm a minister. The chief executive of the hospital knows when I arrive and welcomes me. I would be treated the same way in a private hospital. Yes, I don't queue anonymously and yes, I'm taken to a special ward. But, following that, I get the same treatment as anyone else.
"I don't get favours. I eat the same food, and I access the same doctors and nurses as everyone else.
"My children are not ministers. They go to ordinary wards. They're not welcomed by hospital chiefs – they just go there, like anyone else."
Motsoaledi says: "What kind of a leader would I be if I stood up on platforms ... saying the public health system isn't so bad and then I, and my entire family, get treated at the best private hospitals?"
This same conviction is also why none of his five children – two at university and three in primary school – have attended private schools.
"I don't necessarily choose model C schools for them; I send them to the closest public school," he says.
He says he's "made peace" with the reporter who wrote about his son's admission to Steve Biko Hospital.
"At first I was angry but then I realised she was in her 30s ... This woman was not around when public hospitals in South Africa were working to the highest standards. I was.
"I was around when Johannesburg General Hospital [now Charlotte Maxeke] was one of the best hospitals of choice anywhere and when the world's first heart transplant was performed at the state hospital in South Africa.
"I promise you, eventually, we're going to get there again – I'm working on it."
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