- Stepping into the top seat at the South African Medical Association in February plunged Mzulungile Nodikida into the middle of dealing with “topical issues” such as the National Health Insurance, salaries for doctors in the public sector and the high number of unemployed medical professionals.
- After having been involved with the association for about a decade, “you could say that I understand the association very well,” he says.
- He tells Sean Christie how he went from playing soccer and cricket while at school in the Eastern Cape to studying medicine in Cuba — and how his career path moved from seeing patients every day to shaping systems for helping doctors give people quality care.
In today’s newsletter, content editor Linda Pretorius gives us a look into the life of the new Sama CEO, Mzulungile Nodikida. Sign up.
Life has been hectic for Mzulungile Nodikida since his appointment as CEO of the South African Medical Association (Sama), a non-profit professional organisation “representing the interests of medical doctors and uniting doctors for the health of the nation”, according to their website.
“I came onboard when Sama was in the middle of organising its annual conference in February, which we delivered successfully, I think. Then we plunged straight into the regional expert meeting of the World Medical Association’s Declaration of Helsinki, which was held in Johannesburg a few days later,” he says, accounting for a couple of meeting postponements.
“Now we must face the issues. They’re topical; I’m sure you’ve heard of them,” he says, chuckling at the understatement, and indeed one would have to have been living under a rock to miss the issues to which he refers, like the inexorable progress of the South African government’s National Health Insurance (NHI) plan, going from policy to law.
Sama’s vociferous and sustained opposition to NHI has been hard to miss, too. In place of a central funding system for health services, Sama, Nodikida explains, has been advocating for “a system based on primary healthcare (PHC) principles, focusing on what the World Health Organisation calls the health system building blocks, which includes leadership and governance, service delivery, health system financing, health workforce and several other components”. Sama has strongly advocated against the underpayment of public sector clinicians, too, and consistently chafes the government about the concerningly high number of unemployed doctors in the country.
“We have made representations to the health minister, arguing that the employment of these doctors is not only a matter of their own livelihoods but it’s vital for the health of our country. Work rosters in our country’s public hospitals, especially the rural hospitals, have gaps all over, with no second doctor on call to help in case of emergencies,” says Nodikida, sounding polished, which comes as no surprise given that his involvement in professional associations goes back many years.
In 2013, he became the first international liaison officer of the Junior Doctors Association of South Africa (an organisation under the Sama umbrella), a role for which he was well suited, having studied in Cuba. “We mingled with students from every corner of the globe, swapping notes on our respective health systems and issues,” says Nodikida. He went on to chair Sama’s Eastern Cape branch for a few years, and in 2018 he joined the Sama board, as head of the finance and risk committee.
“You could say that I understand the association very well,” he says, in his distinctively hoarse voice.
An inspiration for life
“It’s a weird voice,” he muses. “I took it from my grandmother. I actually wanted to be in the choir at school but — surprise — they didn’t want me.”
Nodikida played soccer and cricket instead, at Ayliff Primary School in Peddie in the Eastern Cape. “[It’s] one of the best primary schools in the province; I was fortunate,” he says. His parents, two brothers and sister lived in Bell, 30 kilometres away, but Nodikida spent much of his early childhood in the home of his grandfather’s brother.
“I was taken in, with my cousin, in order to be closer to the school. You know how in every family there is one person you just click with? For me, that was my cousin Sinethemba, aka Mtepile. We were very alike and would compete over almost everything. He was a Pirates fan; I was a Chiefs fan. You know how it goes,” he winks.
Sinethemba passed away in the year 2000.
“He was brilliant, and I have used his memory as a kind of inspiration in my life,” says Nodikida, who matriculated from Nathaniel Palma High School in 1999, the year that President Thabo Mbeki infamously declared that certain antiretrovirals have toxic effects and are dangerous to health, inciting national and global outcry.
“I was aware of that fight but dimly, as I was only starting to become politically conscious,” says Nodikida, who was interested in a career in medicine.
“I saw relatives getting old and sick, and my cousin had just died of what I know now was probably renal failure — these things got me thinking about healing,” says Nodikida, who would first apply to study a bachelor of science information systems at Rhodes University.
Worlds apart
In 2000, he came across an advertisement for a bursary to study medicine in Cuba, but when he looked into it he found that the cohort for that year had already flown out.
“I reapplied in 2002, and was one of 11 applicants chosen,” Nodikida says. The chosen students first flew to Madrid, and then on to Havana. Nodikida was allocated to the Universidad de Ciencias Medicas de Villa Clara in Santa Clara, where he spent six months learning to speak and understand Spanish.
“There were lots of misunderstandings, some of them very funny,” he says, recounting how he and some of his South African peers approached their Spanish teacher for advice on how to order a cold drink from the campus tuck shop in hot Caribbean weather.
“The prof told us that cool drink was ‘refresco’, so we ran to the tuck shop, repeating the word to ourselves, and when we got to the counter, we looked at the lady and said, ‘refresco’, and she said ‘cuál?’. We had no idea what she was talking about, so we ran back to the prof, who said, ‘she’s simply asking ‘which cool drink?’ If you want a Sprite you’d say limón, if you want a coke you say cola,’ and so we ran back repeating those words and that’s how we learned, and by the six months mark most of us were relatively fluent in Spanish.”
Nodikida studied medicine for five years in Cuba, in Spanish, and returned to South Africa to complete his final year at the University of Pretoria, in English. He describes the switch as “a nightmare”.
“We had to spend a vast amount of time in our English books, working out, for example, which Spanish abbreviations correlate with which English ones. I remember a day when I was rotating through internal medicine at Steve Biko [Academic] Hospital, and we had a patient with congestive cardiac failure, which South Africa-trained clinicians refer to as CCF, and our prof asked me, ‘what is wrong with the patient?’ I wanted to say ‘insuficiencia cardíaca global’, but instead I sort of looked at him blankly and said, ‘I know his heart is failing.’”
‘We were trained well’
The widespread dismay on South African medical campuses at the arrival of final-year Cuban-trained students has been widely reported, and Nodikida confirms he and two fellow Cuban-trained doctors, “caught attitude from some of the professors, who just hated the Cuban programme”.
“We all felt that we needed to set an example, show that we were trained — and well. At the University of Pretoria, if you do well in your end-of-block exam, you don’t have to write the final exam. I think I wrote only one exam, and in general our group finished in record time, not repeating any blocks,” says Nodikida, who feels that his time in Cuba shaped his approach to medicine more than any other experience.
We were trained in a communist country that is doing far better than many of the developed countries, in terms of health outcomes. If there’s magic in the Cuban system, it’s the focus on primary healthcare and community diagnosis, which is done mainly by medical students going into the community and categorising each individual within a household according to whether they are well, or well with risk factors, or sick on medication and controlled or not controlled, or sick with complications, and so on. You base your interventions on that knowledge,” says Nodikida, who was not alone among his peers in believing, upon his return, that South Africa would benefit from a similar approach.
He returned to Peddie for his community service years, and helped to establish the Eastern Cape Cuban-trained Doctors Forum, which attempted to roll out community diagnosis, and aimed to advocate for a primary healthcare focus in the area.
“We visited people in their homes, believing that if you know what’s wrong with the community, then you’re able to plan accordingly and manage some of these diseases before they become very expensive, and need to be cured at a tertiary healthcare centre,” he says, adding that in his discussions with leaders in healthcare he would often give the example of the country’s approach to tackling HIV.
“South Africa’s department of health acts to prevent HIV, in giving people medication to prevent transmission, yet when it comes to other diseases especially noncommunicable diseases, this lesson goes out of the bathtub and we prefer an expensive curative approach,” he says, lauding the private medical aid provider Discovery for rewarding its members for having a healthy lifestyle.
“My grandmother’s favourite food was sweet potatoes, and those green leafy vegetables called isigwamba. Those things grow everywhere and are actually very healthy, so we could educate people to make healthier choices within the limited resources that they have, to prevent noncommunicable diseases like diabetes and hypertension [high blood pressure] — that’s what we learned from Cuba,” says Nodikida, whose involvement in outreach programmes dwindled as his career path bent away from patient-facing clinical practice towards public health and administration.
Keep on learning
Between 2013 and 2016, Nodikida did a diploma in obstetrics and gynaecology, and his mentor in the training centre in Gqeberha was Mfundo Mabenge, the head of obstetrics and gynaecology [O&G] at Dora Nginza Provincial Hospital, who encouraged him to specialise.
“I very nearly did the fellowship in O&G, but by that time I had started to take an interest in the financing, policy and administrative side of healthcare, and so I decided to enrol for an MBA [Master of Business Administration degree] with the Rhodes University Business School, where my research subject was the transformation of Nelson Mandela Academic Hospital in Mthatha from a tertiary to a central hospital.
When a vacancy for a clinical manager position at the hospital was advertised in 2016, Nodikida applied successfully and moved to Mthatha. In 2018 he became the acting director of clinical services for the hospital, a position he held until his appointment as Sama CEO this year.
“I would like to think that I’ve never lost the desire to learn and improve,” says Nodikida, who did a master’s degree in public health through Peking University between 2020 and 2023, and recently completed training in medical legal mediation.
“The other thing I feel I’ve remained alive to is opportunity. And come to think of it, the two things — ongoing education and seizing opportunity — tend to go together,” he says.
