All South Africans today have access to health care. For some, it is world class. For others it is barely adequate. Nevertheless, as Shrikant Peters describes, the provision of health care in South Africa began haphazardly in the late 19th century and would not have been possible without the contribution of the Church, whose religious communities staffed the country’s first hospitals.
Walk in and around any modern-day South African hospital (public or private), and you would be struck by the secular sterility that inhabits the place. Doctors and nurses treat the unwell, who arrive in their numbers for urgent care. You may have thought such places would be chaotic, unclean and uncivilised. But that is judging them by modern standards. However, the current (if fractured) South African healthcare system is built on layer upon layer of history. Each layer downward is slightly less organised than the last and begins with the chaos of missionary healthcare provision in a nation born of conquest, war and greed.
Look a bit closer and you will see the odd glimpse of a past, which has now been mostly long-forgotten. A piece of stained glass curiously out of place, a painted-over wall Cross, or a disused building hiding in a tuft of weeds at the corner of the hospital grounds. Or simply just gauge the proximity of hospitals and clinics to local parishes and Church halls. With surprising regularity, in what is a nation of Christian pluralities, one finds the seeds of a Catholic past infused in many healthcare facilities across the country. The Church is the largest religious provider of healthcare services on the Africa continent.
This would come as no surprise to those familiar with religious orders, and the fervent zeal with which members carried out their work in spreading the gospel to the farthest ends of the globe, both in word and deed, to those with whom they came into contact. Although the modern history of healthcare provision starts with the arrival of Van Riebeek (a medical doctor himself) and the Dutch East India Company at the Cape in 1652, it was not long before missionary orders in Europe were requested to provide healthcare to inhabitants, both black and white, of the southern tip of Africa.
Early development of Catholic healthcare institutions
The first Mass held in South Africa was a service celebrated on the Island of the Holy Cross, off Port Elizabeth, in 1488. This followed the ructions of the Reformation in Europe and the subsequent scramble for Africa during the era of colonization. The first Catholic order to be sent to South Africa arrived only in the 1850s, in the form of the Assumption Sisters They were called by the Bishop there to initially assist with the education of young girls in Grahamstown.
The first Catholic order to be sent to South Africa to provide medical care was the Holy Family Sisters of Bourdeaux, who staffed the fledgling Johannesburg General Hospital from 1888. This was on the request of the then Catholic Chairman of the hospital board, W St John Carr. They continued to do so, with its move to the present-day Hillbrow, which – during its operation – was initially known as Hospital Hill.
The old hospital building and Hillbrow Community Health Centre stand on this site, as well as a beautiful, but disused old stone Chapel, which gives testament to this history. Here the Sisters served patients, both black and white, and would have witnessed the massive growth of the City. This growth followed the discovery of diamonds in Kimberly and gold in Johannesburg itself in the 1880s.
The nature of Catholic healthcare provision developed with the changing political and economic forces at play in the country. Eventually, Catholic orders were forced to cede their hospitals to the then apartheid State. This move put the population at the mercy of a State apparatus, which had long since decided to provide inferior quality care to the African majority. Their economic input was seen as being confined to menial labour and they were deemed unworthy of Western medical scientific standards, which were improving life expectancy across the globe.
Healthcare facilities, based in the former homelands and peri-urban settlements, thus remained underfunded and squalid with this reduction in funding over time. A lack of purchasing power in these areas made little business sense for private healthcare institutions to invest in them.
On the other hand, religious order hospitals located in areas zoned for use by whites grew in prestige to become leaders in the field of healthcare provision. This initially attracted private practitioners, and then eventually large hospital chains that expanded throughout the 1990s and into the democratic era. The change meant taking over operation from religious Sisters, while ostensibly maintaining a quasi-religious character. This model was replicated across the country, as government pulled its funding from religious healthcare organisations, particularly as it faced escalating debt and challenges to its rule, both from within the country and in the form of international sanctions.
Healthcare on the ethos of the early Catholic hospitals
South African Catholic-inspired hospitals are thus, to this day, a part of the inherently unequal system of public and private healthcare provision. In both dilapidated and prestigious centres you will still find statues, chapels and even members of religious orders traipsing the corridors, praying for and treating the sick. Although Catholic healthcare no longer has a coordinated, defined clerical mandate, its ethos is infused in these institutions and the healthcare providers who work in them.
The South African healthcare system is currently in another period of transition; on the verge of creating legislation, which would enable the creation of a more equitable, unified healthcare sector under the National Health Insurance. There are powerful, vested interests against the delivery of equitable healthcare to realise the highest attainable level of health for all citizens of South Africa.
Although in the current biomedical era, our conversations around health and healthcare have been cloaked in medical jargon and secular sterility, it is an enlightening exercise to reflect on the individuals whose missionary activity formed the historical heart of South African healthcare. Perhaps we could draw inspiration from their motivations, as we move toward a more equitable healthcare system, and a more just country.Republish