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28 January 2022 | Story Prof Sethulego Matebesi | Photo Sonia Small (Kaleidoscope Studios)
Prof Sethulego Matebesi
Prof Sethulego Matebesi.

Opinion article by Prof Sethulego Matebesi, Academic Head of Department, Associate Professor: Sociology, University of the Free State .


In Teams of Rivals, author Doris Goodwin notes how former American president Abraham Lincoln created value by surrounding himself with people who have the capacity and the tenacity to challenge him. Despite many of the challenges he faced throughout his presidency, he managed to build a common cause with his cabinet to foster the interests of Americans. In a completely different text, Crisis of Conscience: Whistleblowing in an Age of Fraud, Tom Mueller laments how people fail to act out of apathy, complicity, or fear. 


These two distinct texts raise the question of how leadership should react to criticism and the requisite degree of freedom of speech that public representatives should have. 


Similarly, the back-and-forth saga between Tourism Minister Lindiwe Sisulu and President Cyril Ramaphosa over whether she apologised for her opinion piece that criticised black judges, effectively drills home a longstanding historical lesson. This lesson is that political astuteness is a phenomenon as old as the history of politics itself.

Although the astuteness shown by Sisulu against critics from her political party may be puzzling, her public exchanges that a statement by President Cyril Ramaphosa was a ‘misrepresentation’ of their meeting are more puzzling. 
But why is this puzzling? What are we to do about what some call a show of unprecedented defiance and others assertiveness? We also need to ask whether Sisulu’s stance can be adequately explained by those who label her as being arrogant and who deserve to be fired by President Ramaphosa.

A political travesty to apologise on behalf of Sisulu

Public apologies are a common occurrence globally. They often come by way of assuming guilt, expressing remorse, and admitting responsibility. Thus, proper apology etiquette requires the ‘wrongdoer’ to deliver the apology. However, this was not the case with Minister Sisulu.

Sisulu acted in a very public way with her opinion piece and her response to the ‘apology in her name’ released by the presidency. Certainly, with her experience as a public figure, she was aware of the implications of her actions.

Furthermore, she was consistent with her narrative against criticism directed towards her. Yet, we do not know why the presidency saw the need to apologise on behalf of Sisulu. Perhaps it had unreasonable expectations that Sisulu would publicly accept what she disagreed with privately.

Notwithstanding the sincerity of the presidency in dealing with this matter, supporters of President Ramaphosa will, on the one hand, be disillusioned by this own goal. At the same time, those who support Minister Sisulu may be encouraged by her steadfast refusal to accept a coerced apology used as a shaming mechanism. She inadvertently represents a dynamic articulation of an alternative repertoire of contention within the ANC.

Lately, we have witnessed a surge of nationalism globally during the COVID-19 pandemic. The Economist referred to the narrative battle between China and the United States over the pandemic as a ‘new scold war’, threatening to tear the world apart. But, as this Sino-US relationship reminds us, what is at stake is less the tit-for-tat scold war between Sisulu and Ramaphosa that threatens to spiral out of control, than the subdued attempts to attain constituent support within the ANC.

Sisulu herself has never publicly indicated her availability to contest the presidency of the ANC at its next elective conference. By any measure, if she does have such aspirations, stepping forward and engaging politically is one thing, but open defiance of authority is another. Since there are no permanently privileged constituencies in political malaise created by regeneration projects such as the organisational renewal drive of the ANC, the struggle to articulate and establish the interests of those who are aggrieved within the party is an ongoing process.

But where does this leave President Ramaphosa?

Many commentators have noted that his long game is no longer effective. However, President Ramaphosa wants to upend the notion that robust debates within the structures of the ANC are not tolerated. He is wary of the propensity of ANC structures to support those who are victimised. And while the scold war is in full swing, others will join in trying to win the hearts and minds of ANC members.

Meanwhile, when failure to act decisively in the face of predictable situations facing the country, particularly during a crisis; we can then no longer talk about protecting the interests of South Africans.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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