Thabo Bester case: How Dr Nandipha betrayed the notion of a ‘good doctor’
Healthcare professionals in South Africa, particularly doctors, are revered for their capabilities to heal the sick based on their knowledge and skills.
Trust is central to the relationship that doctors have with the public based on a presumption that good doctors serve with dedication and ply their trade selflessly, with honour and dignity. As such, the brazen escape of Thabo Bester, a convicted prisoner in the company of his girlfriend, Dr Nandipha Magudumana, left many bewildered.
Caught in Tanzania, on their return to South Africa, trust was once again a talking point as Police Minister Bheki Cele referred to Magudumana as “a good doctor” and “an honourable doctor” while briefing news agencies.
Much loved by her friends and clients as gathered from trending topics on social media, Magudumana, a Wits MBBCh (medical) graduate and a practitioner in aesthetic medicine, had earned the respect of her colleagues and members of the public.
In 2018, aged 29, Magudumana was one of the Mail & Guardian 200 Young South Africans. As the founder of Optimum Medical Solutions, a Sandton-based skincare and aesthetics clinic that specialises in non-surgical treatments, Magudumana met the 200 Young South Africans criteria as an innovator and disrupter trusted with creating a sustainable future for South Africa.
As provided in the infographic compiled by Khaya FM, a Gauteng-based radio station, Magudumana nee’ Sekeleni was profiled in her personal capacity as the doctor (the self) who is a Wits graduate (institution) and a practitioner (the profession) who provides health care to the public.
In terms of South Africa’s legislation, all healthcare providers are required to keep an active registration with the Health Professions Council of South Africa (HPCSA) and pay the prescribed fee annually. That Magudumana had fallen behind and did not pay the required fees for two years confused many — some even suggesting she was no longer a doctor. While on suspension, legally she was not expected to continue practising as an aesthetician. Continuing to practise violated not only the trust but also the contract that is central in the relationship between doctors and the public.
This trust flows from the modified Hippocratic Oath and related versions of it as health sciences students are required to pledge to serve humanity, those they care for and learn from, uphold their human rights, practice with dignity, and respect the confidentiality and privacy of past and current patients and clients. This requirement is extended to include the deceased. Healthcare professionals can never devolve themselves from the three intersecting identities — self, profession, and the public.
It is with these expectations that the public and the police minister continue to struggle in making this shift from “a good doctor”. Appearing in court for the first time charged with aiding and abetting the escape of Bester, Magudumana remained “an honourable doctor” and, as she was permitted to keep her mask, she continued to preserve her three identities.
In maintaining this tricky balance between the self, the profession and the public, all doctors are bound by a duty of care. This duty of care, according to the HPCSA, operates in the personal space, the professional space, and the political space extending ethical and legal obligations or a combination of both ethical and legal obligations to healthcare professionals.
For example, although Aaron Motsoaledi is the political principal at the department of home affairs, he is still a doctor. Thus, he should be concerned about the plight of stateless persons. In the Bester case, a number of women were harmed and some continue to relate tales of narrow escapes as Bester has as many as 13 aliases. Although one can argue that Motsoaledi is not at fault as he headed a different portfolio in the period leading to Bester’s sentencing, in the current context, he has a duty to ensure that all those who reside in South Africa are documented to ensure the safety of all citizens.
Ethical duties as alluded to earlier are governed by four principles. Autonomy, as the first principle, ensures that individuals who are competent and capable can self-govern. A patient (client) who wishes to present for one of the non-surgical treatments offered by Magudumana in her rooms, may do so with the patient’s permission (consent) on condition that the “good doctor” is registered with HPCSA and has established that the treatment will extend benefit (second principle) to the patient (client).
In South Africa, we have many examples of good doctors who extend themselves beyond the call of duty and have earned the trust of the public.
Addressing returning physiotherapy students at the University of Cape Town about the duty to serve, Dr Imtian Sooliman, the founder of the Gift of the Givers fits the profile of a “good doctor” as he prioritises humanity over his personal interests balancing the three identities — the self, the profession and the public.
Yet, we know of instances where trust has been violated as was the case with patients living with mental health conditions in the Life Esidimeni tragedy defying the third principle — first do no harm. Such incidents require members of the public to hold the HPCSA accountable as a gate keeper and an institution that is tasked with the responsibility to ensure that healthcare professionals meet the prescribed standards of care.
Equally, members of the public have a corresponding responsibility to hold their healthcare professionals accountable by checking the HPCSA website annually concerning the validity of their registration (closing date is 30 April). In instances where they have experienced or witnessed substandard care, members of the public have a right to lodge a complaint and can access finalised judgements. However, one should exercise caution, because doctors are humans and should not have their freedoms curtailed if patient care meets the HPCSA standard.
The fourth principle — justice, is premised on fairness in the healthcare professionals dealings with patients, colleagues, and members of the public.
Based on this principle, a reasonable standard is an expectation that a “good doctor” will uphold the trust that is bestowed on them by opting out of prioritising personal interests over the best interests of the public as was the case with funds allocated for personal protective equipment.
A “good doctor” must extend respect to colleagues who may be compromised if one of their own is not accountable to the profession. In that regard, the notion of a “good doctor” is possible and not a far-fetched concept provided healthcare professionals honour the self, the profession (institutions) and the public.
Dr Nontsikelelo O Mapukata is a senior lecturer at the division of public health medicine, school of public health, University of Cape Town.
The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian