My Journey Through Medicine, Humanity, and the Reality of Reform

I write this not merely as a retired orthopaedic surgeon or an emergency medicine practitioner, but as a witness to history, to humanity, and to the silent fractures within systems that claim to heal. My life in medicine has never been confined to operation theatres or emergency rooms; it has been an ongoing dialogue between suffering and hope, between policy and people, and between what is promised and what is lived.

My journey began in places where the world rarely looked with honesty, in the Republic of Ciskei, one of the Bantustans of apartheid South Africa, where geography itself was weaponized to divide human beings. The capital, Bisho, functioned under authority, yet the real governance of life and death happened in hospitals like Cecilia Makiwane Hospital, named after Cecilia Makiwane, a woman whose courage had already challenged the architecture of racial injustice long before I walked those corridors. That hospital was not just a medical institution; it was a living contradiction where resilience stood shoulder to shoulder with neglect, and where doctors from across the world came searching for “experience,” while patients came searching for dignity.

In those wards, I learned that medicine is not simply the science of healing bones or stabilizing trauma, but the art of standing present when systems fail. I saw injuries that were not only physical but deeply social, wounds inflicted by poverty, inequality, and indifference. Those years did not just shape my medical career; they shaped my conscience.

It is perhaps because of those experiences that I find myself compelled to speak today about the National Health Insurance system in South Africa, which has been signed into law under the leadership of Cyril Ramaphosa. The idea of universal healthcare, of health for all, is noble and necessary, and I have always believed that no human being should be denied care because of economic limitations. However, what concerns me deeply is not the intent, but the implementation, and more importantly, the absence of readiness.

I have lived through systems that promise equality while quietly perpetuating imbalance, and I recognize the early signs of strain. The National Health Insurance, often compared to the National Health Service in the United Kingdom, carries within it both aspiration and warning. The NHS itself, once a global model of public healthcare, has in recent years witnessed protests by doctors over working conditions, salaries, and unsustainable workloads. When systems fail to listen to those who sustain them, they begin to fracture from within.

In South Africa, the concerns are not theoretical; they are immediate and visible. Infrastructure remains inconsistent, with hospitals and clinics struggling to meet even current demands, let alone an expanded patient base. Bed shortages are not statistics; they are lived realities for patients waiting in corridors. Recruitment of doctors, nurses, and paramedics is not just insufficient—it is urgent. A healthcare system cannot function on policy alone; it requires people, trained, motivated, and respected.

I have seen young doctors collapse under the weight of expectations that far exceed their support systems. I have known colleagues who have chosen silence over struggle, and tragically, some who have chosen to end their lives rather than continue in a system that demands everything but gives little in return. Burnout is not a fashionable term; it is a silent epidemic. It manifests as emotional exhaustion, as detachment from patients, and as a fading sense of purpose. During the COVID-19 pandemic, this crisis deepened, exposing the fragility of those we once called invincible—the frontline healthcare workers.

The writings of seasoned journalists like Chris Bateman have captured fragments of this reality, but living through it is an entirely different experience. Emergency rooms became theatres of relentless trauma, not just from disease but from violence, accidents, and systemic neglect. There were nights when the line between healer and human blurred, when exhaustion threatened judgment, and when the question was no longer how to save others, but how to preserve oneself.

What troubles me further is the persistence of subtle yet damaging divisions, where terms like “black hospitals” and “white hospitals” continue to echo in a nation that has officially moved beyond apartheid. Language reflects mindset, and mindset shapes policy. If we are to truly build a system of equity, we must first dismantle the invisible walls that still exist within our thinking.

Accountability, too, must be addressed with honesty. Leadership within healthcare cannot remain insulated from the realities of clinical work. Administrative hierarchies that do not engage with patient care cannot dictate the conditions under which care is delivered. There is a need to reassess not only salary structures but also responsibilities, ensuring that those who lead understand the weight of what they govern.

Yet, as I reflect on these challenges, I am reminded of moments that reaffirm my faith in humanity. I recall my visit to Jamshedpur in 1984, where I was received by Ratan Tata, a man whose humility left a lasting impression on me. In an environment of grandeur, it was not the opulence that stood out, but the sincerity of his concern, the way he held my hand and repeatedly asked if I was comfortable, the way he ensured even the smallest details of my stay were attended to. It was a lesson in leadership that transcended industries: that true greatness lies in care, not control.

My introduction to Chuni Goswami that evening was memorable, yet it was the quiet knock on my door later that night, when an elderly caretaker offered a simple act of service, that stayed with me. In that moment, I was reminded that dignity is not defined by position, but by intention.

Today, as I write, I do so not in opposition to reform, but in defense of realism. Healthcare cannot be built on compulsion; it must be constructed through collaboration. Doctors cannot be forced into systems that do not support them, just as patients cannot be expected to trust systems that do not serve them effectively. Reform must begin with listening, with investing in infrastructure, with valuing human resources, and with acknowledging the lived experiences of those on the frontlines.

My journey has also taken me beyond medicine into poetry and visual art, because I have always believed that healing is not confined to the body. Words have allowed me to process what medicine could not explain, and art has given me a language to express what science could not contain. In many ways, my life has been an attempt to bridge disciplines, to understand humanity not just as patients, but as stories.

If my voice today carries weight, it is not because of titles or positions, but because of years spent in spaces where truth could not be ignored. My nomination for the Padma Awards is not a personal milestone; it is a recognition of the countless unseen moments of service, of standing beside patients when systems failed, and of continuing to speak even when silence was easier.

Before I conclude, I leave you with a few lines that reflect the journey I continue to walk:

In crowded wards where silence screams,
I stitched together fractured dreams,
Not just with skill, but soul and sight,
To keep humanity in the light.

I do not claim to have all the answers, but I carry the responsibility of having seen enough to ask the right questions. And perhaps, in asking them, I continue to serve, not just as a doctor, but as a witness to what medicine, and humanity, can and must become.