Big hospital, big boss – Bara ICU’s Professor Rudo Mathivha retires

In July, Rudo Mathivha handed in her notice at Chris Hani Baragwanath Academic Hospital, ending a rightly celebrated 25-year stint as head of the intensive care unit. It was after a truly terrible year. Her story underscores the extent to which quality healthcare for the country’s most vulnerable people remains at the mercy of the indifferent and the corrupt.

Big hospital, big boss – Bara ICU’s Professor Rudo Mathivha retires

Chris Hani Baragwanath Academic Hospital, like so many public hospitals in South Africa, feels conspicuously old-fashioned. For me, it’s the walkways between buildings, covered with decades-old zinc, radiating heat. Even the trees bordering the parking lots look wizened, their roots one with the pavements.

But Baragwanath isn’t like any other hospital in the country.

“Unique in its size [well over 3,000 beds]… unique in the variety and quantity of medical conditions seen… unique in its blend of so-called first- and third-world medicine… unique in its witnessing of the transition of a population from a rural to an urban existence,” wrote Ken Huddle and Asher Dubb in their 1994 book, Baragwanath Hospital, 50 Years: A Medical Miscellany.

Their characterisation holds broadly true. Walking under a vast deodorant advertisement on the face of the main building, I wonder what aspects of life in this behemoth Rudo Mathivha, who had headed the intensive care unit (ICU) for 25 years, will focus on in our interview. I had been told to expect someone who’s outspoken, but there was nothing in our six months of sporadic WhatsApp messages that was suggestive of character traits or concerns.

I was finally in Bara, entering the Friends at Bara building, a block of offices facing Chris Hani Road, next to the main hospital building.

So too, to my relief, was Mathivha.

She opens the door to the office I knock at and looks up at me from a height of 5’2”.

“Come in, come in,” she says. A smiling woman behind a nearby desk waves. “That’s Dr Jacqui Brown, deputy director of the ICU unit,” Mathivha says. “We’ve worked together since, oh, forever.”

The walls are nursery blue, except for a section papered with a tropical island scene behind a circle of armchairs.

“We chose it to cheer the place up,” says Mathivha. “When work is too much, I sit here with a cup of coffee and imagine myself on a beach in Jamaica, sipping a cocktail.”

A suffocating year

“Could you tell me a bit about the year that was?” I ask to start our conversation, and I’m surprised by the depth of her answering sigh, which suggests it’s not a harmless question.

“Our year started with sabotage of our oxygen supply. Someone entered the control room, which is accessible only with an electronic key, and cut the pipe to the ICU. It was…” she pauses for a long moment to find the right words, “… nerve wracking. And anxiety provoking, and just a level of stress that I’ve never experienced before.”

The sabotage had taken place just before Christmas 2022, when she and her colleagues had two dozen patients on mechanical ventilation.

“The worst thing was knowing it was deliberate, that there was a would-be mass murderer on the loose,” says Mathivha, who at the time was grieving the recent loss of one of her brothers.

In May 2023, the first of several death threats appeared on her phone. As to what provoked these, Mathivha remains in the dark.

“There are a number of possible explanations,” she says, and lists them: She had joined a case against the state with regard to load shedding “and the effect it has on patients that rely on medications or medical devices that require electricity at home”. She was also part of a tribunal that reviewed the health ombudsman’s report into the circumstances surrounding the death of Shonisani Letholie, a patient at Tembisa Tertiary Hospital, and she had been very vocal when there was no food for patients in Baragwanath and several other health facilities in Gauteng.

Whatever the reasons, for much of June and July Mathivha went about “chronically vigilant and wearing protective clothing”.

Then, in August, her nephew, Mukona, died of diabetes while she was at the World Intensive and Critical Care Congress in Istanbul. “He was a son to me; I brought him up from infancy until the age of 29,” she says, and after another substantial pause, “I can’t describe how I felt when I came home. It wasn’t just the devastation of losing someone; it was also the devastation of returning to the same fights I have been waging since 1998, when I became head of the ICU here, for equipment, for medication, for staff – everything you need in order to save lives.”

‘How can I keep quiet?’

Brown offers to make tea, and brings Mathivha’s in a mug that says “Like a Boss”.

“I feel we’ve done enough to transform the ICU environment at Bara that it won’t collapse in my absence,” she says, holding the mug in front of her mouth with both hands.

Of this there can be little doubt. In a preparatory conversation, Mathivha’s longtime colleague, Shahed Omar, praised her “relentlessness in growing the ICU to serve the hospital whilst maintaining the best international standards, and expecting the best out of all her staff”.

“There are people who seem not to care,” Mathivha says, “but they’re in our central office, not on the ground. The people on the ground in this hospital are very committed”, and I’m reminded of Simonne Horwitz’s Baragwanath Hospital, Soweto: A History of Medical Care 1941-1990, in which the author describes the famous “Bara ethos”, a phenomenon “which seems to have centred on a dedication to the hospital, and unfailing belief in the importance of the medicine practised there and the ability of the Baragwanath staff to cope with and even thrive on the difficult work and huge patient load”.

Yet, ultimately for Mathivha (and doubtless many others), working at Bara has become too much to endure. Five days after “stepping off the treadmill”, she was diagnosed with Covid-19 and pneumonia, and spent much of November lying on the couch, “bingeing on Netflix shows”.

“I’m feeling more myself now,” she says, and explains that she will in fact be back at Bara this month, for another two years: “Not as head of department, and not on the treadmill, but on a sessional basis, to teach fellows and to provide handover support. I still want to contribute to critical care medicine.”

The collapse of her health was perhaps inevitable. Mathivha freely admits that she’s made her professional life harder than it needed to be.

“I find it difficult to keep quiet when things are going wrong, and I tell my colleagues to speak up, too. But it’s a little self-defeating, because when you speak up, others feel they don’t have to,” she says, and shoots Brown a confederate look before adding: “We tell ourselves, ‘Next time we’re gonna keep quiet’, but it never happens, because if patients don’t have anything to eat, what is it that we’re doing here? One of the basic blocks of treating patients is that they must be well nourished. If there’s no food [for them], it doesn’t matter how many medications you pour into them [patients]; nothing is going to work.”

Her siblings, all outspoken to a degree, Mathivha says, often encourage her “to keep quiet and observe”, she chuckles, shrugging her shoulders.

“How can I, when there’s a shortage of adrenaline in the hospital, and patients will surely die if something isn’t done? Keep quiet, and you’re culpable. No, no, no, I cannot do that,” she says, the last part as much to herself as to me.

A fighting spirit

The more Mathivha talks, the fewer signs of uncertainty and fatigue I see. Omar had praised her “ability to think without thinking”, a reference to Malcolm Gladwell’s Blink: The Power of Thinking Without Thinking, which attempts to anatomise the ability some have to “work rapidly and automatically from very little information”.

“Once a path is chosen, she has the patience and tenacity to see anything through,” Omar had said, and when I mention this to Mathivha she chuckles. “If this is in fact an ability I possess, the roots lie in a dusty little place called Sibasa [a few kilometres outside Thohoyandou in Limpopo], the last stop of the railway buses that came from Johannesburg,” she says, and rewinds the years.

“I was the middle child of seven, preceded by three boys, and followed by three girls. I weighed barely a kilogram when I was born, preterm, and I was too weak to latch onto my mother’s breast,” says Mathivha, who went nameless for the first three months of her life because her parents did not think she would survive.

“I guess in time they saw the fighting spirit in me, because my father sent a telegram to his sister in Masvingo, Zimbabwe, to say, ‘we have a child, would you please give her a name’. And then they asked my maternal grandmother to do the same, and my father’s family also gave me a name.”

The name suggested from Zimbabwe was Rudo. Her maternal grandmother gave the Venda name Lufuno, and her father’s family the Hebrew name, Ahava. All mean “love”.

Mathivha clocks my surprise at the last part.

“I am a member of the Lemba community, we are descendants of the Yemenite Hebrews,” she explains.

This identity had a major bearing on her early years. Her father owned a plot on the outskirts of Sibasa, adjacent to a handful of other Lemba families, most of them relatives. Together, they formed a self-contained world.

“We weren’t allowed to visit anybody’s house, we could only play with the children of other Lemba families, and we could only eat food from their homes, because of the dietary restrictions of our Jewish faith. Fortunately, families in those days were pretty big, so it did not feel limiting,” says Mathivha, who grew up “climbing trees and hunting birds with my brothers”, and eating food that the families had grown themselves.

Her father was a teacher and school principal, and when she was five years old he was hired to lecture at the University of the North, now the University of Limpopo. The family left Sibasa and went to live in Turfloop, the university village.

“From speaking only Tshivenda in Sibasa, I now had to learn to speak Sepedi in order to understand my teachers, as well as Afrikaans and English. In Turfloop there were kids speaking Setswana, Xitsonga, Isizulu, Ndebele and Siswati, and we mixed with them,” says Mathivha, who discovered a knack for picking up languages.

“Ek kan baie mooi Afrikaans praat,” she says, grinning.

The drive to help others

As before, family life had a decidedly communitarian bent.

“I grew up thinking I had more brothers than I actually do, and the penny only dropped when these boys who lived with us graduated, and their mothers came to the ceremony. I asked my father, ‘how many wives do you have?’, and he was like, ‘Why?’, and I’m like, ‘because Matsocha’s mum is here, Tshiila’s mommy’s here, but they’re my brothers’. That evening, he sat me down and told me about our extended family, how Tshiila’s father was his older brother, and Matsocha’s father was his father’s brother’s grandson. There were others who were not even blood relations but my parents treated them all like their own children, and I guess you could say that I grew up thinking that everybody in the world is related to me,” Mathivha says, ascribing a lifelong desire to help those in need to exactly this.

Her drive to help people with their healthcare goes back to a specific day when she was eight years old, though.

“My father fell ill and asked me to accompany him to see our family physician in Polokwane, then called Pietersburg. The doctor said to my father, ‘You’ve got the flu, and the beginnings of pneumonia’, and gave Dad an injection of some milky white substance, which was in a large syringe.”

Mathivha watched all of this from a chair on the other side of the surgery, her father partly obscured by a dividing curtain. A few minutes after the injection, she heard her father coughing violently, and witnessed his body slumping as the doctor pulled back the curtain and called for help.

“My immediate thought was, ‘My father is dead.’ The doctor said, ‘He’s just having a reaction.’ Another doctor came running in, and they both worked on my dad and he recovered,” says Mathivha, who later figured that an injection of penicillin had triggered life-threatening anaphylaxis, which had been halted by adrenaline and steroids.

“As we were driving home, I knew that I did not want to ever feel such helplessness again, and vowed to learn about medicines, just to know what my father is sensitive to. It was the start of something.”

Intensive care

Mathivha excelled at school and jumped Grade 8, making her one of the youngest in her class. The absence of mathematics and science teachers at the newly opened Turfloop Hwiti High School meant that her final years of school were challenging, but Mathivha “worked out of Damelin booklets [a distance-learning institution back then], and passed”.

Without asking, her father enrolled her for a bachelor of science degree at the University of the North.

But unbeknown to him, Mathivha had already applied for – and been offered a place in – the medicine programme at what was then the University of Natal.

“He wondered if I would manage, but I was adamant, and so I ended up at what was actually called University of Natal Black Section, because the faculty of health sciences was mainly for people of colour, and then the rest of the university was for white students,” says Mathivha, who studied with zeal, passed her exams and continued on to an internship at McCord Hospital in Durban. Her decision to apply to be a medical officer in the paediatrics department there was met with derision by one female specialist.

“She said to me, ‘Most Black people become general practitioners after they finish their internship’, as if we don’t have the aptitude to progress. I was deeply offended,” recalls Mathivha.

But it didn’t stop her applying for and receiving the post. Later, she was awarded the department’s registrar post, which she worked at for six months before transferring to the University of the Witwatersrand (Wits) to finish her specialisation at Baragwanath.

She says her registrarship “messed” with her mind, “because of the prejudice of seniors in the department of paediatrics, directed mainly at Black registrars”.

“If you did something very well, they would never tell you, but if you made a mistake you were the topic of discussion in the tea room,” says Mathivha, recalling how she repeatedly called her father to say that she couldn’t go on.

“He said, ‘You will, and you will make it’, and so I struggled through that department.” She ultimately qualified as a paediatrician, but not before leaving to take a post at Bara’s ICU.

The catalyst for her departure was her mother’s death from breast cancer, and the subsequent humming and hawing of specialists in the department when she asked for leave to attend the funeral. Mathivha recalls how her seniors “prattled on and on, until I lost patience, filled out a leave form, and left to bury her mother”.

When she returned, she approached Professor Jeff Lipman in the ICU, and asked for a medical officer post. “He instantly typed an offer letter, and that’s how I put a toxic department behind me and became an intensivist,” she says, adding, “Jeff is white, and male, and he could not have been more supportive”.

In time, Lipman offered Mathivha a specialist post and found her a fellowship at Duke University Medical Center in North Carolina in the US, telling her that “now you need to learn how to train others to be intensive care specialists”. In the final months of her fellowship, Lipman called from Brisbane, Australia, to say that he had been headhunted, and his post [at Baragwanath] had been advertised.

He convinced her to apply, and she prepared for the interview, which was telephonic, using The Complete Idiot’s Guide to the Perfect Job Interview. Two weeks later she received a fax (“Yes, a fax!” she exclaims) confirming her appointment as the head of intensive care.

‘I can be a bit over the top’

Mathivha started work in July 1998, and was happy to find that Jacqui Brown, who had been a medical officer alongside her, was now a specialist in the department.

“Together we set our minds to modernising the ICU, both from an equipment and a teaching programme point of view, and that meant getting rid of dead wood,” she says, in her words, meaning “specialists who had an attitude towards being led by women”.

Mathivha has since had a hand in training 48 intensive care specialists, one of whom is Kuban Naidoo, who admitted, when I spoke to him, to finding Mathivha “a little surprising”.

“I was surprised that someone as respected in her field as Prof [Mathivha] would always have time for discussion, and would always be willing to hear new ideas. She’d reverse a decision based on good input, and I think that’s the hallmark of a good leader,” Naidoo says, adding that Mathivha has helped to both transform and develop critical care services at the hospital, and beyond.

“In her time, the ICU has been female led, and there are slightly more women than men working in the department, so that’s transformative. But this is not to be confused with the development in critical care services that she’s presided over, and by this I mean the increase in staffing she’s managed to achieve, and the educational outreach initiatives she’s set up, which have helped to expand critical care services beyond the metros.”

Mathivha was forced to contend with external power plays, too, including a decision by the faculty of health sciences at Wits to give control of the financial accounts of the ICU to the head of anaesthesia, a white man.

“You don’t need to be a professor in postcolonial theory to clock the hidden messages in that one,” she says.

In response, she and Brown enrolled for a diploma in business administration through Damelin. “Guess what happened while we were studying for that? Well, the money goes missing, while the signing powers are with a white male. I kicked up such a fuss, threatened to go public, and the signing powers were returned to us,” says Mathivha, cough-laughing into her mug and then dropping one corner of her mouth the way one does when faintly perturbed by one’s own energy.

“I can be a bit over the top,” she admits.

A drumbeat like a heartbeat

Before the interview, I’d wondered where the head of an ICU in the continent’s biggest hospital might find solace. A friend, who knows Mathivha, tipped me off: “Music, definitely music.” When I ask her about this, she beams.

“I do love music,” she says. On a typical Sunday morning at Mathivha’s home – her “sacred space” – the volume button of her stereo “will be at the topmost setting”, as she walks through the house “without anybody disturbing, singing along, especially if it’s a Bob Marley track”.

She loves reggae for the messages contained in the lyrics, and she loves traditional music for its more ineffable qualities. “There’s a steady drumbeat that you don’t find in any other music. It’s that… bhuhm,” she says, hitting her chest with a closed fist. “Bhuhm, and you feel like it’s sitting you down on the ground. There’s a song by Sibongile Khumalo called Mayihlome, and she’s singing about HIV, but it’s the way the instruments are played that takes you somewhere else, another realm, and the drumbeat is egging you on, to fight, to fight, to fight for these people in Africa, to fight the scourge.”

Our time is up, and Mathivha shows me to the door. Dr Brown is at her desk, a study in gentle blues.

The passageway is dark and musty, the rest of the building a time warp save for some splashes of colour I hadn’t previously noticed: A Venetian scene papered on the boardroom wall, a Mediterranean vista in the reception office. A phoenix sits atop Baragwanath’s coat of arms, and I exit wondering if small touches like these might cause it to stir.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.