Ubuntu: The concept in a multicultural medical setting

By Rudzani Muloiwa


Almost a year ago a friend of mine, a fifth year medical student at the time, told me of an incident that had happened to her.


A few days before her medicine block assessments she rushed to the ward in search of a "chest." She wanted to fine-tune her clinical skills before the assessments. She arrived in the ward and started flipping over the charts on the foot of each bed, until she came across a "good chest." As every medical student knows, a "good chest" means a very sick chest, where the pathology is readily detectable. As it happened, this chest belonged to a patient who was very ill, suffering from tuberculosis.


Since my friend was not very familiar with the language of the patient, she called to a colleague on the other side of the ward who was also frantically attempting to familiarise herself with one pathology or another before assessments.


"Would you please tell this woman I would like to listen to her chest?"


The friend shouted back at the patient.


But as my friend turned to "the chest," she realised the patient was saying something to her, motioning with her hand to the side table, where a few foodstuffs brought by her relatives were lying. My friend again appealed to her colleague, for interpretation of this unfamiliar situation.


"She wants you to have some of her food," the friend replied.


My friend was stunned.


The patient was wasted. It was obvious she needed the food more. And where she came from, food was hard to come by. But she was offering some of her food to my friend, who couldn't care less about her as a person.


My friend went home and cried. She was confronted with far more than she had bargained for. She went to the ward to look for a chest, and she found a whole person, with feelings. A person who showed her what we in Africa call Ubuntu. My friend was forced to confront herself, and review her attitude.


Maybe my friend is a bad person, I don't know. Maybe she is not. Maybe she is just a prototype product of the educational system in which she finds herself.


Most medical students would be able to relate to this experience. It is an all too familiar story. A story devoid of Ubuntu, on our part as medical students.


Ubuntu. The very word is almost impossible to translate into English. All African languages that I am familiar with have direct equivalents of this word. In my language, Venda, we call it "Vhuthu." It means love, kindness, selflessness, mercy, grace, respect, asserting other people's dignity - to mention only a few of its possible meanings. It is hard to think of a positive personal attribute, which this word does not cover. In fact, it is only by demonstrating Ubuntu that one qualifies to be Umuntu, a person, in the holistic sense of the word. The Zulus say, "Umuntu umuntu ngabantu," which means, "a person is a person because of other people." Only when I affirm your humanity do I fully confirm mine.


In the setting of South African health care, where people from all sorts of different backgrounds and all walks of life come together, where the first and third world come together, where Africa, Asia and Europe come together (either as colleague care-givers or as care-givers and patients), Ubuntu means acknowledging humanity in the context of a foreign and often strange culture and religion. It means acceptance of that which we do not fully understand, and an attempt thereafter to understand. Ubuntu refuses to view people as fragments of themselves. Rather, it views people as whole persons, with feelings and fears. Ubuntu looks further than the chest.


Ubuntu is close to the Greek word "agape," which means love by choice, rather than love by accident. It means choosing to love that which we find difficult to love. Ubuntu finds its ultimate meaning in loving the unlovable: an enemy, who is shown kindness, love and respect which he or she did not deserve. Time and again we come across people of unlikable worldviews and characters. Patients who drive us mad. Patients who refuse for some "stupid" reason derived from a "superstitious myth" of their culture to comply with advice and treatment that are "obviously good for them." Colleagues that live out of a worldview that we find difficult to accept. Only in accepting and respecting all of these as people, showing them dignity and care, only in taking time to allay the "unreasonable" fears and concerns of our "ignorant" patients - then, and only then, have we finally brought the meaning of Ubuntu home.


Any attempt to "rehumanise medicine" will only be a silly joke if it is not done in the context of Ubuntu. All envisaged changes in the training of health care professionals should keep this in mind. My alma mater has a proud history of producing high quality clinicians and scientists. The conscious pursuit of instilling Ubuntu in the coming generation of doctors should in no way compromise the high standards set in the past. Rather, it should add to what we already have. With Ubuntu, we can go so much further.


"Re-humanising medicine" is impossible without a change in attitude, in both students and teachers. This year I had an opportunity to work with a team of really great people. In spite of my relatively miasmic knowledge, and my insignificant experience of Medicine, they made me feel like a person. I mattered. The longer I stayed with this team, the less important the end-of-block assessments felt. Because of the Ubuntu that was shown to me, I became acutely aware of my inadequacies to care for the patient fully. I became worried about the years after my training, when I would be expected to love the patient through the knowledge I have acquired. The care I felt, I wanted to give to someone. I started staying longer for intakes than was expected of me. But I was not motivated by fear. The atmosphere was just permitting.


At our medical school, when you start a new block as a student, your colleagues, on hearing which consultant you will be working under, will either call you lucky or they will shake their heads and be sorry for you indeed ... with the latter predominating. I am not suggesting that the kind of care I experienced is absent among our teachers and units today - but in "re-humanising medicine" we can do with more of this kind of care.


Ubuntu is the pursuit of an ideal. It is the pursuit of the ultimate good of which a human spirit is capable. Difficult as it may be, this pursuit should never be abandoned.


Without Ubuntu, the world, and the hospital, is a cold place indeed.


Rudzani Muloiwa is a medical doctor who was doing his internship in Pietersburg, South Africa when this article was written.


The Big Picture Volume 1 Issue 1 Lent 99 p. 30





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