Welcome to South Africa, where two worlds meet

By Hester C. Klopper, PhD, MBA, RN, RM, FANSA, FAAN, past president of the Honor Society of Nursing, Sigma Theta Tau International

Hester Klopper

Welcome to the land of Nelson R. Mandela (no introduction needed), Desmond Tutu (Nobel Peace Prize winner), Mark Shuttleworth (first citizen to travel to space as a tourist), Zakes Mda (novelist, poet, and play writer), Rolene Strauss (Miss World 2015), and Elon Reeve Musk (founder of SpaceX and Tesla Motors), to name but a few eminent South Africans who have made an impact globally. It is indeed an honor for South African nurses to host the 27th International Nursing Research Congress (INRC), the first one held on the continent of Africa and a dream come true. Of more significance is that the conference is taking place during Mandela Week, when we observe and celebrate, on 18 July, the birthday of Nelson Mandela. During this week and on his birthday, South Africans will give time to service—assisting older persons, for example—to honor his legacy.

Some facts

Every country in the world has some diversity, but South Africa is characterized by diversity. In fact, stretching as it does from the southernmost tip of the continent at Cape Agulhas to its far northern border, the Limpopo River, it most probably takes the winning cup. South Africa is 1,233,404 square kilometers in size and is edged on three sides by nearly 3,000 kilometers of coastline. In the north, the country is bordered by Botswana, Mozambique, Namibia, and Zimbabwe. South Africa also encloses two independent countries, the kingdoms of Lesotho and Swaziland.

Let me share some more quick facts about my country. We have a population of about 54 million people of different origins and cultures who speak 11 official languages. Of these, 79.2 percent are African, 8.9 percent “colored” (a term used in South Africa to describe people of mixed race), 8.9 percent white, and 2.5 percent Indian. The median age is 25.9 years, and 51 percent of the population is female.

As of 2015, life expectancy at birth is estimated at 60.6 years for males and 64.3 years for females. The 2015 infant mortality rate was around 34.4 per 1,000 live births. The estimated overall HIV prevalence rate is approximately 11.2 percent of the total South African population. The total number of people living with HIV was estimated in 2015 at 6.9 million, with just over 50 percent of them on antiretroviral treatment provided by the state. In the last quarter of 2015, the unemployment rate was alarmingly high, at 26.4 percent, and the latest economic downturn and unstable political scene have not helped the situation.

South Africa is, indeed, a country of extremes. The meeting of two oceans—the Indian Ocean to the east and the Atlantic Ocean to the west—almost symbolizes these dichotomies. Scientists disagree about the true meeting point of the Indian and Atlantic oceans. If there is such a thing as the meeting of these two oceans, the boundary lies somewhere between Cape Agulhas, which is the southernmost tip of Africa, and Cape Point. (We were fortunate to visit Cape Point on Saturday, 16 July, with Beth Tigges, PhD, RN, PNP, BC, president-elect of the Honor Society of Nursing, Sigma Theta Tau International, and her family.) Let me share information about two specific South African extremes that may interest you.

Hester and Willem Klopper at the Cape of Good Hope.

Cape Point.

Rich and poor

Of the 3,005 ultra-high net worth (UHNW) individuals who live in Africa, South Africa is home to 835 of them. These business tycoons have built their financial worth through retail, luxury goods, mining, financial services, insurance, and media. On the other hand, 12 million South Africans live in extreme poverty—less than $1.25 per day. According to a 2015 World Bank Report, approximately 3.6 million people have been lifted out of poverty in South Africa, cutting in half the number of South Africans who live on less than $1.25 a day. Thanks to social grants, free basic services, and taxes that favor the poor, the poverty rate has dropped from 46.2 percent to 39 percent, but we still have a long way to go.

In Cape Town, specifically, the contrast between these rich and poor extremes is evident. On the high end are places such as Clifton, Lundudno, Constantia, and Bichopscourt and, on the low end of the financial spectrum, Kayalitsha, Nyanga, and Cape Flats. Nelson Mandela stated: “Overcoming poverty is not a task of charity, it is an act of justice. Like slavery and apartheid, poverty is not natural. It is man-made, and it can be overcome and eradicated by the actions of human beings. Sometimes, it falls on a generation to be great. You can be that great generation. Let your greatness blossom.”

Public and private healthcare

South African healthcare consists of a large public sector, a smaller private sector, and an NGO sector. The government funds the public health sector, and 40 percent of all expenditure on health comes from the National Treasury. Public health consumes around 11 percent of the government’s total budget, and these expenses are allocated mostly to nine provincial departments. Of note, this figure is higher than the 5 percent of gross domestic product (GDP) recommended by the World Health Organization (WHO). However, despite this spending, health outcomes are poor. This is linked to inaccessibility of services, as the public sector provides services to 80 percent of the population. There are 4,200 public health facilities in South Africa, with each clinic providing service, on average, to 13,718 persons. The WHO guideline is 10,000 persons per clinic.

Annual spending by South Africa’s private healthcare sector is estimated to be approximately 120.8 billion rand (R). It covers approximately 16.2 percent of the population, mainly those who have medical coverage. South Africa has more than 110 registered medical-insurance schemes with around 3.4 million principal members and 7.8 million beneficiaries. There are 238 private hospitals in the country—188 of which are in urban areas and 50 in rural—that provide good healthcare access for those who can afford private care. Specific services related to HIV, AIDS, and TB are offered by several NGOs and account for expenditure of approximately R5.3 billion of donor money annually. For the past few years, the Department of Health has been working toward adoption of national health insurance with the intent to fully implement it by 2019. This will allow access to basic services for all citizens.

Celebrating the legacy of Nelson Mandela

As members of the Honor Society of Nursing, Sigma Theta Tau International gather here in Cape Town, South Africa for the INRC—co-hosted by FUNDISA and the Nursing Education Association—I invite you to share in the amazing generous spirit of Madiba, which is how we fondly refer to Nelson Mandela. Please take some time to visit the prison cell of prisoner 46664 on Robin Island (a boat ride from the Waterfront). The person occupying that cell became the first president of the New Democratic Republic of South Africa and, ultimately, a loved and admired world icon. 

So, as the sun sets over Table Mountain on this first day of the 27th International Nursing Research Congress, take a moment and think about your own service and legacy, and as Nelson Mandela espressed it, “May your choices reflect your hopes, not your fears.” Enjoy our South African hospitality and the INRC conference, and may you leave with fond memories!

Fond memories!

Welcome reception

Congress attendees watch African dancers during Welcome Reception.

Attendees join African dancers during reception.

Drummers set the beat for dancers.

Taking pictures and networking were popular activities.