In a report in 2021, the United Nations Secretary-General António Guterres highlighted the importance of a human rights-based approach in creating a new social contract, especially after the dramatic changes brought about by the COVID-19 pandemic.
"We urgently need a renewed social contract, anchored in a comprehensive approach to human rights, in the light of the pandemic and beyond, one that allows many more actors to tackle increasingly complex and interconnected problems," the report noted.
The importance of a human rights approach has also been highlighted as being critical for dealing with public health challenges, such as HIV and AIDS. A report entitled 'Human Rights and HIV/Aids,' presented at the 50th session of the UN Human Rights Council, highlighted that "fully respecting human rights are indispensable to ending AIDS as a public health threat by 2030."
Dr. Tlaleng Mofokeng is a vocal advocate of the need for a human rights-based approach to global health care. She is a medical doctor from South Africa and the UN special rapporteur on the right to health. Mofokeng describes her analysis of global health issues as being anti-colonial and intersectional.
"Racism can have a severe impact on the exercise of the right to the enjoyment of the highest attainable standard of physical and mental health, including the right to sexual and reproductive health. Racism may also lead to violations of other human rights, including civil, political, economic, social, cultural and environmental rights and can, in the worst cases, lead to the death of people belonging to marginalized population groups," Mofokeng noted in her July 2022 report to the UN General Assembly.
Here Mofokeng shares why she believes doctors can use their profession to defend human rights.
My name is Dr. Tlaleng Mofokeng and I am a medical doctor, the United Nations special rapporteur on the right to health, best-selling author, and sexual and reproductive health care provider. I grew up in Qwa-Qwa, a little town in the Free State, which was a Bantustan under apartheid.
Looking back on my upbringing, I think it was good, but there was also the trauma of what apartheid did to children. It’s something that I'm so fascinated by because a lot of my own memories are about that. I was introduced to political slogans, toyi-toying (protesting) in the streets, mobilising your street and your neighbourhood around issues. I was a child around 8, 9, and 10 experiencing that, and I think a lot of my activism — and my predisposition to always be an activist in whatever space I'm in — comes from growing up in that environment.
I've always been drawn to wanting to help people, because in a Bantustan, we had a lot of military presence and there were a lot of fights and clashes with the police. The police would bring in big armoured military vehicles to patrol and instill fear. One of the things I remember is just the state of being in fear, and a constant presence of a threat of violence.
And I think even when I talk about violence, whether it’s with my patients, but also even with the report I recently presented to the [United Nations] Human Rights Council in June, it is very personal to me. I wanted to highlight the absolute torture it is to live under constant threat of violence. Anticipating more violence itself is such a mental and physical torturous state to be in.
Recently a friend was commenting on the work I do saying, “You do abortions, you support sex work decriminalisation, adolescent health, sexual pleasure, and you are also a Catholic.” And I said, “Well, that's the truth as well. And that's not in conflict. There's no internal conflict with my work, my politics, and whatever my spiritual identity is.”
That was so important to me because during the school holidays, I spent a lot of time at the monastery where they had an old age home and a little hospital there as well. And it was, of course, managed and run by the nuns. I remember — now I'm talking about it as if this were a conscious decision, which I doubt it was — but you had to go and pray the rosary for hours or go count out pills. I chose to go cut and count pills for the old people and ended up having quite a lovely time bonding with them. And so, I've also always wanted to be a doctor. I never thought of any other career. I always knew there were other careers, I just never thought they were for me. I never saw myself as anything else.
Dr Tlaleng Mofokeng at her home in Johannesburg in August 2022.
In terms of my activism, looking back, I was always going to be a disruptive doctor. When I was younger, I didn’t have the language to articulate the questions I had about the world. When I got to medical school, a lot of what I was feeling started to make sense. I used to think I was too emotional or “too much” in my analysing and trying to understand certain things. In my first year in medical school, we had orientation week where we had a lecture on medical anthropology with Professor Catherine Burns. Professor Burns spoke about medical experimentation on Black people, she spoke about the distrust of health care systems and the way that distrust and that traumatic history spans across the world.
And for the first time, the penny dropped. I realised I was not imagining things and that the things I was feeling were true. There were words for it like “systemic oppression.” Suddenly, there were words for the ways that racism used the health care system in South Africa to advance white supremacist ideas, all the way from colonialism to apartheid. There were also things I had heard growing up from aunties, cousins, women in my community and their stories were heartbreaking.
From that lecture, I knew that what I had been seeing and what I had been reading were indeed the truth. I remember after that lecture going to Professor Burns and just weeping because it was just so incredibly sad, but I also felt validated in a way. It was just like a weight off my shoulders. I was also aware and involved in student politics and at the medical school, there were concerns around corruption in the admissions process. We were concerned about the racism we were experiencing from senior doctors, as well as people who taught us outside of the hospital.
I think also being at the University of KwaZulu-Natal, the university of [Black Consciousness Movement leader and thinker] Steve Biko and Dr. Nkosazana Dlamini-Zuma, had an impact. All the time, when things got tough, we were always reminding each other, “Guys, don't forget, you're walking through the corridors that Steve Biko walked through.” So that also heightened and amplified this feeling, this knowing that medicine can't just be medicine. It doesn't exist in this perfect world or in a perfect science itself. It's imperfect as a science. All those things were always acute for me from day one.
We also soon begrudgingly participated in a system that is not dignified for us as doctors. There is the idea that doctors will graduate and miraculously just defend and understand human rights and treat patients with dignity, when they themselves in training are being humiliated. We think that by going through six, seven years of humiliation and undignified treatment that you will just pop out at the end and be a person who understands and protects the human rights of patients. And the human rights language in medicine, by the way, is not as strong as we think it is. We talk about the principles of medicine and principles of care, but those are not really articulating human rights and so I always thought that I wish I could have been taught more human rights and where medicine fits into that.
However, there is such clarity for me in what I need to do in any role that I accept. And in this particular one [as UN special rapporteur], I felt that we did not have, in global health and in international human rights, an analysis of what colonialism, apartheid, and racism have done to communities. This is partly influenced by my own experience of having been a child in apartheid South Africa, who then is an adult in a democratic country.
Dr Tlaleng Mofokeng works on her laptop at her home in Johannesburg in August 2022.
It's also due to also reading, learning, hearing, and sharing experiences with women from India, for example, and the caste system. Women in Latin America and the Indigenous communities there and the horrors that are currently happening to them. I see my work as part of that activism. It will look different in a UN report because it is the UN and UN reporting to member states, and there's a particular language that the UN uses. But the analysis is where I have most of my power.
I think that is why I chose to do a report on the right to health — and not just look at access to health or health conditions, but look more at underlying determinants of health that provide for a system of equal opportunity for health and well-being. Because that creates and enables a restoration of the dignity of people, and that’s what matters most to me: dignity.
I think a lot has happened to racialized people, Indigenous communities, and ethnic minorities. Then you add the different intersecting issues around migration, sex work, being an adolescent, and HIV status. There is so much happening to people's bodies, in terms of human rights violations, that is not being analysed. I can’t quantify it, but I can at least analyse it.And so, I decided to take on an anti-colonial and anti-racist analysis to the right to health and to the reports I give to the UN, while also reporting on the practices that show that there are good things being done on these issues.
Early on — especially when I was much younger and talking about sex, sexual pleasure and health, sex and body positivity, and queerness in very open ways — there were colleagues who thought that was very different. People questioned where I got the confidence to dare talk about such taboo issues. I have never really looked at it as pushback, but I think people have always been inquisitive about how I could do this work.
The older I get, and the more political the work becomes, there’s backlash especially online, from mostly right wing associated and identifying organisations. There are blogs about the work I do, about me and my career, even my UN role, but nothing that has gravitas to make me stop, pause, or want to change. In fact, those kinds of challenges make me more determined as a human rights defender to continue doing the right thing, because there are people unashamed to be known as anti-women, anti-gender, anti-Black, racist, sexist, and ableist.
It’s in the face of that, as a human rights defender that defends dignity and autonomy, that I choose to not be swayed or shy because of people who, if they had it their way, would not allow human rights for women, Black people, queer people, adolescents, and people who need abortions. The work I have done with health care workers and the seminars I do every year, as taxing as they are because they are self-funded, is important because other health care workers need a community, a source of strength.
We need a safer space outside of our working environments, where there are often people against the human rights we defend. So, the seminars are important for dealing with the pushback we get, but also in assisting health care workers with understanding human rights and ethics for themselves. Because when you are the only doctor or nurse or social worker in a particular community, doing human rights work, it can be isolating and as if you are the one making up things. Having a community is important for retaining health care workers, especially in sexual and reproductive health care, which can be tiring. That lack of support can often lead to people choosing other areas of practice.
A copy of Dr. Tlaleng Mofokeng's best-selling book is photographed at her home in Johannesburg.
I'm so careful of approaching my work as if it's meant to save people. I don't think people are meant to be saved. And so, for me, it's almost like a mixed feeling when people tell me: "Your analysis and what you're doing in international human rights at that level is giving us a new language. It's giving us new possibilities in international human rights." I had a judge who told me that I'm advancing jurisprudence and I almost fell off my chair!
I feel like there's a community of people, of Black people, Black women, particularly queer people, non-binary people, whose unfinished business I'm trying to finish in my little corner. And I need the people in finance to do the same, the people in environmental work to do the same, for all of us to do it. There’s also the media, and how they perpetuate white supremacist ideas and so we need people there, too.
We need practitioners who understand this unfinished business and who are committed to changing the narrative. I had a young woman doctor asking whether she should go into human rights. I said: "No, go do whatever you want. If you want to be an ophthalmologist, go and be the best ophthalmologist that you can be. But also remember all these different things in the context of your patients, because even ophthalmology patients need dignity. They also need confidentiality. You need to be aware, too, that the fact that people may come to you and it's not just an eye operation — what's happening to this woman so that she's needing this intervention? They also need practitioners who think, 'Maybe this woman needs a cataract operation because of the repeated beatings that she is receiving.'"
As medical professionals, you need to care enough about your patients, regardless of what specialty you're doing. I promise you, if you look hard enough, if you think hard enough, you will find unfinished business. It’s for all of us to do the best we can in our little corners. If you light up your little corner and the person next to you lights up that little space, eventually the whole room will be full of light. That's what is important.
Dr Tlaleng Mofokeng at her home in Johannesburg in August 2022.
As told to Gugulethu Mhlungu.
The 2022 In My Own Words series was made possible thanks to funding from the Ford Foundation.