Junior doctors across provinces report fear of victimisation which breeds a culture of silence. (File photo)
The death of a young intern doctor at Prince Mshiyeni Memorial Hospital in Umlazi, KwaZulu-Natal, after reportedly being compelled to work despite notifying his senior that he was unwell, has sparked outrage across the medical fraternity.
On anonymous online platforms, fellow healthcare workers have broken their silence, echoing stories of exploitation, burnout and fear.
Dr Alulutho Mazwi was only 25 years old. His death must not be dismissed as a singular failure of compassion or miscommunication. It must be recognised as a systemic collapse where the absence of leadership competence, ethical decision-making and safety planning results in preventable deaths.
This situation also reflects failure of psychological safety and workplace health standards. Managing staff requires leadership credentials, emotional intelligence and human resource training. Yet in healthcare, leadership is often conferred through clinical rank, not capability. Holding an MBChB or specialist degree does not make one a competent manager. Yet those titles are all too often treated as de facto licences to supervise and discipline junior staff without any oversight into how those responsibilities are carried out. Assigning power without competency and oversight is negligence.
Section 24 of the Constitution states: “Everyone has the right to an environment that is not harmful to their health or well-being.” When interns are left to continue working despite being ill, this potentially puts the doctor and patients at risk, which is in direct violation of Occupational Health and Safety Act; the OHS and Labour Relations Act requires employers to ensure a work environment free from physical or psychological harm. Leaving interns unsupported, overworked, working while ill and fearful of speaking up because of reprisals creates conditions that are not only unsafe, but legally and ethically indefensible.
Dr Mazwi’s death raises the question: who was the senior who allegedly forced him to work while ill? If they lacked the skill to assess risk or show professional empathy, who appointed them? What criteria were used? And where was the head of department, and the hospital chief executive? If they were aware, why did they not intervene? If they were unaware, why are they in those positions?
The answer lies in a health system that rewards tenure and titles, not leadership competency, ultimately giving rise to institutional structures without substance.
The health department maintains a vast array of administrative units including monitoring and evaluation offices, HR departments, wellness strategies and intern management protocols. On paper, this architecture suggests a system of support and oversight, but in practice, it is failing at every level.
If internal systems functioned as intended, red flags about burnout, toxic culture and unsafe practices would have been identified and acted upon. Instead, junior doctors across provinces report fear of victimisation, grievance processes and a culture of silence. Interns often fear speaking out because of opaque grievance procedures and risk of retaliation. This silence violates the Promotion of Administrative Justice Act and Protection from Harassment Act, both of which aim to ensure just, transparent and safe public administration.
In psychological terms, this is a work environment that scores abysmally on psychological safety where staff do not feel safe to speak up, raise concerns or protect their own health without fear of punishment.
As a country we are fast falling into a pandemic of inquiries and investigations as tick box exercises with no significant outcome, no punitive measures and, most importantly, no systemic reformation.
In provinces like Gauteng, a decision was made to cut overtime for doctors, citing budgetary constraints. This is being done with little to no consultation, despite already chronic understaffing in public hospitals. Cutting overtime without increasing posts or restructuring workloads is not reform, it is risk redistribution. The burden simply shifts onto fewer hands, most often junior doctors who are least empowered to speak out.
These cost-saving measures not only undermine service delivery but also violate the Basic Conditions of Employment Act, which requires fair working hours, sufficient rest periods and safe working conditions. Cutting overtime without increasing staff restructuring duties violates these principles and places employees under duress, exposing them to harm. From a legal perspective, expecting staff to work excessive hours in unsafe environments constitutes constructive dismissal risk, and from a human perspective, it is institutionalised exploitation.
Despite more than 1800 unemployed qualified doctors in early 2025, hospitals continue to operate dangerously understaffed. Junior doctors are reportedly left in charge of departments after hours, because registrars and consultants allegedly leave early. These unmonitored practices violate principles of workplace safety and professional supervision.
If these claims are true, then the health department has lost control of its mandate to manage the very professionals whose salaries cost billions.
The department must explain: Who manages staff work times and the distribution of workloads? Who do they report to? How effective is their management? Are they earning the public salaries they’re paid? These are not rhetorical questions. They demand public answers. We are cutting the lifelines of our healthcare system while preserving the scaffolding of managerial incompetence. This will undermine the South African dream for universal health coverage and equitable access to opportunities for doctors and patients alike.
It is incidents like Dr Mazwi’s death that highlight the misalignment of the National Health Insurance (NHI), the national health mandate with the overarching national goals for a healthier, fair and more just society. At the heart of such ambitious plans is the need for staffing equity, systemic efficiency and strengthened public health, all of which are undermined by the daily dysfunction in public hospitals.
How can we promise universal care when we cannot protect the staff who deliver it? How can we claim to support the poor while gutting the very services that serve them? The NHI cannot succeed in a system where junior staff are abused, senior leaders are untrained and financial decisions contradict ethical care.
We must confront uncomfortable truths as we unpack the fatal reality of this junior doctor and among them are the hard-hitting questions that need to be answered if we are committed to seeking justice for his life and the well-being of all the many others who have been brutalised by this system.
This death is not an exception. It is a consequence of structural negligence and a culture of impunity. Dr Mazwi died working for a system that did not work for him. His death is a national failure, and we cannot afford to look away. We are not just failing patients. We are failing the people who have sworn to care for them. Failure to act decisively, in light of the evidence and outcry, would mean accepting more deaths like this one as the cost of doing business. We owe this young doctor and every healthcare worker battling this system more than memorials. We owe them justice, reform and protection.
Urgent call to action
Dr Mazwi’s death and the collective grief shared since must lead to transformative action. We demand immediate intervention from health authorities, regulators, and political leaders. Specifically:
- An independent, expedited investigation at Prince Msheiyeni Memorial Hospital with consequences for all found responsible;
- A public outline of HR and leadership reform measures by the department of health, acknowledging the widespread suffering of interns and Junior doctors;
- A policy reform mandating that no one may be appointed to leadership or supervisory roles without formal training in human resource management, people leadership, and psychological safety;
- The department of health and Health Professions Council of South Africa must create a safe, accessible and responsive reporting mechanism for doctors in distress, separate from existing slow-moving internal systems;
- Budget alignment must prioritise safe staffing ratios and staff well-being; and
- Audit the readiness of the NHI system, especially in terms of staff safety, leadership capacity, and system accountability- before further rollout occurs.
Naheedah Collins is an industrial psychologist and Haseena Majid is a Global Atlantic fellow for health equity and social justice at the Atlantic Institute, Oxford, UK.