Dr Andrew Ross's idea of sponsoring rural students to study for careers in healthcare has succeeded beyond his dreams. Sue Segar sat down with him and chatted to the four students who bagged the initial fully funded scholarships and who went on to land senior roles in public health.
While working as medical superintendent in the late 1990s at Mosvold Hospital in Ingwavuma, KwaZulu-Natal, Dr Andrew Ross had an idea that would shape much of the rest of his life.
"I thought if we could support rural students to study for careers in the healthcare services, and if they could succeed, then return to serve in the rural communities, staffing problems could be solved forever," he recalls.
Ross had been superintendent at Mosvold, a public district hospital in the Lebombo mountains near Eswatini's border, since 1992, when the hospital had only two doctors. "We were stretched to the limit," he remembers.
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At the time, the HIV pandemic had surged into the province's rural corners. Government was not yet providing HIV treatment and rural hospitals were severely strained. Poverty, inadequate water and sanitation and poor basic infrastructure added to the area's high disease burden. As patient numbers increased, healthcare workers at the under-staffed hospital became increasingly desperate.
In those years, funded government posts were available, but finding staff was the responsibility of the hospital management. Ross had, since 1992, been recruiting British doctors for short-term paid work at the hospital to fill some of the gaps, but this was not ideal. "It was more like a working safari for them. They didn't have the African experience. Language was a big issue, and it was becoming increasingly difficult to register foreign staff through the South African government," he says.
"Recruiting was a huge distraction when you were meant to be running a hospital. The problem of understaffing was common to most of the government hospitals in rural KZN," he says. He says the then health authorities, based in Pietermaritzburg and Ulundi, left them to "paddle their own boats and find their own solutions".
Rural talent could be a "gamechanger"
Ross was convinced that sourcing local rural talent could be a gamechanger. He persuaded the American-funded organisation Medical Education for South African Blacks (MESAB) which, at the time, helped black students with university registration, to go halves with him on the costs of his new initiative and also started scouting for other funders.
"I told them we wanted to pay rural students' fees and fund their residence," he says. "We wanted them focussing on studying and not stressing about the money they needed. We wanted them to have every chance of success."
At first, he says the response from corporates was dismal. "It was hard to convince them that young people from the rural areas would manage to qualify at universities, especially in the health sciences," says Ross.
Undaunted, he directed potential funders to the NGO, Friends of Mosvold, which he'd established to raise funds for rural health programmes, and which later evolved into the Umthombo Youth Development Foundation (UYDF).
Ross shared his idea of sourcing local talent with the local Inkosi (traditional leadership), the community, and Mosvold Hospital staff, who he says committed themselves to encourage local children to work hard and apply, with many of these people also contributing money.
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Next, Ross organised for outreach teams to identify suitable candidates and tell them about work options in the health sciences, and about his scheme. They had to be studying mathematics and science at school.
Interested learners were invited to an Open Day at Mosvold Hospital, to visit different departments and meet qualified healthcare professionals. In that first year alone, at least 100 learners from the wider Umkhanyakude district visited the hospital.
In 1999 the scheme offered four fully funded scholarships. "The deal was: they had to be from Ingwavuma; and to get a place to study a health sciences course which would enable them to work in a hospital. They had to do at least two weeks of voluntary work at the hospital ... and sign a year-for-year work-back contract," says Ross.
Ross's eyes light up when he describes what happened next.
"In January 1999, four young men - France Nxumalo, Dumsani Gumede, Nkosingiphile Nyawo, and Sibusiso Thwala - pitched up at the hospital and said, 'we've got places. Have you got the money?'."
Nxumalo had got into the then University of Durban-Westville (UDW) to study optometry; Gumede had made it into Physiotherapy at UDW; and Nyawo had got into Biomedical Technology at the ML Sultan Technikon. Thwala had got into pharmacy at University of the North.
Not long after that, Siphamandla Mngomezulu showed up with the papers showing his acceptance into the University of Zululand to study psychology. This bright young learner, Ross says, was raised by a single mother, who travelled by donkey into Swaziland every Saturday to buy sugar to repackage and sell. He says Mngomezulu attended a poorly resourced school that didn't have a mathematics teacher and travelled to another school every Saturday to learn mathematics. Ross says the youngster was preparing to join his uncle in the mines when he heard he'd got a place and the offer of a bursary from Friends of Mosvold.
"At the time, I had R30 000 in the bank," says Ross. "The fundraising hadn't gone as well as we anticipated. MESAB had promised to go halves with me, and we decided we had to launch!"
Just over a quarter of a century later, the scheme has helped 663 students from rural KwaZulu-Natal to graduate in the health sciences. Among others, this includes 270 doctors, 99 pharmacists, 45 nurses, and 45 radiographers.
Careers marked by resilience
Each of those first four students, has a backstory, marked by hardship, resilience, and hope. Each remembers clearly the indescribable feeling of being offered a place at university; the numerous challenges, the overwhelming feeling of arriving at sprawling campuses and of trying to navigate urban life.
In separate interviews, they described to Spotlight how, after graduating, they served time in rural communities, before moving into high-powered positions in public health; in the process, breaking the cycle of intergenerational poverty.
Nxumalo says he started school late because there was no school in his community. He had to fight to study mathematics at higher grade at high school. He completed his degree in optometry in 2003. He returned to Mosvold, as the hospital's first ever optometrist, to pay back his time. There he started the optometry department from scratch, ending up as the district optometrist, serving Manguzi, Hlabisa, Mseleni and Bethesda hospitals.
After years of serving in the rural setting, including working for Transnet's Phelophepa train which provides marginalised communities with health services; working for the global Brian Holden Eye Institute, and then within the national health department as deputy director responsible for eye health, Nxumalo currently lives in Durban and lectures in the optometry department at the University of KwaZulu-Natal (UKZN). Home is still Skhemelele, in Ingwavuma, where his extended family live. He remains a mentor for rural bursary students at UKZN.
Gumede recalls how his excitement to be the first person from his village to study in the health sciences was dampened when he contracted cerebral malaria a few months after arriving at university, but he wouldn't let it stop him, even after he had been advised to pause his studies. He qualified as a physiotherapist, returning to work at Mosvold for a year. On the request of the district manager, he moved to Hlabisa Hospital, which had no physiotherapists, where he set up, and expanded the physiotherapy department between 2005 and 2008.
Gumede joined the UYDF scholarship scheme as mentor coordinator at Ross's request at the end of 2008, until September 2018. Since then he has worked at the Africa Health Research Institute (AHRI) in Mthubathuba as a researcher in health and demographic surveillance.
Nyawo says he lived in poverty with his unemployed mother; and ended up going to school in Pongola when it became clear he was good at mathematics and science. He remembers his mother borrowing ten rand for him to visit Ross at Mosvold.
"Dr Ross said, 'come back with an acceptance letter and I'll pay for all your schooling needs'. I said, 'OK, I'll come back once I get the acceptance letter'."
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After graduating in biomedical technology in 2004, Nyawo worked in Mosvold's medical laboratory for nearly three years; and in 2007, he got a post at KZN's malaria control directorate, after which he worked in private laboratories. He has been back with the KZN directorate in Jozini since 2021, working as an assistant director, and managing the laboratory for the malaria surveillance programme.
"Apart from giving me the opportunity to graduate, from my earnings, I was able to start supporting my family, to build a proper house for my mom, who previously, could not make ends meet. Today, I have three young boys, who go to good schools, and who live in a home I built in Jozini," he says.
Mngomezulu went to work at Hlabisa Hospital after graduating in psychology, becoming the only psychologist for the five hospitals in the district. He stayed in the district for six years, first rotating his services by spending a week at a time in each hospital, whilst mentoring young psychologists coming up in the pipeline.
Within four years, there were five psychologists working in the area. In 2014, he went into private practise. He runs, remotely, a full-time private practise, employing other psychologists, in Richards Bay. Recently, he relocated to Johannesburg working at the Poortview Hospital, which specialises in mental health. He completed an MBA and is now doing a doctorate in Business Administration through the University of Reading.
"Currently, it works for me to be in Johannesburg where I have academic contacts," says Mngomezulu. For a number of years, he served on the board of Umthombo and he remains involved in the NGO.
Sadly, Thwala passed away not long after graduating.
"I attended his graduation at the University of Venda with Dr Ross," says Gumede. "He was adamant that he wanted to study pharmacy, and was insistent about getting funding from Umthombo."
Describing him as "bubbly", Gumede says Thwala wanted the people around him to be happy.
"He was the one who organised for the Umthombo students to braai together back home and get to know each other," Gumede remembers.
"He was the one who would encourage us as students, and say, 'guys we must pass wherever we are. We have this funding'.... He was the person who sorted out accommodation issues at Mosvold when students went there to do their stints at the hospital."
Paying back the support
In 2024, Ross was diagnosed with a rare blood cancer, Myelodysplastic Syndrome (MDS), which affects blood cell production. He was given months to live, but since getting a stem cell transplant just over a year ago, he says he is feeling good.
When Ross was first diagnosed, many of his former students got involved in the drive to find him a matching stem cell donor.
"We visited Dr Ross while he was having chemo and all looked for a donor. All of us said, 'it can't be'," says Nxumalo.
Reminiscing on the early days when he was assisted in his studies, Nxumalo continues: "They've been my family ever since. Dr Ross remains my mentor at the university. He never treated us like children. He allowed us to make mistakes. When I got married, he was there. Not just us, but our families have progressed because of this support. Whenever we can do something to help Umthombo, we do it happily."
Nyawo recalls how Ross loved the words "excellent" and "super"! "That 'excellent' word is still there whenever we talk! That's how he inspired us."
For Mngomezulu, the impact of Umthombo has extended to future generations. "My kids will never struggle like I did. I was at a meeting at my kids' school, Crawford College in Randsig, a while back, and I bumped into a doctor who also studied through Umthombo. We reflected on how one person impacted so many people's lives." He adds: "We are the first degree-holders in our families. Dr Ross planted a seed which has changed the lives of generations of people. Even our parents' lives have changed. Most of the graduates started building houses at home for their parents as soon as they started working."
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Transition to NSFAS
Umthombo started off as full-cost funders, but has changed a good deal over the years. Dr Gavin MacGregor, the current director, explains: "Posts at rural hospitals were plentiful, so the agreement was that, for every year of financial support received, the student needed to work back one year at a rural hospital. Thereafter, they were free to work wherever they wanted to.
"In 2010, we started partnering with NSFAS, initially in a small way, but it meant we were not covering their full costs, and so we could not expect them to work back one year for every year of support. We changed it to be one year of work back for every two years of our financial support."
In 2020, all Umthombo's students became fully funded NSFAS students.
Fewer public sector jobs
Meanwhile, there were also changes to the public healthcare system in the province over the years.
MacGregor says massive budget constraints emerging from around 2017 meant that graduates were no longer all employed by the KwaZulu-Natal department of health as previously was the case.
"We expose all our students during their training to rural health (spending four weeks a year in a rural hospital), and request they apply to rural partner hospitals for their community service placements and try to get permanently employed at that hospital after community service," he says. "In most cases, this does not happen these days, due to the lack of funded posts. When they graduate, they're not guaranteed employment in the public sector, let alone in rural."
However, MacGregor is adamant that most Umthombo students have nevertheless worked in a rural area and made a "huge impact in starting new services, or strengthening existing services, which may not have happened if they weren't there".
A committed rural doctor
As for Ross, he says there was never any question that he would end up working in a rural area. The son of medical missionaries, he grew up in Nigeria, Ethiopia, and South Africa, where he says he developed a love for rural medicine.
After qualifying as a doctor at the University of Cape Town, Ross served as a junior doctor in various public hospital postings until joining Mosvold Hospital where he stayed until 2003. He currently works as a principal specialist in Family Medicine at the University of KwaZulu-Natal. He remains a trustee of the Umthombo foundation.
In 2015, Ross received the Order of the Baobab (silver class) from former president Jacob Zuma for his work on Umthombo.
Note: In Spotlight's Rural Heroes series, we tell the stories of people working at the coalface of rural health. Besides platforming these remarkable individuals, the series also aims to increase understanding of the unique challenges of offering healthcare services in rural areas.
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