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A Twientieth Century Chronicle of Nursing in South Africa
By Doreen Merle Foster

ISBN: 978-1-904697-52-7
First Published: 2003
This Edition: 2005
Pages: 159
Key Themes: nursing, South Africa, racism, abuse, history



An authentic account of the experiences that have shaped the history of black nursing in the South African health service during the violent eras of colonialism and apartheid. Lahlekile is largely an oral history which reflects the South African nursing struggle across a hundred years as experienced by black health workers of all ethnicities. Trends in the period are provided at the end of three chapters while the fourth (and last), takes the reader to the cutting edge of the century. The term Lahlekile in Xhosa means ‘lost’ while in Zulu it has the connotation of being ‘thrown away’.

About the Author

Doreen Foster was born in Western Cape, and now lives in East London. She has a BA degree in Nursing Science and has previously had work published in a South African Women’s anthology entitled ‘Hot as Fire’. She has worked for the post-apartheid government in South Africa with the office of the National Minister of Health and after two years became a coordinator for the transformation process in the Eastern Cape Department of Health. At present, Doreen is a Gender trainer and animator for the ‘MASIMANYANE’ Women’s Support Centre. She has also completed her first historical novel ‘Unshackled’, which is yet to be published, and is involved in another book project entitled ‘Urban Stew’.

Book Extract

At the turn of the century the only training open to black girls was basic housekeeping. Ward maids were allowed cleaning duties inside hospitals and black girls were popular as domestic servants to urban white housewives in and around Johannesburg.

It was Dr Neil Mac Vicar of Lovedale, who tested the water for nurse training. First he awarded “Leaving Certificates” to his young protégés until he became thoroughly convinced that black inferiority was a social myth.

The Victoria Hospital was his training base. This hospital, together with the Lovedale Institution and Fort Hare University, formed a triangle of educational campuses around the Tyhumie River in Alice, Ciskei (1:58). Neil Mac Vicar knew that he was swimming against the tide but he began to prepare his trainees professionally with great determination.

The very first girl to pass was Miss Cecelia Makiwane, the daughter of a Presbyterian Minister at Mac Farlane Mission about 12km outside Alice. Her passing of the state examination caused an international stir so great that – like Florence Nightingale – she began to ail. It is very likely that she could not understand the fuss or the backdrop against which it was played off.

Miss Makiwane’s health began to decline as the pressure took its toll on her apparently frail young body. She was given indefinite sick leave. Her father decided to send her to Johannesburg to the home of Professor Jabavu and his wife, who was her sister. In that house a warm and caring atmosphere was created, close relatives and friends tiptoeing in and out of her room, overcome by her great fame. Unfortunately she never recovered. Death came at a very young age.

Cecelia Makiwane’s achievement deserved all the acclaim it got – first registered nurse, first black to pass the state exam. Many years later this was forgotten by the matrons and nurse administrators who avidly testified to black inferiority for the Nursing Act of 1957.

Cecelia’s achievement could also be viewed as outstanding against the social background of the rural area. Her great fortune was having a progressive father who valued education. Her eldest sister had become famous too, as the first African woman to have matriculated with mathematics as one of her subjects.

Today Miss Makiwane stands immortalised by:

A Statue in the hospital grounds where she trained.

The Cecelia Makiwane Medal of Honour for the “African Nurse of the Year”. A hospital – Cecelia Makiwane Hospital – was named after her, putting her name on the lips of generations to come ( 1:52 ).


To the enquiring contemporary mind a niggling question persists. Why did the simple fact of a young girl passing the state examination become an event that rocked the world off its early century moorings? Could it be that across Europe Blacks were simply not perceived as equal to Whites?

This is very possible judging by the words (as quoted) of Cecil John Rhodes who said, “I contend that we are the finest race in the world and that the more of the world that we inhabit, the better it is for the human race. Just fancy those parts at present inhabited by the most despicable specimens of human beings. What an alteration there would be if they were brought under Anglo-Saxon influence.” ( 2:45 ).

One great thing that Miss Makiwane’s success did was to prove to South Africans and the missionaries from other lands that black inferiority was a concept invented in Europe. She turned a wrong belief on its head. Yet this was not openly admitted. Not a single hospital would accept black nurses for many years to come. In 1916 Miss F.E. Shepherd from England submitted a proposal for midwifery training at the St Monica’s Home in Cape Town. The Colonial Medical Council accepted her proposal on the proviso that the courses be presented by a medical doctor. As a consequence Dr Simpson Wells was invited to instruct student midwives.

The trained Nurse’s Association opposed the programme, as they did not want a “Coloured” midwife to have the same certificate as a “White”. They petitioned the Colonial Medical Council to grant a second-grade certificate to “Coloured” trainees and further stated that she should work under “European” supervision and that her training be extended to two years as compared with the required six months.


6 reviews for Lahlekile

  1. Thomas Radcliffe (verified owner)

    Doreen Forster’s book offers an insightful look at the South African nursing struggle. Well-written and highly recommended.

  2. Ananda Conabady (verified owner)

    Lahlekile means “lost” in a South African dialect and “thrown away” in Zulu. It s an impressive story about the South African women condition in the last century.

    Very interesting and instructive.

  3. Marie lebourgeois (verified owner)

    I learnt a lot of things about South African nursing struggles and I advise this book to a large number of people.

  4. Matthew Timms (verified owner)

    Doreen tells the story of South African nurses and gives us a deep insight into the African mental health system. A must have.

  5. Brian May (verified owner)


  6. Bill Paulson (verified owner)

    It’s the history of a black nurse in the South African health services during the violent apartheid. Excellent!

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