Sinikithemba

Sinikithemba - The labour of hope and science at McCord Hospital in the era of HIV is an insightful, inspirational, and most compelling contribution of McCord’s institutional history. While the book charts McCord’s broader evolution from its missionary founding in 1909 to its role in apartheid-era resistance and nursing education, it is Sinikithemba—meaning “We give Hope”—that stands out as its most consequential innovation.

Sinikithemba, McCord Hospital’s HIV clinic, established in 1996 in response to the escalating HIV epidemic in KwaZulu-Natal, served as a multidimensional platform where academia, health professionals, business actors, and policymakers intersected. Through its integrated model of HIV, TB, paediatric, and psychosocial care, Sinikithemba ultimately emerges in the book as more than a clinic. The site provided a space for intersectional knowledge production, bridging frontline treatment with research, funding systems, and health policy development during a period marked by national AIDS denialism and clinical services provided with humanitarian qualities of care, compassion, and dedication in the service of others that influenced the global standards of care

Sinikithemba beautifully chronicles how people at a single Christian hospital navigated the tumultuous medical, social, and political challenges wrought by the HIV/AIDS pandemic. Upton, Giddy, and Burns enable us to understand the heartfelt care that staff at McCord devoted to those suffering at the centre of that pandemic. This is a remarkable and heartbreaking piece of the longer history of biomedicine in Africa that deserves a very wide readership, especially at a time when vital public health infrastructures across the continent and elsewhere are under siege.

For more than a century, McCord Hospital was a special place, perhaps an exceptional mirror of the larger world around it in the region of Durban, Natal, KwaZulu/Natal, South Africa. The story of McCord Hospital in the era of HIV/AIDS needed to be written. A small mission-oriented and organized hospital was almost instantly at the centre of the HIV/AIDS emergency. A beloved place for those with illness, those seeking support in pregnancy, those facing the injuries and diseases of extractive economies, now people found themselves looking at McCord as a death sentence, with little that staff could do to address the increasing number of people, individuals and families, succumbing to this pandemic. Over months and years, amidst deadly risk to its own staff, McCord became a place of learning, research, and practice about HIV that began to offer hope to so many. McCord’s Sinikithemba Clinic, established in the late 1990s, would be the centre of testing new drugs and protocols, of addressing the special needs of patients of families, of improving training in treatment and care. Perhaps no institution in the world would find itself so directly in the vortex of national and global anxiety with the challenges of HIV. And perhaps no three individuals—Jennifer Upton, Janet Giddy, and Catherine Burns—could with love and expertise reconstruct this so-complicated a history of this institution. Their book—Sinikithemba--is so valuable an account of an institution in the crosshairs of HIV across several decades. It is a story to be told and read. . .with its sad parts, heroic parts, a few amusements. . .and it is a story of a vital institution that may have become too successful a unicorn to survive into our present time of state-organized medical care. . .a state too blind to the deep work in which the hopes of people to be well are met by those assembling the compassion to address those hopes.

Hospitals are global institutions, designed according to the bureaucratic logics of biomedical protocols of care and medical and surgical practice. Yet, what becomes clear from the history of McCord Hospital, Sinikithemba, is how the character and culture of health care institutions are shaped by their political and economic contexts, their histories, and the agency of extraordinary peoples’ professional and emotional labour. While the national story of the South African AIDS epidemic tells of how care buckled under the weight of illness and death, the story of McCord Hospital highlights the production of a political economy and culture of hope amidst such precarity and uncertainty, highlighting the innovative compassion of the many different professionals involved in responding to the impact of the epidemic. The authors, having witnessed the devastation of the disease first hand, offer a comprehensive and in-depth account that spans the pre-history and history of AIDS, taking the reader from the hospital’s origins in the early 1900s, through the repression of the apartheid era and the AIDS epidemic of the 1990s and early 2000s, to its unfortunate closure. This is a valuable contribution to the history of care and health, and particularly of responses to the AIDS epidemic, for scholars and practitioners.

One of my favourite quotes in the book is from the late and great Jerry Coovadia, saying “I always thought it was one of the best hospitals in the country, for things other than medicine, but medicine too.” The story of McCord and Sinikithemba weaves together the stories of so many people – well known and lesser known – who worked over decades to create a hospital and an HIV programme that met not just the treatment, but also the psychological, social, developmental, peer-support and palliative care needs of the people they served. The story illustrates the long and proud history of health worker activism – activism that continues today despite significant opposition and fear. Sinikithemba doesn’t shy away from the times in the hospital and programme’s history that were clearly difficult and contested – including staff dissatisfaction, questions over research ethics, and the heart wrenching years between its centenary and the transfer of 4000 patients out of the programme following funding cuts. The book comes, as reflected in the afterword, at another time of transition for the HIV programme, with the abrupt termination of most US funding in 2025. We can only hope, as Peninah Thumbi expresses in the book, that some of the “Spirit of McCord” has indeed infused a health system that is again being asked to adjust and be resilient in the face of less money and continuing need.

In Sinikithemba, the intersections of faith and the global institutional transformations wrought by the HIV crisis fashioned a fascinating episode in the history of McCord Hospital in today’s KwaZulu-Natal, then the epicentre of the pandemic in South Africa. It illuminates the motivations of the men and women whose sense of “calling” and accompanying labours of “grace” fashioned an extraordinary moral community that often bridged apartheid’s racial and regional cleavages from the 1980s. The reciprocal exchanges of care that these social actors understood as needing and dispensing hope fashioned a web of relationships between patients, clinicians, caregivers, social workers, researchers, philanthropists, government departments and many others, both locally and abroad. At McCord, this moral community was as much shaped by actors’ commitment to cutting edge scientific research as it was by their daily intentions of piety. What emerged was a critical node that shaped the global understandings of HIV and its clinical treatment protocols. Where tensions emerged in McCord’s dual practice of clinical practice and social responsibility, they shed light on the dramatic changes in South Africa’s political and institutional landscape from the last decade of apartheid into the first two decades of democracy. This book is a superb contribution to understanding the feelings and moral undertakings by which ordinary people responded to the devastating death toll of HIV/AIDS. Through these reciprocal exchanges of hope, the broad McCord family confirmed the existential status of the sick and the dying as, not statistics of a ravaged population group, but as persons. This is a powerful story of some of the everyday labours of, and struggles for, personhood that incorporated a growing number of then ostracised and shunned individuals into the fabric of everyday respectability in families and households.

At a time when the apartheid state was reinforcing segregation in the practice of medicine and limiting the opportunities for black education, McCord Hospital was a beacon of inclusivity. With the end of apartheid, amidst the ideological furore over the treatment of HIV/AIDS, it positioned itself as a significant site of medical research and treatment. This book therefore covers a fundamental period in the history of medicine in South Africa, tracing the history of the hospital during the tempestuous 1970s into the first decade of the twenty-first century. The authors continue the spirit of inclusivity that marked McCord Hospital by writing a history that rather than the conventional top-down approach, acknowledges the experiences of patients and addresses the intricate relationship between medical staff and those treated at McCord Hospital; and the ways in which research engages with – and is shaped by – a shifting societal context. Drawing upon written archival and oral sources, a comprehensive and readable account is given of the history of a hospital that has been a place of hope and faith for many.

Founded in 1909 by American medical missionaries and the remarkable local leader Katie Makanya, McCord Hospital in Durban, South Africa, was built on an audacious vision of dignity, compassion, and healing for all, a vision it fiercely defended through apartheid’s brutal machinery, political violence, racial segregation, and economic hardship, quietly defying government orders and opening its doors wider when the world demanded it close them. When HIV/AIDS tore through KwaZulu-Natal with devastating force, McCord answered with its most powerful act of humane defiance yet, establishing Sinikithemba! (isiZulu for “We Give Hope”), a groundbreaking HIV clinic that wove together faith, science, and community solidarity through support groups, international research partnerships with Harvard and Yale, palliative care, community outreach. Sinikithemba’s choir featured voices that carried survivor stories from the streets of Durban to the stages of Boston and beyond, raising millions and reaching world leaders. Sinikithemba! is not merely the story of a hospital, it is a testament to what happens when faith, science, and community refuse to surrender, and a powerful reminder that healing, at its most profound, is not a medical act but a deeply human one.

This history of Durban’s McCord Hospital is a great example of what medical history can do as a ‘history in chords’, bringing together different approaches and levels of analysis. It highlights the pioneering role of McCord in providing health care across boundaries of segregation and responding to the HIV pandemic, emphasizing the Christian ethos of its approach. But it is also a richly facetted account of a particular place in Durban and of the hospital’s survival in ‘buffer zone’ areas of apartheid division in the upper reaches of the Berea. It shows readers how McCord’s ‘labour of hope and science’ was undermined by state-centered secularism in the 2010s, and how programmes it helped to develop to contain HIV and tuberculosis are now endangered by Trump II policies and cuts. The three authors have brought together a focused, well-rounded and eye-opening narrative of South African and Durban history since 1909.

Among recent institutional histories in South Africa, Sinikithemba is quite simply one of the best. A long and meticulously researched work of medical history, here is a gripping account of a mission hospital and its hope-giving work at the height of the HIV/AIDS crisis. More than that, the authors paint a vivid picture of faith, politics, culture, globality and the utter humanity of those serving and being served inside a country struggling to find its place in the world. The book is unrivalled as contribution to the medical humanities in the first quarter of this century if only for its scholastic brilliance in being able to hold in tension living and dying, the local and the global, the state and missions, the organizational and the personal, all inside a cohesive and compelling narrative of a single institution on the east coast of South Africa. No doubt, as a bold and innovative work of scholarship, the accessible writing ensures that the book will travel well among academics, students as well as the reading public inside and beyond the borders of South Africa.

At its heart, Sinikithemba brilliantly tells the story of a determined group of medical professionals, academics, and patients, who, in the 2000s came together to transform HIV care and change the course of the global HIV epidemic. With rare scope and sensitivity, the book traces how a small HIV care centre on Durban’s ridge became a global leader in treatment and research. Moving seamlessly from the corridors of the White House and the Global Fund to the lived realities of patients battling pneumonia and TB, it deftly navigates the complex intersections of gender, ethics, faith, and care.

While South African scholarship has often focused on AIDS denialism and AIDS activism, Sinikithemba brings into sharp focus the everyday, gendered labour of healthcare workers and ordinary South Africans so often overlooked. The book illuminates the tensions and intersections between biomedical, religious, and justice-oriented approaches, as well as between local practitioners and global institutions, showing with nuance the subtle logics at work while refusing easy explanations. Essential reading for scholars and students of history, religion, global health, and international aid, the book is also a powerful lens through which to understand changing institutions in South Africa.

Singing in the waiting room. This is one of the many powerful images that stay with the reader of this history of a South African institution that played such a significant role in delivering hope during the dark days of the HIV epidemic. But this is much more than an institutional history. It is a story of the labour of care, the pursuit of scientific excellence, and the complex relationship between society and medicine and between a Christian institution and the state. The result of a long-standing collaboration between two historians and a medical professional, Sinikithemba, explores contemporary dilemmas of health care in South Africa and beyond.

Can hope inspire care? Will care result in hope? These are the questions that this wonderful book asks and answers in one of the bleakest times of South African epidemiological history. South Africa is facing the disease, HIV and AIDS. People are falling sick and dying in large numbers. There is stigma. To whom or to what do they turn? Answer: McCord Hospital in Durban. An incredible story of science, medicine, dedication and unwavering belief.

Sinikithemba offers a searching history of the pioneering HIV/AIDS service at Durban’s McCord Hospital. This beautifully rendered, intimate account details the collective work of a uniquely capacious and effective mode of care that came to an end because of changes in American funding priorities. The book offers lessons in how and why the improbable gets made and reminds readers of the necessary and uncertain work of sustaining such radical experiments.

Reading SINIKITHEMBA threw me back 25 years to remembering the days where all we had was “hope”. Our yearly World AIDS day meetings at work were gatherings to hear stories of loss of families and friends. We prayed for hope and it came to us in the form of SINIKITHEMBA, located near our offices, we talked of SINIKITHEMBA in those meetings encouraging staff to spread the word, to help break the circle of stigma and shame and draw on their courage to go to the clinic at McCord hospital. I learned so much from reading this beautifully written book that I was unaware of even after having visited the clinic many times. The rich detail about the history, the staff, the care that was given and the influence on research in the KZN province and beyond is so important to understand not only for the generation that remembers SINIKITHEMBA, but young people who need to know how this one facility defied the odds to provide excellent compassionate services in such difficult political times.

This remarkable and compelling book describes how a small South African hospital came to have a world-renowned HIV treatment programme, defying general global health inaction and government denial. In the eye of the storm of a catastrophic AIDS epidemic, Sinikithemba clinic at McCord hospital in Durban boldly provided ARVs in a science-driven and compassionate way – saving thousands of lives. Sinikithemba has a widespread appeal: it is both engaging for scholars and invites the interest of the general reader, especially health care and social workers, teachers and activists

Sinikithemba is a remarkable tribute to the men and women who provided care to countless numbers of South Africans for over a century. The book traces how McCord Hospital in Durban evolved from a small mission hospital into a large metropolitan medical center while maintaining its commitment to integrative, holistic, community-based medicine. Capturing the diverse perspectives of multiple actors, the authors reveal how the hospital staff was able to navigate the political, social, and economic challenges created by South Africa’s racial policies, the crush of patients created by the HIV/AIDS epidemic, AIDS denialism, and the constant battle to obtain adequate funding. A truly remarkable tale of perseverance and commitment to a vision of health care that should be a model for medical institutions in South Africa and beyond.

Sinikithemba is a story of the tenacity of faith, science, and above all, solidarity, in times when all three were under assault. Though a history of a single clinic and its hospital, in the midst of a global epidemic, the book illuminates most of the wider themes of late-apartheid and early majoritarian South African history. American civil rights activist Bayard Rustin taught that hope is not something that simply descends on us, but something we must create in our everyday activities and alliances.