Prof Beth Engelbrecht, Leading with Grace

Servant leadership is not a job description; it’s a way of being. One that Professor Beth Engelbrecht has embodied with rare clarity and quiet conviction across more than three decades of public service in South Africa. 

In this episode of Awakening Doctor, we learn about her extraordinary personal and professional journey from young district surgeon to transformative leader shaping a more ethical and resilient health system.

With honesty and humility, Prof. Engelbrecht reflects on the moments of awakening that have directed the course of her career and propelled her rise to leadership through South Africa’s transition to democracy and beyond.

We explore some of the challenges she has encountered as a woman in leadership and discover the strategies she employs to navigate power differentials, political complexity, and personal sacrifice. All whilst remaining deeply grounded in her commitment to faith, family, and service.

Join us for a thoughtful exploration of the inner workings of both a health system in transition and a servant leader with enduring grace.

Chapters

• 0:08 Awakening as a District Surgeon
• 13:47 From Personal Loss to Healthcare Service
• 29:03 Rising Through Leadership Ranks
• 47:57 Navigating Leadership in Western Cape
• 1:09:12 Culture Change and Reflective Practice
• 1:19:52 Life Beyond HOD
• 1:26:28 Leading Through Budget Cuts

Transcript

Prof Beth Engelbrecht: 0:00

You spoke about awakening and that was one of the awakening moments for me, or periods for me, was when, as a district surgeon, you had to examine women who've been raped and also people who have got social welfare pensions, old age homes, special homes. So that was the patient cohort that I was looking at. I could recall, e very Saturday morning, Sunday morning, you are called out to examine young girls and women who allegedly have been raped. At the time, we didn't have computers, so I had a little card system to keep record of every person that I've examined, to make sure that I've got a good record, make sure my record keeping was proper. And then we had a meeting with the South African police service of the time, and in the meeting somebody said, you know, they are so surprised there's no rapes in the black communities. I said, what are you talking about? This is what I see every Saturday and Sunday morning.

Prof Beth Engelbrecht: 0:58

So that night, I went back and packed all these cards on the carpet out and made my own analysis, and I wrote back to them and said this is what I've seen, without giving names. I said this can't be. We have to work on what's happening in our communities. And then I realised to work in the system is very nice, very protected, but for me to make a difference, I need to work on the system, so I need to find a way by which I can be in a more leadership, decision-making role, to be able to steer the system, to prioritize the right things, and to make sure that we take care of those communities who are vulnerable and who need our care.

Dr Maria Christodoulou: 1:41

Welcome.

Dr Maria Christodoulou: 1:42

I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions.

Dr Maria Christodoulou: 1:53

Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. Joining me today is Professor Beth Engelbrecht, family physician and distinguished leader working at the forefront of health systems strengthening in South Africa. Beth has over 30 years of experience in the public health care sector, with leadership roles spanning both the Free State Government, where she supported the transition into a new democracy, and the Western Cape, where she served as the former head of Department of Health. Today, Professor Engelbrecht holds academic affiliations with both the universities of Cape Town and Northwest Province, where she is contributing to the development of health systems leadership programs and the establishment of a new medical school. I had the privilege of working with Beth for a short time when she was head of the Department of Health and I've come to know her as a dedicated servant leader who is passionate about ethical, value-driven leadership and governance, and shaping resilient learning organisations for the future. Welcome, Beth, it's a privilege to have you with us today.

Prof Beth Engelbrecht: 3:02

Thank you very much. Likewise, you've got an impressive series of podcasts, and I'm very humbled to be part of your journey as well.

Dr Maria Christodoulou: 3:09

Thank you, Beth. I really appreciate that. I'm so grateful that people are listening. It means a lot. Also with us today is Amy Kaye, producer and editor of Awakening Doctor. Welcome, Amy, nice to have you with us.

Amy Kaye: 3:21

Thank you, lovely to be here as always.

Dr Maria Christodoulou: 3:26

So Beth, as you know from listening to previous episodes, my first question is always where do we begin?

Prof Beth Engelbrecht: 3:32

Thanks for that question. I must say I've been thinking about it a lot and, just on reflection, there's three broad chunks of story in my journey. I wanted to start with my journey as a senior leader and HOD in the Western Cape because that was such a profound experience in my life, but then I realised you need to have some context for that story. So I'll reach back very, very slightly. What happened before I joined the Western Cape and why that was important in my growth journey towards being in the Western Cape. I think importantly, I've listened to some of the other podcasts. There are people with these most amazing stories of idols, of role models etc.

Prof Beth Engelbrecht: 4:17

And then I realised, for me, my dad passed away when I was 12 years old. My mother was a secretary and she had the three kids of us she had to put through journeys of learning, and I learned to fend for myself in that period. There was no other role models. And then, particularly for me, I had a very good relationship with a pastor who did his work in the coloured communities of that time and it had such a profound impression on me, on our vulnerability and our absolute dependence on the Lord and on the fact that we've got a saviour. So I realised, for me to rise above, I need to work very hard on myself. I need to work hard and I did that. For me it was no effort. I just studied hard and I played hard. I achieved a lot in my sports career and school career and always it was just a feeling of destiny. I think it also built my inner motivation and to me, when I started in the Western Cape, that inner motivation and inner strength was something that carried me through my career.

Prof Beth Engelbrecht: 5:20

In my school years I was surprised to be selected as the Head Girl of the school, but then, on reflection, at the time I was the victrix ludorum of the school for athletics and netball. I was the Griqualand West Woman of the Year sportswoman. So surely these things contributed, but for me it was just, this is what I did, and my belief system is to tell you you don't deserve anything. You work hard but you don't deserve it, and it's always grace.

Prof Beth Engelbrecht: 5:48

I had the opportunity then to have bursaries to go study. My mom's secretary salary was a bit thin for that purpose, so I had a bursary in academic as well as in sport and I could go to the Free State University to study medicine, and it was an amazing experience. I was in the residence there, a female residence, and found myself again in a leadership position when I was elected to be the Primaria of the residence. So, somehow I found myself very often in leadership roles and in that period my journey was also about sport, about learning hard. I recall in matric I had full marks for maths and to me it was just you know, thank goodness, it's hard work, I got it.

Dr Maria Christodoulou: 6:31

Right, and why medical school?

Prof Beth Engelbrecht: 6:34

Interestingly for me, it was just always, it's not about me. There were two particular incidents that happened that had this compelling compassion in me to be there when people need support, and the one was, there was a motor vehicle accident just in front of our home when I was at high school and I realised, I do not have the capability to be of any value in that circumstance and I wish I could be capable of being something to those people. The other one was in 1975, when I was in matric.

Prof Beth Engelbrecht: 7:11

It was the year that my brother and all his friends and everybody that we knew, the boys, had to go to the army, and that was the very sharp end of the war on the Angolan border. So many of these young boys who did not really have a choice but to go. They came back traumatized. They lost limbs and arms and eyes, and they're so traumatized. I was aware that there was very limited, if any, support for those young men and I had this desire to be able to be of value in circumstances like that, and then obviously I had academic strength to be able to do that. So no, it was not a difficult choice and I was very happy to be admitted to the medical school.

Dr Maria Christodoulou: 7:54

And I know you went on to study family medicine, which I imagine was a fairly new discipline in those years. So what was it about family medicine that spoke to you?

Prof Beth Engelbrecht: 8:04

I had a desire to study further. At the time I was starting a family, and at the time, family medicine was a part-time course in Free State and you could do that in modules. So that was suitable for my circumstance. My husband was working full-time. F our kids at the time. Really quite demanding, but I could do that. So I did family medicine. I also did two diplomas after that. So family medicine, I think it fit in with my commitment to primary care but also to be of more value to the system.

Dr Maria Christodoulou: 8:38

Right, I feel like we've jumped from entering medical school, being elected as the prim of the res and loving medical school and then witnessing all these things. Partly at school, the accident in front of your home, your brother and his friends' experience, but also losing your father at the age of 12. I mean, we haven't spoken about how that happened and I'm wondering if that played a part in the decision to study medicine?

Prof Beth Engelbrecht: 9:03

My dad passed away due to a myocardial infarction. It was completely unexpected. Perhaps my mom knew, but I was not aware that he had angina from time to time and I was still at school and they came to call me and say, look, your dad passed away. It was halfway in grade eight and we had to move from Hartswater, where I was in primary school, to Kimberley. Fortunately, we had a home in Kimberley so we could go back to that home. So no, it didn't really influence my decision, but obviously at the time it would have been good for me to know that he had the condition so that I could understand better what has happened and what the risks are for the rest of the family.

Prof Beth Engelbrecht: 9:46

I think since my dad passed away, my mom was busy all the time. My brother and sister were busy with their lives and I was always working on myself, playing sport, being busy, meeting friends, studying hard. For me it was like a non-eventful period of my life, but clearly I worked hard to be able to live up to what is demanded and also I realised my mom doesn't have the financial means, so I need to be able to look out for myself as best as I can and to be as best as I can be for what my future needs.

Dr Maria Christodoulou: 10:21

Right. And when did you meet your husband? Again, we jumped over like starting medical school and suddenly you have four children and a husband. How did that all happen and unfold?

Prof Beth Engelbrecht: 10:29

Whilst I was at university, I was very active in athletics and competed nationally in athletics, and my husband was also in sports training. So we met on the athletic field. He was in a residence next to ours. We started to communicate. We had like a Cremora bottle that you put letters in and then you control the bottle to the one res and then throw the bottle back with letters, and during exam times, that is what happened. So there were letters going up and down, up and down, and he started to write with me. I didn't know him at the time, so it's just through the letters that I learned to know him and then we just built a relationship.

Prof Beth Engelbrecht: 11:10

So he's in a completely different field. He studied physical sciences and business sciences and that is his field. And even in his work life he was in a completely different journey, which was actually great. Then one is more whole if you've got all these other perspectives adding to your life. Interestingly, I mentioned the fact that there were no role models for me, apart from reading the Bible. That is where my role model came from, but my mother was one of 13 children and she was the only one who had matric, so at that time, that was quite an achievement. So clearly she did secretary work. But she had shorthand and 'snelskrif,' two different ways of writing fast when you were a secretary, and she could do both. I was always so amazed by that skill that she had.

Dr Maria Christodoulou: 12:02

Well, you're reminding me of a different era, because when I was at school, I'm sure it was the same with you, shorthand and typing were subjects that you took till matric if you wanted to.

Prof Beth Engelbrecht: 12:11

Exactly, exactly, and today I'm sorry that I didn't take typing because, boy on the computer with the two fingers, it's not going as it should be.

Dr Maria Christodoulou: 12:22

I taught myself to type with one of those computer tutor programs which taught the correct fingering. But now I look at my nieces and nephews and they just teach themselves intuitively how to type.

Prof Beth Engelbrecht: 12:32

Yes, you're right, ultimately it's muscle memory and you just get it done.

Dr Maria Christodoulou: 12:36

And the four children, tell us about them. When did that all happen and where were you in your career while that was happening?

Prof Beth Engelbrecht: 12:44

I was still a district surgeon. So after my studies I had a bursary to work for national government at the time and I then had to work the bursary back four years, so I was just starting to work it back, though clearly the benefit of that bursary was compelling commitment to work back is that you had a job and you had a salary, so that was really useful. And then we got married a week after I qualified with medicine and two years later the first eldest daughter was born, and then within five years I had four kids. It was just one of those roller coaster things. In that period, I was a district surgeon all the time because that was the job that I had to do for national government.

Prof Beth Engelbrecht: 13:29

You spoke about awakening, and that was one of the awakening moments for me, or periods for me, was when, as a district surgeon, you had to examine women who've been raped and also people who have got social welfare pensions, old age homes, special homes, so that was the patient cohort that I was looking at. But the one thing that affected me quite significantly was that I could recall every Saturday morning, Sunday morning, you are called out to examine young girls and women who allegedly have been raped. At the time, we didn't have computers, so I had a little card system to keep record of every person that I've examined, to make sure that I've got a good record, make sure my record keeping was proper. And then we had a meeting with the South African Police Service of the time and in the meeting somebody said you know they are so surprised there's no rapes in the Black communities. I said, what are you talking about? This is what I see every Saturday and Sunday morning.

Prof Beth Engelbrecht: 14:29

So that night I went back and packed all these cards on the carpet out and made my own analysis and I wrote back to them and said, this is what I've seen, without giving names. I said this can't be. We have to work on what's happening in our communities. And then I realised, to work in the system is very nice, very protected, but for me to make a difference, I need to work on the system. So I need to find a way by which I can be in a more leadership, decision-making role, to be able to steer the system to prioritise the right things, and to make sure that we take care of those communities who are vulnerable and who need our care. Then I applied for leadership positions and then, at the age of 32, I became a director and it was, you know, one of the youngest directors in the system. And then I learned a lot. I remember my husband, I said, I'm in a management position and he bought me a book, Help, I'm a Manager, by Arnold Mol, because the head office was in Pretoria. I was in Bloemfontein. And now you sit and you have to do things. You have quite a daunting experience, but the most amazing people that I've worked with and committed, and I must say, in that period we built clinics, we did a lot of good things and I learned a lot in that period from the people that I've worked with.

Dr Maria Christodoulou: 15:54

I imagine there weren't many women in leadership roles at that time, or am I mistaken?

Prof Beth Engelbrecht: 15:58

No, you're absolutely right, it's a men's world. Even in my study years it was a men's world. Being socialised in that reality, you didn't question. That is what it is. In the leadership positions, you realised that the approach of men was different to what you are inclined to be. Clearly, one learned how to navigate that and how to make sure that men feel respected and that they feel stroked. I think you're right.

Prof Beth Engelbrecht: 16:27

I think I was the only female director at the National Department. I didn't keep count, but I know that I was definitely the minority in the meetings. And then, how you phrase your, what you say, how you organise your contributions, it was a strategy. Because very often, I remember there was one of the DDGs at that stage and they were still smoking in the boardrooms, you couldn't breathe, and I made a contribution and he answered. He said, "Meisietjie.” I thought, oh my goodness. So, you know, you're cut to size. And how do you stand up in that power imbalance to be able still to make the difference that is needed for the system? Yeah, so that was quite a learning journey.

Dr Maria Christodoulou: 17:14

I can imagine. So how did you respond to that?

Prof Beth Engelbrecht: 17:18

Look, at the time I was very young and obviously he was much older than I, much more experienced, and in a much more senior position. So you don't immediately react, but you go back and you rephrase how should you approach that next time? And I must say I was very proud when I could start making contributions and that people were listening to the contributions because they were sound, they were based on experience, they were based on data, they were based on real facts which they could not deny. That helped a lot.

Prof Beth Engelbrecht: 17:53

In my journey, a bit later on, I experienced a lot of bullying from people in more power - men - and I tried to understand, why am I being bullied? And then somebody told me but Beth, you are threatening this person because you are good. So this person's identity is being challenged because you are standing up for things that's right, and you are performing very well, even if you are a young woman in the system. That bullying journey was quite traumatic. But then also, stepping back in my belief system, things don't happen to you, things happen for you. Look, Beth, this is your growth journey. You grow through this and this person will not be there forever. You go on and you do what's required and you stay true to your destiny.

Dr Maria Christodoulou: 18:45

Sjoe. I imagine that takes a lot of courage and a lot of strength.

Prof Beth Engelbrecht: 18:53

But I must say, I was on my knees a lot of the time. It was a consistent thing of doing, and the key thing is you are a leader in yourself. I was a leader of a team of people who very often are in the same meeting where this happened. Now in the meeting, you can't react and go against that, because then you bring discord in the meeting. So for me, outside of the meeting, then challenged this person and then said, but this is not on. There was a time that I just challenged in the meeting as well, because then I realised, now it's about being true to myself and also for these people to see that what is happening here is not on. This should not be how we treat each other in our system.

Dr Maria Christodoulou: 19:34

Right. I remember a conversation that you and I had where we spoke about Jesus going into the temple and overturning tables and throwing things around and how sometimes that kind of behaviour is appropriate when it's in service of something bigger.

Prof Beth Engelbrecht: 19:51

Thanks for reminding me about that. What is best for the system and what is best for me and what is best for the team, and always try to balance all of that. If there's discord, it's not good for the system. If there's discord, it's not good for the team and it's definitely not good for me. And, as you rightfully say, ultimately you have to go against that behaviour and you have to confront that, even in public, and that happened a few times and actually, I realised that I should have done that earlier and be brave enough to do that. As I said, I always thought the system is bigger than me and my emotions and my feelings. The system must be respected all the time.

Dr Maria Christodoulou: 20:30

Sjoe. So here you are, Director in the Free State Province in the same time as government is transitioning into a new democracy. What was that like?

Prof Beth Engelbrecht: 20:44

It was exciting. I must tell you. You learn a new language, you learn people, you can go into communities, you can meet with community leaders and you are accepted because you are now part of the system.

Prof Beth Engelbrecht: 20:57

It was really great, and also the ability… At the time, the funding was differently available. We could build clinics for communities, we could consult with them on the design and everything, and so it was a very dynamic period where you could make a difference and you could take your team with you. We built clinics... I say we, but the Free State government at the time, as part of the clinic upgrade and building program. It was a particular program at the time, and obviously dependent on the provinces to be able to drive that forward. So we were very fortunate to be able to partner with the Free State mines and they would help us with the quality control of the buildings, whilst we provided the funding and made sure that the right tenders are provided, but they would look after the quality. It was the most amazing partnership. We built, I think, 13 clinics within a year and the quality was outstanding and the communities were very happy about that.

Prof Beth Engelbrecht: 21:56

It was actually also the time where I had the privilege of meeting Nelson Mandela. It was in Thaba Nchu. He came to open the clinic. Everybody was waiting for him at the front door and I said, Oh Beth, you stand at the side door. You know, who are you. And here he came through the side door and I could greet him. He had the ability to look you in your eyes, and for that moment, you are the only person that's important in that place. It was an amazing experience. I will never forget that.

Dr Maria Christodoulou: 22:26

Wow, I was going to ask you what some of the highlights of the career are. It sounds like this was one of them.

Prof Beth Engelbrecht: 22:37

Definitely, and perhaps linked to that also is to learn how to... opportunistic when the environment is right. At the time, because funding was more available, there is this clinic upgrade and building program, so those who could jump fast and get their plans in fast could get the most money. So obviously, that is what you do. So we really did very well and at the time it was also, I could motivate for funding to be able to take over ambulance services, which was actually not in a good state and at the time it was run by the municipality. So I motivated and we got the money. We took the services over. It was a period of growth, of strengthening the system, of seeing development. It was really great. Obviously, I was there until I left the department in 1999. Clearly, since then things was different and I was in a different space of my journey.

Dr Maria Christodoulou: 23:29

You talk about how dynamic that time was and the opportunities that came with the shift in government, and the funding that was available, and the clinics. What was the shift? From what to what? What were the priorities before this transition happened and how did those change?

Prof Beth Engelbrecht: 23:46

So it was a very fragmented system. So we had the National Department looking after primary health care and the provinces looking after the hospitals. So that was fragmentation at the time. So clearly, primary health care was not a priority for the province who are now the new government, the provincial government, and it was then a very exciting shift, and I think the recognition from the ANC health plan at the time, to invest in primary health care and the district health system. It was so energising, and also the ability to find different expression, your own creativity, innovative, and it was acceptable etc. So ja, it was a great, great period, that particular transition time.

Dr Maria Christodoulou: 24:28

And how did it come to an end? You say you were there till 1999, and then I know you spent almost 20 years in the Western Cape. So what prompted the move?

Prof Beth Engelbrecht: 24:35

My husband was transferred to Cape Town. I was then approached by the Health Systems Trust, which is an NGO. I'm sure they heard from somewhere that my husband was transferred and I would be looking for... But they actually approached me. I was actually so grateful. So they approached me and I thought, what an opportunity. Now, I always believe, you know, it will not come my way if it should not come my way.

Prof Beth Engelbrecht: 24:56

I then moved to Cape Town and I worked from Cape Town for Health Systems Trust. My focus was on the initiative for sub-district support. So we focused on sub-districts across all the provinces and I worked in eight of the nine provinces. So all provinces, but not the Western Cape. Which was... so you built relationships. It was really so fascinating. People were so hungry for different insights and learning and growth and system enablement. It was really a great period and I learned a lot. We started to document certain things and I worked with universities and it was again, such a fulfilling period.

Prof Beth Engelbrecht: 25:38

So it was for three years that I worked with Health Systems Trust, but then I realised, for me... So every time I want to connect with a sub-district, I need to be on top of what is the new policies. So I need to work very hard to get a better understanding to be able to influence that. And then I realised, but I'm starting to lose the cutting edge of new policy development and I need to move on. Then the DDG post in the Western Cape was advertised for all services. It was a new post and I applied and, I jumped directly to being a director and now I jumped directly to be a DDG when I was successful for the post.

Prof Beth Engelbrecht: 26:24

And you know, it is one of those things... In the Free State my focus was primary healthcare clinics, ambulances and then suddenly, all services. I recall driving past Groote Schuur Hospital and Red Cross, looking at these monster facilities and then, oh my goodness, Beth, you are now the manager and the leader of these magnificent places and you're only one person in the Western Cape. I recall the person who was tasked to orientate me also applied for the same position and obviously was not successful.

Dr Maria Christodoulou: 27:04

Oh dear.

Prof Beth Engelbrecht: 27:08

So he was then tasked to orientate me, which was a total of 20 minutes. And then I realised, you have to find your own orientation. Now you don't know whom to trust, you don't know where to find what information. It was a new office, so there's no records, there's no files, there was nothing. But yet, you know, to me, and I think this inner strength that I've learned over the years carried me very well in this period, because I knew this is where I should be. I now need to make the best of it and I must say I systematically went forward. Be visible, try to understand the system, making the best of opportunities.

Prof Beth Engelbrecht: 27:44

An anaesthetic machine at Groote Schuur Hospital stopped while the patient was under the operation. It came to my attention, and I said, but this can't be, this is the Western Cape, it can't be. And then I asked our person in charge of medical equipment to please do a survey for me, just to get a sense of what's happening. Why is this happening? And they came back after a while and said look, Beth, we are 300 million - that was many, many years ago - 300 million short just to replace current equipment, not even new. And I said but this can't be. So I went with that evidence to Treasury and I motivated to say that look, we can't do this. And fortunately, I had a real example of the risk of the anaesthetic machine. So since then they gave us 40 million a year for equipment and we could fill that up. And then I realised I can make a difference. I am making a difference and I am in touch with the core of what the system needs are. And to me that was an important development for myself, but then also for the team I was leading.

Prof Beth Engelbrecht: 28:53

Then they could see the value, they could see that things can be done for the system. Fortunately, my nature is not to boast about these things. It's about you do what you have to do and you're humble about it, and I think that also helped. If one is in a circumstance, that you keep on... it's not about you, it's about the system.

Dr Maria Christodoulou: 29:14

I must say I'm thinking about what you said, about how, even when it was really difficult, you knew this is where you are supposed to be, and so you found ways to make it work. And I'm reflecting on my own experience and thinking about how, when everything feels like it's against me, my tendency has been to go maybe I'm not supposed to be here. What gives you that real conviction that this is where you are supposed to be?

Prof Beth Engelbrecht: 29:41

I think it's my spiritual connection and my absolute belief that my role is to be where the Lord wants me to be. What I do should always be to the glory of Him, and I must grow so that I can be more worthy for the role that he wants me to play. So clearly for me that was a no-brainer. This is where you are, this is where you've been placed, because you've prayed about this job, you applied for it, and he gave it to you. So to me, it was not such a big deal. But to go through those motions I realized that is part of my sanctification, if you want to call it that. Like a lion's den, especially those big hospitals, the powerful professors that was there.

Prof Beth Engelbrecht: 30:19

Unfortunately, at the time, there was not a lot of investment in relationships in the department. It was competition, it was in-fighting. To me, it was a surprise. I came into this massive organisation. You know, the Western Cape was the place, the province in the country. I thought, oh my goodness, a nice cushy job. I suddenly realised it comes with a lot of thorns, so it was an awakening for me to know that a place can perform very well, even if there's a culture that is really undermining but it's not sustainable.

Prof Beth Engelbrecht: 30:55

So it was important for me then to build on relationships, to make sure that we can make things work, to work on trust, to work on understanding each other's realities, especially because if the budgets are cut, it's usually the big hospitals' budgets that are cut.

Prof Beth Engelbrecht: 31:10

Everybody wants to do the best they can and every time they are cut they have to reduce. And how to connect to people, to bring out rather their creativity than their fear and to work... And I must say, when I was HOD, this was also one of my mantras. Let us not have a spirit of scarcity, let us have a spirit of abundance. So when you are in a situation where you feel dire, approach it positively, approach it with hope. Approach it that you know that you're actually in a very privileged position, a very privileged province. So work on the abundance and not the scarcity. And I must say the sense was that people found that very energising. You were able to think differently about their realities.

Dr Maria Christodoulou: 31:57

What stands out for you about your time as HOD?

Prof Beth Engelbrecht: 32:01

When I was HOD, the one thing that I actually remember, my term started the 1st of April, but Craig Househam was my predecessor. He was en route saying goodbye to everybody, and so I started to chair the top executive meetings, and this particular one was in, I think, February, March, and there were terrible fires on Table Mountain and one of our managers house was threatened by that and she then talked about how good people were to bring water and bring everything to support her.

Prof Beth Engelbrecht: 32:33

And then I said in our meeting, let us have a reflective part where we just reflect on the goodness of people. And I was amazed how people responded to that. Just the need to connect differently and to be able to reflect. And there I learned the value of reflective practice, even in busy meetings, and how people respond to that, and actually, your meetings become much shorter because people got that off their chest. That emotion is off. So that stood out for me. To be able to start a journey of building reflective practice, to be more connected to each other. And I think that also started to lay the foundation for the culture change in the organisation, where this was about us as leaders. We always said that if you've got influence over only one person, you are a leader, and you have to show leadership behaviours and live the values. So clearly that message somehow it was quite rapid that it filtered through the department where people then started to talk the same way. Leadership behaviours, reflective practice make our meetings reflective and learning in the beginning, and change the language from judgmental and blaming and fear to constructive. I was very fortunate to be able to be kind of spearheading. But the whole team... It was not me alone, it was the whole team. I must say the whole team worked on that and how we took it forward. We also worked very hard and I think that's also something that stand out for me was the opportunities to be present in facilities. So we would put a kombi of managers together. We'd have our meetings in decentralised places, but the first part of that meeting is asking the local managers, what would you like us to have on our agenda today? And that helped us to check whether we are in touch with the frontline and I'm very grateful to say that more than often we were spot on with what is on the agenda. So people felt also connected to the frontline and I think that leading by example helped a lot.

Prof Beth Engelbrecht: 34:37

Two years ago on this day, you had your interview with Keith and he was part of this journey. And look, he is just one of those amazing leaders and I was so privileged to have him beside me when I was HOD. There's no way I could have achieved what I did without a person like him and obviously the rest of the team. So we moved around, we visited facilities, we visited places and if there was a crisis, like the hospital in Swartland that burned down, you go there, you talk to the people, you listen and you connect and then afterwards you reflect. What did the managers do? What did we do as an organisation? How did the patients get redistributed across the platform? How did we give support to them? And that reflective learning also became practice across the whole department, and to me, those are things that stand out, which I am really very privileged about.

Prof Beth Engelbrecht: 35:30

So in that time, I always said the Lord must love me tremendously, because from the first year, our budget were cut significantly. So for the whole five years that I was HOD, our budget was cut every year. So we said look, never let a crisis go wasted, never let a personal trial go wasted. So I had to work on myself in this period. You know I have to work harder and pray harder. But then, particularly, I took that message to our whole system. I said look, guys, you can either be a victim of the situation or to take charge, and I would like us to take charge. And I recall at the time it was 2016 and Wayde van Niekerk broke the world 400-meter record at the Olympics. Now he was in the outside lane and I looked at the stats.

Prof Beth Engelbrecht: 36:22

In 95 years, nobody who drew the outside lane could ever win the 400 meters. So I used that as an inspiring example to say that, look guys, if Wayde can do that, we can do that. We are in the outside lane. Let us work to be able to win this race. And I must say that people were amazing. So we used that opportunity then to say that we've always been worried about the front line saying the centre is top heavy. Let us, then, work on the centre that is seemingly top-heavy and let us move resources to primary health care, to the frontline, to allow people in the front to be the best they can be. And it was not a trauma-free process, because some people were more sharply affected by that and others were benefiting. You know they say that for such deep-seated, massive change experiences, more than 70% do not succeed.

Prof Beth Engelbrecht: 37:22

Now, clearly, from my perspective, and I left in 2020. In the weeks before I left, we signed off on the outcome of the macro restructuring and we started to move people around to be able to give effect to the new arrangement and we could cut down and move resources to the frontline. That stood out. It was a difficult period but we had a team and we connected to the frontline. We consulted with about 3,000 staff members at the time and people were so willing to contribute to the change because they believe that this is for the greater good and this is what we need. I think, that shared vision, that shared purpose. Ultimately, that stood out for me.

Dr Maria Christodoulou: 38:03

Right. All of that says a lot about you and your leadership style, though, and if I remember correctly, you were the first woman to be head of Department of Health and, so far, the only woman to be head of Department of Health, right?

Prof Beth Engelbrecht: 38:16

In the Western Cape, yes. I was the first female HOD and Minister Mbombo, whom you also interviewed, was the first female and black female MEC. So we came in at the same time, and it was actually such a privilege to work with her, I must say. Her ability to connect to communities and bring that strength into the department. So, you're right, I was the first female, but interestingly, when we had our first top executive meeting when I was now head of department, the 15 people around the table were exactly the same. It was just that the previous HOD left and a new person took over that chair. But the dynamics in that meeting just changed significantly and clearly,

Prof Beth Engelbrecht: 39:01

Whether it was me as a female, or it was just the fact that there was a change, I was so grateful to observe that. And also in provincial top executive, we were two women. You could see the difference in approach. So being a woman, for me, was a strength and not a disadvantage. It remains a man's world, but the fact that one could harness and I think you, specifically Maria, brought it to my attention that technical competencies and relational competencies are equal sets of competencies and I should not steer away from investing in relationships, and that to me was so energising and it gave me freedom to be able to be on that journey of building relations and also speaking about that, and I had such positive feedback about exactly that point.

Dr Maria Christodoulou: 39:50

I remember conversations with you where we were talking about things you had done and your relational insights and competence was shining through. Everything you were describing was about the people, about the relationships, about building relationships, about bringing people along, and you were almost apologetic for it a lot of the time. And I remember us having conversations about how, in a patriarchal model, those things are not deemed competencies, they're not deemed skills, they're sometimes even perceived as a weakness and might even undermine the perception of leadership in some settings. And yet there was such an incredible strength that you brought to the system. And I remember the email you received from somebody saying, I think it was after one of the speeches you gave about the department and where you were at. You got an email that described your time of leadership as the dawn of a new era.

Prof Beth Engelbrecht: 40:42

True, yes.

Dr Maria Christodoulou: 40:47

And I really do think that was true. I do think you brought something really new and different to the table, and you mentioned Keith, so I'm going to bring this up. I know that the two of you were both in the running for the same position and he spoke, I think, briefly in the podcast conversation about the fact that not being made CEO was quite a formative leadership challenge for him. What was it like for you to then, to be appointed over Keith at the time? And I know the fact that you were a white Afrikaans woman also played a role.

Prof Beth Engelbrecht: 41:15

So there were three of us in the department who applied and who were shortlisted.

Prof Beth Engelbrecht: 41:21

So I took the initiative to take the three of us for coffee because I was the more senior of the three. So I took them and said, look guys, one of us are going to be the HOD. We, today, need to commit to each other. Whoever that is, we will support each other. Even at that session it was a difficult conversation with Keith because he was so focused. He's such a brilliant person so I can understand his extreme disappointment. But I'm glad also I listened to his interview that he found and I think he matured amazingly the way that he approached the disappointment, but also used that as a growth point for him. An awakening. And I think the fact that he, and I really honour him for that, he took up that commitment that we gave to each other that he will stand by me. People were saying, oh, my goodness, you are inseparable, you're talking the same thing. Every week we would spend an hour or two just talking about the department, talking where to go, talking how do we approach certain things, and it was really one of those most valuable relationships I've ever had and you know, what was important for me as well, is that we're in the department. We have a process where we appoint the next head of department quite in advance, so he was appointed already in November 2019. And my term ended March 2020. And then COVID struck us January 2020.

Prof Beth Engelbrecht: 42:52

And obviously, he came in when COVID came and, as you know, Western Cape was hardest hit, and what was for me a very rewarding experience was when he asked me to say Beth, I want to give my attention to running the department. Can you stay on for another six months just to help with aspects of COVID, especially the inter-governmental aspects. So I felt trusted enough and that our relationship was strong enough and there's no competition. It was just... He allowed me in his space and that says a lot about him. So, for me, it was a very rewarding experience to be able to still contribute and then slowly let go.

Prof Beth Engelbrecht: 43:30

But I must say, I made the most of it. Because of my care for the vulnerable, the people who are affected and don't have choice, our staff members who were affected and kept on coming to work. I realised the pressure on them. With my commitment to learning, we started with what we called the #StaffCare, which is a learning session every six weeks where, for an hour or 90 minutes, we came together and we invited hospitals and clinics and services, even Labour to come and talk and give us an input on what have they learned and what's happening in these spaces. And so it went on for, I think, a year, two years, and ultimately, so we regularly focused on how to care for our staff.

Prof Beth Engelbrecht: 44:17

How does staff feel? Because top executives had to deal with the politics and the communities and the what, and the staff needed to be cared for differently or more. Also, the fact that we could build a strong relationship with unions during that period was also to say that they were so fearful, they have to play a role with the union members, but they don't know how to approach it. So we kept them informed every step of the way so that they could be our voices in spaces where we could not be.

Dr Maria Christodoulou: 44:51

So again, the prioritising of relationships, and I love the humility that says Keith was so generous to invite you into his space even at the time when you were supposed to be leaving. You invited him and the other person who was in line for your position to a meeting even before you were appointed and then you kept them in the space in a way that built the trust and the safety and allowed them to welcome you to stay on in the space afterwards. Almost feels like there's still a little bit of a theme of underplaying your own relational competence and what you have brought to the table in all of this, and I also love that ability to really see other people and their contribution and create the space for them to shine, because I really think you do that extremely well.

Prof Beth Engelbrecht: 45:37

Thank you very much for that and I think that's a commitment. They say the biggest role of a leader is to develop other leaders, and how do you do it differently than to put them in a position of decision-making and to be able to shine? There's nothing that helps you to grow more than you feel that you are accomplishing something. Thanks for that observation.

Dr Maria Christodoulou: 45:59

Well, I think you've skimmed on the surface of the fact that you were bullied a lot in your time and, for all intents and purposes, you turned out to be a really good leader. One could argue that bullying also turns out good leaders. What do you think the difference is between bullies who are leaders and the people that do it the way you've done it?

Prof Beth Engelbrecht: 46:21

They often say that a bully is an organisational psychopath. So people who bully are very often, if you go back into their history, they've got an identity issue and one needs to understand that, although it is personal. But you also need to say that there is something behind this person and you should admit and recognise that. Very often, the bullies are successful leaders because they manage with fear.

Prof Beth Engelbrecht: 46:51

And if they are in a position of power, obviously people are fearful and they just do what is asked so that they just comply, not because they want to, because they have to, and my approach was rather to instill a purpose and a vision and the inner motivation to say I want to comply than to compel. And I must say I was extremely honoured when, in my term, I think it was my second year, we became the first health department with a clean audit.

Dr Maria Christodoulou: 47:21

I remember. The first time ever, right?

Prof Beth Engelbrecht: 47:22

Ja, the first time ever. So, ja, and again, it wasn't just me. It was the whole system, and clearly I stand on the shoulders of the people before me, and I know that Keith could take that forward. That was so amazing and to me that was just evidence that if people are doing it for the right reason, for the system, for really working with public money, that they understand that better, then we can get a clean audit. So that, to me, was really great, and that was in the period that, despite budget cuts, despite everything, our health indicators improved, our audit outcomes improved, people were better connected and I think also, and the feedback to me was, the fact that we invest a lot in relationships, in the culture, in making sure there's a purpose and there's a vision and people abide by that, that helped a lot when COVID struck. That there was elasticity in the department and that people were already connected. There were already relationships and one could just build on that, because it was a time of fear and uncertainty. Clearly then, it's easy for people to unravel.

Dr Maria Christodoulou: 48:26

What was it like to step away from the HOD role just at the beginning of that big pandemic crisis? Because I know, when we spoke a year or so before, that you had made a decision that you were only going to serve out the five years and you had in fact promised your husband that you were not going to extend your term, but you were acutely aware that there was still so much that could be done and so much you could do. So what was it like to have to step away just as this pandemic was unfolding in our country?

Prof Beth Engelbrecht: 48:56

So I think the one part of your question is what was it like to step away? That busyness, being in the heat of things, was so amazing and I knew there's so much still to be done. Yet you sit with a team that is so strong. You know that they can go on. You know the system is not good because only of you. The team is carrying that forward. So that to me was an easy shift.

Prof Beth Engelbrecht: 49:20

And then, obviously, my commitment to my husband, and in that period that I was HOD, he was doing the groceries, the washing. Our kids already, you know, they left school, they were starting to be parents themselves. So clearly there's other things that the new season of my life demanded of me and I wanted to do that. I know that the Premier approached me to continue, et cetera, but I said, Premier, thank you very much. I really feel honoured by this request, especially now that COVID started. But I knew the team was strong. We had a strong data system to be able to communicate. So everything was in place and what I did in January already of that year, I asked Keith to chair and drive the whole COVID response, so that he was already taking fully that responsibility. So by the time I left he could just continue. I think that transition was great and then fortunately, as I said, I could continue with the #StaffCare. So I was kind of connected in some way. Then letting go was easier at that time.

Dr Maria Christodoulou: 50:21

One of the things I wrote down in the many notes I made during our conversations was something you said in the context of navigating complex relationships in the department and also navigating power differentials in the department, and we've spoken a little bit about bullying and abuse. But the words you used were people have aspirations, histories and scars and things are seen through different lenses. How do I respond to that without adding to the damage? And I'm curious about your own aspiration, histories, scars and the lens that you grew up seeing the world through and how that informed what you did in the leadership roles that you've had.

Prof Beth Engelbrecht: 51:14

That's quite a mouthful question, but you're right. I think the issue of navigating complexity and navigating power differentials has always been a big issue and I think, my experience and the scars from being bullied, helped a lot for me to observe that in others, to be able to protect. And I can recall that there was an issue about medical interns and junior doctors who've been bullied in hospitals and I stood up against that and I made a correspondence out to call anybody in the department who feel bullied to contact me directly personally, just to get the message across that this is not on. This is not part of our culture. I'm at the moment involved with mentoring several leaders and most of the issues that they are dealing with is navigating complexity, is navigating relationships, is navigating power differentials. Some of them are threatened personally. Their lives are threatened because of these things.

Prof Beth Engelbrecht: 52:11

And how does one support, and I'm very grateful for the experiences I've had to be able now to guide those colleagues and ultimately, it's not something that one should take personally, although it is very personal. How do you keep your crown on, how do you keep on the focus on what's the best for the community, and what's the best for the system, and what's the best for the team? And ultimately, it's not about you. It's about what is the best ultimately, but you're right, I think there's a lot of scars. One of the experiences I had was in one of our top executive brainstorming sessions. I think when people start being more comfortable with each other and they feel free to talk and the environment feels safe, they would start saying things that was never raised before, and suddenly the scars of Afrikaans culture and the scars of being in the apartheid years suddenly just emerged unannounced.

Prof Beth Engelbrecht: 53:11

It just emerged in the conversation and I realised, me as a white, Afrikaans-speaking woman, you are not equipped to handle this conversation. I admitted that. I said look, colleagues, clearly, there's a lot of scars and a lot of pain. But I think let us get some professional coaching to do group coaching for us to be able to deal with this, because we can't leave it here. It must be spoken about, but I don't think I am equipped and I don't have the makeup of the individual who should facilitate this conversation. You have to admit at the stage when other expertise that you need to bring in, but you also have to always stay true to what the system needs and what the team needs. They needed to talk about that, they needed to get that off their chest, and I think that was part of the reflective behaviours and reflective culture that we wanted to establish and I had to be true to that as well.

Dr Maria Christodoulou: 54:07

And what did you learn about what it means to be a white Afrikaans woman in the world, in South Africa at that time, with all of this emerging? Because this is the dilemma, I think, of leadership in this transformative time, is that you then open up those spaces where people start talking about those things and you say often one doesn't feel equipped to have those conversations. And again, it takes leadership skill to say I'm not equipped to have these conversations, but I'm willing to engage in a process where we bring someone else in to facilitate the conversations. Through those conversations, what did you learn about yourself?

Prof Beth Engelbrecht: 54:44

I think the critical thing for me was I realised I was more aware of the hurt that people have had and through which lenses I am observed, I am judged, if that's the right word. So I realise, not to say that I must go to being depressed about that. What do you do? You have to say that it was wrong. What you've experienced was wrong, it should never have been, and I apologise for that. Ultimately, do we let ourselves be defined by that, or do we say that we've got a job to do, we have to go forward, we have to make a difference, to go forward and not to have those things be repeated when we can have that change?

Dr Maria Christodoulou: 55:31

Yeah, so you've spoken about meeting Nelson Mandela as a highlight in your career, and I can imagine that must have been amazing. Anything else that stands out for you as a real highlight of your life and your story?

Prof Beth Engelbrecht: 55:47

Since I've moved on from being the HOD, I got involved with two universities. UCT, health leadership development, and with North- West University in establishing a medical school. And then also, with three universities developing a leadership program at the sub-district level in one of the provinces. I must say this is like the pinnacle of giving back, of paying forward, of just sharing with others what you've learned through all these years, because clearly there's a lot of investment made in me to be able now to pay forward.

Prof Beth Engelbrecht: 56:26

I'm part of the Oliver Tambo Postgraduate Diploma Leadership Program at UCT, where I lecture. No surprise, I lecture in people management and leadership ethics, and I'm also coordinating the mentorship program, where we arrange for every student to have their own mentor, and you know, what a wonderful experience. I'm also a mentor of a few leaders. To really connect to people in their uncertainties. Actually, you forget what you've learned. You forget that those things were still your questions as well, and now you can actually let that person leapfrog because you've been there. You can share it in such a way that they learn, not that you tell them. It's a new skill. This continuous learning thing, I love it. I learn how to... You're a brilliant coach, so I learned from your questioning and so on. So it's about how you approach, how you get people to think deeper on the issues, so that very often, especially as experienced leaders, you would jump to give a solution, because that's kind of, you want to be the hero. You know the answer. It's such an arrogant perspective. So it's kind of, understand better the reality, understand what are the assumptions that people make and why is certain things an obstacle and I'm learning how to get to that deeper understanding and for people to come to answer. So this is a wonderful experience.

Prof Beth Engelbrecht: 57:54

At North-west University, I'm working with an amazing team of people. They've got pharmacy school, they've got nursing, but they don't have a medical school, so they're now starting with a medical school, and what a journey. There's a team looking at the curriculum, but my job is to look at the relationship between the province and the university. Now, clearly, having worked with UCT and Stellenbosch and UWC and CPUT, the privilege our four universities in one province, and now there's only one university in one province, and it is an amazing experience how people want to make it work and how one could bring your insights and learnings from the Western Cape to another province, but also learn from other provinces and other spaces as to what would be the best for that circumstance. What I again learn, how many amazing health workers we have in this country.

Prof Beth Engelbrecht: 58:50

I'm blown away by what people do and what they're willing to do for the better of the system. It's so humbling to see that and to hear that, and then I'm privileged to be able to give input into that space. I feel like a blue- eyed girl to be able to do all of this nice stuff. You asked about, what's the highlight? I think this period of my life is an absolute highlight and I would really like to recommend to anybody if you can continue to contribute what you've learned, give it back to the system. It is so rewarding. I must say, I really love it.

Dr Maria Christodoulou: 59:28

I'm so happy to hear that. Do you remember there was a time when you had no idea what would fill your days or your time when you left the HOD role? You were quite anxious about that.

Dr Maria Christodoulou: 59:37

You weren't sure what you were going to do with yourself.

Prof Beth Engelbrecht: 59:40

No, that's true, and I don't think I was unique in that situation. But I just realis ed, we're moving to Franskraal and really, what do you do in Franskraal? But then fortunately, with COVID, Zoom and Teams came to the fore, and suddenly you can do so much without being physically there. So we've learned a lot and that opened so many doors. But also how people crossed my road. The person who approached me to work in the North-West University, I didn't know them from left or right. They came from Potch to Gansbaai to have coffee with me, to ask whether I would work with them. How on earth? The hand of the Lord. He kind of put me there and said you do this and this is where I want you to be. One remains so impressed by where your journey takes you and how one needs to be open all the time. Willing to learn, willing to do, willing to try things out and be humble about it, because you deserve nothing. It was just what came your way.

Dr Maria Christodoulou: 1:00:35

And I imagine that, alongside the story of your career unfolding, there's an entirely different story about four children and I know you're a grandmother too, right?

Prof Beth Engelbrecht: 1:00:45

Yes, we've got eight grandchildren, and I must say, you're right. That is now so integrated in my life. And you think that you have four children and eight grandchildren. How on earth do you have enough space in your heart for all of them? I can tell you, I can do with another twenty.

Prof Beth Engelbrecht: 1:01:04

It is so amazing. The personality, the growth, how they learn, how they mature. It is really amazing. We've got three girls and a boy. They are my confidants. I can talk to them about anything. They will approach me about anything and when I tried to do certain things, even yesterday when I had a very difficult mentoring conversation, I could pull on the strings of the insights of my one daughter and say look, just talk to me. What do you say? How should I approach this? Because she's a psychology qualified person and it's amazing what one can draw from your kids and your grandchildren. And then, obviously, my husband has been a star during this whole life journey. He's just amazing.

Prof Beth Engelbrecht: 1:01:45

Him and I are both honorary rangers, so we do volunteer work for SANParks. Very rewarding experience. And one of the features which I'm quite excited about is that there's a new national park, the Meerkat National Park, and it's between Carnarvon, Williston and Brandvlei, where they established a Square Kilometre Array (SKA), and 39 farmers had no choice but they had to sell their farms for this Square Kilometre Array scientific project. It was farms that were functioning at the time and I just said somebody has to write up the stories of these five, six generations of people that lived on those farms, and now it is just full stop. So I was very privileged to then work and connect with all those farmers and their families and we wrote a book about the lost tales of the Meerkat National Park and it felt it has to be captured. Somebody must capture it, otherwise it will be lost forever. Doing honorary ranger work has definitely been very rewarding. It's an organization that care about each other.

Dr Maria Christodoulou: 1:02:53

That's amazing, and if people wanted to get a copy of that book, where could they find it?

Prof Beth Engelbrecht: 1:03:00

You can just drop me an email and I'll package and send it to you. It's under the bed in our room. All the money we get from that book goes directly to the honorary rangers and we use that money to plough back into conservation and so on.

Dr Maria Christodoulou: 1:03:11

Okay, well, I don't know if I should give your email address out with the podcast.

Prof Beth Engelbrecht: 1:03:15

You're welcome to do that.

Dr Maria Christodoulou: 1:03:16

Great. Thank you. I will do that. So if I got your husband in a room and or your four children or grandchildren and said, what was it like to watch your wife, mother, grandmother go through this career journey?

Dr Maria Christodoulou: 1:03:37

What do you think they would say, each group?

Prof Beth Engelbrecht: 1:03:40

One thing I think they would say is that she's very hard on herself. She wants to really be the best she can be, but then she's very hard on herself. She works very hard and she cares, and even at Saturday nights and Sundays she would take a call of a patient who complains, because that's what she should do.

Prof Beth Engelbrecht: 1:03:55

They often make the comment that they've learned about being dedicated and committed from the way I approached my job, but also, I think, the fact that there was some balance. I was still doing sport whilst I was working, having the family and honouring my husband and the role that he played. They would obviously feel that I didn't give them enough attention. I'm sure that's definitely so. One agonizes about that, but I must say, since I've really retired, I always promised my husband his diary will get preference. So now, when the year starts, we block out all the things he wants to do because he's very active in a lot of stuff, and then, in between, I squeeze my stuff in. But we're managing and we're getting it done and I feel fulfilled and he feels fulfilled. So we have to give each other the space to be able to develop and grow, but fortunately there's more and more touch points as we grow older. This year we're married 44 years. It's a wonderful journey.

Dr Maria Christodoulou: 1:04:52

That's amazing.

Dr Maria Christodoulou: 1:04:55

So I remember a question that you said your son-in-law had asked you when you were HOD, and the question was, how do you go from being a subservient wife at home to being head of the Department of Health in the Western Cape?

Prof Beth Engelbrecht: 1:05:10

It's just a matter of size you know. Subservience remains there. I think it's just how one approaches your leadership. If you see your leadership role as being a servant leader, then it's actually not a difficult transition. Fortunately, in your department you've got a whole team that does it with you, and at home it's only you. I think one of the... You asked about valuable experiences for me to have such a unity in a top team and I think we were forced, because of all the threats and the shocks to our system, we were forced to work so closely together. It was so rewarding. We were trusting each other, talking, meeting. It was a very rewarding experience.

Dr Maria Christodoulou: 1:05:55

Wonderful. You've described the things you're busy with now as the highlight, or one of the highlights, and a bit of a pinnacle in terms of the career. If you think forward into the future, what do you imagine is emerging for you? What do you hope lies in the future?

Prof Beth Engelbrecht: 1:06:12

I don't think that's for me to say. Clearly you keep on what comes your way. You have to be open. Whatever comes your way, do that. I love the mentoring role that I play, the leadership development. I love all the roles that I play and for me I think I need to keep on focusing on those things. And who knows, you know, the Lord might bring some other new, exciting stuff on my journey. I'm looking forward to that.

Dr Maria Christodoulou: 1:06:36

So am I. I'm sure it's going to be interesting. What keeps you awake at night?

Prof Beth Engelbrecht: 1:06:43

Because I'm so hard on myself, I always think about things that I could have done better. So that's kind of a simple thing. And this whole thing of bettering yourself, being a better version of yourself all the time, I think that remains a driving force. And then, obviously, how to balance, how to keep all the balls in the air, is an exciting journey. So for me, I'm very content with where I am. There's not really things that keep me awake, but obviously I'm very committed and I think the inner strength that I've built over these years, from being the 12- year- old without a dad, from investing myself in my studies and in athletics and in sport and in my studies going forward, I think that thread of building your inner strength worked very, very well for me and also that commitment to be the better version and also help other people to be the better version of themselves.

Dr Maria Christodoulou: 1:07:45

What advice would you have for a young colleague who's just starting out and is interested in being of service?

Prof Beth Engelbrecht: 1:07:55

I would say that choosing medicine is one of the best decisions you will ever make, and especially in Public Health, because that's where you can express your servanthood much better, and it's such a rewarding thing to know that you can be of service to people who don't have other choices. These people are vulnerable and burdened of what they carry, with different privileges than yourself. How can you then be of service to them? So I think the issue is, be open, be curious about how people... What their reality is, how they navigate that reality, how they think about their reality, and how you could connect to that thinking process to be able to assist them to really navigate their lives, because it's not easy. How to get into the system, how to navigate if you are poor, if you've got a family, if you don't have a husband. There are so many challenges that our communities are facing these days. You cannot stand distant and say that you can't be part thereof.

Dr Maria Christodoulou: 1:09:01

Your passion and commitment shine through everything you say, and I think about how you have devoted your life really to being of service and your commitment to strengthening the health system. Mentorship, leadership, like all these different contributions, what's your vision for healthcare? If you could fast forward time, 10 years from now, 20, 50 years from now, what are you hoping our health system will look like?

Prof Beth Engelbrecht: 1:09:26

So obviously I'm privileged to have been in the Western Cape, to see a system that works, to understand what's possible just by making the right choices and get people in the places of leadership and make sure that they take the right decisions. And I think the one thing is not to have political interference. Now, if there's one wish I have, is that across our country, that political interference in health, that people keep the boundary between the department and the political sphere. That could happen. You actually don't have to do anything else. The system will do what it's supposed to do. I've seen what political interference is doing to our leaders. How political interference is pulling the carpet out of people who want to do the right thing. So clearly that is the one thing. And obviously, if we can connect better to our communities for them to feel much more supported in what they need to live better lives and to be well. Just think of a young pregnant teenager.

Prof Beth Engelbrecht: 1:10:31

There's so many factors that contributed to that state that she is in. Now she has to deliver a child. You can't think yourself into that situation. And how many young people are in that position. How can we grow empathy and understanding for that reality, to make sure that we design a system that actually is a safety net and a support system for those people. If we could have leaders, people who could do that, and I tell you, they are there. There are really the most amazing people in our system. But boy oh boy, they're undermined by the political realities and I have to say that not in the Western Cape. I was really privileged to work in a place where those things did not happen.

Dr Maria Christodoulou: 1:11:16

I guess I'm also thinking about the story you shared earlier of working as a district surgeon, and every Saturday and Sunday you're seeing these patients who've been raped and violated, and then there's this gap between that and what the police service knows or understands about what's going on and almost like the blind spots in the system, about the reality versus the idea of what is happening. What would you imagine is a blind spot for our politicians at the moment?

Prof Beth Engelbrecht: 1:11:47

I've got a theory that many of our politicians... Actually, there's no health politician apart from the National Minister of Health.

Dr Maria Christodoulou: 1:11:57

Who often isn't a health professional.

Prof Beth Engelbrecht: 1:11:59

Exactly. None of them are health professionals, and health is complex. There are so many facets and variables and things and dynamics, and it's a system that moves all the time. If you suddenly be put in a position and you don't understand your role. Your role is not to manage the system. So the blind spot is that they don't understand. They feel uncomfortable in that position and my theory is that you sit with that imposter phenomenon. So they control more, they micromanage more, they try to force their power on everybody to be able to be seen as being effective. They can dismiss somebody. They can bully them. They can do this and they can do that.

Prof Beth Engelbrecht: 1:12:43

And if there was a way by which there could be a deeper understanding of, what does the politician's role be for a system to work well? I know that there has been attempts for that, towards that, but somehow it is not penetrating. You sit with people with ideologies. You sit with people with aspirations. All of them want to be much higher and better and more powerful. How do they give effect to that desire for more power? I think there's a misconception. What does power mean in health? And if one could get that right, it would be very helpful. And also if the national health leadership could then play a role to be able to correct that, that would be great.

Dr Maria Christodoulou: 1:13:24

I'm wondering to what extent the way we think about the medical profession and health systems and even doctors. You spoke earlier about, you become HOD and then you drive past these monster institutions and you think, oh my word, I'm responsible for these and/ or these intimidating professors and consultants, and you speak about imposter syndrome, and I think to myself, I wonder how somebody who is maybe new in the political space feels stepping into a room full of consultants in a hospital like Groote Schuur, or what that might be like and the power dynamics that play in that sort of space.

Prof Beth Engelbrecht: 1:14:02

Exactly. There it's a power competition, because now the politician wants to exert his or her power and they've got all the money and the decision making on their side whilst the professors are academics. But it's a competition of power and who facilitates those conversations? So clearly you're right. I do think it must be such an uncertain period for those people. Suddenly, if they're appointed today, tomorrow they need to make pronouncements on health, and it's just too complex a system. Hence I think I was so privileged to work with Nomafrench Mbombo. She's just this... she understands health systems, she's got health systems thinking, she understands a lot of stuff and she did not interfere. She had her own pet things that she wanted to do.

Prof Beth Engelbrecht: 1:14:45

I could understand my role as HOD to say that my role is to make her shine, but keep the line and make sure that we follow the right processes and watch her back, that she's not exposing herself without knowing that. H ow to make that relationship work, that she feels respected, that she can achieve her things and that she can make promises to communities and we as a department are working very hard to be able to give effect to that. I think being a politician coming in must be so daunting and I think it's actually unfair. This complexity of health, all the relationships, all the dynamics, all the variables in health, it's not an easy feat. You can't just say input - process - output. Health is not input - process - output and very often people are schooled in that and that thinking is a linear thinking and health is not linear.

Dr Maria Christodoulou: 1:16:43

What would you say has been the most difficult choice you've had to make in your career?

Prof Beth Engelbrecht: 1:18:42

I think for me it was when I applied for the HOD position, because I knew I might be successful. I knew it's a 24-hour, seven-day-a-week dedication. I would not be able to do what I have to do for my family, but I knew that I could do that. So I obviously prayed about that. I asked my husband and my kids what they think and they encouraged me to apply and hence also that I met with other colleagues who also applied. It was a difficult decision. You don't know fully, but you know that it's going to take something of you and I also knew that I am privileged to be able to stand on the shoulders of a leader that came before me. But I also knew that there were certain things that has to be changed and that if I'm successful, I'm the one that has to take that forward and lead the way to bring those changes about. So that was a difficult decision but I did it in faith and the rest is history.

Dr Maria Christodoulou: 1:19:39

What's it like to look back now and watch that department flourish and thrive?

Prof Beth Engelbrecht: 1:19:50

I'm so proud of them and I must say, in the Oliver Tambo Leadership Program as well as the mentoring program, obviously a lot of Western Cape people and I see these amazing young leaders. I feel so honoured. What I also am very grateful for is that leaders from other provinces are now part of the journey and there's such a culmination, such a sharing, and it's not us and them, it's us together. What can we do together? So I must say, I'm very proud. How they handled the COVID period, how they handled this budget cuts, how they handled the USA stopping money for AIDS and TB. You know people are on it, they are connected, they make sure everybody feels part. They are doing brilliantly. I'm very, very, very proud of them.

Dr Maria Christodoulou: 1:20:32

Are you able to acknowledge that you played a part in that?

Prof Beth Engelbrecht: 1:20:36

I had a piece of that.

Dr Maria Christodoulou: 1:20:38

Good. Is there anything about you that would surprise other people if they were to find out about it?

Prof Beth Engelbrecht: 1:20:52

That's an interesting question. I'm so open about my stuff that I'm passionate about. The children, the grandchildren and those things. I think the fact that I kept on doing sport whilst I was being an HOD. I had Western Province Colours for biathlon. Just to keep those things on because that was part of my sanity. I remember when, after my interview for the HOD position, I went to run for, I think, 10 kilometers, just to get it out of my system.

Prof Beth Engelbrecht: 1:21:18

And now that we talk. I remember the evening before the interview. We were coming from Beaufort West. It was raining, it was October, it was the lights on the road and then suddenly, this man walking right in front of us in the road and there was a big truck next to us, w e couldn't turn out.

Prof Beth Engelbrecht: 1:21:35

And we hit this man. It was the most terrible experience. So I ran back and tried to get to him. There was still a pulse, but then he passed away and then the next morning was my interview. So it was a terrible experience, yet for me again, it was just, it is what it is, I've got a job to do, you have to go on.

Prof Beth Engelbrecht: 1:21:55

But that trauma and that trauma remained there. More so for my husband. And I must say, there was a traffic cop who came to the scene of the accident and he called my husband and us aside and he said, look, Beth, you have to support your husband. This was terrible. It was not his doing. He was driving. This person wanted to commit suicide. He was walking in the road. This is what he wanted to do and you were the unfortunate ones there. You have to support your husband. That, to me, was such a rewarding thing to hear that empathy and that's from a traffic cop. He was so caring and I thought, wow, you know, this is how people should be. 

Dr Maria Christodoulou: 1:23:33

Amy, anything you want to ask?

Amy Kaye: 1:23:42

Firstly, I just want to acknowledge and thank your husband, your children and grandchildren for giving South Africa the gift of you, for sacrificing your attention, for sacrificing your time, for sacrificing your life with them, because you have given South Africa so much and I know it cost them a lot. I know it cost you a lot, but I'm very grateful to your family for allowing you to be with us. 

Amy Kaye: 1:25:06

And just thank you for everything you've given South Africa. You have given so much to this country and I hope that you can really feel that and see that and appreciate that and that that lives in your heart and that that connects in some way. It's great to be humble, but it's also great to own it as well, and so, from the bottom of my heart, thank you very, very much.

Prof Beth Engelbrecht: 1:25:49

Thank you so much. I really appreciate your kind words Amy. I'm thrilled by that. Thank you so much.

Dr Maria Christodoulou: 1:26:20

So maybe one last question or two questions for you, Beth. The one is if you were to sum up, who is Professor Beth Engelbrecht, what would you say?

Prof Beth Engelbrecht: 1:26:24

I'm a female health system leader with a passion for people being the best they can be and for developing other leaders.

Dr Maria Christodoulou: 1:26:36

What's going to stay with you at the end of this conversation? What are you taking away?

Prof Beth Engelbrecht: 1:26:41

Well, I'm all sweaty now. What I take away, I must say Amy's words to me was really very encouraging. I really appreciate that. And also, Maria, the way that you can make one feel comfortable. Even when I started, I said this feels like my SODA of years ago in terms of trying to find the right words to say what's in your heart, and that is such a skill. You listen to other people that you've had on these podcasts and they are so amazing. Oh my goodness, will I ever be able to match that? But this is not a competition. This is about me and I try to give my best.

Dr Maria Christodoulou: 1:27:26

You have given more than your best, Beth, in many domains in your life and I'm very grateful that our paths crossed.

Dr Maria Christodoulou: 1:27:29

I'm humbled that I was given the privilege of working with you for that short time that we walked the leadership journey together, and I was struck even back then not only by your passion and commitment but also your heart and your I'm going to say, unconscious competence about relationship. You really brought to the table a feminine style of leadership that I think was sorely needed in the department. You know it's sometimes difficult to tell on the screen, but when Amy acknowledged the contribution and the sacrifice that your family had made in order for you to serve in this way, I could feel the emotion of that for you, and so I really want to appreciate not just you but your whole family for the service and the contribution you have made to this country and to the people of this country, and to thank you for your ongoing contributions, and I love that you're involved with new medical schools and leadership programs for the future, because I think the effect of that is going to ripple out into the world in ways that you and I can't even imagine today.

Prof Beth Engelbrecht: 1:28:31

Wow, that'll be so great, but thank you for your kind words Maria. I really appreciate that. Thank you for the contributions you've made in my life.

Dr Maria Christodoulou: 1:28:38

No, it's a pleasure. I want to remind you of a definition of humility that we formulated together back then, which was that humility is not thinking less of yourself. It's thinking about yourself less.

Prof Beth Engelbrecht: 1:28:52

Oh, I remember. That's so powerful. Ja, thanks.

Dr Maria Christodoulou: 1:28:58

So, thank you, Beth. Thank you for your time, thank you for sharing your story, and I wish you everything your heart longs for, for the future.

Prof Beth Engelbrecht: 1:29:06

I really appreciate that. Thank you very much and good luck with your podcast series. It is wonderful and thanks, Amy, for your contributions as well.

Amy Kaye: 1:29:13

Thank you so much.

Dr Maria Christodoulou: 1:29:15

Thank you so much. I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook or Spotify, and go to Apple podcasts to subscribe, rate and leave us a good review. Thank you for listening.