A transgender woman, Buhlebendalo Mthombeni, has come forward with allegations of sustained mistreatment, transphobic remarks, and procedural failures at Universitas Academic Hospital in the Free State, raising broader concerns about access to gender-affirming healthcare in South Africa’s public system.
Supported by The Forge Foundation, a civil society organisation advocating for the rights of transgender and intersex people, Mthombeni’s experience highlights what advocates describe as systemic barriers rather than an isolated incident.
“It drained me emotionally”
According to Samora Mbambi, Executive Director of The Forge Foundation, the case reflects a troubling pattern.
“What stood out most was not only the content of the experience itself but the pattern of how it unfolded over time,” Mbambi said. “This was not an isolated incident but a sustained experience of feeling unheard, dismissed, and unable to access necessary medical support and documentation.”
Mthombeni, who began her transition in 2015 and later sought care through the public health system, described multiple encounters with healthcare professionals that she says were hostile, dismissive, and deeply harmful.
“She was hostile… even reminding me that I’ll forever remain a man,” Mthombeni said of one doctor. “It drained me emotionally… I had low self-esteem… to a point that I wanted to give up.”
In another instance, she alleges she was told she would “never be a woman” and was “taking space” from others, comments she says had a lasting psychological impact.
Barriers to documentation and opportunity
A central issue in the case involves access to medical documentation required for employment opportunities and legal gender marker changes.
Mthombeni says repeated refusals to provide appropriate documentation cost her real opportunities.
“I had to decline many jobs… when I appear, it becomes an issue,” she said. “I feel like they robbed me of opportunities in my life.”
She also described frustration with being given medical documentation that did not align with Home Affairs requirements, despite multiple visits and explanations.
“I was made a fool several times… they said they can’t give any other letter except this one,” she said.
Mbambi notes that such challenges are not uncommon.
“Many transgender individuals report difficulties in navigating public healthcare systems, particularly when it comes to accessing gender-affirming care and the documentation required for legal gender marker changes,” Mbambi said.
Concerns around procedural fairness
The Forge Foundation also raised concerns about how the hospital handled the complaint.
Mbambi pointed to a lack of meaningful engagement, including the cancellation of a scheduled redress meeting intended to allow Mthombeni to fully present her case.
“A fair and rights-based approach would have included a genuine opportunity for the patient to be heard, transparent communication, and timely handling of the complaint,” Mbambi said.
Mthombeni described the process as dismissive and frustrating.
“The cancellation of the meeting a day before… that was so unprofessional for me,” she said, adding that the overall response made her feel “not that important… like let’s just dismiss this person.”
Hospital responds
In response to the allegations, Universitas Academic Hospital CEO Dr Balekile Mzangwa confirmed that an internal investigation into claims of transphobic remarks is underway.
“The process remains ongoing,” Mzangwa said. “No definitive findings can be pronounced until the process is finalised.”
Mzangwa emphasised that the hospital is committed to procedural fairness, including the presumption of innocence and adherence to labour and disciplinary frameworks.
Regarding the redress process, the hospital said the initial meeting was deferred due to Mthombeni’s inability to attend in person and a request for a virtual alternative. A written response was issued, followed by an in-person engagement on 19 March 2026.
“The process, when viewed holistically, reflects a reasonable effort to balance procedural fairness with practical constraints,” Mzangwa said.
On the issue of documentation, the hospital maintains that it provided standardised templates aligned with institutional and national protocols, and could not adopt externally sourced formats.
“No institutional liability is conceded in this regard,” Mzangwa said.
A broader systemic issue
While the hospital maintains it acted within established frameworks, advocacy groups argue the case reflects deeper systemic shortcomings.
“This matter presents an opportunity to reflect on how public healthcare institutions engage with transgender patients,” Mbambi said. “We would like to see improvements in how complaints are handled, clearer processes for gender-affirming care, and stronger alignment with constitutional principles.”
Mthombeni feels her experience is not unique. “I do believe that my experience reflects a wider problem for trans people navigating public health in South Africa,” she said.
She called for better training of healthcare workers, stronger collaboration with LGBTQI+ organisations, and clearer processes across institutions.
Seeking dignity and change
For Mthombeni, the case is about more than her own experience.
“At the end of the day, we cannot be denied our identity… we cannot be let down when we voice out,” she said.
She also emphasised the emotional toll the experience has taken. “It has really affected me in so many negative ways… I no longer feel the same,” she said.
For Mbambi and The Forge Foundation, the goal is both accountability and reform.
“Ultimately, the goal is not only to resolve this case,” Mbambi said, “but to contribute towards a healthcare system that is more inclusive, responsive, and respectful of all patients.”
