I had a phone call this evening. I love texting, I love e-mails, whatsapps and even old fashioned letters. Goodness, I’ll even send a fax… but I battle with phone calls. I take them. I make them, but out of necessity rather than choice. They do not blow my hair back. So when, let’s call her Devi, phoned me this afternoon, I reluctantly answered. She chatted about a host of things and I could sense she was uncomfortable. She recently had surgery and I was wondering whether she was trying to ask for step-down care. But it was not that. Devi needed to borrow money. She works in one of the top hospitals on the continent. She is professional, well-educated and competent, and yes, she has medical aid, but despite all of this, her medical savings ran out and additional out of hospital investigations were needed. She had to put her pride in her pocket and call on people she knew to make her rent this month. What is wrong with our systems? Where did we go wrong? Contemplating this made me wonder where the wheels came off, which led me to consider how and where hospitals started in the first place.  


It is believed that the first centre that kind of represented hospitals dated back to 2500BC in ancient Egypt, and was known as the Imphotep’s temple. Later in ancient Greece, the Asclepius temples did similar work (The Hippocratic Oath, a foundational ethical guide for physicians, emerged during this era, emphasising the importance of patient care and the physician’s commitment to the well-being of the sick). However, in these eras the establishments were mainly for the wealthy. It seems your “healing or your cure” was very much dependant on the “offering” you were willing or able to give to the deity or gods. Physical healing was seen as part of your emotional and spiritual health and a lot of rituals, cleansings and dancing was involved… and of course, payment.


It is believed that the very first hospital, as we understand it today, was started in the early Christian era in Rome, known as The hospital of St. Spirito. This institution was radically different from anything the world had ever seen, and represented a 180 degree shift from the  prevailing attitudes of the time towards the sick and the infirm. This “institution” offered kindness, healing, care and solace to those in need, irrespective of their socio-economic position and also regardless of whether they could offer any reward or favour in return. It is here that the centres of wellness became charitable rather than transactional.


In those days, illness usually led to isolation and exclusion from your loved ones and society  (picture the poor dudes with Leprosy in Biblical times hanging outside the city walls losing body parts and scaring travellers). Apart from ignorance and fear, society believed that sickness was usually a result of divine punishment by the gods and people ‘deserved what they got’ or that suffering was karma. So why get involved? They had it coming.

In terms of a more organised hospital system, early Christian communities in the Roman Empire began to establish institutions that combined medical care with charitable work.

During that time, St. Fabiola established the first hospital in Rome. Fabiola was from a wealthy family and was an aristocrat, but she had many setbacks, including a failed marriage (imagine the “skandaal”!). While her peers rejected her and enjoyed the juicy gossip, she was accepted and loved by the new rebels on the block – the Christians. Fabiola’s conversion led her to wanting to lead a life of service and compassion. With her considerable wealth and connections (and not having to please a husband and look after a brood of children) she managed to establish the St Spirito hospital in Rome based on her deep commitment to the principles of Christianity. This institution aimed to provide holistic care, incorporating both physical healing and emotional support, which was a revolutionary concept at the time. She prioritised others needs above her own, an idea largely foreign to the human race until the Sermon on the Mount.


In John Ortberg’s book, Who is this man? he emphasises Jesus’ revolutionary approach to human suffering and illness. Jesus consistently demonstrated a profound compassion for the sick, the marginalised, and the outcasts of society. He challenged societal norms by touching and healing those with various illnesses, transcending the boundaries that separated the healthy from the sick. Jesus’ teachings and actions laid the groundwork for the transformation of societal attitudes toward the sick, the vulnerable and the rejected. His posture towards the rejected and his repulsion towards the leaders and the wealthy changed everything forever. If you ask ChatGPT, it agrees that the roots of hospitals, as we know them today, can be traced back to the early Christian era inspired by Jesus’ teachings, where Christian communities began to take on the responsibility of caring for the sick and injured. These early medical institutions were primarily established within monasteries and convents. As Christianity spread, so did the concept of compassionate care, resulting in the establishment of formal hospitals. An example of the impact of these early communities is people’s response to the plague: when most people were fleeing from the ill and dying during the black plague, the Christians were running back to help them, fearless and fuelled by compassion.


But before I get too excited about the fact that hospitals were built on grace alone, the story does not end there. Soon after the fabulous Fabiola pulled a Florence Nightingale, the power-hungry Romans cottoned onto this great concept and the Roman empire started building hospitals for their soldiers. Instead of sending them home after injuries and constantly training more men, they were now investing in healing their troops so that the army could continually grow.


As the Roman Empire crumbled and the Middle Ages dawned, religious institutions began to take on an even more central role in healthcare. Monasteries and convents established infirmaries, offering care not only to their religious members but also to travellers, the destitute, and the sick. The practice of offering shelter, sustenance, and basic medical attention laid the foundation for the hospital model we recognise today. I find this a bit spooky, picturing monks walking around, chanting quietly with their matching bald patches in damp hallways, but apart from brewing whisky and making vows of silence, they were caring for the sick and laying the foundations of what we have come to know today as places of healing.


As I am typing this, I feel a little bit like this has turned in to a history lesson, and for this I apologise. I will speed things up.


The Renaissance shook things up in the world of healthcare, like it did with everything else, and as advances in medical knowledge were made and new life was breathed into healthcare institutions. Almhouses sprouted up all across Europe which not only provided food, shelter, religious and medical care to everyone regardless of stature, but they also started education in health care. Physicians were being trained and in institutions like Hotel-Dieu in Paris in 651AD and so, a “teaching hospital” was established.


It was only in the 18th century that specialisation started and hospitals would focus on specific ailments. Healthcare workers started seeing the advantages of keeping patients with similar needs together and physicians started specialising in the way we understand it now. It is not surprising that the first hospital for mental illness was established in the United States (sorry, I could not resist). In 1751 the Pennsylvania Hospital in Philadelphia was established introducing a “new concept” of humane treatment of the mentally ill. (So even the Christians spent many a century getting that right!). Fun fact, the asylums just about emptied once hormone replacement therapy was introduced and they realised that women suffering from hysteria were actually mostly just menopausal.


The 19th and 20th centuries marked a period of unprecedented medical advancement and institutional growth. The discovery of antibiotics, the development of vaccines and breakthroughs in medical technology revolutionised healthcare practices. Hospitals evolved from basic care facilities to centers of cutting-edge medical treatment and research. Florence Nightingale’s contributions during the Crimean War in the 1850s pioneered modern nursing and hospital administration. Her emphasis on hygiene, patient care, and data-driven decision-making laid the groundwork for evidence-based medical practices. (I wrote a blog a while ago about her and how she would be turning in her grave because of our nursing care today).


And here we are in the 21st century. Now we have specialist specialists, incredible technology, unbelievable cures and access to more information and education than ever before. Yet, few can afford it. The divide is bigger than ever and just like before Fabiola, it would seem that medical services are once again transactional. Your access to healthcare is directly linked to your wallet. If people like Devi, who work in the hospital, do not have access to the care she offers unless she gets a loan, who else does it exclude?


I love writing this blog as I can ask the questions, but don’t really have to answer them. Capitalism is of course one of the reasons we have advanced so much and so quickly, but would it not be grand, if we could meet somewhere in the middle and we could go back to valuing every person and deeming them worthy of care no matter their status or financial position? For all our talk about human rights, dignity and equality, we certainly don’t live it out in practice.