In an attempt to contribute to change and redress in a post-apartheid, racially and culturally diverse society whose Constitution  condemns unfair discrimination, this study considered Emergency Medical Care (EMC) culture within one province of South Africa through the lens of prestige, privilege, power and authority. The aim was to document discriminatory social practices during EMC education and practice specifically in the context of EMC students engaged in work-integrated learning (WIL) during their Clinical Practice (CP). Although focus was placed on racial discrimination, other forms of discrimination emerged during the data analysis (resonating with the work of Bonilla-Silva et al. . In addition, this study, framed by Critical Race Theory, demonstrates the impact of discriminatory practices on EMC students. This leads to an understanding of how racial discrimination is experienced or perceived by victims. This study, therefore, contributes to the racism discourse from a transformative stance.
The exploration of racial discrimination appears to have little presence (or voice) in the EMC discourse. However, within the South African healthcare sector some studies have documented discrimination experienced by medical students during their hospital clinical attachments. In a study conducted by Thackwell et al. , Black trainee participants reported experiencing racism at some point during their training and indicated that it was not overt racism, but covert racism which collectively accumulated into feeling unwanted within the medical working environment.
When addressing overt or covert racism, it is useful to consider some of the definitions provided in the academic literature. Stevens  defines racism as an unsupported belief that among humans there are biological hierarchies in the form of different races and attempts to justify the political, economic and social exploitation of certain social groups by others. Phiri and Matambo  argue for the use of ‘Fanonian analysis’ in that the credibility given to the conception of race has been overrated, as the argument associated with the conception of race or racism gave it an ontological significance, thus making ‘race’ a standard factor to decide who is human and who is not.
Critical Race Theory (CRT)  views race as a political and social construct that may be manipulated by society when it is convenient. In addition, CRT considers racism to be a social norm that is a common everyday experience for a Black person . CRT also states that racism is not the same as discrimination, hatred or racial prejudice because racism involves a series of systems embedded through institutional policies and practices in society that ensure that one group has the power to discriminate, shape cultural values and beliefs that eventually support these racist policies and practices .
“Everyday racism is racism, but not all racism is everyday racism. From everyday racism there is no relief” . This statement is helpful in unpacking covert racism which happens when People of Colour (regardless of class or culture) are subjected to vicarious racism and the indignities of micro-aggressions that contribute to racism-related stress . Greene and Blitz  suggest that White people’s inability to relate to micro-aggressions experienced by ‘People of Colour’ renders them unable to be empathetic to their friends and colleagues who are People of Colour. Solórzano, Ceja and Yosso  found that this overt racial microaggression and stereotyping resulted in African-American students underperforming academically to the point of eventually having to drop a class, leave the institution for somewhere else or change their major.
In 2019, the South African Human Rights Commission (SAHRC)  found that in the past 20 years the public universities in South Africa have failed to sufficiently transform, and discrimination remains prevalent on the basis of gender, race, disability and socio-economic class. There exists, therefore, a disjuncture between institutional policies against discrimination and real-life experiences of students and staff.
To understand the pervasiveness of racial and other forms of discrimination, it becomes necessary to consider intersectionality as well. Segalo’s  definition of Intersectionality is drawn from a South African context and is worth citing in full here: “Intersectionality refers to the “overlapping” of social attributes such as gender, race, class, ability, religion, sexual orientation. This “structure” can be used to appreciate how systemic injustices and social inequalities occur on multifaceted levels. Intersectionality contends that the traditional notions of oppression such as racism, sexism and homophobia are not independent. Rather these interrelate and generate a system of oppression that resonates the “intersection” of multiple forms of discrimination”. This definition provides an understanding of how social inequality and systemic injustices occur on multi-faceted levels, and we can comprehend that traditional notions of oppression such as racism and discrimination on the basis of gender are not independent but may occur simultaneously interconnected.
In addition to intersectionality, there is privilege that aids and abets racism. McIntosh  documents five basic aspects that describe privilege: (i) it is a unique advantage that is not normal; (ii) the individual does not earn it by talent or merit, it is granted; (iii) it is an entitlement that comes in relation to a preferred status; (iv) it is exercised to benefit the recipient but to the exclusion of others, and (v) the person possessing a status of privilege is often not aware of it. Mathews  focused on White privilege in South Africa, providing an understanding about the persistence of White privilege in the post-apartheid period, i.e. from 1994 to the present. In his book: Run racist run: Journey into the heart of racism, McKaiser  argues that even though not all White people are perpetrators of anti-Black racism, they all benefited, and they still do. He describes this as ‘unearned privilege’.
Historically during the apartheid era, the country was divided on the basis of race and majority of the Black people had limited access to basic education (known as ‘Bantu Education’) and few in this system were afforded the opportunity to access tertiary education  compared to their White counterparts. This obviously created an imbalance in employability as most Black people were limited to jobs which did not require any set skills that had to be studied at an institution of higher learning, making most unskilled workers. The few skilled workers at that time would be those who had studied at a separate Black University for a specific discipline or specialised in a specific skill; for example, a doctor, teacher, nurse . Racial discrimination had an impact on the overall training of Black students enrolled into the University to study medicine during the apartheid era. Black medical students were not allowed to treat White patients during their work-integrated learning; and some hospitals also refused Black students entry to White patient wards .
With the death of apartheid and the advent of the free South Africa, the education system underwent a radical change to become inclusive, especially in higher education, where some historically white universities were merged with historically black universities and technikons in an effort to level the playing fields. New universities of technology were created through these mergers. A massive process of recurriculation happened alongside the merger process. New subjects and degrees were on offer to all students. However, the student protest movement “Rhodes must fall” (#RMF) and the Movement to Decolonize the University indicated Black students’ awareness and acknowledgement of the existence of institutional racism and patriarchy . Thus, discrimination, intersectionality and privilege were still active even 25 years after the demise of apartheid, also within institutions of higher learning affecting students in their learning environment and well as their subjects which required work-integrated learning.
Within the EMC curriculum, work-integrated learning is a very important component which is featured within the subject called “Clinical Practice”. EMC students are placed with EMC providers, such as ambulances, hospital emergency rooms, response vehicles to gain work experience in a real-life work environment. According to the Health Professions Council of South Africa (HPCSA)  qualified and registered EMC providers are expected to offer EMC to all patients in need without subjecting the patient to any form of racial discrimination. Failure to do so is a violation of the patient’s rights and undermines adequate patient management. All EMC students in South Africa are required to register with the HPCSA and adhere to its protocols.