Special Hearings — Health Sector Hearings — 1997-06-18

EDWARD BARKER: Dr Randera, Commissioners, forgive me if I read again.  This is for the sake of keeping within time and to ensure that we get my message across exactly as I want it to come out.
 At the outset of today's proceedings concerning the Medical Association of South Africa, I would like to make a personal statement regarding my own position in appearing before you to present the Association's submission.  My position here could be seen by some people to be equivocal and I would like to explain why I have accepted personally this onerous and rather necessary task.  The present day MASA has taken upon itself the task of examining the history of the organisation in an effort to uncover and disclose human rights abuses which arose by commission or omission by the MASA under apartheid.
 As one of the members of the Association who was active at the time in opposing a range of decisions and policies of the MASA as it then existed and in the period covered by this submission, I am in a position to explain and elucidate to the Truth Commission the matters covered by the submission document.  
 The membership of the present organisation, approximately two thirds of whom were not even qualified at the time of Steve Biko's death, have taken on responsibility for examining the darker side of the history of the Association.  While the MASA of today is a vastly different institution from the MASA as it existed under the period of examination, the present membership recognises that the history which it has inherited requires full exploration and disclosure.  Collective responsibility for this history has to be accepted before the organisation can be freed of the burden of the past and move forward to fulfil its role in the life of the community. 
 Before I go on to address the substance of our submission document, I would like to make one extremely important correction of fact relating to something that appears in our submission.  It relates to the decision by the Federal Council of MASA in 1974 to prohibit the South African Medical Journal from accepting advertisements for professional appointments that can contained any terms discriminating between doctors on grounds of race or colour.  This is mentioned on page 37 of the document.  However paragraph two on page 38 states that MASA decided to amend rule 19, which was a rule limiting advertising for professional appointments to professional journals only.  The documents state that this amendment was made by MASA in order to ease the difficulties for the government which was then unable to advertise State posts with a racial criteria.
 Now this is a grave error.  This fact is simply not what happened.  Rule 19 was in fact a rule of the statutory body, the South African Medical and Dental Council and it was this body which amended the rule in order to rescue the government to allow it to continue making discriminatory appointments. The MASA stuck to its policy and since 1974 has never again accepted discriminatory advertisements.
 Now I make this correction, not because I believe it's part of my submission today to tell you about any of the good things which MASA has done in the past, MASA has done some good things, this is not what we're concerned with today, the only reason I have made this statement about this factual correction is that I believe it's equally important that MASA not be asked to accept blame, guilt for things which it did not do, such as for example the impression created by this.
 And now Mr Chairman, to go on to my main presentation.  It's not going to be possible for us, there's a 104 pages of detailed fact in the submission and there is no possibility in the time available for me to cover this.  What I want to do is to give an overview of what we have tried to do, how we approach the subject, what our intentions are and then make as much time available as possible for questions from the Commissioners who would like to elucidate matters and we'd be very happy to answer.
 Now MASA as such was always, without doubt, a part of the White establishment in South Africa, and for the most part and in most contexts it shared the world view and the political beliefs of that establishment. Inescapably it also shared the misdeeds and the sins for which that establishment was responsible.  From the time of its inception in 1927 until the day that Steve Biko died, the 
Association flirted along in terms of human rights and its approach to human responsibilities in a fairly unconscious and unremarkable fashion with a few issues being taken up such as, for example, its repeated calls for the abolition of discriminatory differences and the salaries paid to doctors of different race groups.  These efforts were not immediately successful, it took many years to achieve parity.  
 Apart from these the Association in general was quite comfortable with the status quo and its public reaction to any criticism of the inequity and the iniquities in society, particularly the inequities in health care delivery was to dismiss that criticism as the work of enemies of the State and defined all sorts of means to defend itself and the system.
 The death of Steve Biko, and particularly the circumstances surrounding his death, in which members of the medical profession were clearly and shockingly involved was the event which rocked this complacency  and started to force the Association to examine the ethics and the morality of its actions in many different contexts.  
 The Association was initially able to resist calls from within and without its ranks and for the actions of the doctors concerned in the Biko death to be investigated and judged on the grounds that an inquest was to be held and that justice demanded that any action that preempted this inquest would be unjust. When the findings of the inquest magistrate were released, the clamour started up again for MASA to take action in the name of the honour of the profession and it's claim to be the upholder and guardian of professional ethical standards.
 The Association again resisted these calls, again on the grounds that the matter had now been referred to the Medical Council for investigation and was therefore still sub judice.  
 When the Council finally, two and a half years later, issued the findings of its committee of preliminary inquiry which, astonishingly, and unbelievably, absolved the doctors concerned from any blame, the fires of controversy really flared up. Under growing pressure from vociferous protest, among which I participated fairly actively, again from within and without its ranks to publicly reject and to condemn the Medical Council's indefensible finding, which seemed to simply ignore the evidence given at the inquest, the Association was finally faced with its moment of truth.   It had the opportunity to rise to the occasion and to meet the challenge to demonstrate it's commitment to truth, to equity, to justice and the centuries old tradition of professional honour.  It not only failed to respond to the challenge and thereby betrayed the values for which it supposedly stood, but the leadership of the time then mounted a vigorous nationwide propaganda campaign to make sure that the membership of the Association followed its lead in this matter.  
 However, this sad and disgraceful episode marked the beginning of a movement within the Association, a movement of opposition to the actions and attitudes of the then leadership of the Association which haltingly and with many setbacks and failures finally grew powerful enough so that by 1989, it was quite clear that the Association had set its feet firmly on the road of renewal and transformation. 
 Our written submission details the many failures and compromises that occurred along the way, failures of will and courage, compromises founded on expediency, many of these occurring even in the years since 1989.  It's not possible in the time available today to explore in detail all the misdeeds of commission and especially of omission that have been detailed in our written submission. However I can assure the Commission that we have made every possible effort to provide as complete and as honest a disclosure as it lies in our power to do.  
 I plead with you and with the Nation, that this submission be accepted with respect for the truth which it embodies.  It is vital for the Association, at this point in its development, its renewal and its transformation, to achieve reconciliation, and this can only happen if there has been full disclosure and full acknowledgement of all the wrongs of the past.  If there are gaps or omissions in this submission, they are unintentional. We would welcome any input in this regard from whatever quarter it may come.
 The transformation of MASA of which I speak is an ongoing process. A significant event along the way was the unconditional apology for the past wrongs of the Association that was made in June 1995.  We stand by every word that was spoken in that apology.  However there are those who understood this apology to be an attempt on the part of the Association to achieve what they termed blanket amnesty and to sweep everything else from our past under the carpet. This was far from the intention of that apology.  The apology was a necessary step along the road we are travelling, but it was only a step.  Our wholehearted participation in the work of this Commission is yet another step on this road, but again only a step.  
 In terms of the way forward there is much that we have done to make sure that the wrongs perpetrated in the past by doctors can never occur again, but there is much that remains to be done.  We intend to participate fully in the work of the proposed over-arching Health and Human Rights Organisation.  We propose to enlarge and to strengthen the office and the activities of our ombudsman, our public protector. Our peer review system has already been sharpened and structured much more effectively than it ever was before. We are currently engaged in a programme designed to promote structured ethics education in all the medical schools in this country and we are planning formal structured training for prisons' health service personnel. 
 However, in all these efforts we still find ourselves hampered by the huge baggage of past wrongs that the Association has had to drag along with itself and from which it has found it impossible to free itself.  It will only be through the process of truthful disclosure and reconciliation that we will finally be freed from the burden of this baggage.
 And Mr Chairman I now would welcome questions.