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

TCHIPIWA MAUMELA: Thank you.  Honourable Chairperson, honourable members of the Truth and Reconciliation Commission, we from the South African Interim Nursing Council feel humbled to be allowed an opportunity to come and make the presentation we came to make today.  My colleagues and I decided that I be the one to make the submission but that we, at the same time, should make this hearing aware that I make this submission as one of those within the South African Interim Nursing Council who represents the community.  That is because amongst other things, the South African Interim Nursing Council stands for the interests of the community and therefore has set the means in place to solicit, accommodate and give expression to the needs of the community visa a vis matters of health, if not just matters of nursing.
 Chairperson given the horrific picture yielded by the picture of our beloved country, which picture permeates all spheres of life and all classes of professions, it may well be conceivable that normal people will embark on a spontaneous effort to try and dissociate themselves as much as possible from the past.
 Concomitant to such a mindset we find a tendency to spare people on in a campaign, a campaign to forget about the past, yes to forget all even before we get to fully understand what it is exactly that should be forgotten.  We therefore come here today with a vivid realisation that denials, excuses and explanations will not take this country anywhere.  At the same time we are thankful because today everybody can speak, reveal and uncover.  Yes we are all free to speak today.  The former oppressors and the formerly oppressed, all alike.  
 It is with that in mind that we wish to borrow the wisdom of on who was with us yesterday in this very room who once declared in years gone past and if he himself was quoting someone else, then I don't know yet, but I heard him declare and I quote, "no one shall be free until all are free".  We note with an immense measure of gratitude that the very temporary failures of the past very strongly form a firm basis for the successes of today and the same shall apply for the future successes.
 Oh yes, the temporary failures, more especially of those who tried from positions of weakness to fight against a tide, a tide that enjoyed the benefit of the wherewithal to oppress, to maim and to vilify, indeed to brainwash and to abuse, they risked their all to resist segregation, social biases, disempowerment and a whole range of other negative eventualities that of course would be denied from time-to-time.  But today, through the grace of God, those temporary failures do not seem to stop in getting transformed into great successes, successes that now spur some of us on into speaking up.
 Chairperson, nursing as a profession did not and perhaps could not have escaped this erstwhile wide web of racial biases.  Nursing with its militaristic approach to both training and the shaping of the nurses work environment ended up perhaps like many other health-related establishments as one of the tools tailored to suite the whims of the authorities of the day.  Consequently it should come as no surprise that the Nursing Council, from it's own corner, also contributed in giving form and direction to these temporary failures that we speak about.  
 However Chairperson the evolvement of these temporary failures gives us such a strong feeling of redemption, it reminds us once more of the words of someone who once said, and I quote, 
"It is better to fail temporarily even if it is a million times on a course that is bound to ultimately succeed, than to succeed temporarily, even if it is a million times on a course that is bound to ultimately fail".
 Chairperson, the South African Interim Nursing Council came into being in August the 23rd 1995, and we make the following submission primarily on behalf of former South African nursing councils.  We also make the same submission on behalf of the nursing councils in the former areas of Transkei, Ciskei and Bophuthatswana.  We note that we have inherited a process within which perceptions were created which suggested a perpetuation, if not support active or by way of omission of certain circumstances.  
 We further acknowledge and accept without justification that Council was influenced by the policies of the government of the day.  This could have resulted in both a conscious and unconscious perpetuation of those discriminatory policies and legislation leading to gross violations of human rights. 
 We are aware that Council was all the time morally bound to adhere to a strict professional approach to matters of nursing without allowing itself to be used as a tool of the apartheid machinery.
 We also appreciate that Council could have at times exercised a free discretion on some of the issues.  We therefore wish to apologise unreservedly, both for conscious and unconscious activities, that could have the effect of undermining human rights from time to time.  We however acknowledge that some of the Council members have from time to time tried their best to rid the Council of any apartheid overtones but they would time and again be steamrollered into a collusion because of the circumstances of the day.
 Having indicated our awareness of instances perpetuating apartheid, we wish to bring into light some of the known incidents by way of highlighting areas of failures and the areas of success vis a vis the Council under an apartheid regime. 
 Regarding failures, and I'll come up with failures resulting from legislation and policies:
1. As prescribed by the segregationist nursing legislation of 1957, Council kept separate registers and rolls in respect of different population groups.
 2. Only White persons could serve within Council with a result that nurses of other colours could not participate in making decisions that affect their profession.  See in that respect, Section 4, subsection 1(c) of Act No. 69 of 1957.  
 3. While Council was aware that there was segregation in health treatment along colour lines visciating against the Nurses Pledge, they apparently made no effort to protest against the system.        
 4. Where, with the aid of press reports and other sources of information, where through those sources we became aware that victims of accidents were denied emergency treatment on the same because for their colour, there is no evidence to suggest that Council made any effort to confront the situation.   
 5. Surrogate nursing councils were established by the Homeland governments without the consultation of nurses in homelands.  These tended to undermine the professional status and international recognition of these nurses.  
 In other instances nurses in Homelands ended up having to pay dual fees to better their situation.  Those councils commenced without any financial support to assist them.  Whereas Council was not responsible for the formation of these surrogate councils, Council failed to protest against the fragmentation of the profession along tribal divides.  
 6. Council failed to react to gross inequalities in the provision of training facilities for various population groups.
 7. Where inspection results revealed a dire lack of facilities at educational institutions and training hospitals, Council failed to do more than just bring this to the attention of the authorities.  This situation was more prevalent in Black hospitals.
 8. Where former political prisoners and detainees made allegations against nurses in prisons and other hospitals, the Council failed to conduct proper investigations.  Council would investigate only if complaints were laid.  We know now as much as we knew then that most of the victims would not have known how and where to lodge their complaints.
 9. Council failed to create a user-friendly image in dealing with professional conduct issues.  This resulted in a near militaristic approach to the situation of the nurse.  In most instances nurses were not empowered to know and exercise their rights.  Many could not afford legal representation.  Seemingly many of them also did not trust the pro forma complainant to protect their interests.
 10. From 1960 to 1978 Council continued to apply the Nursing Act No 69 of 1957.  This Act had the effect of introducing harsh apartheid measures into the control of the nursing profession.  For example,
a. Section 12(4) of this Act provided that separate registers and rolls be kept for different population groups.
 b. Section 4(1)(c) provided that membership of the Council be limited to Whites. The result was that other racial groups were denied a say in matters affecting their profession. 
 c. Section 3 limited voting to White members of the Profession. 
 d. Section 49 made it a criminal offence for a White nurse to be put under the supervision of a nurse belonging to other race groups.
 Regarding Communication. -   The Nursing Council failed dismally in terms of communicating issues to the members of the Profession, the communities and all stakeholders.  This resulted in the Council being seen as dwelling in an ivory tower remote from the profession and those it was supposed to serve.      
 Regarding Staff Appointments -  
1.  Appointments of staff in the categories of typists, clerks and upwards were almost exclusively limited to Whites. There was no deliberate effort at all on the part of the Council to empower members of the disadvantaged communities.
 2.  Although there was no deliberate policy promoting job reservation, Council's requirements for employment, namely the minimum qualifications being standard 8 for appointment as a typist clerk, and secondly fluency in English or Afrikaans, these things tended to exclude many would be and actual applicants who could otherwise have succeeded.  
 We felt that maybe it is a little bit worthwhile to make mention of some of the legal successes there have been down the years and we are very conscious that we do this at the risk of sounding a sort of jakkels prys sy eie stert kind of a note.  But we felt we should do this because in every battle and in every struggle there is the concept of the unknown soldier who is not there to speak for himself, and we felt we should not end up undermining the efforts of those who tried because the features of the unknown soldiers are not much more in the successes but I think what should be taken into regard is much more the decision to try under very, very hard circumstances. 
 And I want to begin with the legal successes by way of excuse, Honourable Chair, but just for the record.
 Nursing Education:  Although the Council in terms of the Nursing Act of 1957 kept separate registers and rolls for the different population groups, its educational programmes were the same for all trainees, thus ensuring a uniform standard of education and training throughout the country.  This standard is so high that South African-trained Nurses enjoyed international recognition.  
 The Council's Database:  The Council has always kept an excellent database of details regarding all nurses, both in training and qualified. This is of great assistance to the Department of Health when planning its nursing manpower to meet the country's health needs.
 Constitution of the Council:  In the Nursing Act No 50 of 1978 provision was made for the election as council members of five White nurses, three Black nurses, one Coloured nurse and one Indian nurse.  In 1989 the Council petitioned the Department of Health to remove all references to racial groups in the Act.  The motivation was that the Council is a professional body which does not distinguish between population groups inasfar as training, registration or professional standards are concerned. This resulted in the Nursing Amendment Act of 1992, which made the Council a totally non-racial body.
 The Nursing of Prisoners and Detainees: And before I come to this I just want to make a legal comment about constitution.  We are aware that there are other concerns and it has to do with gender balances within the Council, it would seem it's female-dominated, if I may put it that way, it is a concern that is being looked at and I always say, they went to Beijing, maybe we should also go to Taipei.
 The Nursing of Prisoners and Detainees: In 1988 the Council issued a policy document dealing with this issue, including political prisoners. The following extracts from the policy are highlighted:    
"In her professional capacity the nurse maintains political neutrality.  Any deviation from this is unethical because such impartiality provides the basis for mutual trust, respect and protection of the rights of the patient are indivisibly linked to the duties and responsibilities of the nurse towards such a patient".
 The following principal does apply:
 It is the professional obligation of the nurse to provide life-saving care and alleviation of pain and suffering.  
 The patient has the right to the protection of his physical and mental health and whatever treatment and nursing are needed.  
 The nurse may not be involved in any relationship with a prisoner or detainee other than that required to evaluate, protect or improve his physical or mental health.  
 It is unethical for the nurse to participate in any procedure for restraining a prisoner or detainee unless medical grounds exist for such procedure in order to protect the physical or mental health of the prisoner or detainee or of these fellow prisoners or detainees.
 It is unethical for the nurse to participate in any form of interrogation or torture of a prisoner or detainee.   In the case of torture it is unethical for the nurse to conceal knowledge thereof.
And finally,
Recommendations
a. Further Councils should ensure that no legislation or policy violates the rights and dignity of any nurse or any patient.
 b. The Council should promote the preservation of the image, dignity, integrity and values of the Nursing Profession.
 c. Openness and transparency, the right to be heard, accessibility and user-friendliness should be the fundamental premises to realise the role and functions of the Council based on exhibitions, vision and goals.
 d. Communication with the Profession and the community should be improved and intensified.
 e. The autonomy of the Council should be maintained and respected.
 f. In the event of victims of Council violations being identified, Council recommends that appropriate reparations be made for the benefit of such victims. 
 We also recommend that nurses should be encouraged to report human rights violations directly to Council.
And lastly,
With regard to any future collaboration platforms, if any are being mooted, we recommend that such platforms should be geared not to facilitate with regard to advisory resources to avoid stifling the all-important autonomy of the individual professions, more especially the Nursing Profession.
 The Council would like to reiterate its apology to anyone who may have suffered unjustly as a result of former councils' actions and policies. Appreciation is also expressed to the Commission for the opportunity to make this submission.  Thank you.