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

EDWARD BARKER: Madam Chair, I think at close reading, I don't know whether you've had the opportunity of reading the submission in detail, but I think if one goes through this in detail, some of the statements that you mention like MASA was never sort-of involved in this or that, these are in quotes, these are statements which were made by responsible MASA spokesmen at the time which we now publish with frankness as being things which we would certainly not today say.  It's very difficult.  We have done this job as completely as we believe it's possible to do and really I believe it is a very complete document, it is totally, totally revelatory of everything we have been able to find and as I have said, if there are omissions or shortcomings, we would welcome being filled in.  What I am uncomfortable with is being told that no it's not good enough, it's incomplete. I want to know if there is further information available to anybody that we have not included in this.  This is what we are asking for, for input.  We have given everything we've got.  More than this we don't have, but if there is more, we plead that it be brought to us in detail so that it can be incorporated in our final document, remembering that this document as it stands is - my only criticism of the document is that it is patchy.  There are large sections where it is not quite clear what the context was in which certain actions took place and I believe as a history of the time it's going to need some very skilful professional editing and in the process may well need the insertion of further facts that have not appeared but beyond that Madam I don't think we can do.

HENDRIK ANDRIES HANEKOM: Mr Chairman can I just maybe, I don't think there is any specific contradiction in specifically the  section on MASA and human rights violations.  I think it's stated very clearly that the mandate of the TRC has been to examine gross human rights violations.  The Act on which the TRC is based defines gross human rights violations as killing, torture, abduction etc, which is politically motivated.  MASA has not committed gross human rights violations as per this definition.
 What we further said is that MASA allowed Black and White people to be treated differently and it's this form of human rights violations for which it stands disgraced. So I don't think there's any contradiction or anything.  I think it's very clear what we've said.

CHAIRPERSON: Thank you, Dr Ramashala.

MAPULE RAMASHALA: On pages 86 and 87 of your document you very briefly refer to the problematic issue of district surgeons. I'm also aware that you have a document from the AAAS which I believe addresses the issue of district surgeons in detail. It is also my understanding that you have a very active continuing medical education programme, am I correct?
 On page 87, the second paragraph, this refers to the HSRC study work group investigating the operational effectiveness of health care services in South African prisons but my question is more general and my comment is more general. You state and I quote, 
"The work group recommended the continued role of the district surgeon that efforts should be made to sensitise district surgeons to ensure that they respect the doctor-patient relationship in the prison context".
 I want to relate this to the broader context more than just the prison context. The issue of sensitisation is a very superficial issue, the successes in terms of sensitisation depends on voluntary actions of the participants, those people as we know about the history in the United States, those people who tend to be successfully sensitised are those who are already converted. 
 I have not examined the section, there's a section there on continued medical education, what I'd like to see is a stronger commitment, not just with respect to the district surgeons but with the medical profession in general, a stronger commitment that ties in into continuing medical education, the requirement for human rights education and training, but tied into continuing medical education credits and a much stronger commitment, much stronger than the superficial sensitisation requirement. Perhaps you might want to comment on that if I've missed it somehow?

EDWARD BARKER: Yes Madam Chair.   I did in fact mention it briefly in my presentation.
 Some years ago the Medical Association, aware that there were gross sort-of episodes of misbehaviour, not just in terms of race and politics but simply of doctor/patient relationships.  The frequency of gross violations of patients' rights of the numbers of doctors who fail even to understand the patient's right, the patient's right to information, to consent, all this sort of thing and the Association found the wide-spread nature of this problem to be very worrying and it has set up and has managed to engage all the seven medical schools.  It is a MASA initiative, they are running a committee for undergraduate medical, ethical education and this committee consists of teaching representatives from all the medical schools and we are busy, we held a very large two day workshop last year in Cape Town devoted to the same thing where we are developing techniques and structures which are going to be put in place in all the medical schools, some of them are more advanced than others, but this is a MASA initiative and without this there are many medical schools who would today not be even thinking of educating their students in ethics.  We are taking this extremely seriously.   
 I agree with you that it is important also in the continuing medical education field and some two years ago our journal of continuing medical education was devoted, an entire issue was devoted to questions of medical ethics.

MAPULE RAMASHALA: Just as a quick follow-up of that, the question I raised was based more on the individual approach, that is physicians' behaviours. I want to explore further the issue of the systemic approach, that human rights abuses, let me put this bluntly, the ill-treatment of patients is also related to how resources are allocated in facilities.  That has not been addressed in your document and I'm not posing it as a criticism, but I'm posing it as a way to encourage you to be involved with the Department of Health in examining those factors within the system that tend to encourage this kind of behaviour at the individual level.  In other words, the way resources are allocated, the way patients sleep in a ward, the resources that patients have, that tend to delegate a secondary level to patients and that encourage others to treat patients as if they are not human.

EDWARD BARKER: Madam Chair, one of our most consuming endeavours over the last three years has been our contribution to the development of the National Health System which the present Minister of Health is desperately trying to put in place.  We have made an enormous contribution to this.  We have been intimately involved with the Department of Health over these years.  We have produced huge really well-studied documents, recommendations covering all the fields that you have outlined.  We have been involved in this as one of our major enterprises for the last, at least the last three years, so I would ask please that we do get recognition for that.

UNKNOWN: Chair, just a rider to that, in addition to that, health policy documentation, we commissioned the  document on human resources by a Mr Nicholas Crisp some years ago and within that document are all the elements of what you are asking, in that human resource documentation.

CHAIRPERSON: Wendy.