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

MS A HARPER: Thank you very much, and thanks for the opportunity to present something in a more structured form than the previous submission we made to the TRC.  It was certainly at their nudging that we were encouraged to try and put down some of our thoughts into a more structured format.
 I perhaps need to explain that I am certainly not speaking here as OASSSA, the organisation, in case some of my colleagues in the audience think I have forgotten organisational discipline, I actually am speaking as the Durban Branch of OASSSA, and more specifically the Detainee and Repression Counselling group.  
 So if I could preface my input to say that this was drawn together by the remnants of that group who have spent time together trying to reflect on the experiences we've been through which in fact we discovered had pre-dated OASSSA days.  
 And perhaps if I could just try and follow the order of your questions and structure my input by saying that there are two specific events, although obviously all the issues that have been raised over the two days informed the response of the organisation and of this particular group.   I think two in particular are linked to the roots of this particular group of counsellors. The one was the mass detentions in the 1980's, and as a result of that, and one of the many responses was the formation of the Descoms, the Detainee Parent Support Committees, and those committees, very quickly, as their work increased, started to pull in legal, medical, psychological, welfare sub-groupings into the Descom structures, and a number of the people who were part of this counselling group had their origins there.  So it goes right back to those days.
 What happened after that was the need to organise perhaps more coherently the work of the psychologists, the social workers, the people who were coming at the detainee work from a mental health or health perspective, and the Natal health group was formed in support of the Descom work.  As that developed more and more we found we were drawing in physiotherapists and doctors, students, and I need to give enormous recognition of the role that students played in the work that we did, they certainly nudged the professionals into moving faster.  
 As this was  going on in the Durban region OASSSA was
forming itself in the Transvaal, and that was in the 1984/85, so that in the Durban region there wasn't really a need, it wasn't perceived to be a need for us to, at that stage, form an OASSSA branch.
 The next major event I think that shifted the focus of what we were doing to some extent, and also deepened the work was the state of emergency.  That the health care systems and the social service systems of that time were inaccessible as it was were fragmented, were certainly not near to where the need most was.  And what became apparent to us is that we had to have a response to that lack of accessibility.  
 So from the Natal Health Group a new group formed called the Emergency Services Group which worked together with the NAMDA people and a number of organisations that my previous colleague articulated.  So we had a history, if you like, of development, the two main political events that happened, one was the mass detentions and the need to have a response to that from the mental health sector, and finally the state of emergency which really made accessibility to any kind of care and support almost impossible for the people who most needed it.
 I had included here some background on OASSSA, but perhaps if I could throw it out as a challenge to executive members of OASSSA, the need to really write their history and to put together in fact the origins of that organisation as a whole because I cannot hope to do justice to all the areas of work which were included in that organisation's brief. 
 If I could just touch on the headings of what OASSSA was attempting to do at that time.  By 1989 there was a branch in the Transvaal which had started in '83, Cape Town '85, Durban '87 and 'Maritzburg '87 and Grahamstown in 1989, so by that time OASSSA was well launched.  It's general brief and terms of reference, because one has to, and I think, I don't want to belabour the point it's been made very well in the last two days, that the mental health services, the practice, the training, the professions, the professional bodies in particular were very closely reflective of the wider society, the divisions, the fabric of the apartheid society certainly was reflected within everything that - all those areas of psychological life.   What OASSSA then tried to do, and I'll talk a bit about, I think the origin in the Transvaal as quite a symbolic beginning for the kind of people who were drawn to OASSSA was, the group of ad hoc students who got together in about 1984 to protest the location of an Institute of Family Therapy conference on the family to be held in Sun City, and I think that that was quite a significant turning point for many people because the total obscenity of holding a conference that was going to be focusing on family life in a homeland where, and in the context of a system which is actually destroying families, did not seem to perturb the organisers of the conference, but it certainly motivated a group of students of the time to say there is something terribly wrong with this type of process.  So I think that was the kind of - then there were moments like that in psychologists lives I think where suddenly having seen South Africa a different it was impossible to say you did not know or you had not thought about it.
 So what OASSSA tried to do really was look at how the Mental Health and Social Service workers were organised and to try, I suppose, in many ways provide an alternate home for the psychologists and social workers.  We had a number -we were quite open membership who just did not feel that they fitted into the traditional professional bodies.  So it did have an organisational aspect to it.  
 It also attempted to research and expose the social, economic and political conditions which we believed undermined the wellbeing of all the people of South Africa, and I don't want to go into that because I think it's very well covered.  We certainly are willing to put a more detailed report together to list those.
 Also to develop and try and offer more appropriate social service which was much more responsive to the real needs of the society as we saw them and based more in the realities of the people who were most disadvantaged in terms of access to the few and fragmented services that were available.  So we also wanted to challenge the way we went about our work.  In fact it was reinforced today, the training of psychologists was happening in this extraordinary vacuum, it certainly wasn't happening in South Africa and you learnt nothing in that training about the realities of the difficulties that the majority of our citizens were facing and the threats to their actual wellbeing.  So we felt it was necessary for us to start examining what we were doing to try and find different models of doing our work.  
 Another part of that was to try and share our skills.  The South African psychologists were very elite, maybe, I am not sure about past tense, but there is very much a sense of "expertise" and you do not work with non-professionals.  You do not share your case notes with social workers at one stage.  So we were trying very hard to share our skills as much as we could wherever there were people who were already identified as care-givers in the community.
 So the counselling group in particular, perhaps I need to focus for the rest of the time very quickly on them, the counselling group, the detainee counselling group then which was a subsect of the OASSSA were specifically counselling ex-detainees, their families and their friends.  I think the point has been made that the State was certainly not just targeting individuals, they were targeting the whole social network and support system of people who were detained.  
 And as our work developed we found ourselves more and more working with victims of various forms of oppression and repression and violence as well.  I will go into that in a bit more detail.  Police and vigilante harassment especially in KwaZulu, compulsory conscription, we found more and more that as we became identified as a resource within the community this very small group of health care professionals and workers were being called upon to intervene or become involved in the care of a number of different people, although as I said we did start out as a detainee family and friends group. The work with the detainees, as Barry has mentioned, was carried out very much with NAMDA under the auspices of the emergency services group.  
 The other work that we felt it was important to get involved with was just presenting workshops and seminars and talks on detention and the effects of detention, because at that stage we felt it was really necessary to try and counter the denial of State officials that in fact torture and abuse of detainees was really taking place.  And if you remember the state of emergencies there is no way that you could get that information published.  You remember the Weekly Mail where they eventually published just one blank page because everything was banned and censored at that time.  So we felt it was really necessary to keep running workshops, keep trying to tell people about what was going on.  And again we need to give credit to the overseas supporters who enabled us to publicise some of that work.
 It also arose the need for workshops to try and broaden the net of support in the townships because it became impossible for us to hope to get our services into the townships.  If there were services in the first place people just did not - were not able to enter or leave the townships and the people who were in there we found were enormously resourceful, the ministers, the teachers, the grandmothers in particular, the mothers, were very much seen as the support system within the townships, and we felt it was much more worthwhile for us to train other people who might be able to offer the support at source, if you like.
 We were also involved in a number of other activities which I will elaborate in a more detailed submission.  But perhaps if I could go on because I think it is a slightly different stance that I would like to present here about the way in which being a professional psychologist, or a group of professional psychologists who were trying to do things differently, or work with people who were seen to be enemies of the State, the way in which that actually was made more difficult by our professional organisations, the lack of support from colleagues, also the way in which it compromised the kind of service we could offer to people.  So I'd like to spend a bit of time on that and avoid the repetition of the other inputs.
 The most frequent groups we saw, as I had mentioned earlier, apart from the ex-detainees, were people, activists who anticipated being detained or becoming victims of violence, and in KwaZulu that was quite a significant group.  That created a very particular challenge for the psychologists, because when you were working with people on the run the assumption that you would be seeing people for a number of sessions, or you would see them in a location which was clearly identified was totally thrown out the window. You had to become a person who would go to where people were in hiding, and that usually involved a whole network of moving around. At that time that was not an exercise without its own dangers.
 Another group that started coming to us much more were the conscripts, so they were people who were attempting to avoid the call-up, people who are AWOL and on the run, or those who had completed their military service and were totally traumatised by their experience.  I found that group escalated, especially during the state of emergency, in terms of the students on the campuses.
 The other groups which, and in our more detailed submission we will go into the kind of issues that we were forced with, were ex-political prisoners, returning exiles and I think it's a group that still needs some thought.  And in KwaZulu in particular, displaced children, children who were trying to escape the violence, particularly of the Midlands and Pietermaritzburg and we found this huge wave of street children who suddenly entered the city of Durban.
 From a counselling - another obstacle was just the profession itself, I don't want to go into that too much because I think Lionel captured it very well this morning, but basically the PASA - although we had made attempts to try and get them to take a public stand against apartheid and to actually come out in recognition of a link between apartheid and the enormous damage that it was doing to the people in the country, both PASA and the Society for Student Counselling refused to do that.  Eventually, I think after two years, they came out with very watered-down versions.
 So we were operating without a base, if you like, without the support of our professional body.  I think it was mentioned this morning, they hid behind the professional neutrality or objectivity, and in fact their silence and inaction of the majority of the health professionals possibly, became a way of colluding with what the State was trying to impose at that time.
 It is more than possible that collusion took more of an active form and I think a lot of people have alluded to that, and one encourages the TRC to try and investigate that.  We will certainly cooperate in whichever way we can.
 You also asked me about our role as professional counsellors, and I'll try very quickly to cover what we thought as the ways in which our own professionalism had been compromised.  And even started questioning the quality of the care that we were able to give to people.  It became an issue of your political credibility actually outweighing your credibility as a good psychologist or a good counsellor because of the way in which we were having to offer our services.  We were often seeing people in inadequate facilities because you couldn't see people in the clinics because the State services or a lot of the places where you might have been able to operate were viewed with suspicion, especially by the people on the run, and there were certain buildings which were being watched.  So where we ended up seeing people were often odd ad hoc rooms with no sound proofing, not conducive to counselling at all.  
 The whole issue of confidentiality and record-keeping I think Barry covered it very well, became an enormous issue where it was important for the people we were seeing that nothing was written down and we had to go through all sorts of manoeuvres to try and disguise what we were having to record, but certainly in terms of professional behaviour and ethics, the fact that we didn't keep records and we did not make those available to anyone could have become an issue.   The lack of continuity, you could not assume that you would be able to see people in a follow-up or referral situation.  The referrals were impossible.  You had to rely on the network of people who you were working with and the network organisations to do those referrals.  So again as a professional you were compromised, you were seeing people quite often one off, and you had to try and do what you could within that time.
 Another moral and ethical dilemma and I won't cover the other points that we did raise, was that you needed to maintain your credibility as a profession so that your word was treated with seriousness, but at the same time in doing that you were put into a moral dilemma.  I'll give you an example of having to assess the mental status of conscripts knowing full well that if they were not sick enough they would be forced into a situation which they found totally abhorrent, so you were all the time - your own professional standards were being challenged by the moral consequences of what you were being faced with at the time.
 Also just to mention that it was a very, very small group of people, so the pool of people you could draw on, because you were not getting the support of your professional bodies, it was a very small group of people who were engaged in this work and that put enormous strain on a very small group who were having to face quite seriously traumatised people, be they detainees, torture victims, be they conscripts.  
 So I think if I can in a very rushed way, knowing your time constraints, if I can just move on to some of the recommendations we had in mind and make a commitment to put this into some sort-of form, a report that would stand more substantially on its own. 
 Our recommendations for the TRC I think really just underline and reinforce recommendations that have been coming from some of the submissions today, that adequate allocation of resources for the provisional of mental health and community care to those still traumatised by the violence, oppression and human rights abuses of the past, and I think it's been emphasised by others as well, and those who are experiencing ongoing violence, I think there is an assumption that all is well.  Certainly in KwaZulu this is an ongoing need and certainly the facilities are not there.  It's the same people quite often who didn't provide facilities and services before who are still the people in charge of the services if they are there.
 That, in our opinion needs to include ongoing and systematic support for those people who have been encouraged to tell their stories at the TRC.  There is a worry from our side, I think coming from our experience of working with people who you are encouraging to talk about their traumatic experiences, that that trauma is a very ongoing, has very ongoing consequences, and although there's a feeling of relief at having spoken about things I guess it's a plea to the TRC to ensure that their support is an ongoing and structured one for those people who might be telling their stories for the first time.
 A group, as we were talking, our little detainee counselling group, a group that we never thought we would want to focus on as much as it's becoming more apparent to us, that young boys of 18, 19 were forced into compulsory brutal military training.  They were deployed inside and outside the borders, often forced to commit the most dreadful acts, and for them only to discover, in the light of the new political dispensation and public revelations that the rationale for their behaviour and the framing of their experiences was being manipulated by politicians and securocrats and I think we are not even touching what is going on with that group of young people.  I am not talking about permanent force people, or people who made a choice, I am actually talking about those people who were forced at a very young age to commit some of the most vile acts.
 I think the plea to the TRC would be to recommend that all avenues be explored to enable these young people to tell their stories be given a sympathetic hearing and obtain professional assistance.
 The final suggestion, if you like, because we battled to know quite what it was that you were asking, was to have some sort of public - we couldn't decide if it should be a protector or ombudsperson or a monitor for human rights as they pertain to the health sector.  I think a couple of presentations today have underlined that as well.  And they need to include in their brief and monitoring of the consequences of human rights abuses from the perspective of the health sector, and especially the mental health, because quite often mental health is put very low on the list of needs, mental health and community care actually, to monitor whether the professional bodies do actually fulfil their commitment to change, their model and their training, their models, the behaviour, if you like, of their members.  We would take a guess, without hoping to be too cynical about it, that self-regulation of the profession and the health sector just hasn't worked in the past.  
 So it feels like there needs to be an outside agency that is monitoring that, and we have got a number of examples of the kind of things we feel would need ongoing monitoring, even in a society which is perceived to be a democratic one.
 I think then, just in conclusion and I am sorry that I've gone over, is that I think an awareness that came to us as we talked about our experiences that changing the distribution of the political and economic power will not automatically change the nature, accessibility, training models availability if you like of mental and community health services.  It actually has to have a push, something needs to push that to make it happen, and I think we are hoping that the TRC sees itself as having an on-going responsibility in giving further impetus to the kind of commitments we have been hearing today.   Thank you.