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

MALCOLM BARRY KISTNASAMY: Thanks Madam Chair.  The National Medical and Dental Association came into being on the 5th of December 1982 at a conference in Durban after more than two years of consultation amongst all progressive doctors, dentists and other health workers nationally and internationally.
 In the preamble to its constitution NAMDA proclaimed its acceptance of the World Health Organisation's definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  And perhaps I think that these are things that colleagues within other organisations, both represented here today and over the last two days, probably need to examine in terms of their own submissions in terms of this WHO definition of health.
 It reiterated the belief that health is a basic human right which should be available to all the people, irrespective of race, colour, political belief, economic or social condition.  It further committed itself to creating the conditions for optimum health which can only exist in a free and democratic society.  And I think that's where the variance came in with many of the organisations that saw itself, at that stage, as part of the apartheid State machine, or sharing the world view of White South Africans, and that was earlier alluded to in various things.  Whereas NAMDA felt that you cannot have optimum health for people if you did not have the conditions, the structural changes that needed in society to bring about optimum health, and NAMDA committed itself to creating those conditions as well.
 Its aims and objectives were as follows:
1. To attain the highest possible level of health for all South Africans.
 2. To promote and practice comprehensive health care, emphasising both preventive, curative and rehabilitative health care.
 3. To promote the health and allied sciences at all levels of society.
 4. To promote and protect the honour and interests of the medical and dental professions, and ensure that every member adheres to the highest ethical code governing the profession.  Again we might have deferred with other organisations when it came to these issues.
 5. To promote improved standards of teaching in the health, medical and related professions relevant to the needs of the majority of South Africans.
 And I think later on when we address the issue of standards we have to ask ourselves what do we mean by standards when we talk about the issues about linking up with the health needs of all South Africans.
6. To affiliate or cooperate with any scientific, professional or other groups which contributed to the advancement of (...indistinct), and this was later to the international context.
 And lastly but not the least important;
7. To actively encourage and develop community and workers participation in all matters affecting health care.
 Now the background to the formation of NAMDA has gone into quite a bit, suffice to say that the Biko saga and the sad story relating to his death was one of the factors that led to the formation of NAMDA.  Let me move on.
 Health professionals in South Africa have long been aware of the damaging effects on the health of the population imposed by a system of racial and economic exploitation.  
 The social consequences of apartheid were so gross, so thoroughly destructible and so widely acknowledged and abhorred by the international community that there could be no avoiding the intrusion into the professional lives of medical men and women in this country.  The idiocy of the pencil test for babies, abandoned babies; of floor beds on one side of the hospital while the other half remains empty; Black medical students in ward rounds that ended in the tea room with the porters while the White students continued with the White professors to the White side of the hospital; Black nurses that could not have White nurses looking after them, and you heard from DeNOSA and maybe their submission later on will point more to that.  
 The issues about conferences upon conferences where government policy was acclaimed in terms of the Transkei Medical Association, the Homelands, the League of Nursing Associations of South Africa where SANA and the Transkei Nursing Association, KwaZulu Nursing Organisation came together, where these conferences were to acclaim and loud-hailing the government policy of the day were seen as being part and parcel of delivering health care to the majority.
 Now the effects of apartheid and its devastating consequence on the majority of our citizens are well-documented.  Suffice to say that it combined class and race to give White South Africans their health care system better than some of the Scandinavian countries, and for Blacks worse than Botswana, a country just north of us.
 We need to note that the health planners and the medical superintendents and the heads of departments of health at that stage, we need to note what positions do they occupy today in South African society.  These issues of separate casualties, separate waiting rooms, do these health planners still have a role in South African society today.
 Thirdly, the formation of NAMDA.  With popular resistance rising in the seventies through the eighties the apartheid regime increased repression, even health facilities were not safe, and you've heard of instances of that over the last two days. 
 There were instances of active collusion by health authorities as with the District Surgeon in Colesberg handing over a patient to the police, to possible participation in biological and chemical warfare.  Indeed the doctrine of low intensity warfare had become one of high intensity with deaths, disappearances and detentions being the order of the day leaving us a society deeply traumatised and hopefully this process will bring about healing.
 Bishop Tutu himself spoke about Johnny on a submission to a conference in the Frontline States late in the eighties.  
"Johnny....",
writes Archbishop Tutu in his forward to the report of the lawyers committee,
"...is real.  He used to be a lively youngster full of life and fun until he fell into the clutches of the security system of the apartheid regime.  It is not quite clear what the police did to Johnny, perhaps it does not matter anymore, what is certain he went in a lively, healthy and normal youngster and he came out walking a human vegetable.  The police did something to him.  It is quite important for the world to know.  Johnny is no figment of a feverish imagination.  I saw him with my own eyes in Kotze House, Johannesburg".
 These are issues later on when we are talking about handling of children in detention NAMDA campaigned for "free the children".  "Free the children" in terms of not having a code for the handling of children in detention and these are the issues that we are saying we are at variance with counterparts that presented earlier today.  You could not have a code for handling children in detention.
 Lastly, in terms of NAMDA's coming into being, was the programme to train health workers for Black, mainly rural areas, by the South African Medical Services, the so-called COMOPS, designed to win the hearts and minds, gather military intelligence or a genuine commitment to the poor?  What of the biological and chemical weapons experimentation?  Was it merely defensive?  The Reverend Frank Chikane's poisoning, organophosphates, the death of Sipo Mtimkulu.  It must be noted that the forensic laboratory's services up to now still reside with the South African Police Services. 
 The TRC needs to note that health professionals, not just doctors, but biological scientists, psychologists and others would have had to be part of a wider group providing inputs for the destruction of our people, using their knowledge of human physiology and a psyche.  Earlier reports of torture to this Committee and others allude to the use of truth sera(?) being injected to detainees.
 Historical perspectives are such that it's well-documented about the social conditions and the determinants on health and I'm going to leave that out.
 Let me go onto, "did we know"?   Given what has been documented previously and what the TRC has heard to date, it is amazing that there are not more health professionals coming forward to testify, similar to Sean, and we would hope that the TRC would continue so that more health professionals could come forward.
 Ergonomics is a scientific discipline and in its simplest definition looks at designing the work place to suit the worker.  Since the earliest days of our mining industry, the backbone of our economy, heated climatisation chambers were set up to design the worker to the workplace.  We need to document what the Chamber of Mines and Wits Physiology Department had done in the early days of designing workers to the workplace.
 Recently there has been widespread news coverage of a public health service study in the United States which began in 1932 and continued until 1972 involving 399 Black men who were left untreated for syphilis to let doctors track the course the disease.  Madam Chair, our own (...indistinct) continue today.  Pneumoconiosis research with volumes of slides of lungs of dead miners in Johannesburg documenting advancing stages of disease, and as yet no interventions.   The various drug trials, the people in Lebodi, the rural doctor who spoke about rural health problems, the ex-miners in Prieska, what are we going to do about them and the destruction of family life in terms of migrant labour?
 Let me move on, NAMDA's structures.  NAMDA was active in all parts of South Africa and enjoyed international support. It grew from 52 members at inception to well over a 1,000 by 1990.  I must pay tribute at this meeting to the international aid organisations and governments which provided funding for the organisation's activities aimed at redressing the effects of the apartheid state.  
 On the other hand the organisations' members were harassed by the State and its structures in various ways.   Firstly, inability to get jobs in the public sector.   Secondly, harassment by the Security Police.  
 Thirdly, mysterious break-ins in our offices in Durban and Port Elizabeth and elsewhere with theft of computers and various documents of the organisation including detainee care records, which led us then to devise substantive ways of disguising names of ex-political prisoners and detainees.
 Second lastly, detention of members, and lastly bombings and death threats against members.  We would like to know who bombed Professor Jerry Kouvadia's house, and that we would ask of the TRC to find that out.
 It was unable for us to hold meetings at some of the medical schools, example, Stellenbosch University campus where the students invited us but we could not go onto that campus.  The meeting was banned by the Rector, the NAMDA meeting at that stage.
 Lastly, we could not get scholarships or research grants, whereas the Medical Research Council continues to contribute to the brain drain of scientists from South Africa by granting scholarships internationally.
 The South African Medical Journal, a reputable health science journal, at one stage devoted an entire supplement, I have a copy of it here, attacking Dr Emjee(?), a former president of the organisation.  A similar article attacking NAMDA dental colleagues appeared in the Dental Association South Africa's journal.  We heard of earlier submissions where the journal refused to tackle what they call "academic valued articles", and peer review (...indistinct) articles, and we would like to know what is the peer review of this article in terms of it being there in the supplement of the SAMJ, 18th of July 1987.
 At a branch meeting of the Medical Association of South Africa in the Western Cape in 1987 an Army Intelligence officer addressed that meeting about NAMDA.
 Where is the organisation today?   Unfortunately the Association finally merged with other progressive organisations in 1992 to form SAHSO, South African Health and Social Services Organisation.  Since 1995 a core group of ex-NAMDA doctors have rallied around the umbrella of the Progressive Doctors Group to begin discussions about a united medical association for South Africa that will espouse the true values of health and human rights.
 Very briefly NAMDA's programmes, and this might have an impact in terms of the future function of the TRC and the health sector in general.  There were major health policy initiatives by NAMDA that are now coming to bear within the Department of Health's formulation of health policy and we are glad to say that NAMDA's earliest contributions have contributed in more ways than one to a national health system for South Africa, a new system of medical education and training for the health sciences, and lastly debates on health financing.  Those policy options are now firmly entrenched within the South African Government's programme of action.
 Secondly, care of ex-political prisoners and ex-detainees and their families.  You heard yesterday testimony from one of our colleagues in Livingstone Hospital, of NAMDA's inputs that were made together with other progressive organisations.  We had made submissions to structures such as the Department of Health at that stage, the Medical and Dental Council, from example, the Fort Glamorgan issues in the East London area, the Eastern Cape, however to no avail.  We would like to know where those documents are today and whether there would be a re-opening of some of that evidence.
 In addition the State very soon after NAMDA safeguarding hospitals in the eighties began to move ex-detainees to No.1 Military Hospital.  What was different from public sector doctors, so-called NAMDA doctors treating people in public hospitals than military doctors in no.1 Military Hospital?  There were quite a few ex-detainees, the detainees that were moved to the Military Hospital.
 Lastly there were psychiatrists as you heard today that began to justify detention and justify torture and I think those issues need to be examined further. To the extent that NAMDA began to say that we were treating not post-traumatic stress syndrome, that we were treating continuous traumatic stress syndrome.
 First aid training.  This programme began as a direct result of the violence in the townships and the many mass rallies that were being held.  Many wounded people were arrested in hospitals and thus were afraid to go into health facilities.  Examples abound where security forces surrounded health facilities or set up mobile police stations outside health facilities.  In addition health facilities were at times closed during periods of unrest. 
 At that stage Madam Chair, organisations such as St Johns, the South African Red Cross and Noordekulplike were, according to our perspectives, not responding adequately to the needs of the victims of security force action.  They were still continuing with life-saving activities and old age homes.  Content of the training which NAMDA developed was aimed at community based organisations and trade unions and focused on first aid, emergency medical supplies, counselling skills and organisational skills to meet urgent health needs.
 NAMDA members and other progressive health workers were asked to ensure the safety of all patients at health facilities and provide care for the victims of violence, and yesterday was quite an emotional outbreak in terms of Dr Pat Naidoo and other colleagues like Betty at Livingstone Hospital.
 Of special note was an attempt by NAMDA during the latter half of 1985 and early 1986 to get information on the nature of the compound used in teargas.  We needed to know what was in teargas and how to treat it because there were instances coming through of media reports attributing deaths and severe ill health to the indiscriminate use of teargas.  This information was denied to the organisation.
 The next programme was a progressive primary health care network which was launched in 1987 and still remains to today in terms of a highly major grouping of community based organisations and health workers contextualising the political, economic and social conditions which give rise to ill health, and that structure continues to this day.
It emphasised community accountability, comprehensive health care and ensure that health workers use their knowledge and skills to service the needs of the disadvantaged.
 We further went on to have a national campaign on apartheid in health de facto in 1987 this was launched.  The campaign had four objectives, to publicise the fact that hospitals were segregated by race; to enable Black patients to be seen at White hospitals; to de facto integrate hospital inpatient facilities and to force government to publicly declare that all facilities are open to all races.   International campaigns that NAMDA engaged in was against torture, detention and racial segregation of facilities for the isolation of health professionals in South Africa, especially the Medical Association, the Dental Association, SANA and such structures, government functionaries and academics.  And particularly when it came to academics who held a fairly liberal view of individual rights versus group rights, and they felt that this was curbing their international linkages.  And unfortunately there are many of them present here today in the audience who still feel that this was a major impact in terms of their own growth, whereas the needs of the majority of the South Africa's citizens were being denied at the same time.
 Lastly, NAMDA campaigned for the release of political prisoners who had health problems.  
 We did publish articles that were not covered in this SAMJ but were covered in prestigious journals like the BMJ, The Lancet and such international journals.  
 The very special programmes that we worked with, there were local programmes like "Free the Children Rights" campaigns, etc, and I must say, in conclusion, that all the other programmes while initiated by NAMDA had close collaboration with the Health Workers Association, which later became the South African Health Workers Congress, the Detainees Parents Support Committee; the Organisation for appropriate Social Services in South Africa; the South African Council of Churches and various doctor and dental guilds.
 Some thoughts on the way forward.  Human rights as a discipline becomes part of the curricula in our education system, and the patient's charter of rights needs to be emphasised.  However, we should be wary that the custodians of this human rights culture are not the very perpetrators who benefited from a system in the past.  I find it almost impossible where we find chairs of human rights or whatever ethics that are still held by people from the old establishment.  We need to see about people who were actually denied fundamental human rights taking up those chairs and those professorial posts.
 The annual NAMDA human rights lecture, we had a human rights lecture series be resuscitated in conjunction with the Human Rights Commission and we feel this would be a token to NAMDA and the work that it did in those dark years in terms of the human rights lecture series being resuscitated, where we would then work with local people, the African experience and further experiences in South America where I think those things need to be probed as well, the links in terms of South America and various countries like Uruguay, Argentina etc, and the South African Government and its agencies in those dark ages of the seventies and the eighties.
 Thirdly, very important to the future function of the TRC and its recommendations.  Many of the survivors of the high intensity conflict need health care, especially counselling services, and it's nice to know that Project Curamus is there for ex-servicemen and servicewomen, what about a Project Curamus for the victims and the survivors of apartheid's human rights violations?  One of our own workers who over 20 years worked in the human rights field has currently had major psychological problems and he doesn't have an Operation Curamus to help him.  Can we get the SANDF to assist us further in this field, together with the Department of Health.  Let's extend their services.
 Fourthly, we need a much closer examination of the role of the district surgeons.  They are still present today.  And the delivery of health care to prisoners and victims of State-sponsored violence.  Perhaps we should note that many part-time district surgeons also have those separate segregated facilities.  How many of them are members of current organisations such as MASA?  Should we not be taking them to court, Constitutional and other ways, but apart from the fact of saying part of the conditions of service with Government as district surgeons that you cannot have separate entrances and separate facilities?
 Fifthly, as with the landmines campaign which we applaud the South African Government for taking the lead on, we should begin a campaign against biological and chemical weapons, in fact campaign for peace and promote a war against poverty.  That's the biggest threat to this country, poverty. 
 The TRC further needs to explore the relationship, if any, between military regimes, especially in South America and the brutal methods of torture and violation of human rights that took place in our country all these years, in line with biological and chemical weapons offensive.
 Six, seven and eight, in terms of its recommendations the various organisations, Medical and Dental Council, Pharmacy Board etc needs to examine their own rules and that they have started to do.  The professional organisations MASA, DASA, the Optometry Society, the Occupational Therapy Society, there's a whole range of these bodies across the range in South Africa and I don't think the TRC hearings have concentrated enough in terms of beyond doctors and nurses and psychologists.  Many other health professionals helped in some ways or the other to uphold the apartheid state.  They need to examine their roles.
 The voluntary organisations, the Red Cross, St Johns, Noordekulplike, consider their role in terms of the international charters that they were part of, and what were they doing and what are they going to do.
 Lastly, I am part of the Department of Health, and I spoke in my personal capacity, I hope that through my own involvement in the Department of Health we will continue to make changes, with government involvement, with political inputs, to make changes that satisfy the aspirations in terms of the health needs of all South Africans.
 In conclusion the wounds and the scars remain, memories of a continuing past which will not disappear.  We are only beginning to set the economic and social foundations for a health system that meets the needs of all South Africa.  Medical ethics in times of armed conflict are identical to medical ethics in times of peace.  The World Medical Association quotes that the supreme guide of the doctor is his conscience.  How many of us have been true to our conscience?
 I thank the TRC on behalf of NAMDA and its colleagues for allowing us to make this submission and we will continue to work with yourselves in whatever forms to actually take this process forward in terms of the reparation process thereafter.   Thank you very much.