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

UNKNOWN: Thank you very much.
 Students in their early years felt there was very little or no support for their protest activities against the injustices surrounding them.  In the 1980's there was much more support for students involved in politics and this included reschedule of examinations and also the opportunity to write examinations while in detention and all the support structures.  However, despite these measures, students felt that not enough had been done by the University.  Students had boycotted graduation since the late 1970's because they felt that the University was predominantly White and racist, that conditions at the Medical School were inferior to those at the main campus of the University, that there were unfair rules and difficulties in transport from the residence to the medical school, that Black people were unfairly bypassed for promotions and that most of the administrative staff, secretaries, receptionists, etc were White.
 They also felt there were many outstanding doctors produced by the Medical School but none of them were appointed as professors or head of department.  However other Medical Schools were willing to appoint them in these positions, for example Professor Ephraim Mogokong, Professor Madivati and Professor Macqina.  The students were protesting the trend of not promoting Africans although they were not saying that those who were appointed were not qualified.  This went on until 1995 when the University held a reconciliation graduation and apologised for their unfair practices and actions of the past.  
 The high failure rate of students, especially Africans in the second year and to a lesser extent in the third year of study has been a major cause of concern.  Many students were excluded from Medical School for failing in the second year.  This caused great bitterness amongst students because the Medical School appeared to be doing very little or nothing in addressing the problem.  In the early days it was the exception rather than the rule that students would receive their degree without repeating second year.  Many students were excluded after their first attempt at second year even though they had successfully completed the preliminary year and first year without having to repeat either year.  This has also caused great economic hardship to students and their families.  The nature of the courses in second year have changed but the failure rate remains a problem and students are still unhappy about the rules relating to exclusion.
 In the late 1980's the University considered opening the Medical School to White students. Every province in the country had a medical school for Whites except Natal.  However the students were not prepared to concede that this medical school should be opened.  They argued that given the needs of the country more Black doctors were needed and since other medical schools were practising apartheid, this restricted the number of Blacks who could be admitted to their institution which the University of Natal and other institutions.  The students were prepared to reconsider the position only if other medical schools opened their doors to Black students and until new constitutional guarantees were placed.
 In fact the primary reason that the University of Natal could not open itself was that the students would not allow it.  It is only in the last two years that White students have been admitted.
 Students also fought against the conditions at the King Edward VIII Hospital, and also staff had protested against racial discrimination in the hospitals in the Durban Metropolitan area.  Indian doctors had refused to accept positions at Addington Hospital which admitted White and Coloured patients on the ground but Indian and African patients were not admitted to this hospital.  
 Furthermore African doctors were not permitted to work in Addington Hospital.  Doctors were punished for protesting against the prevailing conditions. Some were denied paid leave to go to conferences or to get further training overseas whereas other doctors would get paid leave for these activities.
 It is noteworthy that students at the Medical School did not engage in protest activity which involved violence or damage to Medical School property.  The administrators at the Medical School had tried to make changes at the Medical School but did not always have the backing of the University.  Despite the fact that they were not always effective in changing the adverse conditions, many felt that it was important to stay and fight in whatever way they could, rather than resign and be replaced by someone more conservative.  Also the Medical School was under close scrutiny by the Security Police and the Administration would try to help as far as they could in the late '80's.  
 King Edward VIII Hospital was initially a hospital for African and Indian patients.  However, the patient wards were segregated as well as the tea rooms and changing rooms for the doctors.  In the 1970's RK Khan Hospital was opened for Indians.  At this time all the Indian patients were moved to RK Khan Hospital and King Edward VIII Hospital became an African hospital.
 In the early years the first difficulties doctors of colour faced were from sisters in charge of wards in the hospital who were White and who resisted taking orders from doctors of colour. These sisters were subsequently told to either resign or transfer to other hospitals.  Most were transferred and the ones that remained were willing to work with Black doctors.  Over a period of time more Black sisters were appointed by the Provincial Health Administration.  
 Conditions at King Edward VIII Hospital were inadequate and not conducive to caring for patients. The hospital was overcrowded, lacked sufficient sanitation facilities and was understaffed.  The hospital was much poorer than Addington Hospital which admitted White and Coloured patients.  It was difficult for the administrators to get equipment to make King Edward VIII Hospital a proper teaching hospital. For many years patients would be put on floor beds if the hospital had already reached capacity because Black patients could not be transferred to the other hospitals.  
 The medical equipment at King Edward VIII Hospital was often old and outdated.  The new equipment that the hospital often got was that which got discarded by the Addington Hospital.  
 These adverse conditions made it difficult to treat the patients as humans in such an inhumane environment.  There were not enough toilets to accommodate the number of patients in the ward.  For example the obstetrics and gynaecology ward had 70 beds but at times it operated at 200% capacity an there were only five toilets for these approximately 140 women. 
 It was not until the 1990's that the hospitals became integrated and the patients could be transferred to other hospitals that had empty beds.  For a long time there were no intensive care units at King Edward VIII Hospital.  These facilities were available at Addington hospital which refused to accept Black patients.  
 Doctors at King Edward VIII Hospital had a problem because whenever they protested there were difficulties, especially regarding their conditions of service.  
 Black students were not allowed to train in the White hospitals for example the Addington Hospital.  Some doctors felt that their training suffered from the fact that they were forced to do their training and internship at King Edward VIII Hospital.  The segregation of hospitals limited their training to one race and they could not get the opportunity to study First World diseases.  
 Some also felt they did not have the opportunity to use certain types of technology due to the inadequate equipment at King Edward VIII Hospital.  Others did not feel that it hampered their training at all.  Most of the graduates at the Medical School felt that the overall training was of a very high standard.  
 At King Edward VIII Hospital there was also very poor accommodation for Black interns that either had to live in or spend the night at the hospital due to long shifts. The accommodation for White interns was separate and superior, the Black students felt that if they complained they would not be given jobs.  
 Everyone was encouraged to do postgraduate work, however, most of the postgraduate students were White and Indian.  Few applicants went on to do postgraduate studies because of financial constraints and because of the perceived lack of upward mobility. Many had to take care of their families or repay loans and thus opted to go into private practice.
 The question of inequitable compensation has already been dealt with, but when staff were engaged in protest activity they would receive support from their White colleagues in principle although no concrete action had been taken at that time, and two of the doctors who were leaders in the strike were targeted to be punished by officials.  These two doctors were not allowed back into their positions after the strike and interns were told that they had to apologise in writing, otherwise they would be stopped from even getting another position in the country and thus would  never be able to practice as a doctor.
 Most of the administration of our Medical School including professors and heads of department were White males, especially in the early years of the Medical School.  This changed slowly over time as Black medical doctors gained the credentials to fulfil professorial administrative posts.  However, there has never been an African appointed to professor or head of department.  There has only been one Coloured member appointed as head of department and only two females appointed to this position.  Many of the doctors at the Medical School have been frustrated by the lack of role models and implicit glass sealing that they face in terms of promotion and advancement.  Many feel that the Medical School overlooked highly qualified African doctors who left the University of Natal Medical School to become professors at other medical schools, or have been appointed to top levels in government.
 In the early 1980's many politically active doctors believed that a black list had been drawn up by the security forces of names of doctors that were too politically active and were therefore a risk to the security of the State.  The black list affected doctors in four fundamental ways:
 They were prevented from attaining any governmental positions,
 they were denied promotions;
 many were denied international travel by not being given a passport; 
 and many could not publish in the scientific press which further hampered the prospects of promotion.
 For people who were black-listed the security police tapped their phones, threatened them and their families, raided their homes and offices, held them in detention without reason and even tortured them.
 Some faculty members also felt that certain departments were much more difficult for Blacks to get jobs in than in other departments.  
 The State pathologist said that they were forced to have a security office system.  This may have hampered their autonomy of pathologists.
     Ethics and human rights patients were treated very badly due to the conditions at the hospital but often this was the only exposure to the patients that the doctors had. So they never learned anything any differently. Respect for patients was not always instilled. 
 Concerns were also raised that some of the research done on patients at King Edward VIII Hospital was not done in an ethical manner and that the Declaration of Helsinki was not always observed.  
 Patients were not always properly informed of the risks of the procedure and other options available. 
 So in summary, culpability, complicity of the University and the Province, both the University and the Province could have done much more.  They should not have accepted such conditions for a medical school and its teaching hospital.
 Now regarding recommendations which are not in the submission that you have.  Mr Chairman we would like to suggest that apartheid was a process of dehumanisation.  That it reduced the majority of our people to objects or physical entities. Imperceptibly medicine also became dehumanised.  The focus was on the disease and not the person, their family and community.  South Africa is politically free, however our people need to be healed spiritually, mentally and physically if we are to create the type of society and country that we all desire.  Doctors, medical schools and their teaching staff, and medical students can become important instruments for this change.   The most important step in this process is to re-humanise medicine.  
 Firstly we need to view every person as a whole being.  In other words we need to recognise that it is the spirit, mind and body which makes up a human being and that these aspects are intimately interrelated.
 Secondly, we need to embrace the concept of health rather than disease.  Health should be viewed as a state of perfect spiritual, mental and physical wellbeing, not merely the absence of illness and infirmity.
 Thirdly, we need to accept that a person is part of a family, part of society, part of our country and part of the global village, the world.  Therefore the state of a person has far-reaching implications which go far beyond the individual. 
 The medical curriculum has to be changed accordingly.  It has to become human centred, in other words, person centred, family centred, community centred.  
 The social sciences and the humanities need to be introduced and issues such as human rights and ethics covered. 
 Respect for all people including those of different ethnic backgrounds and respect for all cultures needs to be instilled.  
 The new graduates should have received training which enables them to have a broader vision so that they can be more socially aware and socially responsible. The new graduates will find it natural to take up issues such as human rights, violence, crime, child abuse, pollution of the environment and global warming irrespective of where in the world these issues may arise because they understand that these issues impact on health.
 In short, change is not merely desirable, it is essential.  The narrow outlook of the past can no longer be justified.