Special Hearings — Health Sector Hearings — 1997-06-17

MARK BLETCHER: Thank you very much Hlengiwe.  Good morning members of the Commission and thank you for allowing us this opportunity to give evidence.
 I'd like to begin by paying a tribute to those health workers who were there when times were bad; the times when people were shot in the townships and it was almost impossible to get a health worker to give care; the times when detainees had come out of prison or out of police stations had been tortured and it was very difficult to find a health worker to be there;  at the times when hospitals were segregated on racial grounds and it was very difficult to find health workers who would stand up and say what was right. 
 And I would like to just give some examples of some health workers in this category, although it's obviously impossible to name many.  But people like for example like Dr Di Hewitson, who I worked with at the SACLA Clinic in Crossroads, who in her own quiet and humble way, through the most difficult times, entered into the townships and gave of caring and healing to people.
 To Dr John Frankish, currently director of the Cape Metropole Region, who after a whole day of treating people in the day hospital in Guguletu where he worked, would come and help us in the clinic in Crossroads when we were treating injured people at night.
 People like Mr Ken Ngcu(?), a driver of St John's Ambulance, who through the most difficult and dangerous periods drove right across the townships selflessly giving of everything to help the needy at that time.
 People like Dr Lesley London who, ever since I've known him over the last 10 years, will phone every three weeks to say, "can you please come and attend at this funeral or this meeting or whatever because something has to be done".
 People like Dr Fazel Randera, who from the National level, in those most difficult times supported us in setting up a detainee services and services like that in some of the most difficult settings.
 And people like Professor Trevor Jenkins, and Professor Frances Ames, who for those of us who worked in the most difficult ethical situations, provided some kind of ethical framework or parameters by which we could judge what was correct to do.
 I want to give some evidence about my experiences in Crossroads and Duncan Village between the years of 1985 and 1987, and I will start off in Crossroads Clinic.   Now the story of Crossroads is fairly well-known but I mean the failure of the State started off as a primary failure to actually even recognise the existence of that whole area as an area which had a right to exist.  So that up to 100,000 people were living there and the State had failed to provide even the most basic of health services.  They hadn't put a day hospital there, the most basic environmental services were lacking, like water.  
 It was in that background that the SACLA Clinic was put into place by a group of committed people.  The State persisted in hardly recognising the Clinic in its support, to the extent that shortly before the Crossroads massacres broke down in 1985 we had received funding from the State for about two health worker's salaries, and we had to use those funds to basically pay about five health workers out of those funds.
 In the Crossroads Clinic I think that we had an atmosphere of care and healing which was something which was very meaningful to me.  I think we had a lot of dedicated health workers.  And when the township went through some of its most difficult times I think we were a place of refuge.  We had close relationships with the community and had a Clinic Committee and delivered a fairly comprehensive primary health care service to the Crossroads community.
 In February 1985 the, what is now known as the Crossroads Massacre, occurred, and I would like to briefly explain just some of our experiences in that as a health worker.
 On the first day, February 18 1985, we came to a police roadblock in Crossroads and the police said that we couldn't go into the township because stones  were being thrown and so on, and health workers gathered some one or two kilometres further down the highway.   And I remember feeling as a health worker at the time, that was the first time - I had never before been into a dangerous situation in a township, and I remember at the time feeling incredibly torn as to what I should do, and what was the correct thing to do and what was right for me and what was the correct thing to do for my patients.  
 And I remember at that time people said to me right, some people have to go - what should we do, and a number of health workers immediately, and it was really a tribute to them, immediately said we feel our responsibility is with our patients and they went through, they walked through the bush along the roads with roadblocks and burning barricades and so on and they walked into the Clinic and gave care.
 Some of us they said we need to get some supplies like resuscitation equipment and things like that for the many patients who are going to be injured, and I was one of those who was asked to go to get the supplies and at that time I felt very grateful because I hadn't made up my mind what the correct thing was to do.  
 So the first thing I did then was to go back to the teaching hospital where I had shortly before then been an intern, a houseman, because I had qualified fairly recently before then, and I went to the superintendent, and said to the superintendent, there are going to be a lot of people dying and being shot in Crossroads today and we desperately need equipment and the Superintendent of the hospital said no it's got nothing to do with us you must get the equipment, it's not our problem. Anyway we managed to get some supplies, essential supplies from Red Cross.  
 And I remember several times later on in that day phoning through to the Clinic and hearing the most terrible stories.  Health workers would say that there are a lot of people being shot and so on.  I remember one particular phone call where I spoke to a lady whose name was Nomazizi, and she said to me, "Mark it's terrible here.  Injured people are being carried in all the time, people are bleeding, people are dying", and then she said "my baby, my baby, the teargas, my baby", and it was at that point that I just felt that I had to go into the township.
 So I phoned and said okay I'm coming into the township, and they said no well don't come in right now come tomorrow morning because we are going to be very tired after not sleeping through the night. 
 And the next morning we came into the - we parked again at the side of the highway, the N2, which is opposite Crossroads and we walked through the bush and coming to the Clinic we walked across Klipfontein Road, but the road was blocked with tree trunks and boulders and stones, and we embraced the health workers who had been through the night.  They had been through a very difficult experience.  There were smouldering remnants of barricades around in the road.  
 In the Clinic many of the examination couches had been converted to beds and on them the injured lay covered with bloody bandages.  We did a ward round and decided who could be discharged and who would need referral to major hospital for admission and specialist treatment.
 Not long after that firing started up and soon mini-buses and cars arrived screeching to a stop and unloading their injured.  Somebody would help with stretchers to bring injured persons in.  Some of the injured people hopped in supported by one or two friends, coming in from between the shacks.  We would rapidly check their state of consciousness, their breathing and their airway and then remove their clothes to see their injury.  We knew the most common cause of death would be blood loss and resulting shock, so our number one priority was to stop bleeding.  Most of the injured had been shot with shotguns and the severely injured patients usually needed urgent fluid replacement and rapid transfer to hospital.   Throughout the day the injured poured in.  Often they would describe how they were shot, almost invariably by Police.  Many were young, the majority between 15 and 25 years of age.  People moaned with pain and parents and relatives sobbed.
 The injured, as we saw them, did not appear to have had weapons to speak of.  Most of them appeared to have fought with sticks or stones.  Many women brought in their babies who had been in teargas and we also had to treat asthmatics and people with chronic chest diseases who had been made worse by the teargas.  When a body already dead was brought in we would certify the person as dead and then usually the nursing staff would clean the body and wrap it in a particular way.
 By the end of the first two days we had treated around 200 people who had been shot.  Just for an example I would just like to show members of the Commission, this is just like a list of pages, each of them of just a person shot, each page is about 30 lines, and it just goes on for pages and pages and pages of people who were shot and that's just during the two days of February.
 I would briefly like to describe some of the injuries that we treated.  This type of shooting,
particularly by Police continued right through 1985 and by November we had treated over 500 people that alleged, and according to their injuries, appeared to have been shot by Police.  And of those 500 people who had been shot, 464 of them had been shot by shotguns and 31 by rubber bullets, and 5 by high velocity bullets.  
 13 of the patients we saw died and 65 of them had serious injuries which needed referral.  The kinds of serious injuries we saw due to shotguns were penetrating eye injuries with blindness, 12 people;  penetrating chest injuries, seven people; penetrating abdominal injuries, seven people, and head injuries with neurological loss, six people; and severe soft tissue injuries, 14 people; and fractures or joint involvement, 15 people.
 It was quite difficult to follow up the patients but we treated many patients with permanent disabilities, including blindness and hemiplegia, nerve palsies and contractures and so on.  People with injuries from rubber bullets included things like fractures, including a fractured skull, fractured mandible, acute abdomen with a partial hepatectomy and so on.  We also treated a large number of people that had been beaten, many with batons and quirts and they had sub-junctival haematomas which is bleeding in the eye, ruptured ear drums, scalp lacerations, cut lips and so on. 
 Teargas was used very frequently and disrupted the work in the Clinic on a number of occasions.  Severe problems were usually seen particularly when it was shot in a confined space, like we saw a patient who was brought in unconscious after being teargassed in the back of a police van. 
 The patients we treated were usually young, in fact 43% of patients were less than the age of 20 years, and we saw five children less than 10 years of age who were shot, and 36 children who were shot who were less than 15 years old, well between the age of 10 and 15 years old, 36 children who were shot.
 Now I'd like to describe some of the difficulties in referring patients to hospital.  Now initially we had difficulty referring patients to hospital because ambulances wouldn't enter into the area.  Subsequently we then had to refer patients to hospital with vans and other kinds of vehicles which would take the person outside the township to hospital, and then we found out that a lot of our patients were being arrested.  In one particular hospital a whole ward of patients was held under police guard.  In another hospital which we visited all the patients that we referred who had been shot, their names were being underlined in red in the admissions book.  We spoke to some of the staff and they said no, well the police were being given these names.  In another hospital most of our patients were not arrested but we had one or two cases of patients who we referred through and they were arrested.
 That led to fairly serious problems because later on in the year when we wanted to refer patients then who were shot later on, the patients would then refuse to go to hospital, often.  We frequently had patients refusing to go to hospital even though in some cases by that stage we - because in some of the hospitals conditions seem to have improved.  For example I remember one patient who had a septic hand injury who we really thought needed to be admitted potentially for surgery or intravenous antibiotics but refused to go to hospital because he feared he would be arrested.
 We had difficulty in getting emergency equipment.  I have given some examples of that.  In some cases I remember some of our staff having to walk across the N2, across roads that were fairly dangerous at the time to get equipment which would not be delivered into the township even by members of the provincial staff.  
 The Clinic suffered several searches by security forces demanding records and information about patients who were injured.  I remember one particularly vivid case where about, literally about 60 police and army people came to the Clinic and they wanted to know the identity of people who had been shot and they wanted to take records, and wanted to know who was the staff member who worked there and there because someone had told them about that person and so on.  They tore down posters off the walls of the Clinic and so on, but I am proud to say that the Clinic resisted that type of intimidation.
 There was also various harassment of health workers.  One of our doctors, Dr Ivan Thoms was detained during that period.  Dr Bressick was arrested in one of the areas just adjacent to Crossroads and held.  Dr Myburgh our dentist was charged for illegally entering a Black area without a permit.  One of the other members of our staff, Mrs Peter, was held for many months before being released.
 I'd briefly like to talk about the role of - well our interaction with lawyers around the period.  We treated a lot of people who were injured during the period and we thought - we tried to make legal services available to them because we thought a lot of them would want to bring cases against those who had injured them.   Perhaps I'd like to just show you one photo here if I may.  This is a photo of a young boy of 14 who we treated at the Clinic.  He was shot from the back at fairly close range with a shotgun.  And why that young man was particularly, I remember him particularly well was because of all the 500 people we had seen who had been shot he was the only one which we ever ended up giving evidence in court around.  And that evidence that we gave wasn't evidence of him laying a charge against those who had shot him, it was evidence kind of in support of him when the State charged him with public violence.  So of 500 cases at least, of people who we had treated, we are aware of only about one or two people who ever brought a successful case against those who injured them.
 The role of the Press was very important during that period, and that contrasts with my experience in some other environments.  Because it was an NGO the Press, we had easy access to the Press and the Press was very, very helpful in highlighting abuses during that period.  
 We submitted an article to the South African Medical Journal around that time of 500 people that we thought had been shot by Police and problems we were having with referral to hospitals and so on, the South African Medical Journal at the time refused to publish that article.  We felt that they could at least have given some response to us which would have supported the difficulties that we were experiencing during health workers of that period.
 We experienced several difficult ethical issues during the period as health workers.  Some of the difficult ethical issues that we confronted were issues like one day we treated three women who had been beaten by a People's Court.  They had received a 100 lashes each by a People's Court and the youth from this particular People's Court placed a lot of pressure on us as health workers not to complete assault forms and things like that.  It was a difficult situation.  
 We were put into difficult ethical situations when we were confronted by vigilante groups who became known as Witdoeke.  Sometimes they didn't want particular staff members to work in the Clinic, the didn't want us to treat particular patients and so on.  
 And I've mentioned some of the difficult ethical situations we faced with the Police.
 We also treated, shortly before the burning of the camps close to Crossroads, about 15 people who were tortured, many of them quite severely.  I will just read you a very brief extract from just one of them. This young man was arrested from his home, taken to a local police station in Cape Town.  He says,
"I was given electric shocks.  My whole body was affected.  They took the cap off my head and asked more questions.  They then put the cap back over my head and held it tightly around my neck.  I could not breathe.  This continued with the shocks.  One policeman put my head between his thighs while the other hit me with a cane and others kicked me.  I could not tell how long this continued.  I was hurting and suffocating".
Torture was not uncommon during that period and we saw a lot more of it in the Eastern Cape, which I will come to shortly.  
 One of the people we saw tortured, I can perhaps show this picture as well to members of the Commission, was a community leader in the Crossroads area.  This particular gentleman had - a very dignified and respectful man, and he had had electric shocks.  The picture I am passing around we thought at the time that that showed fairly clear evidence of - he had a small ulcer with little abrasions around it where the electrodes had been applied.  He was actually beaten and tortured on more than one occasion.
 I remember one particular experience with that gentleman, who was quite a prominent community leader at the time, where he was then arrested and sent to Valkenberg Hospital, which for those of you who don't know Cape Town, that's a hospital for mental illness.  And I remember visiting him in the very high security unit of Valkenberg Hospital where it's kind of very - it's almost like a fortress-type arrangement, and it was the most strangest situation, that the person who let me into this ward was a young woman, barefoot, and here he was - I met this particular man and we spoke to him and he told me some of the things that had been happening to him.  Here he was being held in a high security mental hospital shortly after we had seen him being tortured and it wasn't more than a month or two after that where his whole area was in fact burnt out in the Crossroads strife around that time.
 For pressure of time I think I must proceed fairly quickly.  In 1986 I then went to the Eastern Cape and went to work in Duncan Village Day Hospital in the township of Duncan Village in East London.  Now in Duncan Village the whole day hospital had been closed.  Their response to the injuries and what was happening in the township was to to just close the hospital.  Now it's quite a big township Duncan Village, but it was just completely closed, so there were no health services then available to people.  And then after several months of the township being completely closed the nurses went back, but the doctors didn't go back, so there were no doctors in the hospital at all.
 They had the strangest system of operating.  The nurses had to see the patients and fill in the records and say what medicines they thought the patient should have, then they had to send the folder up to the nearby hospital and the doctor had to sign it.  It was a very strange system, and it then had to come back to the day hospital before the patient could go home.  So the patients waited for hours and hours and that went on for many, many months.
 So I went to work at this hospital and the situation in the Eastern Cape was very difficult.  Frere Hospital, which was the local hospital in East London was completely divided on racial basis, hospital apartheid was very strong during that period.  I remember often working in casualty, there was of course a White side to casualty and a non-White side to casualty and the non-White side of course there were always lots of patients, and the White side there was always just one or two patients, but there was continual pressure why were we not at the White side?  Why were the people at the White side waiting and so on.  
 I was hauled over the coals at one point by the Superintendent because I had attempted to eat in the dining room with the non-White nurses because the dining facilities of course were all segregated during this time.  
 To enter the township obviously before commencing work there with the help of people like Dr Trudy Thomas, who is currently the MEC of Health in that Province, we had to enter into negotiations with township community groups, but we were actually prohibited by medical authorities in the area from working in the community at all.  They said go into the day hospital, do your work, and don't go into the community at all.  
 Now during that period in the Eastern Cape we saw a lot of very severe injuries, there was a lot of severe assault by Police, a lot of torture going on from police stations in the vicinity and we saw a lot of people with very severe injuries.  
 One of the particular problems which maybe needs to think through in terms of the future is being a State institution it was almost impossible to get access to the Press.  If you wanted to get anything out in the Press we had to go through official channels, of course you know there was virtually no chance of it coming out.   
 I requested permission to do a thesis, a master's thesis on people that we were treating who were injured, because there were so many of them that we wanted to document what was happening, and after preparing like a 50 page protocol and so on, we got a one line response back from the Provincial Health Department, definitely not!  No, nothing on this.
 I must say that during that period we experienced really gross human rights violations and as health workers, the few health workers who were there who were progressive, I mean there was really absolutely no support.  There was a complete failure of the profession to speak out on what was happening, really on any accounts. We were very isolated, except for the support of people like Dr Randera who were supporting from Joburg and so on.
 We started a detainee service for released detainees in the East London area and many thousands of people had been detained without trial and that was the most astonishing and horrible period.  Anybody could be detained for anything, for any length of period basically.  
 One particularly strange episode happened in church, in the church in East London known as Roma, which I presume is the Roman Catholic Church, and the entire church was arrested.  The police were under the impression that something was happening in the church and they arrested the entire congregation, and that entire congregation spent about six months in detention in the Eastern Cape. We first saw the detainees coming out of that episode after about six months they had been in detention.  It was incredible.  About 300 people were just detained in that episode. 
 We established this detainee service and many other organisations like the Descoms and the Black Sash and others, and Union organisations which still were able to function in the very harsh conditions of the Eastern Cape, gave a lot of support during that period.  We tried to offer fairly simple medical services, screening, we managed to get a psychologist to help and try and do some kind of basic counselling.  The conditions were very difficult.  There were very few health workers' resources.  We treated over a couple of months about 300 released detainees.
 The first group to come out after about six months in detention contained a lot of the younger detainees, the 13 year-olds, the 14 year-olds, the 15 year-olds, the 16 year-olds, they came out after about the first six months of detention.  In the next batch we treated a lot of the old men.  We must have seen about 10 or 15 people over 75 years-old, about 5 over 80, and some of them were completely out of their mind.  They were just - they had been in detention for so long they were completely disorientated.
 The torture that we came across was fairly extensive.  It occurred especially in the police stations rather than in the prisons and included things like what's known as "Boeing", where a person is tied, say by handcuffs, over a pole and kept there for say two days or something like that.  People having rubber tubes put over their heads, electric shocks, severe beatings, explosions,  a whole range of things.
 We saw a lot of people who were in solitary confinement.  If I remember the emergency regulations correctly people could be kept in solitary confinement for up to 14 days.  We saw people who were in solitary confinement for up to a year alone, and we saw a lot of people with quite severe emotional effects from being in solitary confinement.
 The kind of response we got from the medical profession in the area was fairly typical.  I would just like to read something from a newspaper article of the period.  This is from the Daily Despatch in East London.  The heading to this newspaper article.
"Prisoners in solitary confinement get better health care the Court told".
The senior district surgeon of East London, I won't mention his name here because his name is in the article, he was testifying in the trial of two people who were charged and the magistrate Mr Dapula asked him the question, he said,
"Is solitary confinement an inhumane way of keeping humans?"
and this is the response of the senior district surgeon from East London.  He says,
"From my own experience solitary confinement is not the image conjured up in books and various political propaganda pamphlets".
the doctor said.  He said,
"Those in solitary confinement were in constant communication with prison guards.  Every complaint in the Border area was investigated".
He says,
"Only one or two people in the Border area had been sent away for psychiatric help after solitary confinement...."
but agreed that there was always the danger that a person could have an abnormal reaction.
 That was the kind of response that we had from the kind-of official establishment during the time.  We wrote back to this particular district surgeon and said we had actually seen about 300 released detainees and a lot of them had been in solitary confinement and we were seeing fairly severe effects on them.  We took the liberty of sending him a list of about eight references on care of people in detention and so on.
 We also made submissions to various people on conditions in Fort Glamorgan which was one of the prisons in the East London area.  
 Now as health workers we also suffered some harassment because of our involvement.  The Security Branch kept quite a close presence around our detainee services clinic. I was questioned on one occasion when they came to ask me what the hell we were doing here, what we were doing.  
 Then a short time after that all the tyres of my car were slashed outside the hospital where I was working in the Eastern Cape.  I got my car fixed up again and about three nights later in my home in East London the same thing happened.  All my tyres were slashed.  And then a few weeks after that we were taking detainees home to Ndantsane township just outside East London, and one of my tyres burst and we went off the road and I nearly had an accident.  Well that happened twice.
 Just in summary, because I'd like to end now, I mean there is no question that in the townships in the mid-eighties, which is the period I was there, that there was gross abuse of human rights.  There were a lot of people who were shot, killed, tortured, and my own experience was that our profession, which is the profession which we would like to be proud of, was incredibly silent about what was happening.  And that the profession consistently refused to get involved in issues which they said were political.  I think, certainly in my mind, there is no question that the profession has consistently, over many, many years, refused to take a stand on social issues.  That is something that we have to address.  Thank you.