CHAIRPERSON: Can I welcome all of you again today. We had a very long session yesterday and I hope that we will be able to cut down on the proceedings today. I want to hand over to Dr Ramashala who is going to be making some opening remarks and then I want to follow that up with some points on today's proceedings.

DR RAMASHALA: Thank you Chairperson. Good morning everybody. This morning I thought I would set the tone so to speak by remembering those doctors who couldn't walk away from it. I think this is an important occasion to help us do a critical analysis of our past behaviour and I say more broadly, particularly in the field of human rights, to do an honest assessment, not only looking at individual behaviour but also examining those policies, structures and procedures that enable the perpetration of those gross human rights violations, particularly in the health sector.

First I want to pay tribute. Dr Mvuya Tom, Dr Abe Nkomo, Dr Aaron Mac Claury(?), Dr Rafiek Ismaela(?), Dr Ndeleza Mjee(?), Dr Joe Viriaver(?), Sister Madelaine Tshabalala, and many many others of you for whom the floor was frequently your surgical table, for whom improvisation was your practice art, for whom life was very dangerous just by the act of intervening. Many of you were detained just for intervening, many of you were tortured, many of you were harassed.

My tribute to Black doctors is not to take away or demean what was contributed by doctors in the broader South African community, but it is a special tribute because they couldn't walk away from it you see, they were part of the morass, part of the pain, part of the struggle and overriding all of that was the question of caring even under very difficult circumstances.

To all South African doctors, both Black and White, it is arrogant of me to remind us that caring is more important, much more important than State objectives, that our patients are much more important than the security of the State, and that perhaps as we look to the way forward that we'll learn from our past experiences and our past behaviour and that we make a strong strong commitment that our patients come first.

I want to read some excerpts from some of the letters we received, and this will be done throughout the day, just a few excerpts. The first is from the Harvard School of Health, Centre for Health and Human Rights.

An excerpt from Johan S.Veer Stigting (?) Foundation for Health and Human Rights,

An excerpt from the World Federation of Mental Health:

And finally for this part of the morning, a letter from the Province of KwaZulu Natal Health Services, the Minister's Office:

Chairperson, excerpts will be read throughout the day from all the different letters we received and thank you very much.

CHAIRPERSON: Thank you Dr Ramashala. Can I call the MASA delegation to the table. And whilst they are doing that can I say that after yesterday's experiences we are going to be fairly strict today. I know everybody in the audience does not have the respective submissions being made. So I'm asking the delegations to cover the important points in your documents. Time limits have been set down on the timetable and I'm going to actually be fairly strict on keeping people to those times today for several reasons. I certainly don't think I want to actually have a situation like yesterday where we're going well beyond our time.

Secondly, many of you have come here today to participate in the workshop at the end of the hearings and I'm sure many of you want to get back to your respective homes. So in order to give that meeting the respect it deserves, we need to finish all the proceedings at the right time.

So please don't be affronted if I intervene when my colleagues and panel are leading you but I don't think we're going to get through the timetable unless we do that today. Thank you very much.

MASA SUBMISSION

Dr Barker, I welcome you and your delegation. Perhaps you can introduce all of them to us before you stand to take the oath.

DR BARKER: Thank you Chairperson, Dr Bernard Mandell is in fact the chairman of the Medical Association and we're prepared to be (speaker's microphone is not on) and on my left is Dr Hendrik Hanekom who is Secretary General and to his left, Dr Dan Ncayiyana who is the editor of the South African Medical Journal, who clearly is very closely, the journal itself, is very closely associated with the activities of the Association throughout all the years, and I think Bernard is going to start the proceedings with a brief introduction and then I'll take on as far as the submission is concerned.

CHAIRPERSON: Is there a possibility that the others may speak as well just in terms of taking...(intervention)

DR BARKER: They are here just in case there are questions which are posed to us by the Commissioners which they are perhaps in a better position to answer. They are not making submissions themselves, they are here in case of questions.

CHAIRPERSON: Sir can I ask all of you then to stand I will assist you in taking the oath. Glenda will you do that?

DR RAMASHALA: Could I ask you please state your names for the record before I administer the oath. We'll start with Dr Mandell.

DR BERNARD MANDELL: (sworn states)

EDWARD BARKER: (sworn states)

HENDRIK ANDRIES HANEKOM: (sworn states)

DANIEL NCAYIYANA: (sworn states)

CHAIRPERSON: Thank you, Dr Mandell, you may start.

DR MANDELL: Thank you very much Chairperson, Councillors, thank you very much for giving us the privilege of being with you at this very important occasion in the last two days. We are extremely concerned about the past and spending the whole day with you yesterday it was something which all of us have thought about very deeply before and do so now as well. I am, as Dr Barker said, the Chairman of the Federal Council of the Medical Association. I also have the privilege of being the president of the World Medical Association.

MASA is a voluntary professional organisation of medical doctors. There are approximately 27 000 doctors registered with the interim National Medical and Dental Council at present, some 21 000 of these are practising doctors and 14 000 of them have chosen to voluntarily affiliate with the Medical Association of South Africa. The Association's mission is to empower doctors to bring health to the nation. The association must certainly not be confused with the Interim Medical and Dental Council, a statutory body in place for the State to protect the community through licensing education and the maintenance of standards with disciplinary powers to act against doctors for unprofessional conduct.

On the 24th of January 1996 following an international meeting on the caring of survivors of torture which took place in November 1995 which I've tendered on behalf of both MASA and WMA, the Secretary General of MASA wrote to the TRC as follows:

The first current collection of important documents surrounding MASA and Human Rights was published in an article in the South African Medical Journal of September 1996. Immediately following the publication MASA approached Miss L Louw, a master of Philosophy student with an honours degree in Psychology as its researcher. Ms Louw was given carte blanche to go through any of the MASA files and archives to gather any material related to human rights. After four months she collected a substantial amount of documentation which was presented and is presented today in MASA's submission to the TRC. MASA members have been on both sides of the spectrum, some have been perpetrators of human rights violations and others have been victims. Some have campaigned to advance human rights and others have been complacent. The complete submission attempts to cover the role which MASA as an organisation played in Human Rights development.

Just briefly I want to mention the question of the World Medical Association and MASA and I want to refer to the visit of the World Medical Association to Somerset West last October and the opening address by Mr Thabo Mbeki, the Deputy President of South Africa. He said,

In his statement the chairperson of the Federal Council of MASA mentioned some of the issues on which MASA has remained silent and had been insensitive and indifferent and went on to commit MASA to broadening access to quality health care for all the people in South Africa.

It was an important announcement and MASA deserves credit for having made it. The point was also correctly made that the notion that it should be a beacon pointing the way to the completion of our transition, indeed much work remains to be done merely to deal with the legacy of the past. And that serves why we're here today.

I'd like now with your permission to ask Dr Barker who's our main spokesman in the submission. Thank you.

DR BARKER: Dr Randera, Commissioners, forgive me if I read again. This is for the sake of keeping within time and to ensure that we get my message across exactly as I want it to come out.

At the outset of today's proceedings concerning the Medical Association of South Africa, I would like to make a personal statement regarding my own position in appearing before you to present the Association's submission. My position here could be seen by some people to be equivocal and I would like to explain why I have accepted personally this onerous and rather necessary task. The present day MASA has taken upon itself the task of examining the history of the organisation in an effort to uncover and disclose human rights abuses which arose by commission or omission by the MASA under apartheid.

As one of the members of the Association who was active at the time in opposing a range of decisions and policies of the MASA as it then existed and in the period covered by this submission, I am in a position to explain and elucidate to the Truth Commission the matters covered by the submission document.

The membership of the present organisation, approximately two thirds of whom were not even qualified at the time of Steve Biko's death, have taken on responsibility for examining the darker side of the history of the Association. While the MASA of today is a vastly different institution from the MASA as it existed under the period of examination, the present membership recognises that the history which it has inherited requires full exploration and disclosure. Collective responsibility for this history has to be accepted before the organisation can be freed of the burden of the past and move forward to fulfil its role in the life of the community.

Before I go on to address the substance of our submission document, I would like to make one extremely important correction of fact relating to something that appears in our submission. It relates to the decision by the Federal Council of MASA in 1974 to prohibit the South African Medical Journal from accepting advertisements for professional appointments that can contained any terms discriminating between doctors on grounds of race or colour. This is mentioned on page 37 of the document. However paragraph two on page 38 states that MASA decided to amend rule 19, which was a rule limiting advertising for professional appointments to professional journals only. The documents state that this amendment was made by MASA in order to ease the difficulties for the government which was then unable to advertise State posts with a racial criteria.

Now this is a grave error. This fact is simply not what happened. Rule 19 was in fact a rule of the statutory body, the South African Medical and Dental Council and it was this body which amended the rule in order to rescue the government to allow it to continue making discriminatory appointments. The MASA stuck to its policy and since 1974 has never again accepted discriminatory advertisements.

Now I make this correction, not because I believe it's part of my submission today to tell you about any of the good things which MASA has done in the past, MASA has done some good things, this is not what we're concerned with today, the only reason I have made this statement about this factual correction is that I believe it's equally important that MASA not be asked to accept blame, guilt for things which it did not do, such as for example the impression created by this.

And now Mr Chairman, to go on to my main presentation. It's not going to be possible for us, there's a 104 pages of detailed fact in the submission and there is no possibility in the time available for me to cover this. What I want to do is to give an overview of what we have tried to do, how we approach the subject, what our intentions are and then make as much time available as possible for questions from the Commissioners who would like to elucidate matters and we'd be very happy to answer.

Now MASA as such was always, without doubt, a part of the White establishment in South Africa, and for the most part and in most contexts it shared the world view and the political beliefs of that establishment. Inescapably it also shared the misdeeds and the sins for which that establishment was responsible. From the time of its inception in 1927 until the day that Steve Biko died, the

Association flirted along in terms of human rights and its approach to human responsibilities in a fairly unconscious and unremarkable fashion with a few issues being taken up such as, for example, its repeated calls for the abolition of discriminatory differences and the salaries paid to doctors of different race groups. These efforts were not immediately successful, it took many years to achieve parity.

Apart from these the Association in general was quite comfortable with the status quo and its public reaction to any criticism of the inequity and the iniquities in society, particularly the inequities in health care delivery was to dismiss that criticism as the work of enemies of the State and defined all sorts of means to defend itself and the system.

The death of Steve Biko, and particularly the circumstances surrounding his death, in which members of the medical profession were clearly and shockingly involved was the event which rocked this complacency and started to force the Association to examine the ethics and the morality of its actions in many different contexts.

The Association was initially able to resist calls from within and without its ranks and for the actions of the doctors concerned in the Biko death to be investigated and judged on the grounds that an inquest was to be held and that justice demanded that any action that preempted this inquest would be unjust. When the findings of the inquest magistrate were released, the clamour started up again for MASA to take action in the name of the honour of the profession and it's claim to be the upholder and guardian of professional ethical standards.

The Association again resisted these calls, again on the grounds that the matter had now been referred to the Medical Council for investigation and was therefore still sub judice.

When the Council finally, two and a half years later, issued the findings of its committee of preliminary inquiry which, astonishingly, and unbelievably, absolved the doctors concerned from any blame, the fires of controversy really flared up. Under growing pressure from vociferous protest, among which I participated fairly actively, again from within and without its ranks to publicly reject and to condemn the Medical Council's indefensible finding, which seemed to simply ignore the evidence given at the inquest, the Association was finally faced with its moment of truth. It had the opportunity to rise to the occasion and to meet the challenge to demonstrate it's commitment to truth, to equity, to justice and the centuries old tradition of professional honour. It not only failed to respond to the challenge and thereby betrayed the values for which it supposedly stood, but the leadership of the time then mounted a vigorous nationwide propaganda campaign to make sure that the membership of the Association followed its lead in this matter.

However, this sad and disgraceful episode marked the beginning of a movement within the Association, a movement of opposition to the actions and attitudes of the then leadership of the Association which haltingly and with many setbacks and failures finally grew powerful enough so that by 1989, it was quite clear that the Association had set its feet firmly on the road of renewal and transformation.

Our written submission details the many failures and compromises that occurred along the way, failures of will and courage, compromises founded on expediency, many of these occurring even in the years since 1989. It's not possible in the time available today to explore in detail all the misdeeds of commission and especially of omission that have been detailed in our written submission. However I can assure the Commission that we have made every possible effort to provide as complete and as honest a disclosure as it lies in our power to do.

I plead with you and with the Nation, that this submission be accepted with respect for the truth which it embodies. It is vital for the Association, at this point in its development, its renewal and its transformation, to achieve reconciliation, and this can only happen if there has been full disclosure and full acknowledgement of all the wrongs of the past. If there are gaps or omissions in this submission, they are unintentional. We would welcome any input in this regard from whatever quarter it may come.

The transformation of MASA of which I speak is an ongoing process. A significant event along the way was the unconditional apology for the past wrongs of the Association that was made in June 1995. We stand by every word that was spoken in that apology. However there are those who understood this apology to be an attempt on the part of the Association to achieve what they termed blanket amnesty and to sweep everything else from our past under the carpet. This was far from the intention of that apology. The apology was a necessary step along the road we are travelling, but it was only a step. Our wholehearted participation in the work of this Commission is yet another step on this road, but again only a step.

In terms of the way forward there is much that we have done to make sure that the wrongs perpetrated in the past by doctors can never occur again, but there is much that remains to be done. We intend to participate fully in the work of the proposed over-arching Health and Human Rights Organisation. We propose to enlarge and to strengthen the office and the activities of our ombudsman, our public protector. Our peer review system has already been sharpened and structured much more effectively than it ever was before. We are currently engaged in a programme designed to promote structured ethics education in all the medical schools in this country and we are planning formal structured training for prisons' health service personnel.

However, in all these efforts we still find ourselves hampered by the huge baggage of past wrongs that the Association has had to drag along with itself and from which it has found it impossible to free itself. It will only be through the process of truthful disclosure and reconciliation that we will finally be freed from the burden of this baggage.

And Mr Chairman I now would welcome questions.

CHAIRPERSON: Thank you Dr Barker. You've been very disciplined in putting your ideas forward.

Dr Barker as you know I've already submitted a number of questions to the Medical Association. I think there are other questions that we would like to submit in due course, but again, and I don't want time to become the only factor today, so I'm going to actually ask a few questions and then hand over to my colleagues.

My first question is related to your apology. As you know within the South African Medical Journal a number of people have already criticised that apology as being superficial as not taking into account real disclosure but referring to generalities. I wonder how you would respond to that?

DR BARKER: As I said in my presentation Mr Chairman, that was a step along the way. It was a statement of intent and it was not meant as I said, to be a plea for blanket amnesty or an attempt to simply close the door on the past without examination.

The opportunity to examine and really to come to terms with our past, to explore it fully has only been provided by the existence of the Truth and Reconciliation Commission. I think you would agree with me that, but for the existence of this Commission, it would have been somehow not even possible to spontaneously and for ourselves, go into this exercise of self-examination. We are so grateful for this opportunity because without it we couldn't have carried forward.

CHAIRPERSON: Can I just follow it up Dr Barker and ask, does the apology include, or can you respond to the idea that MASA, quite often you mention yourself that 1989 perhaps was the final breaking point in terms of your declarations, but many individuals during that period and other organisations who stood up for help in human rights were criticised within MASA and within the South African Medical Journal, does the apology also include some of the remarks, statements made by MASA in response to those groupings?

DR BARKER: Yes Mr Chairman it has to do so in view of our urgent drive towards unity throughout the profession and the closer and closer negotiations that have been going on over the past two years between ourselves and these very people whom in the past we regarded as our enemies, whom we criticised, whom we kept at a distance, attacked. Yes we are and have been for the last two years, approaching them and are coming closer and closer, we are now at a point where I can see a very real possibility that within six months the profession as a whole in this country will be united under one umbrella organisation. So that this is a necessary part of that apology.

CHAIRPERSON: Dr Barker I want to just come to one point of the segregated hospital issue, the separate facilities for training. In your own document you refer firstly to a resolution that was passed in 1970, I think by the Tanzanian Medical Association at the Commonwealth Conference and then subsequently a resolution passed at the 1973 World Medical Association again critical of what was happening in South Africa in terms of health services and the role that the organisation played. Now both you and Dr Mandell have been part of this organisation for a long time. We need to understand what happened in that period. Dr Ramashala has already referred to the responsibilities of health professionals being one of caring and speaking out when that is being contradicted.

Given, and again going back through your document, there was a letter written by doctors from the Medical School in Natal in the '60's, raising the question of discriminatory practices. I accept that you say that the organisation has always been open in terms of its membership, but yet there were glaring examples throughout this 29-year period that we're talking about, and why was it that it actually took the Association such a long time to come out with clear policies when you were clearly interacting not only within the country but outside the country as well. I accept again when you say that other medical associations also didn't take a political position on issues, but yet at these international conferences MASA was being criticised, can you comment on that?

DR BARKER: Yes Mr Chairman, as I stated at the beginning of my presentation, MASA was essentially a part of the White establishment with, and it shared by and large, not entirely, but it's membership by and large shared the world views, the political views, political attitudes of the White establishment in this country which regarded the sorts of criticisms which you've mentioned as motivated by enmity to the country as part of what later came to be known as the 'total onslaught'. The total onslaught mentality was certainly extant and operative in the White South African context in those days and the explanation for this lies in an understanding of where the White population of this country stood in relation to all these matters.

The other point is that it took a long long time for those of us who recognised the difference between problems of ethics and morality and problems of politics, but there was a vast difference between the two large numbers of members. Very large numbers of our members for a long, long time failed to see any difference. A political stance, even though it might be based upon what moral basis, if it was antagonistic to the current status quo, the actions of the country or particularly the Association or the Profession, this was regarded as an attack and was opposed with vigour. This of course was completely wrong. It was not what doctors should have been doing, but it took a long, long time, certainly up to 1989, before those of us who had for years been trying to make the right noises and persuade the Association that ethical behaviour in relationship to the population it left their patients in relation to the structure of health care had nothing to do with politics and should be a concern of all

members of the Association no matter what their associations. It was only from 1989 onwards that we had sufficient support among our membership to be able to drive this forward.

CHAIRPERSON: Thank you Dr Barker. May I ask Dr Hanekom who would like to speak?

DR HANEKOM: Just to add to what Dr Barker said, on page 95 of our submission I think there is a specific answer to your question which is very clear that these deeply ingrained discriminatory attitudes pervaded our society and MASA did not escape them. MASA tolerated a system in which doctors treated patients and colleagues differently based on the colour of their skin. MASA was so wrapped up in its White male elitist educated professional world as individuals and as a collective organisation, and as part of a broader society from which doctors were drawn, that it failed to see the need to treat all people as equal human beings. Perhaps the same could be said of other groupings in society. MASA allowed Black and White people to be treated differently and this is the form of human rights violations for which it stands disgraced. I think it's very clearly stipulated in where we come from and I think this part of our submission also answered the question that you raised.

CHAIRPERSON: I want to come to the question of Mr Biko. I know from your submission and reading the journals, your branch and you yourself were very vociferous at that time, but you were saying in your earlier statement that there seemed to have been major outcry at the time within the Organisation. But yet when it came to the actual vote within and supporting the initial response of the South African Medical and Dental Council, the organisation came out in support of that initial decision. Perhaps you can just give us more details on your own experiences and your feeling now on how the Organisation responded?

DR BARKER: I think this part of the history is very important in an understanding of where MASA was in those days and how it came to be that it did the things it did and failed to do the things it should have done. There was a very strong leadership, there was close association between the top leadership of the Medical Association, the - can I say the establishment certainly a close association between the MASA leadership of the SANDC and without any doubt in my own mind I'm convinced that there was close association, certainly with various structures in the government and certainly with people in the government on a very personal basis. Now the leadership at that time, I believe, felt, were told, felt for themselves that if these doctors were to be found guilty it would create such a furore for the Health Department and for the Government itself, for the Security Police, for everything that it had to be damped down and smoothed over as effectively as possible.

Now there was a huge outcry and as you say you've read the journals, there were letters from all the provinces, from all the branches, lots and lots and an enormous amount of correspondence received by the journal which has only now this month been published, a whole lot which was not published by the journal, load of letters and the then Chairman of Council undertook a whistle-stop tour of all the branches in the country, he addressed them all making an impassioned plea to the membership please to support that they couldn't possibly question the integrity of people on the Medical Council. It was unthinkable that doctors of that standing could remotely have their integrity impugned, which was these wild people writing these subversive letters were trying to do.

He managed to convince meetings held at every branch to express support for the position of the then MASA executive with one exception, he came to the Natal Coastal Branch and this was the only branch in the country that refused to accept his plea that while he was there, rejected, passed a resolution rejecting first of all dissociating itself from the SAMDC finding and rejecting the action of the executive in approving this, demanding that the executive in fact altered its stance, and this was basically an explanation of what was going on then.

DR MANDELL: Mr Chairman I'd just like to add something to it. The specific reaction at the end of the day and what the Federal Council did, and this was in the early days when I had become a Federal Council then was the special meeting of the Federal Council which was held on the 12th of November 1980 to discuss these issues and what the reaction of the Federal Council was going to be to the outcry of which Dr Barker speaks. There was a considerable debate and one must also remember that there were four members of that Federal Council who were also members of the Medical and Dental Council at that particular time, one of whom was the chairman of the Council too, and they paid considerable attention to what those councillors, the members of the Medical Council had to say at the meeting of the Federal Council. There's no doubt whatsoever that the Federal Council was attempting to avoid a direct confrontation with the South African Medical and Dental Council for the major reason and that was the destruction of the Medical Association itself, if they had adopted a policy at that stage of condemning the Medical Council. They didn't face up to it, and I was one of them at that particular time, didn't face up to the reality of this. Each one of the members of that Federal Council represented a branch, it was purely at that particular time branch representation. They represented the interests of those particular branches and as we rightly have here, the outcry came from certain branches, but at the other branches they wished to maintain the status quo and not upset anything that might have happened, whether it was government inspired or whether it was the Council itself. They did not take that action, they found a compromise, what they believed was a compromise to examine detention, to examine children in detention, and that was as far as they were prepared to go to accept some committee which would examine these issues rather than face the possible destruction of the Association.

CHAIRPERSON: Thank you, my last question and then I'll hand over to my colleagues and it's to do with racism. It was only in 1994 that you finally made a decision on separatist rooms that doctors had for examining patients. What has the Organisation done since then? Because I'm sure none of us will disagree that racism still remains within our society, what has the Organisation done to eradicate racism and to what position would the Organisation take today if it was brought to your notice that some of your members was still practising in this fashion?

DR BARKER: Mr Chairman could I just go back a little bit before 1994, from 1990, at that time the then Minister of Health set up quarterly meetings with the executive of the Association that later became the Board of Trustees and at every one of these meetings the Medical Association Executive brought forward its demand to the then Minister of Health for the abolition of the fragmented Health Services, the abolition of the 14 Ministries of Health and their unification on the one hand, and on the other for the opening of all hospitals to all races, the abolition of the racially separate nature of State hospitals. That was our position from 1990 onwards and a demand which we made repeatedly and it was only finally acceded to by Minister Venter I think in about 1993, that she finally conceded and the hospitals throughout the Republic were open to all races. I think our stance today would be unequivocal rejection, and I really don't believe that we could maintain, within our membership, people who overtly and clearly were practising in a racist way. I don't think that this could be conceivable particularly in the light of our move towards unity with the entire profession in the country.

CHAIRPERSON: Over to my colleagues. Pumla.

MS GOBODO-MADIKIZELA: Thank you Chairperson. Gentlemen I really find your comments, the forthrightness, the frankness and openness very refreshing. I think that you have very clearly illustrated what the evil system of apartheid did to many of the structures that were supposed to be promoting health in our society did not do, and I really appreciate that openness that you have demonstrated.

My question to you is about the South African Medical Society, SAMS in the military. Did MASA have a relationship with the South African Medical Services in the military and if so, what was the nature of this relationship?

DR BARKER: I am unaware of any but I could ask my colleagues. I'm not aware of any formal structured relationship with SAMS.

DR MANDELL: That's quite correct, we didn't have a formal structured relationship other than the odd invitation to a military dinner ...(intervention)

MS GOBODO-MADIKIZELA: ...hobnobbing with the military.

DR HANEKOM: That's correct yes, but no other specific formal relationship. Probably what you're leading up to say is, why didn't we examine that relationship and try and find out whether there was any discrimination there in any way?

MS GOBODO-MADIKIZELA: Not so much questions of discrimination but really from the point of view of the medical profession being custodian of all medical ethics and medical practice in the country, I would assume or would have assumed that you were the sort of guardians of those kinds of organisations. So I'm surprised to hear that in fact you did not have any relationship.

DR MANDELL: Well there are two ways of looking at it. Firstly the question of us not being a statutory body and then obviously it would be the Medical and Dental Council which should look after the interests of the soldiers in the army and others within the army to see that their rights were respected despite the fact that they happen to be part of the military, and to take any action that might be necessary. And certainly as an Association and if we were aware, obviously aware of any discrimination of any sort within the army, well then we should have taken it up. But Dr Hanekom may have a little more information from the point of his being the secretary general and had a more close relationship with those in the army. Possibly he may want to answer differently.

MS GOBODO-MADIKIZELA: Yes thank you.

DR HANEKOM: Thank you Dr Mandell. Commissioner although there's no formal relationship, there is on the one Committee of the Medical Association, the committee for fulltime practice there is a fulltime representative from the South African Medical Services, representing the military doctors on that specific committee. That committee deals more with terms and conditions of service. There's always been, although not a formal relationship, a very open relationship between the Medical Association and the South African Medical Services, always when there were specific problems and I can't remember the specific dates but there were at one stage quite a few problems. Doctors had certain problems, they approached us, we then approached the Surgeon General or his office and I must say that most, at that stage it wasn't specifically about human rights issues but problems that people experienced or people that couldn't, were called up for service, that couldn't, because of family reasons, we had a very open relationship and I can't think of one opportunity when we had to go to the military that they didn't do what they could, but we didn't have any specific, human rights-specific issues that we took to the military.

MS GOBODO-MADIKIZELA: Yes, Dr Barker.

DR BARKER: There is something that I want to say also in reply to your question, Madam Commissioner and that is again to draw your attention to the fact that it was a slow process. The move of the Association to an awareness of its responsibility in terms of human rights, in terms of its social responsibility, its responsibility for the welfare of the community rather than the welfare of doctors, and it was really a slow development and certainly very recently only have we started to be proactive rather than just reactive to matters of ethics and human rights and that sort of thing. We now are an Association that has a large part of our activities devoted in this direction, but this is a very recent development.

MS GOBODO-MADIKIZELA: I had in mind the submission yesterday by a person who was in the military, who was a military medic. I don't know if you were here yesterday, who told us about the training of a military medic which clearly illustrates a violation of human rights and a violation of medical ethics, where they were trained or they practised, as you said, on Black patients in Tembisa and another hospital, I think it's Attridgeville, and that really was what I had in mind and I wondered if those are the issues on which you would exercise your pro-activeness in just investigating, having heard of how things are done?

DR BARKER: Madam Chair, I would say I was here yesterday and I heard the submission and being just a member of the audience I was not able to comment, but I do know that all paramedic personnel, whether they be in the ambulance services, whether they be within the hospitals, whether they be in the military, whatever, all paramedical people including nurses undergo training in simple wound management in all the hospitals, Black, White wherever. Every hospital where I have ever been, in the casualty department have been students, medical students, nurses and paramedics of all sorts, including military medics, not practising, who are being trained. Their subjects, victims if you like, have been patients of all races in all hospitals. And I really mean this in every hospital I've worked in.

MS GOBODO-MADIKIZELA: So just for the record so it is incorrect to claim that the practice or the training of these medics at the Black hospitals has anything to do with the colour of the patient, it's incorrect?

DR BARKER: I didn't regard that as a violation, no.

MS GOBODO-MADIKIZELA: Okay thank you.

MS WILDSCHUT: Gentlemen, I'm allowed one question and I'll try and ask this question quite quickly. I can't resist asking whether MASA had any relationship with the Broederbond and if so, what kind of relationship there was?

DR BARKER: The answer to that is in terms of what we know, no, the Association as such certainly had nothing to do with the Broederbond in any way whatsoever. However, it remains my strong conviction that the relationship that I spoke about earlier, which I personally found quite, quite wrong way back at the time between the leading members of the Medical Association, the leaders of the Association, the people who really sort of set the tone, set the policies, persuaded the membership to come in this or that direction, the relationship between those people, between the heads of the SAMDC and between the people in the Department of Health particularly and other areas of government, particularly this I have no doubt the Security Police as well, my own belief, and it is completely unsubstantiated, was that that was based upon Broederbond membership. This is something which I can only say was an opinion which I held and I have no evidence for it.

MS WILDSCHUT: Thank you very much.

MS MKHIZE: Just one question from me. I was just going through your document, looking at your section where you talk about MASA and human rights violations, looking at different paragraphs, to me it sounded like a very difficult position to comprehend as to exactly what is your position. In some section you talk about MASA has not committed gross human rights violations, and in others you look at the different degrees of conspiracy, complicity, and even of human rights violations, MASA was not any time directly involved in conspiracy or complicity. There are different sections where one picks up this contradiction as to what exactly is your position.

My specific question is that under this section where we look at MASA and human rights violations, in view of the fact that we are at the phase where we're all working towards transformation but the essential stage is the establishment of the truth, I would have liked a document where you have made a careful assessment of what went wrong and actually documented, as a vehicle for transforming this professional grouping, and I think that would be very, very important in view of the documents whereby other organisations like NAMDA and other progressive structures actually embarked on a campaign internationally that MASA be one of those professional bodies who should be isolated. So I'm just looking for your position where you think things went wrong.

DR 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.

DR 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.

DR 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,

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?

DR 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.

DR 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.

DR 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.

DR MANDELL: 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.

DR W ORR: I don't have a question, I have a comment and a suggestion and this is about the MASA apology of which a great deal has been made and of which very little has been made and I hear you say that it was a step in a journey. I don't think it was a big enough step or a step that has been followed up adequately. It's very easy to make an over-arching apology, it's difficult to look people in the face and say we are sorry, and I really feel that in the interests of reconciliation and moving forward that the Medical Association should consider making individuals personal apologies to those individuals and those organisations whom it vilified and whom it failed to support during those years.

CHAIRPERSON: Thank you, you don't have to respond to that right now, Dr Barker. Thank you very much for coming today. I hope you're going to be staying for this afternoon's proceedings and continue to take forward what's been said today and in the submissions that we've heard already, thank you again.

DR BARKER: Thank you.

SANC SUBMISSION

CHAIRPERSON: Can I call the South African Nursing Council and whilst they're taking their positions I just want to welcome some of our international guests and others who are here and I'd like people to stand as I announce their names if they are here so that others who are in the audience can get to know them as well. Dr Maria Pniel Khali, I hope I pronounce your name properly from the Medical Rehabilitation Centre for Torture Victims, Mr Hans Ransecht from Medical International.

From the American Association for the Advancement of Science we have Professor Robert Lawrence, Audrey Chapman, Marion Gray Secundi, Len Rubenstein, Vince Coppino and Professor Jack Geiger.

From the British Medical Association we have Professor Vivien Natenson; Medical International, Mrs Ursula Merck and the MEC for Health from the Free State, Ms S Nhlaba Bati. I'm sure that there will be other people that we will be welcoming during the day. Thank you very much.

Good morning Ladies and Gentlemen, can I please ask you to introduce yourselves and the organisation you're representing today.

MR GERMISHUIZEN: Thank you Mr Chairman. I am Frank Germishuizen the Registrar of the South African Interim Nursing Council and the three council members with me are Professor Wilma Kotze, the vice president of the Council, Ms Ethel Radebe, she's the chairperson of the Council's transformation committee and Mr Tchipiwa Maumela who's a community representative on the Council.

Mr Maumela and I will be doing the presentation, he will present the Council's submission and I will answer the questions which we received in advance and any other questions which might arise will be divided up between us as we see fit, and we wish to thank you for the opportunity of being able to appear before the TRC.

CHAIRPERSON: Thank you very much, welcome to all of you. Can I ask Dr Orr to assist you in taking the oath, if you will just stand and then Ms Wildschut will take over thank you.

FRANK GERMISHUIZEN: (sworn states)

WILMA KOTZE: (sworn states)

ETHEL RADEBE: (sworn states)

TCHIPIWA MAUMELA: (sworn states)

CHAIRPERSON: Thank you very much. Glenda.

MS WILDSCHUT: Good Morning, Mr Germishuizen and Professor and the rest of the delegation. I know that you have a written submission. You also have given me a written response to the questions that I sent you some time ago. Please feel free to go ahead and present your submission and then we will address the questions after the oral presentation. Thank you.

MR MAUMELA: Thank you. Honourable Chairperson, honourable members of the Truth and Reconciliation Commission, we from the South African Interim Nursing Council feel humbled to be allowed an opportunity to come and make the presentation we came to make today. My colleagues and I decided that I be the one to make the submission but that we, at the same time, should make this hearing aware that I make this submission as one of those within the South African Interim Nursing Council who represents the community. That is because amongst other things, the South African Interim Nursing Council stands for the interests of the community and therefore has set the means in place to solicit, accommodate and give expression to the needs of the community visa a vis matters of health, if not just matters of nursing.

Chairperson given the horrific picture yielded by the picture of our beloved country, which picture permeates all spheres of life and all classes of professions, it may well be conceivable that normal people will embark on a spontaneous effort to try and dissociate themselves as much as possible from the past.

Concomitant to such a mindset we find a tendency to spare people on in a campaign, a campaign to forget about the past, yes to forget all even before we get to fully understand what it is exactly that should be forgotten. We therefore come here today with a vivid realisation that denials, excuses and explanations will not take this country anywhere. At the same time we are thankful because today everybody can speak, reveal and uncover. Yes we are all free to speak today. The former oppressors and the formerly oppressed, all alike.

It is with that in mind that we wish to borrow the wisdom of on who was with us yesterday in this very room who once declared in years gone past and if he himself was quoting someone else, then I don't know yet, but I heard him declare and I quote, "no one shall be free until all are free". We note with an immense measure of gratitude that the very temporary failures of the past very strongly form a firm basis for the successes of today and the same shall apply for the future successes.

Oh yes, the temporary failures, more especially of those who tried from positions of weakness to fight against a tide, a tide that enjoyed the benefit of the wherewithal to oppress, to maim and to vilify, indeed to brainwash and to abuse, they risked their all to resist segregation, social biases, disempowerment and a whole range of other negative eventualities that of course would be denied from time-to-time. But today, through the grace of God, those temporary failures do not seem to stop in getting transformed into great successes, successes that now spur some of us on into speaking up.

Chairperson, nursing as a profession did not and perhaps could not have escaped this erstwhile wide web of racial biases. Nursing with its militaristic approach to both training and the shaping of the nurses work environment ended up perhaps like many other health-related establishments as one of the tools tailored to suite the whims of the authorities of the day. Consequently it should come as no surprise that the Nursing Council, from it's own corner, also contributed in giving form and direction to these temporary failures that we speak about.

However Chairperson the evolvement of these temporary failures gives us such a strong feeling of redemption, it reminds us once more of the words of someone who once said, and I quote,

Chairperson, the South African Interim Nursing Council came into being in August the 23rd 1995, and we make the following submission primarily on behalf of former South African nursing councils. We also make the same submission on behalf of the nursing councils in the former areas of Transkei, Ciskei and Bophuthatswana. We note that we have inherited a process within which perceptions were created which suggested a perpetuation, if not support active or by way of omission of certain circumstances.

We further acknowledge and accept without justification that Council was influenced by the policies of the government of the day. This could have resulted in both a conscious and unconscious perpetuation of those discriminatory policies and legislation leading to gross violations of human rights.

We are aware that Council was all the time morally bound to adhere to a strict professional approach to matters of nursing without allowing itself to be used as a tool of the apartheid machinery.

We also appreciate that Council could have at times exercised a free discretion on some of the issues. We therefore wish to apologise unreservedly, both for conscious and unconscious activities, that could have the effect of undermining human rights from time to time. We however acknowledge that some of the Council members have from time to time tried their best to rid the Council of any apartheid overtones but they would time and again be steamrollered into a collusion because of the circumstances of the day.

Having indicated our awareness of instances perpetuating apartheid, we wish to bring into light some of the known incidents by way of highlighting areas of failures and the areas of success vis a vis the Council under an apartheid regime.

Regarding failures, and I'll come up with failures resulting from legislation and policies:

Regarding Communication. - The Nursing Council failed dismally in terms of communicating issues to the members of the Profession, the communities and all stakeholders. This resulted in the Council being seen as dwelling in an ivory tower remote from the profession and those it was supposed to serve.

Regarding Staff Appointments -

We felt that maybe it is a little bit worthwhile to make mention of some of the legal successes there have been down the years and we are very conscious that we do this at the risk of sounding a sort of jakkels prys sy eie stert kind of a note. But we felt we should do this because in every battle and in every struggle there is the concept of the unknown soldier who is not there to speak for himself, and we felt we should not end up undermining the efforts of those who tried because the features of the unknown soldiers are not much more in the successes but I think what should be taken into regard is much more the decision to try under very, very hard circumstances.

And I want to begin with the legal successes by way of excuse, Honourable Chair, but just for the record.

Nursing Education: Although the Council in terms of the Nursing Act of 1957 kept separate registers and rolls for the different population groups, its educational programmes were the same for all trainees, thus ensuring a uniform standard of education and training throughout the country. This standard is so high that South African-trained Nurses enjoyed international recognition.

The Council's Database: The Council has always kept an excellent database of details regarding all nurses, both in training and qualified. This is of great assistance to the Department of Health when planning its nursing manpower to meet the country's health needs.

Constitution of the Council: In the Nursing Act No 50 of 1978 provision was made for the election as council members of five White nurses, three Black nurses, one Coloured nurse and one Indian nurse. In 1989 the Council petitioned the Department of Health to remove all references to racial groups in the Act. The motivation was that the Council is a professional body which does not distinguish between population groups inasfar as training, registration or professional standards are concerned. This resulted in the Nursing Amendment Act of 1992, which made the Council a totally non-racial body.

The Nursing of Prisoners and Detainees: And before I come to this I just want to make a legal comment about constitution. We are aware that there are other concerns and it has to do with gender balances within the Council, it would seem it's female-dominated, if I may put it that way, it is a concern that is being looked at and I always say, they went to Beijing, maybe we should also go to Taipei.

The Nursing of Prisoners and Detainees: In 1988 the Council issued a policy document dealing with this issue, including political prisoners. The following extracts from the policy are highlighted:

The following principal does apply:

It is the professional obligation of the nurse to provide life-saving care and alleviation of pain and suffering.

The patient has the right to the protection of his physical and mental health and whatever treatment and nursing are needed.

The nurse may not be involved in any relationship with a prisoner or detainee other than that required to evaluate, protect or improve his physical or mental health.

It is unethical for the nurse to participate in any procedure for restraining a prisoner or detainee unless medical grounds exist for such procedure in order to protect the physical or mental health of the prisoner or detainee or of these fellow prisoners or detainees.

It is unethical for the nurse to participate in any form of interrogation or torture of a prisoner or detainee. In the case of torture it is unethical for the nurse to conceal knowledge thereof.

And finally,

And lastly,

The Council would like to reiterate its apology to anyone who may have suffered unjustly as a result of former councils' actions and policies. Appreciation is also expressed to the Commission for the opportunity to make this submission. Thank you.

MS WILDSCHUT: Thank you very much. Maybe we should just move very quickly into the questions. I would like to ask the question relating the Nursing Council's relationship with other bodies internationally. What was the nature of the Council's relationship with such bodies, if any? And were there any representations from abroad or elsewhere in respect of Council's policies, racist policies, separate registers etc?

MR GERMISHUIZEN: Thank you Chairperson. The Council had a good working relationship with the Nursing Councils of the United Kingdom, the Republic of Ireland, Swaziland, Botswana, Lesotho, Namibia and Malawi. Those are all that we could find and we couldn't find any record that there had ever been objections from any of those Councils to Council policies there. The only correspondence seemed to be about matters of mutual interest such as nursing education and registration and so on.

MS WILDSCHUT: Were there any local objections that you know of, of nurses who were objecting to being on a separate register and does the perception being there that there are different standards for different races and so on?

MR GERMISHUIZEN: Chairperson, the only racial discrimination of which the Council was aware, now I'm speaking on behalf people who existed before my time there, was the keeping of the separate registers and rolls for the different population groups as prescribed in the Nursing Act of that era. Although we are not aware, as a Council of any specific complaints from the Profession, I am very convinced that there must have been many, but there was nothing that we could find in writing anywhere, but I'm sure that the Profession did object.

MS WILDSCHUT: So Mr Germishuizen, the only way in which objections are dealt within the Council is through formal writing to the Council so that if the Council were to be aware of any objections through Press, through conferences, through other means, it would not respond to those objections?

MS WILDSCHUT: I couldn't say they would not respond. All I can say is that we couldn't find any trace that there had been, either verbal or through the media or through letters, but I'm sure that there must have been objections raised. Maybe direct to Council members on a personal basis.

MS WILDSCHUT: I asked the question about the relationship within international organisations and your response is that the Council had a relationship with the International Standards Convention, am I correct?

MS WILDSCHUT: Yes the Council in fact was a founder member of a thing known as the International Conference on Nursing Regulatory Bodies. This was founded in 1993. Prior to that there didn't exist any forum for regulatory bodies to belong to. There was and still is an organisation known as the International Council of Nurses but that's an organisation for nursing associations and no regulatory bodies belong to that.

MS WILDSCHUT: Yes, we have to understand the difference that the International Council of Nursing is for bodies of nursing associations and bodies that look after nursing issues rather than issues of registration or regulation and discipline, so we need to draw that distinction.

My question about the separate registers, what information did the Council gain from having a separate register, in other words, how did you use that data? What use was it to you to have separate registers?

MR GERMISHUIZEN: I can only speculate on that one, and my speculation I'm going cancel out when I've said it, possibly so that the Council could provide statistics to the Department of Health on the numbers of nurses in the various population groups and having said that, it really is not necessary because up until about 1994 nurses were identified on the register which was by then long amalgamated. In fact from 1978 with the new Nursing Act there was only one register, but they were still identified according to population group, so I can't see what the point was at that stage, except that that was the policy of the government of the day.

MS WILDSCHUT: Nor could I. I couldn't ever work out why I always had a C in front of my registration number.

MR GERMISHUIZEN: Could I come in on that? Those letters, "W,C, V and I" have been removed. There is no way now of identifying the population group of any of the nurses, which in a way is creating some problems for the Department of Heath if they're doing planning for nursing education for example. We can't give them statistics.

MS WILDSCHUT: The issue with relation to - there has been a lot of comment and criticism about the close relationship between the Nursing Council and the Nursing Association where senior members either were serving or had some dealings with the Council thus compromising impartiality of such members. How does the Council react to that? Is it unusual that nurses who are members of the Association are linked to Nursing Council and so on?

MR GERMISHUIZEN: The principle of members serving both on the Council and the Association did not create problems in itself. You must also remember that up until 1993 it was nurses were legally compelled to belong to the Association as well as to the Council and that in itself caused problems. But criticism was expressed at the fact that somewhere in the early eighties the president of the Nursing Association was also the vice president of the Council and it was extremely difficult for this person to wear two hats, particularly on issues where the Council and the Association were on a collision course.

MS WILDSCHUT: Was there often a collision course because it seemed as though amongst nurses there seemed to be the perception that there was very close cooperation and very close collusion rather than the Council and the Association being on a collision course?

MR GERMISHUIZEN: Chairperson may I ask Professor Kotze to speak to this, she has more experience of that having been a member of SANA ...(intervention)

MS WILDSCHUT: Certainly.

PROF KOTZE: Chairperson I think one should look at the historical development of this. One needs to remember that the South African Nursing Council in this country was instituted through the work of the old South African Nursing Association, the South Association for Trained Nurses, SAATNA. So historically there was a close collaboration between the two bodies. As a matter of fact, when the Nursing Council was instituted in 1944 it did so with a

£1 000 that the Nursing Association gave to it to start its work with, and over the years the leaders serving on the Nursing Association were almost naturally also members of the South African Nursing Council. This persisted for some 30 years. But over the past 10 years there's been a marked division that developed naturally between the two bodies, so that at the moment I don't think there's a single, and for the past five to six, seven years, there has not been a single member serving on the Association as well as on the Council.

So I think historically it's worked itself out and particularly with the factor of voluntary membership of the Nursing Association, that close relationship has been broken.

So yes, there were the effects and definitely there were conflicts and there was dissatisfaction amongst the professional members and the profession down at the ground because of this. But I think we've gone through that stage now.

MR GERMISHUIZEN: There was a marriage and now they're divorced.

PROF KOTZE: Yes there's been a definite divorce Chairperson.

MS WILDSCHUT: I raised the question particularly because it seems that it's important that nurses feel that they have the Nursing Association supporting them in whatever activities they're about and that when it comes to issues of discipline and registration and so on, that that body is autonomous and not influenced by the decisions within the Association, and so I raised that because of that struggle. The Council has made an honest attempt at examining the past and we really do want to thank you for your presentation, but we also would like you to help us explore just one of the recommendations that you make.

Can you just elaborate a little bit on the Council's recommendation to preserve and promote the image of the Nursing Profession? What does that mean, and how can the Council be involved in doing that?

PROF KOTZE: Chairperson, the South African Interim Nursing Council has been working very hard on this particular matter because we were tremendously concerned at the poor image of the Nursing Council and the development of a poor image of the nursing profession in the country. We've done several things to combat that over the past two years.

First, with relation to the developing poor image of the nursing profession in the country, a launching of a campaign to stress nursing as a caring profession.

Also a campaign to make nurses more aware of the Council's rehabilitative approach in professional conduct matters so that the image of Council being a punitive body could change.

And then there's a concerted effort from the Council side to move towards becoming more involved in monitoring the standards of nursing practice in health institutions, because the Council realises that it's built up the image of an ivory tower over the years. Nurses are striking, they are dissatisfied with what's going on in the health services because of the poor conditions under which they work and the Council has always taken a stand against that and only regarded the interests of the patient in this regard.

Now Council realises that a lot of dissatisfaction among the members of the profession is there because of the poor conditions under which nurses work. For that reason there's proposed amendment of the Nursing Act to make it possible for Council to also inspect the conditions going on in health services in order to make recommendations and to help nurses with regard to that.

So that the emphasis will in future not only on the interests of the community but also on the interests of the nurse and the rights of the nurse to have the facilities and the conditions worthy of to give proper care to the community.

So there's a definite shift in emphasis in the approach of Council towards its own image and the image of the profession.

MS WILDSCHUT: I've asked the Chairperson for indulgence. He is not very happy with me about that but I just need to slip in one more question and that's related to standards that the Nursing Council may or may not be considering in relation to training for health and human rights, I'm not talking specifically about the nursing ethics training but specifically around health and human rights with specific emphasis on the treatment of detainees, treatment of prisoners and the treatment of people who have been severely ill treated in vulnerable situations.

MR MAUMELA: Ma'am the approach of the Interim Nursing Council to specifically the issue that you raise is currently under review. As you may be aware, there are different sub-committees within the Nursing Council, specifically the Laws Committee is busy reformulating with a view to make

suggestions to amend some of these regulations in order to take on board all human rights considerations.

We are also tapping from the experiences of the past. We are also keeping our ear to the ground with regard to developments, even from the Constitutional Court, and also having a look at the interim and both the current constitution of the country so that we can be able to avoid visciating against those considerations.

MS WILDSCHUT: Thank you very much, I hand you back to the Chair.

MR GERMISHUIZEN: Chairperson might I just add a sentence to this, grant me your indulgence. Ms Radebe is the chairperson of the Transformation Committee which is a new committee formed by this Interim Council and one of its functions is to monitor how the other committees are transforming, and that would include the Education Committee. So the Transformation Committee is looking at what improvements are being brought into the training regulations to address issues such as has been raised. Thank you Sir.

CHAIRPERSON: Ms Mkhize has just one question.

MS MKHIZE: Just a quick one from me. I was looking at page three of your document where you referred to the formation of surrogate Nursing Councils in the Homelands. My question really moves beyond professional structures but around the human rights and patient care. In those settings we have heard people coming before the Commission talking about how they died in the hands of nurses, mainly because the nurses were from the neighbourhood and they knew them very well. There were divisions, ideological differences and I was wondering whether you are aware of those problems in the Nursing Profession?

And if you are aware as to whether you have thought of any possible rehabilitation programmes which might assist those nurses who found themselves in the position where they will be influenced by their ideological persuasions in caring for people who appear before the health (...indistinct)?

MR MAUMELA: I will say there is a programme in place but it certainly becomes one of the issues that is being looked at. We are aware that the nurse, like any other health worker, has been used as a tool to perpetuate some of the atrocities. But with regard to having a programme in place, I think that is something that hasn't started as yet, most probably because one tends to feel that to a certain extent some of the activities within the Interim Nursing Council should not have the effect of preempting some of the bigger processes like we have the TRC and we have other people coming up with civil cases because of specific instances. But we realise even now, the need to change the mindset and I think it's going to be a process. It cannot be an overnight kind of a project and for that we also rely heavily on advices and guidance from other sources, even including yourselves.

MS RADEBE: Chairperson just on that point. We have heard today, from yesterday, that in the health system there was a sort of a relationship and a link in the way in which human violations were done on the patients. This link was not only basically facing the nurse, the psychologist or anybody or the doctor, it was also the question that some nurses became aware of these abuses but because of the linkage in the system between the professional organisations, councils, it was very difficult for the nurse to come forward with these abuses. Like we don't have a tangible project to say we have in the Council as part of a healing.

But another way that prevented nurses from reporting these violations was the mechanism, a system of management in the hospitals. That is why now in our recommendation, part of what we are doing as part of transformation is to have the Council accessible to all nurses from the ground and up to national so that the nurse herself is able to directly get in touch with the Council for whatever violations that could be there, without working through the mechanism of authorities within institutions like superintendents and nursing managers. The Council is now accessible to the nurse. There is communication that is on the ground. The Council has opened up issues with professional organisations like unions so that these organisations, together with the nurses and the Council, should be aware and if they are aware they know that there is a forum for them to report these violations.

So there is a concerted effort from the Council to be more open than before to work issues together, although in the true sense we haven't got on the ground an idea of a project for healing of the nurses themselves, but we have opened up a line to communicate directly with the Council. Thank you.

ADV POTGIETER: Chair thank you very much for being so indulgent this morning. Can I just ask, noting your reference to the approach of your predecessor to professional conduct issues as near militaristic and also noting your apology to those who may have suffered as a result of the actions taken by your predecessor, are you possibly engaged in a process of trying to identify cases where disciplinary action against nurses was unjust in nature, which would amount, as we understand it today as violation of human rights because it was political in nature, because it was racist? And are you taking steps to set those cases straight if those do exist?

And then secondly, are you aware of any prosecutions in terms of Section 49 where it was a criminal offence for a white nurse to be put under supervision of a nurse belonging to another race group?

MR GERMISHUIZEN: Chairperson could I start with the last question. We're not aware of any prosecutions having taken place but that does not mean to say there weren't any.

Your first question doesn't have an easy answer. The Council's Professional Conduct hearings have always been open to the public and in fact up until fairly recently invitations were even sent out to training schools and to hospitals. Nurses have always been allowed to have legal representation even though obviously many of them could not afford so. So that the actual hearings, the transcripts of the hearings, I don't think would indicate the Council acted against somebody on racial grounds. Again I'm not saying that individual members of the old disciplinary committees weren't biased in their own way but it 's certainly in the 15 years that I've been with the Council they never came through as such and if it had I wouldn't have stayed 15 years.

It's an interesting thought that you suggest that one does research into the past to see if nurses' rights have been violated in any way and then to see in what way reparation can be made to them by the Council.

ADV POTGIETER: Should you not invite nurses who have complaints of that nature to come forward to you, for you to look into those and to see what you can do to set it straight?

MR GERMISHUIZEN: Yes we're now, the Interim Council also instituted a Newsletter for the first time which now goes out to - it will on basis of three times a year be posted to every individual nurse in the country. So we can certainly thank you for that suggestion.

ADV POTGIETER: Thank you very much.

MR GERMISHUIZEN: Thank you Chairperson.

CHAIRPERSON: Thank you ladies and gentlemen. Can I say, I seem not to have stuck to my words that I started off with which is that we're going to stick to time. I want to appeal to my fellow Commissioners on the panel that they restrict their questions or that they send questions to organisations so that they'll be able to answer in writing. So please, I'm going to actually stop further questions. I know Professor Simpson was not here earlier on, so I'm going to actually repeat what I said.

All the groupings that are now presenting will have only 15 minutes to present, so can I please ask Janet to come along. I'm afraid if you're thirsty you may as well start walking out now and get a glass of water. I'm not allowing a tea break, you'll have to wait until lunch. Thank you.

ABUSES IN RURAL PRACTICE

CHAIRPERSON: Janet welcome, will you please introduce yourself.

DR GIDDY: This submission is on behalf of myself and my husband Steve Reed and we are two doctors who worked at the Bethesda Hospital which is 250 bed rural hospital in Maputoland which is in North East KwaZulu Natal up near Swaziland and Mozambique.

CHAIRPERSON: Can I just stop you and can I ask, Denzil will you assist.

ADV POTGIETER: Only with pleasure Chair.

JANET GIDDY: (sworn states)

DR GIDDY: We worked for nine years in a rural hospital from 1986 to 1994. Steve objected to military service and was allocated to do six years of community service instead. Our work included a wide variety of clinical duties at the hospital, teaching of primary health care nurses, working as district surgeons and a responsibility for community work in a district of 70 000 people.

With regards to Human Rights abuses, we would take as a starting point that the right to basic health care is a fundamental human right. Anything which prevented access to basic health care could be construed as a human rights abuse and we will describe factors which undermined the provision of health care. We'll also describe situations in which health care available was abusive in some way.

The first point is the institutional neglect of rural homelands. The homelands of the apartheid era, largely situated in rural areas were dumping grounds of people. As doctors we dealt on a daily basis with the ill health and disease suffered by large numbers of mostly illiterate, poor and marginalised people. This is primarily the reason we've chosen to make this submission to the TRC in order to make known the plight of vast numbers of forgotten people who lived desperately on the edges of extreme poverty in harsh environments and battling with effects of diseases such as malaria, measles, bilharzia, TB, typhoid, aids. The marginalisation of rural people continues to this day and we believe that it is an urgent priority that this be redressed under the new dispensation.

When I was asked to make this oral submission, I was specifically told to just focus on rural private practice abuses and leave out all the other stuff and in fact I've specifically not done that because I feel like that, it's part of the general attitude that rural health is just a non-issue, it's peripheral, it's not a big priority. So that's why I'm speaking about my whole submission although I'll try to keep it to 15 minutes.

Inadequate funding of rural health services.

Rural health services have been chronically underfunded relative to equivalent urban facilities because they're conveniently out of sight and out of mind. They received less than half the budget allocations of urban hospitals of equivalent sizes.

The general shortage of health care workers.

A well functioning health team needs to be comprised of a whole range of professionals such as nurses, doctors, therapists, lab technicians, pharmacists and dentists. At no time while we worked at the Bethesda was there ever such a team. This is problematic for the following reasons:

In rural areas there are large numbers of people who are disabled and require physiotherapy and occupational therapy for example. It's an area where the mysterious Msileni(?) joint disease occurs.

We only had an occupational therapist for one year in 1993.

A dentist visited once a week for six months in the entire time. Otherwise the only dental care available was provided by the doctors who taught each other to do tooth extractions.

There was never a trained pharmacist employed at the hospital. The laboratory was always short-staffed which had serious implications for the work in an area where there were a large number of epidemic diseases such as malaria, TB, bilharzia, typhoid and others.

There was an ongoing shortage of nurses. This resulted in much of the work which should have been done by professional nurses being done by staff nurses who were compelled by the circumstances to function far beyond their scope of practice.

The South African Nursing Council would not have been pleased if they had known about these irregularities but we didn't think they particularly cared what happened.

The shortage of doctors.

One of the main reasons why rural communities did not have adequate basic health care is that there were not enough doctors working in rural areas. As we all know there's a severe maldistribution of doctors in South Africa. The vast majority live and work in urban areas. The reason for this are multifactorial.

However, we would highlight the following reasons as ones which could have been managed differently.

Firstly incentives. The Department of Health provided inadequate incentives for South African doctors to work in rural areas. Some doctors employed by State health were given a territorial allowance which was an attempt to compensate them for working in these areas. Although it sounded reasonable one had to bear in mind the realities of living and working in a rural area. These doctors had no housing subsidy like colleagues in public sector jobs in urban places. There were many inconveniences and expenses associated with living in very remote rural areas including bad roads, having to travel far to do shopping, repairs or anything like that. Unreliable telephones or no telephones for months on end. Erratic electricity and water supplies. Schooling was problematic for those with children. There was no access to medical libraries for continuing medical education.

One could continue this list which serves to illustrate that life in a rural hospital was awkward or inconvenient for people. While a few adventurous doctors accepted the challenge of living in the bush and tried to live as positively and enterprisingly as they could, for most doctors these situational factors were serious disincentives to working in rural areas.

The Department of Health could have provided financial incentives to doctors to recruit them to rural areas. Many young doctors have loans to pay off and travel to other countries specifically to earn more money to pay their debts.

The Department of Health could also have thought of other creative alternatives, for example a paid sabbatical leave for any doctor who worked for a fixed period of time under a contract. There was such a system available to British doctors employed in a rather strange way, but no one else.

Rural medicine is uniquely stressful and the idea of paid long leave after a number of years of service would be a real encouragement to doctors to commit themselves for longer periods.

The KwaZulu Pledge.

There were to our knowledge no Zulu doctors working in rural hospitals in KwaZulu between 1986 and 1994. The University of Natal have been graduating Zulu doctors for about 40 years, so how did the situation come about? The reasons are complex but one important one I've singled out was the KwaZulu Pledge. This is a law requiring all KwaZulu public servants to sign an oath of allegiance to the KwaZulu government and its leaders. If a person refused to sign the pledge they could not be employed as a public servant in KwaZulu. We ourselves were not required to sign it as we are employed in State health posts. This pledge deters Zulu doctors from working in rural areas.

Doctors need training, professional support in the field of ongoing continuing medical education in order to be motivated to do a good job and to provide a good quality of service. The University of Natal showed very little interest in rural medicine. While there may have been political and situational reasons for failing to provide academic support for rural health were they truly adequate excuses for neglecting to support the doctors and health service that attempted to provide health care for a few million under-served poor and marginalised rural South Africans? We do not believe the excuses were adequate.

It is our firm recommendation that specific attention and resources be given to rural health and rural medicine by the country's medical academic institutions, a kind of affirmative action towards rural areas without which the situation is likely to remain unchanged in the future.

Very few South African doctors and the difficulty of registering foreign doctors.

There are very few South African doctors who are willing to work in rural hospitals. Many were leaving the country for personal as well as political reasons. These included the problem of conscription for White male doctors, the general level of violence and unrest in the country and perceived unsatisfactory working conditions.

In contrast to this was the situation of doctors from other countries wanting to work in South Africa, often specifically in rural areas. It is not an exaggeration to say that in the majority of rural hospitals, foreign doctors were the life-blood of the service. Without them there would have been no service. The problem was that the procedure for registration was difficult and got worse from the mid-1980's. We were very frustrated by corresponding with interested doctors from countries with a good standard of medical training to see them lose interest because of the problem of registering with the South African Medical and Dental Council. The burden of an understaffed health service which could have been lightened continued. Ultimately he suffered with the disadvantaged rural communities.

The consequence of lack of doctors.

If doctors left and there was no one to replace them it created enormous stress and overwork for those who remained. No one wanted to go and work in a hospital that was badly staffed because they knew it would be very stressful, so more left and a vicious cycle developed. Some hospitals were down to one or two doctors for two or three hundred bed hospitals and there were some hospitals that had no doctors for a few years.

The next part looks at doctors who do not respect the human rights of their patients. This is what the TRC apparently most wanted to hear about. There were a number of GP's in the area who provided curative health care on a private basis. On a few occasions I did locums for them and was thus able to experience aspects of their practice which undermined the dignity of the people who were unethical in some way.

Firstly separate facilities.

Black patients were treated differently to White patients. Doctors' surgeries were divided up and had separate waiting areas as well as consulting areas. Whites had a waiting room which was comfortable while the Black patients waiting room was uncomfortable and inadequate. It might have just been a verandah or just sitting outside on hard benches or on the ground.

The consulting areas were also different. The White patients were seen in a room where there is privacy, a desk where the doctor sat, an examination couch and curtains around the bed for the patient to undress with dignity.

The Black patients were examined in a room which had been divided up with partitions to create three of four kinds of stalls which is a narrow space which scarcely fit an examination couch. The doctor stood and hurried from one stall to the other and they lined the patients up. There was no privacy as the partitions did not prevent patients from hearing what the doctors said to others. There was no linen on the couches. It was very uncomfortable. The situation was undignified and created a feeling of a depersonalised production line.

The abuse of the jova(?)

Black patients were treated differently to White patients. They paid a standard fee for which they got a consultation and medication as part of a package deal. Medication had to include an injection, the Zulu word for which is the jova as well as two or three different kinds of pills or medication in syrup form. When doing a locum I was told in no uncertain terms that this practice was non-negotiable. Every patient must have a jova. When I asked what to give a baby withe diarrhoea, which is a common primary health care problem which requires a detailed enquiry into feeding practices, use of enemas and then advice about oral rehydration but no medication. The doctor said, oh just give them anything, penicillin, streptomycin, gentomycin, sterile water, vitamin E, anything you like but just make sure they get the jova.

The practice was defended on the grounds that the patients demanded it and were not satisfied with the consultation if they did not get it as well as a few other pills. Clearly the GP's felt they would lose patients if they did not continue this well established practice. For medical and ethical reasons this is a very problematic thing. I won't go into it now but if people want to know at questions...

I was told stories by nurses about GP's re-using needles until they were blunt. This was something they had observed while attending GP's as patients. This practice is purely unethical and dangerous and spreads infections such as hepatitis B and HIV.

Failure to provide primary health care.

GP's are in an excellent position to provide primary health care, the minimum being to give routine immunisation to children. They do not do it. This results many missed opportunities. I would add that I know that none of these circumstances are any different now to the period under discussion.

The third point was police violence.

We were expected to do medical examinations to determine if minors were medically fit to be whipped by the police. This was degrading and humiliating for all concerned. We saw patients who had been assaulted or tortured by the police. I won't talk about this because people have talked about that a lot.

Disability is something I want to talk about because I feel like nothing has been said about it in these health hearings.

Disabled people have very difficult lives in any situation but particularly so in rural areas. Wheelchairs cannot move on soft sand and life is often intolerable for people with serious disabilities. I'd like to tell you just about one patient of ours, a Mr Frans Pimbi. He became quadriplegic after an accident in 1979. He had no movement in his legs and only a little in his arms. He was totally dependent on his mother for everything and he was confined to a wheelchair. They lived in a home comprised of sticks and mud huts about 10km from the hospital and he received a disability grant of R242 every second month. He was subject to terrible urinary infections and bed sores which were difficult to treat because of the scarcity of clean water and the distance from the hospital.

In other situations Frans could have expected to access resources and assistance to cope with his condition but because he was Black and because he lived in a rural area, he suffered far more than others with similar disabilities and he died far sooner.

I present Frans's story as an example because his life and subsequent death of TB in 1990 was an expression of the abominable effects of the whole system on an individual. That he lived with such dignity and inner strength, despite the cruelty of his situation was a source of great inspiration to us and testimony to the power of his faith in God.

As District Surgeons we were obliged to assess applicants for disability grants, a system that was fraught with difficulties. Many who were clearly eligible, or had serious disability, had endless bureaucratic problems. The system was very inefficient, bureaucratic, waste of the time of all concerned and in many, many cases corrupt. People whose lives were filled with physical suffering were given very little real support.

The last point is TB repatriation from the mines.

In the course of our work we frequently came across TB sufferers who have laid off work at the mines because of their illness despite an official policy to the contrary. They were paid out a lump sum and discarded by the employment agency TEBA because they were unfit to work and ended up in our TB wards with their lives barely intact.

In conclusion, we have highlighted a number of situations in which we felt that the Medical Profession and those responsible for the provision of health services abused the human rights of rural communities and individuals through the neglect of their duties towards them. We know that people died prematurely and suffered immeasurably in obscure corners of rural South Africa as a result of these sins of omission. Their suffering was no less significant for it's hidden and undramatic nature.

It is our hope that by sharing these experiences and raising the issues that the health of rural people and communities in this country would be given the attention it deserves in the New South Africa. It many ways it is an indicator of the extent to which the new government succeeds in its task.

CHAIRPERSON: Janet thank you very much. You've packed in everything in the 15 minutes. You've also raised your concern that the TRC asked you to concentrate on one aspect. You've done that admirably. I've said already that we're not going to be asking questions. If people wish to send you questions we'll send those to you. I hope you will, because many of the issues that you raise need to be continually discussed and taken up, certainly in the workshop this afternoon. I hope you'll be staying for that workshop.

DR GIDDY: I can't stay for the whole time.

CHAIRPERSON: Thank you.

Maybe as I sort of prevented stops, I've prevented people from going to tea, if you'd like to stand for three minutes just to stretch your legs while Professor Simpson comes to the table.

PSYCHOLOGICAL ABUSE IN DETENTION

CHAIRPERSON: Professor Simpson are you ready. Can I just say that if people want copies of the submissions they can make a copy at a Quick Copy which is down stairs, Shop 6, 101 St George's Centre, and they have all the submissions there.

Professor Simpson before I hand you over to Mr Denzil Potgieter will you just introduce yourself.

PROF SIMPSON: Thank you Fazel. My name is Professor Michael Andrew Simpson, I am a physician, psychiatrist and human rights activist. I was in exile from South Africa from 1961 until 1984 and then returned and worked on a series of major human rights court cases from 1984-85 to date. I returned having worked as a professor and senior academic in Britain, America and Canada and with special emphasis in my research on human rights and on the effects of trauma on individuals and communities.

CHAIRPERSON: Thank you. Denzil.

ADV POTGIETER: Thank you very much Fazel. Professor I'm just going to ask you to take the oath before you present your testimony. Thank you.

MICHAEL ANDREW SIMPSON: (sworn states)

CHAIRPERSON: Professor your presentation will deal with psychological abuse in detention. You have in fact furnished the Commission with a very very full written submission and you have arranged to let us have access to a lot of other material which is relevant, which we will use together with your submission for the work that we will be doing but for purposes of your presentation here, you will simply just be highlighting the main sections of your full submission that you have made to us in writing. Over to you.

PROF SIMPSON: Thank you Sir. I've spent the last six months abbreviating thousands of cases with evidence into hundreds, into dozens and the 60-minute presentation has been cut down - I am pleased I've spoken before it's been cut down to ten minutes.

I was struck by the similarity between my experiences and those of David Klatzow yesterday. Having been subjected to cross-examination and often very, very cross-examination as an expert witness for up to three and a half weeks in human rights cases, I know what he meant about the appearance of confabulated and fake expert evidence which never ever, ever received critical attention of the courts. I think what we often experienced were not simply miscarriages of justice, they were full legal abortions of justice.

I would also like to support what Francis Ames said yesterday about how some of us were harassed and discredited for speaking the truth. We need and deserve and look to you ladies and gentlemen for proper and official rehabilitation.

The extent to which racism and the disregard of the human rights dominated South African health care is hard to believe, even to those of us who lived through it and struggled against it. As an illustrative example, when I was the medical director of the Highway Hospice in Durban, which I think was the first non-racial hospice in South Africa based in what was classified as a White area though servicing all areas we could reach. We insisted on providing non-discriminatory health care to anyone who qualified by the simple criterion as being a dying patient. And one day I received a telephone call from a senior government health official, saying,

Swallowing my anger and thinking quickly I said to him,

There was a long silence and much rustling of paper and he finally admitted very grumpily that he could not think of any regulation that specifically forbade that and we continued caring for all who needed our help, and we didn't hear from him again.

I think one reason I quote that sort of example is I think it is under-appreciated how much might have been achieved, perhaps in a succession of similar small victories, had anybody bothered to try to say "no" more often than most of our colleagues ever did.

It had been noted in all significant other historical examples of oppression, the indifference of the bystanders is critical for the success of the aggressors. It is deeply unwholesome that in the South African situation the bystanders continue in many cases and we saw some illustrations yesterday afternoon to deny, develop amnesia and ignore the essential role they played in that past process. This is a political ointment but one that the health care sector should not accept. It's not anyone's task to comfort the afflicted, it is sometimes necessary for us to afflict the comfortable.

There has been far too little genuine debate about the nature of social healing and what surely promotes it. Truth is one essential component of the needed social antiseptic which could cleanse the social fabric of the systematised habits of disregards for human rights, but it needs to be an examined truth, it needs to be considered, thought about, debated and digested and metabolised by individuals and by society. Failure to comprehend recent suffering is too often, in the studies I have made received, the seed of future suffering.

Soon after my return to South Africa I began to be consulted about the problems of political violence and of political detainees. Perhaps our first major case was the case of the detainee Surish Surnee(?) in 1985, in which we succeeded in gaining his release, as I think was entirely appropriate, on health grounds, but from that date on I and those of my colleagues who assisted in that case received consistent severe harassment, both within the university and outside it, including death threats and death attempts. Some of us were dissuaded from such work by these experiences and some of us perhaps being more congenitally stubborn continued. Cases I worked on include State v Tsele and Others in Newcastle and Utrecht which occupied much of my time over three years. The State v Tuka and Others in the last of the major Delmas trials, the matter of my colleague who has joined us today and yesterday, Ebrahim Masinya, an ANC official who was kidnapped from Swaziland and very severely treated in captivity, and the lengthy Potgietersrust inquest into the death of Donald Madisha from 1990 on in which incontrovertible evidence of gross irregularities and improprieties in this very highly suspicious death of a detainee, perhaps one of the last of the detainees to die in detention even after 1990, was so carefully and skilfully ignored by a magistrate sitting with a professor of forensic medicine as an assessor.

There are many examples but I have, at your request, winnowed those down to a few that specifically most clearly illustrate the problems, but we do appeal, and I've discussed this with many of my colleagues from more northerly regions, appeal to you very distinctly to enable at least a further hearing at which more of these examples of which there are so many, can be examined properly because the process you have begun is one that cannot be curtailed, and if it is, the fact that you have done it, may be used by many others as an excuse not to take it further and the process has to be taken further.

We need to recognise the roles of those that were played by, not only by those who actively assisted in the abuses that occurred, but also the essential role played by those who so deliberately and skilfully ignored what was going on.

Bystanders in the health sector were not as they claimed being neutral in a conflict with regard to item issues involving torture and repression. Doing nothing or behaving as if nothing untoward was happening is not neutral. It is highly effective and often essential assistance to the primary perpetrators and renders one a secondary perpetrator. No doctor expects to be neutral in dealing with cancer or aids and we should not consider our task or our role any different in dealing with torture and repression which are merely cancers and infections of freedom.

When doctors, as so many whom I am naming to the Commission in my more detailed submissions, when doctors and other experts were actively involved in helping to disguise the evidence of abuses that occurred, they were actively assisting in the survival of evil as much as if they had allied themselves with the virus.

It is also important to realise that none of the major institutions, including the Medical and Dental Council, ever took action including cases I didn't mention in their submission yesterday, as in the Soni case where one of the psychiatrists who had examined him announced in his affidavit, both that he had advised this man to end the suffering which was essentially self-imposed because all he needed to do was to tell the Security Police what they wanted, and of course he would then be released. Who actually, I am told by the detainee himself, was advised by the psychiatrist of the details of the witness protection programme that he might have access to