Olive Shisana, special adviser to the minister of health, in The Mark Gevisser Profile
When Olive Shisana was appointed special adviser to the minister of health exactly a year ago, she found herself dreaming the same recurrent nightmare that had dogged her through her first five years of exile: “I am locked up in the borders of South Africa, trying to get out and I can’t. The police are after me and I can’t escape them. This dream kept coming and coming, and so every white South African who was in government to me was part and parcel of those police out to get me.”
And so, when she entered the Civitas building (a Pretoria monument to banality and enclosure carefully designed to make civil servants feel they are being detained without trial) for the first time, “I looked at these people, and in my mind what was coming through was, ‘Oh my God! They’re gonna get me!’ Therefore I must be defensive. I must defend myself otherwise I’m going to be trapped within and I’m never going to come
Olive Shisana comes from a family and a part of the world — the far-North — where dreams and visions are taken seriously; where the lines between this world and that of the spirits are not clearly defined. She listens to her dreams. To her immense credit, she is one of the few, in the new black elite, who will articulate the traumas and agonies that accompany sleeping with the former enemy.
And she has been working on it: “It has taken a long time to deal with this, but I’ve begun to see these people as human beings and colleagues rather than as parts of an evil machine.” Not that this admission has made it any easier for those who have borne the brunt of her paranoia (she quotes Kissinger: “Just because I’m paranoid doesn’t mean there aren’t people after me”).
As the woman charged with restructuring the health sector in this country and the leading contender for the position of director general, she is without doubt one of this country’s most controversial new technocrats — the quick-witted counterpoint to her phlegmatic minister, but as politically clumsy as Dr Zuma is wily.
When she first started, notes one of her supporters, “she blundered around in a very self-opinionated way, and she trod on a lot of toes — not only in the department, but in the health policy world. She just didn’t trust anyone.” That is an understatement — she apparently reduced outgoing director general Coen Slabber — an easygoing gynaecologist from Bloemfontein — to a gibbering wreck, and has incurred the wrath, at one point or another, of almost everyone working in
She came in, says one of the leafers of a provincial strategic management team, “shooting from the hip. She wanted to change things, to shake things up, and she had a very poor understanding of the sector. The fact that she was offhand, dismissive and arrogant meant that the people who could have helped her didn’t.”
Shisana tells the story of how, when she first arrived in the United States in the mid-1970s to study clinical psychology, “I was too scared to open my mouth. I thought, I’m the only black, a rural girl from Africa, what do I have to say?” But a friend — a Jewish woman — took her on, and once pushed her hand up in class, saying, “Sir, Olive has got something to say!”
“She literally forced me into speaking. I’ll never forget that experience. I had no self-confidence until then, but once I started talking, I went overboard! Only after a while did I start toning down …”
Although she disputes it, that seems to me to be the very model of Shisana’s first year at Health. Call her Olive Overboard. She has ridden bareback into a whole plain of windmills, the most razor-edged of which was the ill-considered Deeble Plan for national health insurance, which would have guaranteed universal access to health by collapsing the private and public sectors into each other — and bankrupted the system.
Despite opposition from almost all quarters, she insisted that it be implemented, pre-empting the work of a further committee to be chaired by health economist Dr Jonathan Broomberg.
In the storm that ensued she relented. Now, after having chaired the committee with Broomberg, she has co-authored a plan, to be presented to Parliament next week, that is by all accounts exactly what the doctor ordered. Her comment? “I don’t even think Deeble would believe in his plan now, given the process we’ve gone through and how much more we know and how many people we have consulted.”
It is a clear admission of her earlier impetuousness, and a sign of how quick — and willing — she has been to learn. Just like that first year in America, she has begun to tone down. “There has been a definite wind- change,” notes her associate. “She now listens to people. She seems comfortable. She delegates. She has begun to smile.” Her detractors and supporters agree that she is both intellectually brilliant (she has a doctorate in public health from Johns Hopkins, perhaps the most prestigious institution of its kind in the world) and belligerent. She claims that she has had to be “tough and firm” to get results: “I came in here,” she says, “and I found a department that was unwilling to look at substantive change. I was not put here to reform the system. I was put here to transform it, and I am succeeding.”
A more neutral observer, Dr Craig Househam, who runs the Free State health system, says: “She has a strong personality, but she gets things done. She has driven the process of change and the result is that health is one of the departments further along the road than any other.” Indeed, the funding community has estimated that health is at least nine months ahead of any other department in terms of restructuring, and has thus made Shisana its darling.
She has shaken things up, in terms of staffing, budgetary allocation and interprovincial co-ordination. But there are, once more, many who disagree. Yes, they say, there has been movement. But to what end? They accuse Shisana of academicism; of worrying unduly about policy and restructuring when there is, in fact, a crisis of delivery that needs to be sorted out first.
These people — and they are the ones on the front line, the superintendents of crumbling hospitals and resource-starved provinces — want a manager first. The vision stuff, they say, can wait.
The vision stuff is basic, and powerful: “There is still one thing about the Deeble plan I stick to, and that was its insistence on universal access to health. I will fight for that as long as I live. And, whether or not I am appointed director general, I will stay in government until I see a national health system in place.” If this is not hearfelt, then Shisana is an excellent politician.
She claims that her detractors are a small group of people who have been left out of the process. “Let’s be frank,” she says, “there are people who are uncomfortable about Africans taking on a leadership position. We are challenged as if we are intellectually incapable and we are challenged about our political background.” This last point in response to a rumour that Shisana, in contradiction to her CV, was not allied to the ANC in exile, a rumour that is easily
She is patently wrong when she says that her critics number only a handful and when she implies that they are all not African — critics of Olive Shisana come in all colours, and they are all over the place. But let’s be frank, there is a major race issue happening in the upper echelons of the new technocracy; one about which everyone will hold forth at great length off the record, but no-one will tackle publicly.
It goes like this: Africans are bitter that the supposedly-progressive coloured/Indian/white intelligentsia is nabbing most of the senior posts (and indeed, there are very few African directors general), while appropriately qualified, progressive non-Africans fear that they are being left out because they are not black enough. The one side cries “racism!” and the other “Africanism!”; both sides over-exaggerate the issue, but both have a point. And Shisana has become a lightning rod in an ever-intensifying storm.
She responds with indignation. “Wait a minute! Where do I come from? I come from the very people I’m trying to help! It’s not academic or theoretical for me! I’m talking about my brother, my sister, my mother, my neighbor; I’m talking about the people I grew up with, in Mamelodi, in Makotopong. Why do I have to prove anything beyond that?”
In a day spent with Olive Shisana one sees both the flickers of embattlement and the ease which comes with a sense of arrival. She talks, with much emotion, about the guilt of bringing her two children, born in the United States, back to the captivity of South Africa (they returned in 1991), and of the house she built with her husband — who lectures at the University of the Western Cape — at Tableview, “with a picture- perfect view of the sea and the mountain”.
She had never before been to Cape Town — she and her husband chose it from the pages of a book while in Washington DC as the place they would “return” to. It says something about the single-mindedness with which she is pursuing a sense of emplacement; a sense that was first shattered, perhaps, when she was forcibly removed with her family from their ancestral land at Makotopong, outside Pietersburg.
She was 17 at the time, and her memories of life before removal are pastoral and idyllic — all dew-covered berries, the twittering of birds, and the welcoming hearth for wayward travellers. Even the poverty of having to sleep around a fire under blankets made from mielie meal bags is remembered as being “close to the
There is, in Olive Shisana, both a quest for unattainable perfection, and a manifest self- consciousness of her own imperfections. That combination results in the kind of drive that propels a black woman, against all odds and in the face of much opposition, to the very top of the civil service.