Doctors, heal your profession, is the call as pressure mounts on the medical profession to hold its own truth commission. Rehana Rossouw reports
Isaac Rani was tortured for three days by security police after they arrested him in the Sixties for leaving South Africa for military training. On the third day, he was visited by a district surgeon while he lay in his cell vomiting blood. Rani told a Truth and Reconciliation Commission (TRC) hearing the doctor said there was nothing that could be done to help him, he would be dead soon.
Commission investigators, after listening to evidence like this at countless hearings on gross human rights violations, are hard at work uncovering proof of the torture and the names of the police involved. But they will not necessarily attempt to discover why the unnamed doctor did not insist Rani be taken to hospital for treatment, or that his torture be stopped immediately.
There are doctors who are concerned by the mounting evidence that their colleagues were involved in human rights abuses either by omission or commission. They are clamouring for a medical TRC to uncover the past and prevent such violations in the future.
Some of the abuse is already well documented and infamous around the world. The conduct of the two district surgeons who attended to dying activist Steve Biko, led to the Medical Association of South Africa’s (Masa) resignation from the World Medical Association.
The Biko affair focused the international spotlight on South Africa’s doctors and their ethical stance in an apartheid system. It highlighted the failures of the Medical Association of South Africa and the South African Medical and Dental Council (SAMDC) to censure — or protect — doctors when their ethics were questioned.
One of the Biko doctors, Dr Benjamin Tucker, was a Masa member. When the association refused to cancel his membership or disassociate itself from the SAMDC’s findings, several prominent members resigned and formed the National Medical and Dental Association (Namda).
One Masa member did attempt to highlight the dilemmas which the medical profession faced in South Africa. The late Dr Jonathan Gluckman, a Masa office-bearer who worked closely with families of detainees, spoke out about the problems of segregated health care.
Gluckman went up against former minister of law and order Hernus Kriel, whom he accused of conducting a fraudulent investigation into the treatment of detainees. Kriel responded by accusing Gluckman of “self-glorification”.
However, the previous minister of health, Dr Rina Venter, exonerated Gluckman. In an attempt to desegregate hospitals, Venter discovered there were no laws on the statute books which forced them to care for white patients separately from blacks.
It appeared that the medical profession itself had instituted these rules — not only in state hospitals, but in countless private practitioners’ surgeries which had separate waiting rooms for white and black patients.
In 1995, Masa finally apologised for its silence on race-based policies affecting the medical profession. Without listing the issues for which it was apologising, the association admitted “persons within and outside the medical profession might, in the past, have been hurt or offended by acts of omission or commission on Masa’s part”.
The most successful challenge to the medical profession came in 1985 from a young Port Elizabeth district surgeon Dr Wendy Orr. She brought a supreme court interdict against the prison authorities to stop them from assaulting her patients.
The case won her instant infamy in government circles and she was effectively stopped from performing her clinical duties. Today, Orr is a commissioner on the TRC and attends its hearings where victims of police brutality often highlight the failure of doctors to protect them from assaults from the security forces.
Victim after victim has told the TRC how district surgeons treated them in the presence of the security forces, how some gave the go-ahead for further interrogations despite their patients showing obvious signs of mistreatment and how inquest documentation did not match the wounds relatives had seen in state mortuaries.
In Cape Town this week, the medical profession debated the call for a medical TRC. At a panel discussion organised by the Trauma Centre for Victims of Violence and Torture, speakers spoke of the need to uncover and document the sins of the past.
Dr Leslie London of the Department of Community Health at the University of Cape Town (UCT), said the case for a medical truth commission was compelling.
“Masa’s apology is not underpinned by concrete documentation of what it needed to apologise for. It does not tell us when abuse stopped. An apology does not identify what the failings were in the past and how we are going to prevent it in the future. It is almost like a self-declared amnesty,” said London.
He said the medical TRC should be public and send a strong message that the transgression of human rights would not occur again in the South African medical profession. The commission could make recommendations at its conclusion to upgrade ethical education in health sciences and improve reporting mechanisms in places of detention.
Masa’s manager of medical ethics Gavin Damster said he believed it was unnecessary to duplicate the functions of the multimillion rand TRC, which it supported.
“We have asked all of our members to go to the TRC if they have been involved in gross human rights violations. This has been an issue of concern to Masa even before the TRC was up and running,” Damster said.
“We are prepared to criticise our members who are not performing and this practice has always been there. Doctors involved have been sent by Masa to the Medical and Dental Council.” Damster admitted that many doctors working with the police and prisons believed they had a dual responsibility to the state and their patients. He suggested this dilemma be investigated in a similar manner to the British Medical and Dental Association, which published a report on state doctors called Medicine Betrayed.
Dr Mary Rayner of Amnesty International, said the problems highlighted in Medicine Betrayed supported the call for a medical TRC. The investigation had shown how ordinary men and women became unwittingly involved in systematic human rights abuses.
“Our experience around the world has shown that there are all sorts of reasons why medical practitioners working in a prison or army barracks can fail in their duty to their patients,” Rayner said.
“They can accept the security force’s ideology and motives, they can be affected by the social milieu in which they mix in daily life, they could be concerned about their careers or be subject to direct threats. Over time they can be drawn into a situation of complicity in which the detainee suffers grossly.
`It is outside the scope of the TRC to tease out the subtle, institutional ways in which the security forces found support outside their own ranks for what they did.
“In South Africa there are examples of this. There are doctors who participated directly by falsifying medical records. There must be more cases than Steve Biko — people who did not have publicity and expensive advocates at their inquests.”
Rayner said the situation was not only of academic interest as abuse was still occurring in South Africa. The “unreformed” police force was still torturing people by electric shock and suffocation.
People entering the medical profession needed information about where the traps lay. They needed to learn the small and passive ways doctors could participate in human rights abuses.
“District surgeons embarking on their careers won’t know how to conduct themselves if they don’t know what happened in the past,” Rayner said.
The Interim South African Medical and Dental Council’s registrar, Nic Prinsloo, said his organisation did not discuss the call for a medical TRC and he could thus not comment on it.
He pointed out that the organisation replaced the SAMDC and could not be accountable for what it had done in the past. Although Prinsloo had served on the SAMDC, he was not prepared to discuss how to address its failings.
Dr Judith van Heerden, of UCT’s Department of Primary Health Care, sent a direct challenge to Masa and the SAMDC to organise a parallel medical truth commission.
Writing in the June issue of the South African Medical Journal, Van Heerden said South Africa’s past was littered with incidents where doctors neglected their caring duty. “Collusion with the state was regarded as patriotic duty by some of them,” she said.
“The pain and remorse of this process will be living proof as a commitment to ensure that what happened to Steve Biko should never be allowed to happen in any country that regards itself as civilised,” she quoted from a South African Medical Journal editorial of 1991.