TRC Final Report

Volume 4

Chapter 5

Subsection 13

■ THE ROLE OF THE NURSING PROFESSION

72 Nurses in South Africa form the largest body of health workers in the country and make a great impact on health care delivery. During the period under review, they were very often at the frontline when it came to treating patients who had been subjected to human rights abuses resulting in injuries.

73 Nurses working for the prison services were very often the first points of contact for prisoners or detainees with medical complaints arising from abuses. The role of nurses in preventing and reporting abuses could thus have been absolutely crucial, as they could have brought cases to the attention of the relevant authorities and the public at large. The fact that this seldom happened reflects the hierarchical relationship between nurses and doctors, the subordination of nurses, the lack of awareness of ethical rights and responsibilities and the failure of the South African Nursing Council (SANC) to support and encourage the observance of human rights. Rather, nurses were encouraged to support the political situation of the day:

If they [nurses] suspect that a person is involved in insurgent or terrorist activities, they are required to report this to the medical superintendent or the nearest police station or army unit. If they do not do so, they may themselves be charged under the Terrorism Act if there is evidence that they have given assistance to a ‘terrorist’.³⁶

74 Submissions and statements received did not indicate that nurses actively participated in gross human rights violations, but they did suggest that acts of omission and ‘turning a blind eye’ were common. “I think we are all guilty, but we had blinkers on, so did not see it at the time.”³⁷

Experience of Ms Betty Ncanywa, a nurse at Livingstone Hospital (Port Elizabeth) in the 1980s

Most of the cases that we attended were for gunshot wounds and tortured people and detainees with severe depression. Some died before they reached us. Some died on arrival. Some were taken before we could treat them. The Security Police would take them from the casualty department before we could even treat them.

As nurses, we were given an instruction that we mustn’t obstruct the work of the security force. We mustn’t stand in the way of the police. The only thing we need to do is to just treat the patient. Even if we see people being tortured, we must just keep quiet. This was the instruction from the hospital management … I must try to refrain from politics, otherwise my future would be in jeopardy.

75 This testimony very starkly illustrates the dilemma in which nurses found themselves. On the one hand, their training inculcated a culture of adherence and obedience to the hierarchy (doctors, matrons, sisters, nurses) and to authority of any kind (for example, the police). On the other hand, those who were conscious of human rights and ethical issues found themselves having to lie (for example, to admit a patient with ‘severe depression’ when they knew this was not the diagnosis); discouraging patients from going to hospital when they knew hospital care was desirable, and performing procedures (for example, removing bullets) for which they knew they were not qualified.

76 The way in which nurses were perceived to collude with apartheid policies and, during unrest situations, to co-operate with police (even though this perception was not always accurate) undoubtedly had a negative impact on the delivery of health care by nurses to communities.

This touches individual lives and safety, the ability to function in one’s professional capacity and a fundamental loss of trust between various sections of the community, leaving jagged wounds of a physical, psycho-emotional, social and spiritual nature, which may take a long time to heal.³⁸