TRC Final Report

Volume 4

Chapter 5

Subsection 17

107 The apparent collusion of some doctors with state security forces and the lack of response from professional bodies in relation to this led to deep divisions within the South African medical world. Therefore, two bodies came to represent the medical profession - MASA and the National Medical and Dental Association (NAMDA).

108 The older body, MASA, was a voluntary, independent, professional association for medical doctors. It was historically (at the time of reporting) the largest professional medical organisation in South Africa, with a membership of about 14 000. At the time of the hearings, it saw its role as “empower[ing] doctors to bring health to the nation”⁴⁵ by representing the collective interests of the profession and the patients it serves, as well as shaping health policy to meet the needs of the community.

109 MASA made a 104-page submission, the result of an extensive study of its records and archives. The submission noted that MASA had members that actively supported the apartheid government and members that actively opposed it. Rather than focusing on the activities of individuals, the document examined MASA’s role as an association. It said, in this regard:

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 it defined all sorts of means to defend itself and the system.

110 The submission also acknowledged the fact that MASA failed to respond appropriately to the health needs of the majority of South Africans.

MASA was always, without doubt, a part of the white establishment … and for the most part and in most contexts, shared the worldview and political beliefs of that establishment. Inescapably, it also shared the misdeeds and the sins for which the white establishment was responsible.

111 Dr Hendrik Hanekom of MASA clearly acknowledged the organisation’s past positioning in his response to a question at the hearing:

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.

112 The written submission added, however, that the events surrounding the death of Steve Biko forced MASA to begin a long process of examining the ethics and morality of its actions.

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.

113 NAMDA was an ‘alternative’ medical association, formed on 5 December 1982. In its submission to the Commission, the Progressive Doctors’ Group (PDG), a core group of ex-NAMDA doctors formed to pursue discussions about a united medical association for South Africa, gave some of the reasons for the NAMDA breakaway from the MASA. These included:

a the conduct of the profession in respect of the medical conduct of those responsible for the death of Steve Biko;

b the devastating effects of apartheid on health and human rights, and

c the failure of existing medical organisations to respond cogently to these issues.

114 With the increased repression of the 1980s, it became important to work at making health facilities safe or providing alternative services. NAMDA, together with other professional organisations, such as the Organisation for Appropriate Social Services in South Africa (OASSSA), took on this responsibility.

115 NAMDA disbanded in the early 1990s when it became evident that South Africa was moving towards a new democratic dispensation in which the Department of Health would (it was believed) take on the issues that had triggered its creation.

116 The PDG highlighted a number of other concerns in its submission: The first was the harassment of NAMDA and its members, which manifested itself in various ways. Second, was the concern that so few health professionals came forward at the time to testify about human rights abuses in the profession. “It seems that many more health professionals were aware of problems or were involved in problematic practices than they were prepared to acknowledge.” A third concern was the way in which certain research was conducted, particularly in the area of occupational health: for example, heat acclimatisation chambers set up to ‘customise’ workers to the work place. Last was the fact that, at the time when NAMDA was supporting the ‘Free the Children’ campaign, MASA was involved in drawing up, ‘Children in places of detention: a code for their handling’. In other words, while NAMDA abhorred the very concept of detaining children, MASA was trying to find ways to make it more acceptable.