TRC Final Report

Volume 4

Chapter 5

Subsection 2

13 The evidence available to the Commission suggests that most district surgeons were not directly involved in committing gross violations of human rights during the period under review. Their most common offence was a failure to carry out their duties within internationally accepted guidelines of medical ethics and human rights. All these points are starkly illustrated by the Steve Biko story. The doctors failed to:

a maintain patient-doctor confidentiality norms;

b treat their patient with dignity and respect;

c examine the patient thoroughly;

d record and report injuries accurately;

e diagnose illnesses and prescribe appropriate medication;

f register complaints (particularly pertaining to assault and torture).

14 On many occasions, district surgeons examined patients with security officers or prison warders in the room, which may have inhibited patients from disclosing abuse or torture by the police. This practice also reinforced the belief of prisoners that district surgeons collaborated with the authorities. District surgeons breached patient-doctor confidentiality by allowing third parties (police or prison authorities) automatic access to patients’ files without informing the patients concerned or obtaining their consent. International standards require a doctor to inform the patient before he or she conducts an examination if the information in the medical records will be released. Finally, a number of deponents (generally detainees) told the Commission that they did not receive what they believed to be appropriate care from district surgeons.⁴

15 These circumstances were aggravated by the fact that most district surgeons were white, while the majority of the detainees were black. Because white and black people had for years been separated by apartheid policies, there was a strained relationship and a lack of mutual trust and understanding between doctor and patient.

16 Many district surgeons also claimed that they did not know they could override the orders or wishes of prison warders or police on medical matters - for example, by not releasing information or by insisting that warders leave the room during examinations.⁵ Finally, where a district surgeon did take a stand to uphold the human rights of his or her patients, he or she received little or no official support from the profession or the Department of Health.

17 At the height of the state of emergency in the mid-1980s, there was a flood of detainees into the prisons. The increased workload pushed district surgeons into unprofessional medical practices – such as failing to examine detainees properly, failing to insist on private examinations and failing to investigate complaints by their patients. While a number of independent sources reported evidence of almost routine torture and assault of detainees, district surgeons, with only one exception, failed to report or speak out about these violations.

18 While it is easy to criticise district surgeons, it must also be appreciated that the conditions under which they had to work made it difficult for them to uphold human rights. They were given no specific training for work in the prisons, no continuing medical education and no independent avenues to report abuses. They were generally isolated from the rest of the profession and sometimes actively ostracised. It is, thus, perhaps not surprising that they adopted the culture of the police and prison officials from whom they received affirmation and support. The Department of Health submission said:

[District Surgeons had] a firm belief that the detainees were the enemy of the State and that it was the right thing to do to assist the police in getting the information out of the detainees, as they were trying to overthrow the government. The country was fundamentally racist and this included many district surgeons. The ideology was such that it was regarded as completely normal not to give black people the same services as whites and to treat black people as second class citizens.