TRC Final Report

Volume 4

Chapter 5

Subsection 3

Lack of support from institutional bodies

19 Institutional bodies such as the Department of Health, the SAMDC and the MASA contributed indirectly to breaches of ethics by district surgeons. None of them took responsibility for the inadequacies of the system in which these doctors operated. The Department of Health was responsible for ensuring that district surgeons (who were, after all, employees of the Department of Health) were aware of their rights and responsibilities within the prison and police systems. It should have provided practical guidelines for action by district surgeons faced with situations in which violations of ethical conduct seemed inevitable. The SAMDC was supposedly responsible for dealing with those guilty of professional misconduct and for educational guidelines and ethics. There are well-documented cases in which the SAMDC failed to take proper action on professional misconduct. Both the SAMDC and the MASA gave little support to those who upheld human rights, thus discouraging health professionals from challenging the system. None of these organisations provided guidelines to assist district surgeons in dealing with adverse situations, in which it was almost impossible to treat detainees properly.

The death in detention of Ms Elda Bani⁶

Ms Elda Bani, a fifty-year-old political activist, was detained in 1986 in North End Prison, Port Elizabeth. She suffered from severe insulin-dependent diabetes, which she reported to the medical staff at the prison. Initially, she was able to treat herself with medication she had brought into prison but, when her medication supply ran out, she received no treatment from the district surgeon. In spite of her condition, she was made to eat normal prison food at inappropriate times (for example, supper at 16h30 with no further meals until breakfast the next morning). The district surgeon made no attempt to intervene, although it should have been obvious to a doctor that such long gaps between meals were quite inappropriate for a diabetic.

Inevitably, Ms Bani’s condition deteriorated as her untreated diabetes worsened. She became confused and incontinent. Her cellmates reported this, and Ms Bani was taken away, they assumed, to hospital. When she returned, however, she reported that she had not been taken to hospital, but had been beaten by the police. Her cellmates saw blood on her clothes and injuries on her back. Her condition continued to deteriorate and she eventually lapsed into a hyperglycaemic coma. She died shortly afterwards of an entirely preventable and treatable condition.

Examples of misconduct among district surgeons

20 There are numerous accounts of district surgeons who failed to fulfil their moral and ethical duties as doctors. For example:

a A district surgeon declined to refer to a hospital a detainee with three gunshot wounds in his groin, or even to apply disinfectant or a dressing because she believed it was more important for the detainee to assist the police with their enquiries.

b A district surgeon did not ask a youth whose teeth had been broken or allegedly extracted by a security police officer how he had acquired this injury.

c A district surgeon found no marks or injuries on a former detainee, although another district surgeon had recorded extensive injuries when he examined the same detainee.

d A district surgeon was allegedly requested by the security police to advise them as to whether a detainee was fit to undergo further electric shock torture.

e A district surgeon asked the security police questions about the health of a detainee, instead of asking the detainee himself.

f A district surgeon performed perfunctory examinations or did not inquire into the cause of injuries suffered by detainees.

g A district surgeon was personally acquainted with members of the interrogation squad.

A doctor who exposed the system

In September 1985, Dr Wendy Orr lodged an urgent application with the Port Elizabeth Supreme Court for an interdict restraining the police from assaulting detainees. Since the declaration of the state of emergency, Dr Orr had documented 286 cases concerning detainees who complained of police assault during questioning. In her affidavit, she reported that the police seemed to believe they were immune to proceedings against them and that none of the complaints of torture or assault was ever investigated. Dr Orr told the Court that she felt “morally and professionally bound”⁷ to seek legal intervention. As a result of her action, the requested relief was granted. She was, however, barred from seeing detainees; her telephone calls were monitored; she felt ostracised by some of her office colleagues and her duties as a district surgeon were reduced to almost nil. She subsequently resigned and began work at the Alexandra Health Centre.

It is interesting to note that the Security Branch of the South African Police (SAP) instituted strict security clearances for all district surgeons subsequent to Dr Orr’s revelations – further evidence of the influence and involvement of the SAP in the work and conduct of district surgeons.⁸

21 Health professionals who are employed in situations in which they have dual loyalties are, because they do not enjoy full independence in making or implementing decisions, at risk of becoming involved in overt or covert abuses of the human rights of their patients. It is all too easy for health professionals who are not particularly vigilant or well-informed to assume the culture of the organisation for which they work, rather than maintaining independence and putting the needs and rights of patients above those of the organisation. Appropriate measures are needed to prevent or pre-empt the moral and ethical dilemmas that may arise for health professionals faced with the (often conflicting) needs of their patients and expectations of their employers. This issue needs careful consideration.