COLD CASE FILE CUT!

 

 

3pm Monday afternoon:  May 1953  The patient is wheeled into the tutorial room of 5th year medical students.  He is pallid against the pale blue hospital gown. Slightly apprehensive.  The students wait expectantly for the tutorial to begin. Professor Fransie Van Zyl, an esteemed surgeon who was to become the Dean of the Faculty of Medicine at Stellenbosch, gives brilliant tutorials.

The Prof lifts his head and motions with his eyes to the exit.   ‘Mense. Kom mense…’ he says. His tone is impatient. Twelve coloured students stand up and walk down the steps. The swing door rocks noisily on its hinges in smaller and smaller arcs, finally cutting out the sound of van Zyl reciting the patient’s clinical history to the remaining white medical students. 

Dr David Stein says, “I was a student. In that class.”

“Eventually we bravely asked our class representative to ask Professor Van Zyl not to do this anymore,’ says Stein with a self-deprecating laugh. “When he started using only non-white patients for tutorials we thought we had performed a great victory for enlightenment!

But during the tutorials, no-one stood up to be counted. No-one questioned.  No-one walked out in protest.  It was only later in my life that the shame of what we did not do came home to me.  The price of inaction is far greater than the cost of making a mistake.’

It was a protracted mistake enforced by so few and affecting so many.

Stein is a senior surgeon at Chris Barnard Memorial Hospital.  He has a story to tell. And he wants it told now. The catalyst for telling the story was also a tutorial. But it is 2007. There are three black female students (aged 23) (checked) a black male and two white male students.

The subject to the 6th year students is weight and diet in obese patients.  Stein’s lecture is aggressive. ‘No fat people came out of Auschwitz, Buchenwald or Belson. ‘Their faces are blank. ‘No-one reacted,’ he says. ‘Do you know anything about the Nazi regime?  Anything about the Holocaust?’   he asked. ‘The apartheid and discrimination practised in this hospital then?’  ‘Don’t you parents talk to you about apartheid?’ ‘No,’ they said.  So, David Stein told them.

After the lecture a student approaches him and asks why he doesn’t write it down.  So his memory unfolds….

‘The survivors of the holocaust didn’t speak for 50 years and it seems that many of the survivors of apartheid are not speaking either. We need to talk about what happened – particularly behind those sterile masks.’

David is a Latvian Jew.  His family fled their home country during the pre-war anti-Semitic purges. His family were refused refugee status and entry into a number of countries, including America. South Africa opened their doors to the foreigners.

‘My father’s appreciation for this shelter’ says David, ‘was such that he found it difficult to judge the discrimination in this country without the jaundiced eye of overwhelming gratitude.’  His parents settled in District Six and made it their mission to provide the best education possible for their son, David, so that he could ‘get on in life.’ Later during his house calls in District Six, he would hear, ‘Is jy nie klein Steintjie nie,’ from the people with whom he had grown up.

The warm environment on the slopes of Devil’s Peak was soon left behind and David did ‘get on in life’ personally and academically. He was accepted into medical school and moved further and further away from the people who had accepted these Latvian refugees so seamlessly.

Stein started medical school in 1949, exactly ten years after Groote Schuur was built and divided exactly in the middle. One half, White. One half Non-white. All the staff except the cleaning staff were white.  Entrances, blankets, crockery were colour-coded.  They needn’t have bothered. You could tell the wards apart easily. The black wards were overcrowded, the white ones not.

In 1939 the first non-white students were enrolled at UCT Medical School. There were six coloured students but they could only complete three years of their training at UCT. Then they had to leave. ‘That’s why so many coloured doctors have their degrees from Dublin, Edinborough, Glasgow and London.’

The idea of ‘Africans’ enrolling at UCT Medical School was not entertained.  Much later, they were able to study at Natal University but even here, they experienced severe forms of discrimination, both in access to education and living conditions.  Black students were not even permitted to wear clothes with the university badge.

‘World War Two changed the ‘three years only rule’ for coloured students at UCT. Because of the war, it was impossible for students to get to British Universities so the South African government relented, reluctantly.  By 1943, Coloured and Indian students were allowed to complete their training at UCT medical school for the first time. Conditionally. They had to  sign a document  undertaking not to attend any class, clinic ward round, tutorial operation or post mortem examination involving a white person…’

And the authorities went to grotesque lengths to ensure that the rule was kept.

The presence of black students during an operation on a white child resulted in apoplectic letters in Die Burger and questions raised in Parliament.  The furore died down only when the students concerned explained that that they had not ‘realized the child was white’. Again medical students and doctors were pawns in this complicated game of chess between the Hippocratic Oath and Hypocrisy.

‘In the 60s, the Medical School could no longer avoid confrontation with the government.  The first casualty was Dr Bill Hoffenberg, a specialist endocrinologist and leading figure in NUSAS, a liberal national student body.  Not only was Hoffenberg considered a threat to the state’ but his wife too, had been branded a ‘communist.’ In the same year that Hoffenberg was deeply involved in Chris Barnard’s heart transplant, he ran into political trouble.  ‘A banning order was slapped on him so that he could not lecture or practice medicine.  Hoffenberg was forced into exile. He and his family were given an exit permit and told never to return. An open letter of protest was signed by 200 doctors and published in the Cape Times.  I remember 2000 medical staff and students stood in silent farewell in a show of solidarity.’ 

A highly respected specialist, his career flourished overseas. He was knighted in 1984 – one of his regular patients in exile was Oliver Tambo – both of them untiring campaigners for human rights.

At a meeting organised to discuss the lack of action by the South African Medical Association (SAMA) taken over Hoffenberg’s exile, medical staff found that Professor Van Zyl of the ‘mense mense’ notoriety had rallied support from Paarl, Stellenbosch, Worcester, Beaufort West and Mossel Bay. The meeting was tense, the proposers and opposers vehement and obdurate in their belief.  But the motion from enlightened doctors supporting Dr Hoffenberg was overturned. The stand-off heightened tension.

Even a tacit gesture of support in the late 70’s had dire consequences.

‘Dr Ralph Ger an attending part-time surgeon at Somerset Hospital, was approached by Adrian Leftwich, an anti-apartheid activist who was blowing up pylons at the time.  He was asked if he would look after anyone who was injured. To which Ger replied: ‘I am committed to treating anyone who is sick or injured.’  Leftwich immediately wrote Ger’s number and number plate in his diary with a false name as a contact if an activist was injured. Leftwich was caught and Ralph Ger arrested for a ‘crime against the state.’  His teaching rights were removed and his employment at Groote Schuur and Somerset Hospital terminated. He left South Africa and his career flourished. He was appointed professor at Stoneybrook at the Albert Einstein College of Medicine in New York.’

By 1964 coloured nurses were accepted at Groote Schuur, but were paid half the salary of white nurses. By 1974, the new west wing of Somerset Hospital (the original teaching hospital) was built adjacent to the old wing and reserved for Whites.  “Each hospital had its own theatre, x-ray department and casualty ward. East and West.  White and Non-white. Later a bridge was built between the two hospitals to protect patients and staff from the rain when they walked between the two.’

The bridge soon became an organic link, responsible for a growing equilibrium between the segregated buildings.

‘After a few years it was obvious that it was ridiculously expensive to keep two separate operating theatres and radiology departments. Obviously we kept the  newer theatres and equipment in the ‘white wing.’   It was like a Carry On movie…Non-white patients were wheeled across for x-rays, wheeled back to wait for results, wheeled across to the operating suite for surgery, wheeled back to recover. A tedious business. The first ‘concessions’ came when black doctor’s wives were allowed admission into the white hospital (with permission and only in a private ward). Slowly, slowly, we allowed more and more patients to go to the white’s only hospital.

It was economics ‘not conscience’ which brought the two wings of the hospital together.

One day I met the white superintendent of the hospital, Dr Koosie Roux on the infamous connecting bridge. He looked stern, complaining that we were letting too many coloured patients into the white wing without his permission.  I had to so some fancy footwork and flattery. ‘Koosie, we know you are really busy, so we didn’t want to keep on bothering you. I want you to know that the students and doctors hold you in really high regarding your attitude towards the stupid rules of apartheid and putting your career in jeopardy. We all think you are very brave.’

I could see him getting taller and taller. His substantial paunch shrinking as I spoke.  He thanked me and left with a distinct swagger in his step back to his office.

A small victory for us in a battle of mutual manipulation.’

By 1976, coloured doctors were allowed to train at Groote Schuur Hospital – But only in coloured wards.  Two coloured registrars (Dr Jonker and Dr Yakoob) I had with me were allowed access to facilities but when they reached a white ward they had to wait outside!  The anger and indignity stays with many of them today.

‘I often worked with Dr Elaine Clarke a coloured anaesthetist

and she was vociferous in her condemnation of the system. She used to bombard me during surgery with what I saw as “political tirades” about the situation in the country.  I remember feeling that she was right. But impatient. My blinkers were inculcated by the society.

I remember at the Red Cross Children’s Hospital, Elaine was about to administer an anaesthetic to a white child when she told the surgeon she was forbidden to do so. He was outraged. There would be no apartheid laws in HIS department! Easier said than done.  He hadn’t considered the reaction of the white porters and some of white nursing sisters who immediately rebelled.

So did the black youth. The Soweto Riots of June 1976 were devastating. Detention without trial resulted in a number of deaths labelled as suicides, accidents, natural causes… Medical negligence was not mentioned. Steve Biko’s death was the most infamous and inflammatory of these deaths in detention.  He died in 1977 in detention, six days after being interrogated.  The injuries told the medical history:  Head injury with associated brain injury, disseminated intravascular coagulation as well as renal failure. Steve Biko was murdered. And we knew it.’

At the inquest in 1979, a young political reporter, Helen Zille, from the highly respected Rand Daily Mail had the guts to state that circumstances around Steve Biko’s death were a lie.  She told me subsequently that she was threatened with detention by Jimmy Kruger if she persisted with her ‘fabrications.’

|When Biko’s attending doctors,’ Tucker and Lang were declared ‘not negligent’ in treating Biko was an outcry from doctors at UCT.  Still MASA refused to investigate. And no action was taken by the South African Medical and Dental Council (SAMDC).

The apartheid policy was so drummed into our heads, so pivotal in our thinking, that even the words from the Hippocratic Oath:  “I will treat without exception all who seek my ministrations” sometimes bowed to the doctrines of the state.

Much later the Supreme Court ordered the SAMDC to review the case.  Finally, in 1985 MASA found the doctors guilty of ‘behaving intolerably in its response to Biko’s death and the doctor received what we felt was a very light sentence.  But Biko’s death had a huge impact on student leadership committed to social justice.

David Stein enrolled with the UCT Medical Faculty in 1949 and was absorbed passively into an iniquitous system of discrimination. In 2008, District Six is flattened. The TRC’s apartheid post mortem complete.  It is all over.

But he says: ‘Remembrance is vital.  The way we remember our past helps create our present identity and nurture our vision in the future.’

 

Racial breakdown in 2006 – South Africa – UCT figures to be sent today 20 August 2008

Indians:        156

Coloured:      97

Africans:       576

Whites:         481

Total:            1310

 

Please note that terminology used in this article is that which was used during the Apartheid era.

 The way it was…

In 1974 it was illegal for a non-white doctor to see white patients.  So there always had to be a white surgical registrar on standby in the Emergency Unit… sometimes the white registrar was called out three or four times a night.

A coloured surgeon  with a practice in Cape Town says, “We ate a lot of humble pie to qualify as surgeons.  We had to adopt a back seat and try to get as much experience as possible in the six months allocated to us before being sent back to Somerset hospital – a non-white only hospital.  My deepest regret is that my training wasn’t complete. I didn’t have the privilege of being exposed to all the disciplines, for example vascular and endoscopic surgery.  Today, you can’t qualify unless you have been through all these divisions.”

Only one non-white surgical registrar was allowed at Groote Schuur at a time. Dr Mat Jonker has the dubious honour of being the second non-white surgical registrar ever to be allowed at Groote Schuur.

‘I always wanted to be a doctor,’ says Matt Jonker, I’m not sure why, but it was from early primary school.  I was totally focussed on the goal.  Focussed enough to zone out when he took the long journey from Bellville South each day by train and then walked through District Six to Trafalgar High School. Far from the nostalgic memories of many people he doesn’t have fond memories. ‘I remember it being dirty and loud with fairly threatening skollies ‘accosting’ me regularly as I walked down Tenant and Hanover Roads after school.’

He remained totally focussed.  In 1965 Jonker  applied for a permit to attend university and was one of the quota of 24 non-whites admitted to medical school. He has a different take on the quota system.  ‘Our inferior education meant we were lagging academically so if there was not a quota system, we would not have had access to UCT.’  However the quota of 24 students of colour in a first year intake of 300, was also highly restrictive.

In 1970 Matt Jonker qualified as a medical doctor but he was not allowed to be a registrar at Groote Schuur and had to go to the ‘non-white’ Somerset Hospital.  It was a stressful time for South Africa with arrests, detentions, uprising and riots the disorder of the day.

In 1975, Dr Jonker left for the UK after he qualified but returned after two years.  ‘My heart belonged in Cape Town – heaven knows why,’ he says.  In 1981 he returned to a more enlightened Groote Schuur to treat patients of all races.  He recalls with wry amusement and little obvious resentment doing ward rounds one day as a consultant with a coloured intern.  He arrived at a elderly lady’s bed. She was white and blind and recovering from an operation.  When he took her hand she said conspiratorially. ‘I’m so glad I have a white doctor looking after me.  You can’t trust these new coloured doctors you know….’ Matt Jonker was there to practice his profession and his profession only. He smiled and said nothing.

 


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