TRUTH AND RECONCILIATION COMMISSION
MENTAL HEALTH WORKSHOP
ON RESUMPTION - DAY 2
MR GREY: We don't need to be so formal today, we're going to work. Okay I think as I said yesterday we're gonna, I think we're gonna approach today by splitting into two groups with the, and we're gonna phrase the topics so that they orientate themselves around recommendations because that's our end point. I don't think some of the sections actually lend themselves. Like the role of psychologist regarding political prisoners. I don't think that's the sort of recommendation type sort of topic that will help us. So I'll speak to those when we move onto the groups. Can I invite Glenda to do a review of yesterday and then Wendy will follow to really sort contextualise that work within the Truth Commission's mandate so we become clear about what our task is. Thanks.
MS WILDSCHUT: I was thinking you know, how valuable will a review be because most of the people who are here in fact did the presentations. But perhaps just to remind ourselves of what areas have been covered and what were the important points made by some of the presenters. I've tried to, where presenters have, have mentioned the same issues sort of incorporated them altogether. So if I don't mention your name, I'll mention the issues.
The presentations started, the morning started off with Dr. Saths Cooper reminding us a little bit about the status of mental health and the status of health delivery in South Africa and presented a few facts in that regard. Particularly with relation to the somatic bias in treatment and health care delivery in South Africa but also pointing to the lack of mental health delivery and the innovative mental health delivery systems within South Africa.
With regards to mental health legislation he reminded us that we need to give consideration to issues of kinship relationships and family context and develop that, incorporate that into legislation. Also in formulating policy we need to examine other societies where innovative legislation has been developed with regard to marginalised people and he mentioned India with the programme for the Untouchables, so called Untouchables. Where there's a window period of time for preferential employment and other opportunities for those people who have been historically marginalised and excluded from such opportunities.
We were also reminded of the bases, particularly the philosophical bases of legislation and to remember that previous legislation, particularly mental health legislation was based on Apartheid ideology. And thus the present legislative attempts and the ways in which we develop legislation should bear that in mind. We should also look to not just making technical amendments to the Mental Health Act for example but, also look to developing legislation which will focus on wellness and well-being. Rather than just including a few, I suppose politically correct terminology to make the act look good.
Then the question of the ownership of knowledge arose and we, I think we all agree that our academia and other discourse around mental health is based on the Euro-American paradigm and that we should actually make that paradigm shift. And develop our own indigenous knowledge and our own indigenous body of discourse.
We were also challenged as a commission to look at a few issues. One being that we should look to the recommendation of the rationalisation of departments and ministries that deal with human resources and human resource delivery. And attempt to bring together under one umbrella as it were, departments that deal with human resources and human resource delivery.
We also were challenged to interact with other commissions and other institutions that deal with human rights issues and human resource development.
With regard to human resource development there were some interesting suggestions with regard to curriculum change and new ways of producing at the end practitioners who are able to immediately go into the field and to deliver. And the example given was the - what was it (...indistinct)? The B.Psych degree where people would come out as counsellors and are able to immediately practise as practitioners.
Lionel Nicholas presented some interesting critique on some of the work of the commission. Particularly his concern, I will raise here again is the issue of the abuse of psychological diagnosis in the attempt for people to gain amnesty. And I think that we need to really pay quite serious attention to that problem and deal with how we can highlight, how that kind of abuse needs to be dealt with.
Professor Seedat reminded us of how we've been able to rationalise our on-going war in this country, our on-going conflict. And how as psychologists we've been able to in a sense sanitise the exploitation of blacks in labour and sanitise the issues of war in our country. He alluded to the issue of structural violence and it's relationship to interpersonal violence and also the whole notion of pathology and the issues of PTSD and how that impacts on our understanding of violence.
But what was also very important in the presentation, certainly in my mind was the development of knowledge from non-academic people and how one can incorporate that into the mainstream academic knowledge. Confidence boosting amongst people who are not traditionally people who write academic works and so on. And how one can engage other people in writing. And the challenge really to the TRC at that point was; how can one facilitate that exercise? And particularly since we've been forging partnerships with people in NGO's, training people to be involved in our briefing process and so on. And how can we incorporate all of that knowledge?
I think the implications for the future in terms of Professor Seedat's presentation was how do we adapt to the new dispensation taking into account that we've come through a very violent and conflictual past and how do we deal with the issues of democracy but also deal with the issues of conflict in the past and the legacy that we, that is left behind.
I think the biggest challenge that came to us from the Citizen's Commission for Human Rights was the issue of the worse thing that can be done is not to do anything. And I think that the challenge there is how do we take up what has come before us in those presentations, incorporate that into our report and make very solid recommendations for good delivery and good mental health interventions in the future.
In the afternoon's presentations, particularly by Professor Mike Simpson looked very carefully again at the issue of post traumatic stress disorder, the long term impact of post traumatic stress disorder and trauma. And also the intergenerational and multi-generational factors involved in dealing with trauma. But also looked at how we need to consider the issues of commodity and perhaps personality in the, when people present PTSD as a mitigating factor in their applications.
I think the presentations with regard to psychiatric care and psychiatric nursing and interventions, mental health interventions needs to be looked at critically with a view to how we can make solid recommendations about good interventions in the future. I think most of us who have been involved in working in psychiatric hospitals and elsewhere are well aware of the conditions that mental patients, psychiatric patients are subjected to. But also not just to rehash and dwell on the narrative and explaining what has happened but also to look towards how we can make recommendations about solid and good psychiatric interventions.
Our mandate is very limited and yesterday we were getting a bit concerned about the challenges that were being placed before us as a commission. So Wendy will be talking a little bit about what our statutory mandate is. But also I think that we have accepted the challenge that we can act as a catalyst and forge together relationships with organisations and NGO's and academics and other people to continue this process into the future. Thank you.
DR. ORR: Thanks Glenda. You actually took one of the words right out of my mouth, I have catalyst written down here in front of me as well. It's my task to perhaps inject a dose of realism into the proceedings and I want to do this in a way which doesn't dampen people's enthusiasm and desire to bring about change. But which perhaps underlines what the capacity and the statutory mandate of the Truth Commission is. In other words what the Truth Commission can and cannot do. It doesn't mean to say that other things can't be done through forging alliances and using or creating new organisations. And as I say catalyst is one of the words I've used. A facilitator for change is certainly a role that the Truth Commission can play. But I think it's very important that the health sector and I use this in the broader sense of the word, from mental health to doctors, nurses, OT's, physiotherapists, needs to put it's own house in order. And not look to the Truth and Reconciliation Commission to solve the problems which exist within the health sector.
The mandate of the Truth and Reconciliation Commission is very clear. And that is to establish as complete a picture as possible of the causes, nature and extent of the gross violations of human rights committed during the period of 1 March 1960 to 10 May 1994, including antecedent circumstances, factors and context, etc, etc, etc. And the definition of a gross violation of human rights is killing, abduction, torture or severe ill-treatment of any person which emanated from the conflicts of the past and committed by a person acting with a political motive.
Now that's really quite a limited mandate. We've tussled with the definition of "severe ill-treatment" and have come up with one which we hope is more or less acceptable. But it does exclude for instance the kinds of things and being a doctor I'm going to use medical examples. It would excluded for instance doctors having separate waiting rooms for white and black patients. And while I believe that, that is a violation, certainly of professional ethics, it would not fall within the definition of a gross violation of human rights in terms of the Truth and Reconciliation Commission. So we need to bear in mind that our mandate is really to deal with quite a limited group of violations.
However the open door for us is that we are also mandated to compile a report containing recommendations of measures to prevent future violations of human rights. And interestingly enough they don't say gross violations of human rights in this particular section. So that does widen things up for us.
And also to make recommendations to the president with regard to the creation of institutions conducive to a stable and fair society and measures which should be introduced to prevent the commission of violations of human rights. So that's really the door which I think this workshop must be focusing on. The issue of recommendations which can be introduced and institutions which can be created in order to reassure non-repetition of violations of human rights. And I think as we look at those, formulating those recommendations we need to be careful not to throw and I think someone else said this yesterday as well - not to throw the baby out with the bath water. We have professional organisations, we have statutory bodies. Yes they have histories, they come with a lot of baggage but that doesn't mean that they are completely incapable of transformation. I think the fact that an organisation like SISA has grown out of what has existed in the past and is doing some incredibly exciting and proactive work is an example of what can be created from what was. And I think we must interact with existing statutory and professional organisations to try and bring about change within those and to really be very active in pushing for change and transformation.
An example; I know a great deal of negative things have been said about the South African Medical and Dental Council and I agree that their history is not one to be proud of. But as a direct result of the hearings which were held in June, they have asked for a change in the act which governs their work in order to enable them to be proactive in their investigations. Because that was one of our biggest criticisms of them. That they could only respond when a complaint was made. They have now asked for a change in the act so that they can investigate when they believe that unethical behaviour or unethical conduct is occurring. And that's a very positive change and a very exciting thing and it's a concrete step which the Medical and Dental Council has taken as a result of the catalytic, facilitating role which the Truth Commission has played.
And I think that's what we'd like to focus on in our workshopping today. Is how we can use existing organisations? What kind of transformation needs to take place in them? Do we need new bodies? Do we need a human rights, a health and human rights watch dog body which ensures accountability and puts in checks and balances and those sorts of things? The kind of physicians for human rights in South Africa. But we want to be very concrete in our recommendations and very realistic.
I think I must also remind you of the capacity of the Truth and Reconciliation Commission, it is limited. We were asked for instance to subpoena documents to investigate life care institutions and Smith Mitchell and while I agree that this is necessary, the TRC cannot do it. And I'm going to be perfectly frank with you. We had about 17 000 statements from victims which have to be corroborated by investigative unit, we have seven and a half thousand amnesty applications which have to be investigated and either ratified or proved incorrect by investigative unit. We have a number of special investigations which are going on for instance into cross-border raids, into taxi violence, into train violence. So our investigative unit does not have the capacity to do that kind of work within the health sector and it's up to us to try and work out how that could be done by another body, be it an existing one or a new one. So as I say a very strong reality check that I'm giving you here.
Also in terms of amnesty I want to remind you that the cut-off date for amnesty has passed. So we cannot call for people to apply for amnesty now. The cut-off date was the 30th of September this year. So if people have not applied for amnesty it's too late and we need to explore other ways of finding out what for instance psychiatrists or doctors or nurses or whatever did during the period under review. Amnesty is no longer an option.
As I say I hope this hasn't thrown a whole lot of cold water on your enthusiasm. I think there is still tremendous scope in our final report for making really creative, concrete, viable recommendations to ensure that the human rights violations which we spoke about yesterday are not repeated in the future and I look forward to our deliberations this morning, coming up with those kinds of recommendations. Thank you.
MR GREY: Thank you Wendy. Did it throw cold water on anyone? Good, good, good. Can I ask the lady in the blue to maybe introduce herself as you're a new face.
(INAUDIBLE: )
MR GREY: Lovely, okay so you can go into group one. (
LAUGHTER: ) Ja the best group. I think what we'll do now is just discuss how we're going to move forward in terms of the groups. I think what we're gonna have is, we're gonna have two facilitators for each group and then one scribe each. Zeena you'll be a scribe in one group, I'll be a scribe in the other group. But just to focus it maybe just to get more sort of (
INAUDIBLE: ) also to say (...indistinct) Victor Nel will be joining us, he said around nine thirty and I think the best way to use him would be for him just to step into the first group and give, and guide thinking around the legislations in that respect. Okay.
The first group will be facilitated by Lionel and Wendy. I'm smiling because I'm not going to let you get away with it, not being a facilitator. And scribed by Zeena. And these were some of the issues which came over yesterday and they're really pointers to come up with recommendations. Can I say when we, good morning, another mental health director. Just to say that when we, what we're aiming towards is the kind of recommendations that's not broad and general because I think anyone in the commission could have made a load of recommendations before this workshop that are sort of broad, wide ranging. You know "We think they should be A, B, C, D." And really nothing would come of them. I think we have to really be quite specific and focus in very, very clearly and try and be, well as specific as possible. So that the government can't just sort of turn around and say "they gave us a broad, wide ranging." As the RDP document they got. (
LAUGHTER: )
But, so these are the topics that were covered and I suppose just quickly now I want to see whether anyone can remember or thought of any other topics. We spoke about the Mental Health Act and the proposed amendments towards that on a philosophical bases. What, so in other words what we're gonna say is; "through an analysis of the Mental Health Act in relation to our mandate the Truth Commission recommends that the following amendments should be made or," etc, etc, okay. So that will be the product if you like. If we're going to discuss the Mental Health Act.
Review of international legislation, I think Victor Nel can probably make quite a good input into that. Changing the psychological degree that's what the bachelors that Wendy was talking about, how we go about that. Okay we need to make a recommendation in terms of what are we saying. Are we saying that, that should be a four course, scrap the honours and that it should be a more experiential course?
(intervention)
(
INAUDIBLE: )
MR GREY: Okay, are you a psychiatrist?
(
INAUDIBLE: ) LAUGHTER
MR GREY: Okay, professional control of psychologists okay, how, what exactly do we mean by that? What are we going to do? What are we going to recommend around that? And conditions of care, that came through in I think in your submission, Zanele and Jeanette's submission. How we going to ensure that conditions of psychiatric institutions are improved.
The other topic that group one will be discussing, okay are there any other issues that people can remember about legislative regulations?
FLOOR: I think that one of the things you might want to think of is the relationship between professional associations and bodies like that (...indistinct) that you have like proactive (...indistinct)
MR GREY: Between professional (...indistinct) and government?
FLOOR: Ja.
MR GREY: And (...indistinct)
FLOOR: Out of that you'll probably get a more direct recommendation.
MR GREY: Okay. Welcome. Could you introduce yourself?
PARTICIPANT:: I'm from the (...indistinct)
MR GREY: Oh, great. Okay, we'll summarise and help you to report on this.
PANEL MEMBER: (...indistinct) I just wanted to know if you have (...indistinct) it will come in we have just (...indistinct) about (...indistinct) all the mental health team. I'm also concerned about the relationship. It's not good enough to say the psychologists will be professionally controlled. I think we need to put something about the relationships of the team themselves. That is why you have one group, you know who are dominating even if they think it (...indistinct) We need to have control in a legislation, how do we relate to each other. I don't know if it will come up very clearly.
MR GREY: Okay. Is everyone okay with that. That's quite a lot, it's a lot to sort of concretise. The next section with psychiatric interventions in government hospitals and community setting. That was the topic but what I think we're really talking about is generally interventions. What can we do about mental health workers and their interventions? Lionel raised a lack of military and police controls or at least in your investigations it was a very murky area, there didn't seem to be any sort of consistent controlling body or focus or policy around psychology. So I think that's something to, and psychiatry. We'll put psychiatry in there as well.
MEMBERS OF THE FLOOR TALKING SIMULTANEOUSLY
PARTICIPANT:: (...indistinct) accessibility of a monitoring body into the institution. We start with a situation where section 66 for these people to go but we have monitoring centres. How do we access, how do the other people who are not access this information so that there is monitoring. I don't know if we'll put it in education or it will fall here. All institutions they could be - what do you call it? Correctional services, where there's mental health. There should be accessibility.
MR GREY: Isn't that issue also a privilege because I remember in our workshop with (...indistinct) what was that point?
PARTICIPANT:: (...indistinct) comment about it but (...indistinct) when somebody talks to a psychologist in a private consultation that consultation is not protected by privilege if the person is subpoenaed to testify in court or if the person has to appear in court. Now I'm not quite sure about the legality about that. Jasmine had made some comment about that. But I don't know if we want to include that in that kind of legislation (...indistinct)
MR GREY: I think (...indistinct) available to who? Are the military, can the military subpoena their counsellors, their psychologists? And I ask and I mean I wonder whether they, you know in general can they just tell us about what so and so is saying or so and so is. They can't say that.
PARTICIPANT:: (...indistinct)
MR GREY: Alright. Ethical considerations regarding medication compared with already existing
PARTICIPANT:: (...indistinct) is the problem of double agency. If you are psychologist employed by the military are you looking out for this person or that person's benefit (...indistinct) by the confidentiality of that (...indistinct) or are you working for the army to decide how to make (...indistinct) Therefore the (...indistinct) confidentiality does not hold because (...indistinct)
MR GREY: Alright thanks for clarifying that. Okay ethical considerations regarding medication compared with already existing recommendations. I think it was your point around.
PARTICIPANT:: Ja, but what is quite interesting is that it also (...indistinct)
MR GREY: I'm glad.
PARTICIPANT:: Ja.
MR GREY: Group 1. Fine okay this, the next topic I don't know whether it does really fall under here but study of torture. Who was saying the study of torture was under-developed? It was Lionel and how we're going to, has not had a high profile or priority in clinical care in international institutes is very undeveloped. What are we going to recommend in terms of increasing that knowledge base of torture? What are we going to do with it? And why do we need it, anyone?
PARTICIPANT:: I think (...indistinct)
MR GREY: I thought (...indistinct) academic session.
PARTICIPANT:: (...indistinct)
MR GREY: Okay. And then more preventative and proactive intervention taking multi-generation factors into consideration. Well that's an over-riding thing really with all the things we need to be proactive, develop sort of proactive. Group 2 will consider the role of mental health workers in a transforming society. I rephrase that from the role of psychologists in entertaining political, because I think that's just more accurate in terms of what we're trying to achieve.
PARTICIPANT:: Sorry. I think the question of torture and the long term management of what we're talking about should come under that.
PARTICIPANT:: Ja.
PARTICIPANT:: Ja. Like looking at what we've designed in the medium term and long term.
MR GREY: Okay.
PARTICIPANT:: Look what (...indistinct) okay the last two (...indistinct)
MR GREY: Okay. (...indistinct) We said training (...indistinct) clearly how we envisaged training. I mean Saths spoke about representivity in courses, the knowledge base. But what do we see, first of all a group will deal with this. But how do we see training contributing to a sort of more healthy development of mental health workers? Okay and then ownership and acquisition of new knowledge was another issue that was raised. How we're going to do that? How we going to encourage that proactively? Contribution to policy development. We said how it's a shame that workers on the ground don't contribute to policy development. What sort of recommendations are we going to come up around that?
And then accessibility, social relevance of psychology. I think that Saths was speaking to us, oh it's Mohammed Seedat. How we're going to make mental health and psychology more accessible or relevant to people beyond the suburbs?
PARTICIPANT:: (...indistinct)
MR GREY: Okay and another one?
PARTICIPANT:: Ja. Broadening the training. I think it has been said it must be broadened I think to the whole mental health team, including everybody. But also I think, I stand to correct me, I think that we need also to look back that if you talk of academic information and knowledge it was more or less, I know that other people in some institutions look down on other alternative methods of research. I believe that with the victims of torture the research - I'm happy that the sociology is here, that will be very more accessible and more (...indistinct) to our people in the qualitative research. Because they've got stories to tell. We need to look at that as well. And in our training we need to look at those people who can access those experiences through alternative type. I know it's not so much popular in some of the academic institutions but I think that to be relevant we need to look at the other type of accessing information.
MR GREY: I think that is a good point. Research is really the preserve of about five journals. I mean how do you put out what knowledge is being gained to people generally and not just keep it in-house.
PARTICIPANT:: I think (...indistinct) sense that academics (...indistinct) experience (...indistinct) the other issues that will impact you know the experience like cultural environment and so on.
MR GREY: And other topics for transforming the role of mental health workers and transforming society? (...indistinct) say just society themselves as well participate.
PARTICIPANT:: (...indistinct) I hope you look at also capacity building. Because really mental health is something which is always been done by different groupings, religious groups, cultural or indigenous healers that we need to (...indistinct)
MR GREY: Okay. And the other heading that was one of our sections was the contributions to a progressive psychology. We were examining what was the contribution of the progressive psychological bodies but what are we going to say about progressive psychology? We said, we touched on academic improvements in terms of, I mean it's merging with the topics on the other side. But how (...indistinct) representivity in relation between NGO's, CVO's and government, how is it going to be established? But I ran dry perhaps you could give us a few more pointers, we will be (...indistinct)?
PARTICIPANT:: I would imagine that a lot of this actually falls, comes under previous (...indistinct) really shouldn't actually be a separate and not only again I think it is progressive health (...indistinct)
PARTICIPANT:: (...indistinct)
MR GREY: Great, we'll just use these two sheets. Are there any other comments around? Okay the second group will be Doctor Bhana and Glenda. The first group will be Lionel and Wendy. Darkies and whities.
PARTICIPANT:: I just want to know about the (...indistinct) partners that including (...indistinct)
PARTICIPANT:: On community (...indistinct) ja where there's NGO's.
PARTICIPANT:: (...indistinct) separate topic. (...indistinct)
MR GREY: Thank you. Right I see you're thirsty now to participate. We've been talking too much. One more (...indistinct)
PARTICIPANT:: (...indistinct) on the issue of mental health (...indistinct) either of both groups but I didn't see it quite fitting into either of those.
MR GREY: No I took out the role of detainees but I think that in terms of torture I think that covers. And in terms of - what was the second one?
PARTICIPANT:: (...indistinct)
MR GREY: I think it's over-riding, I think it over-rides them both. I think they've been absorbed into both of them really. Unless anyone feels really strongly.
PARTICIPANT:: Can I just say something? I should think it was (...indistinct) critical. We should look at the (...indistinct) which come out with those.
MR GREY: Oh yes.
PARTICIPANT:: Ja. So that in the process that is not lost. So
MR GREY: (...indistinct)
PARTICIPANT:: What I'm saying even what we say oh that's an overall issue we should make sure that it's captured. Otherwise when we write up a report we'll lose out or groups might easily miss out. We should always refer to what we said, the key areas. Because the reason why we lost that is because we thought we are not, our numbers are small for us to have four groups.
MR GREY: Okay.
PARTICIPANT:: The original idea was to make sure that those things are kept alive.
MR GREY: They are, they are. fair enough I'll just point them out. Political repression, I think if we can cover custodial law maybe. I mean I think that's one, somebody mentioned prisons and correctional services. I think that's one area where legislatively psychology or mental health involvement could to come to sort of bring to bear some sort of positive influence. But has anybody got any suggestions what, how can we phrase that question about the use of psychology for political ends? How can we do that?
PARTICIPANT:: (...indistinct) to raise is the issue of psychological testing (...indistinct)
PARTICIPANT:: (...indistinct)in a sense that (...indistinct)
PARTICIPANT:: (...indistinct) psychologists and psychiatrists who refusing to the rights of covering up their views are still in position to major powers, major advisors of provincial health (...indistinct) foreseeable future. And if we ignore those (...indistinct) it will continue and (...indistinct) we will do what usually is done with mental health. Institutions of health (...indistinct) so important, all of us do that, all of us and in fact nobody ever does in any (...indistinct) to be going on some
MR GREY: Alright we're talking about rehabilitating (...indistinct)? What are we talking about?
PARTICIPANT:: (...indistinct) can I say something? I think we must be clear about what was done yesterday. This was a compromise in view of the fact that we thought we can't have four groups. But I should think these, what has been put here it shouldn't really lead to a risk of us losing the theme. I can understand the concern where it's coming from. If we lose these things it can end up being like another general mental health exercise. So I should think what should happen in groups, people should be conscious of the fact that group 1 and group 2 has been collapsed together and then look at the theme which we have in our original document and make sure that they're not lost. What is here is merely a guide but the themes, that we have them focused. Make (...indistinct) of mental health care that's really a main focus.
And then also they should know that there (...indistinct) intervention in government hospital and the themes are there. This was merely to assist people to structure their work but it shouldn't then make people lose focus. And again the concern that I suppose Michael is raising is under group 4 and 5 which has been collapsed under group 2. The facilitators will have to start off by talking to these things because this is really merely to help them.
PARTICIPANT:: I've also written down under the heading of mental health intervention the heading called checks and balances, monitoring accountability. And I think a lot of the stuff that you talking about here could come under that sort of discussion from the use of appropriate testing to are there psychiatrists still in positions of power who in fact should not be there? So certainly in group 1 we'll be picking that up as well.
PARTICIPANT:: So what was raised by (...indistinct) yesterday (...indistinct) in an important position. I should think those are issues which shouldn't be (...indistinct)
MR GREY: Okay are we happy then that they've been absorbed in the two groups?
PARTICIPANT:: (...indistinct)
MR GREY: No, no this is section 1.
PARTICIPANT:: (...indistinct)
MR GREY: No hang on.
PARTICIPANT:: (...indistinct)
MR GREY: No this is section 2, but this checks and balances is here.
PARTICIPANT:: Is under 1 but torture and (...indistinct)
MR GREY: Torture is section 2.
PARTICIPANT:: You combined two (...indistinct) generational (...indistinct)
MR GREY: This is 2. This is 2. It's decreed, it's going to be discussed in 2. That's all there is to it. It's 2 and this is 1.
PARTICIPANT:: (...indistinct) I think the onus here is on torture as a subject itself and (...indistinct) how are we going to do this and how are we going to look at it and where (...indistinct) all these people (...indistinct)?
PARTICIPANT:: As a way forward can you just tell us about the programme? We're going to go into groups (...indistinct) and I think part of the (...indistinct) because of the nature of the (...indistinct) If there's going to be time (...indistinct)?
MR GREY: Yes. That's after tea, ja.
PARTICIPANT:: (...indistinct)
MR GREY: Ja, absolutely. So are we clear? No we're not.
PARTICIPANT:: I've been struggling to find my way and I think my experience tells me that (...indistinct) I'm concerned and I want to stop this process for a moment, (...indistinct) I'm concerned about (...indistinct) And I remember (...indistinct) referred to the (...indistinct) of what's happening here in the (...indistinct) system. And then just clarify it for me, this is not the formal Truth Commission hearing with the objectives of finding all the culprits of (...indistinct)? (...indistinct) At times it did feel like that and I wonder will you be doing anything different (...indistinct) professional and have the information in supply (...indistinct) legal (...indistinct) what then are we (...indistinct) ? And what I want to say is maybe it's actually making it difficult to make specific recommendations and I'm not (...indistinct) and I realise that I would also like to (...indistinct) on a process level I'm reminded by words of (...indistinct) that the major part of the work is identifying myself that which I hate (...indistinct) And I'm concerned that we just splitting (...indistinct) and that everything's been split and there are (...indistinct) and it seems that if we from this perspective can make any, can make a real change it would be in the minds of all of us to (...indistinct) I just had to get that off my chest. I don't know what difference it's gonna make or where do we go with that.
MR GREY: That, my response to that is that I sit in an awful lot of commission workshops and meetings, they on reconciliation (...indistinct) and so forth and there is a sort of (...indistinct) micro process always going on within people. Do you know what I mean? People have been coming as professionals addressing these issue yet at the same time they're dealing, you know what I mean, with their own reconciliation. And it's always, it's always a split. I felt that in doing the workshop because there's a sort of task orientated nature yet there's this micro processes going on. And really over the time of the commission I've come to terms with that split. I don't think, I think it's a separate issue. I think we could have a separate workshop about where we're at as clinicians and with the process, you know with transformation and etc. I think it's a, I think we have to split it. It's a sort of false split. It's a sort of, it's a fallacy to imagine that we could disengage ourselves completely like that but I think for the work I'd invite us to put, I mean I don't think we've got time to naval gaze. I think we are anyway, I think we are anyway. I mean does anybody else have a contribution?
PARTICIPANT:: (...indistinct) we are still trying (...indistinct) because (...indistinct) because anything (...indistinct) it's a process and then somehow there is going to be internal split (...indistinct) and of internal split. So what I think we have to look at the consequences of this collectivity before, so that we don't have to say in retrospect oh that we (...indistinct) what each want to do with our transformation activity because all of this is about (...indistinct) And obviously it has to be (...indistinct) if it has to be (...indistinct) and in that (...indistinct) some people have to move, have to (...indistinct) so that the rest shall (...indistinct) But let's take heed of what (...indistinct) because already I'm (...indistinct) so (...indistinct) That's how I went home yesterday. I said: "Wow" you know let it come out openly and also (...indistinct) psychologists are now wanting to create a human resource centre where they will be (...indistinct) So let us not go there because it's going to split. Let us look at the mental health care of everything and (...indistinct) psychological (...indistinct) how are we going to be changed? All of that (...indistinct) it's very relevant but let them be put in the relevancy. I know there was a (...indistinct) in Cape Town a steering committee which I have feeling it's giving me the same things Wendy, if I'm not wrong. That we are doing now. There (...indistinct) and somehow I brought that paper. I know (...indistinct)
PARTICIPANT:: Okay can I say something(...indistinct)? I should think (...indistinct) yesterday really we try (...indistinct) why this workshop having had the hearings in May or June? The thing is at that time was that mental health as a field was not (...indistinct) their (...indistinct) It emerged as a Cinderella to - I don't know how to separate physical ends or whatever.
Okay. Then they felt the only way in which we can do damage control is to bring together a few (...indistinct) Initially we thought we would review submissions which were already in our office. And then some of them of course that's what we did. And we said: "Look let's review them and see whether we can get some more submissions." That was the rationale. I'm answering to the first part that what was (...indistinct) to what was done, it's not. We are supplementing what we did earlier on and it's gonna be merged nicely together as a health report under the TRC report we have section reporting on health, human rights violations related issue. And then we didn't want mental health to be compromised in the TRC report.
Okay coming to what now has lead to a feeling of a split going into groups and so forth. We have this thing, we looked at the field of mental health, what we call focus or themes. Maybe instead of focus everybody's got that. We thought (...indistinct) and that's how we divided it. The splitting into different groups we know is (...indistinct) but we just thought we need a structure and a time where in which we can think very carefully as to what are human rights issues under each topic and the kinds of recommendations we want to make. But we realise that we'll have to bring the group together as soon as possible. So that those are debated and ultimately we'll take positions as a committee.
We felt in smaller groups people would be much more disciplined and can take a shorter period of time than if we do it in a big group like this, we can the whole day. Because each and every person will be interested. In a small group it's easy for everybody to come in quickly. That was just directional.
MR GREY: Okay can I? I don't think we're talking about a split as if everyone is feeling it. That may not be the case. But split is a very emotive word to chuck in to the (...indistinct) psychologist, for goodness sake. But I don't want to lose you in the sense that I do hear what you're saying. It's corny to say I hear what you're saying. And I have experienced that split. I just, I wonder whether your headache is going to go away. You'll tell me, good. And also I mean use that in your contributions. I think that will be useful. That's why we are doing this in a group (...indistinct) in group way. So can we move on and basically I'm gonna sort of tear the two sheets. One group will stay and work in here. One group will work in there and we'll get on with it with me and Zeena scribing and then come back after tea. Which I think should be eleven thirty. Sorry? What do you want tea now?
PARTICIPANT:: No, no.
MR GREY: It's ready, let's have tea and then go into groups. And then groups until lunch time.
PARTICIPANT:: (...indistinct)
MR GREY: That's what I thought but in terms of time. Hang on, please, please. (...indistinct) Okay we'll break for tea until (...indistinct) and then have a group, till eleven thirty okay and then we'll come back. So we'll have an hour and a half groups.
PARTICIPANT:: (...indistinct)
WORKSHOP ADJOURNED
ON RESUMPTION
PARTICIPANT:: I mean this morning there was a concern about a split. Can we just ask people to report on behalf of their groups? Before they do that, let's be in agreement as to how we are going to take the process forward. We will let, are we going to allow a person to go through everything and then start checking each and every point? Okay it's like most people are happy with that. So can we get a reporter of group 1 and 2?
DR. ORR: I by default and to my surprise and (...indistinct) for group 1. We spent some time with the (...indistinct) looking at the old mental health act and then were very helpfully advised by the representative from the Gauteng Mental Health Services, what's his name I can't remember I'm afraid. That the new Mental Health Act in fact doesn't even deserve that name yet. It's still very much in the process of being thought about. A draft hasn't even been produced which is actually good news for us because there's still a lot of time for us to make input and suggestions as to what the new Mental Health Act should look like.
We found it difficult to come to consensus on this issue. The two kind of diverse opinions which were represented was 1: that without a doubt we do need a new Mental Health Act which should be separate. Which should be, which should take mental health out of the purview and dominance of the medical profession. On the other hand we had a point of view that said the Mental Health and the Health Act should be combined. So that we have one comprehensive act which puts everyone on the same footing and which covers health (...indistinct) in terms of both of those recommendations. I think we did reach consensus on the fact that the old Mental Health Act certainly needs a great deal of revision. But whether it becomes part of an overall health act or not we were unable to decide.
We then discussed the issue which was also raised yesterday of instead of having a Department of Health and a Department of Welfare having a Department of Human Services. And again we discussed whether this should be a separate new department or whether it should be a, whether we should set up a multi-disciplinary committee with representatives from all the ministries involved, which meets once or twice a year to discuss the issue of human services. To ensure that people are viewed as whole beings rather than as bits and pieces and that we look at the issue of well-being in the overall, holistic sense. So that was another suggestion that we really explore quite thoroughly the issue of a department or a committee on human services.
We were also reminded that traditional healers should not be left out of this equation and we must bear in mind that they are on the ground and available already. And they need to be brought into whatever service provision is planned for the future.
We then looked at education and training and I think the consensus was that without a doubt doctors dominate the health care sector because they are taught to dominate the health care sector. Because in their training they only interact with other health care professions in an hierarchical, autocratic kind of way and we would encourage the creation of multi-disciplinary training where there are issues which are cross-disciplinary. Students are brought together from nursing, OT's, physiotherapy, wherever to undergo training together, to interact with each other. To talk to each other and to realise in fact that medicine is not necessarily a hierarchy. That we all have particular skills and knowledge and those should be used appropriately in multi-disciplinary teams where the doctor is not necessarily the head of the team.
It was pointed out that perhaps one of the reasons why the medical profession has dominated for so long is that it has received most of government funding, both in terms of training and service provision and that issue needs to be looked at. Whether it's appropriate in fact for us to, for the government to be putting so much money into the training of doctors and the provision of what has been really Euro-Western type biological model of medical care. Because looking back over the last forty years we must agree that medical dominance has not resulted in good health care for the vast majority of the South African population. So training and research funding need to be re-examined.
Rural areas need a particular focus in whatever services are provided and also in the training of health professionals. They need to be made aware of what the particular needs are in rural areas and how to consult with communities in those areas as to what the needs are. Wherever health services are offered so should mental health services be offered. Mental health is a primary health care concern and should come out of the kind of mental institution and into the primary health care clinic.
The last issue we looked at was that of custodial care which includes the issues of dual responsibility. Does the doctor, nurse, psychologist's primary responsibility to his or her employer or to his or her patient? And we all agreed entirely that the primary responsibility is to the patient or client. And that confidentiality is paramount and that this should be protected by law.
We also proposed the setting up of some sort of independent - I hate this word - whistle blower network. But some (
LAUGHTER: ) (...indistinct) system in which independent reportage of abuses and unethical behaviour can take place in a confidential way. So that the person who is reporting is not subsequently intimidated or discriminated against but the issues are brought to the attention of a body which can take action around the unethical behaviour. So we're talking about some kind of watch dog body, ombudsperson, you know you can name it what you like. But we feel it's very important that this kind of system be put in place. And we believe that we should be encouraging the professional organisations to be playing a proactive role in setting up these kinds of networks. And we feel that they have neglected this role in the past and should be taking this up as part of showing their commitment to transformation.
We believe it's important that custodial institutions be open to public scrutiny and reportage and that section 66 A of the Mental Health Act should be scrapped. The new act is non-existent at the moment.
We briefly discussed medication and with the implementation of the Essential Drug List we hope that every institution will have access to those drugs which are on the EDL. And I can't believe that, that won't be the case but it's certainly an absolute recommendation that, that is the case. That every institution no matter what it is or where it is or what it does should have access to the same drugs and that very clear guidelines should be drawn up about the appropriate usage of drugs. The input was that particularly in mental health care drugs are often used as punishment or for the convenience of the service provider rather than for the well-being and for the health of a patient. And that is a situation which needs change.
I don't know if there are other members of my group who feel that I've missed something out who want to add things.
PARTICIPANT:: (
INAUDIBLE: )
DR. ORR: Oh, yes. We talked a little bit about the example which Saths gave yesterday about the untouchables who, where a window period is being created. Where they were given preferential access to training, education, learning and jobs and suggested that should be an issue which is considered in South Africa for victims of human rights violations.
PARTICIPANT:: Maybe this group should assist us to look at areas which you think needs a discussion. Like this whole notion of the relationship between different professional grouping.
PARTICIPANT:: I think the, as I say the one area where we really found it difficult to reach consensus was; should the Mental Health Act be something entirely separate and removed from the medical profession? Or should we have one comprehensive Health Act which covers everything? And I think some discussion around that would be useful.
PARTICIPANT:: Thank you but you have noted that this whole issue of the location of mental health is likely to be an important point fr discussion, Okay thank you.
MR GREY: Okay thanks. I would have deferred to my group as well but as it stands at the moment I feel that what we spoke about. We spent, we initially started discussing training which came under the role of mental health workers in transforming society. I then spoke quite beautifully about SISA's initiative to, based on the fact that there's currently a drastic fallout from induction for graduates, from induction to graduation. And that people are actually falling out of courses and from about 500 inducted students you end up with about 8 qualified psychologists. SISA's proposal and it might not be that new in terms of the national proposals but is to suggest a diploma which qualifies someone in specific areas. In other words you get an Aids Counsellor or a - I don't know, a Bereavement Counsellor, a Trauma Counsellor. And really the proposal that came from that was that we should endorse that broadening and demystifying of mental health services which make it more accountable and also more accessible to the people who need it. And that's because I mean it's cost effective, it's got a better service delivery and then also to include the experiences that we've learned from the consequences from gross human rights violations into primary health care teaching and the curricula itself. So that was our first training recommendation.
Then we spoke at length about this issue of knowledge acquisition and ownership. And the group spoke for quite a long time around the issue of incorporating the TRC's body of knowledge into a culture of story telling and keeping a self examination and revisiting memories. The sharing of collecting material, how could we promote that? How could the Truth Commission make a recommendation that promotes that short of culture of looking back and examining the material that's come up from the Truth Commission. There was a recommendation to stress the importance of developing a case study and role playing aspect of teaching not just, moving away from a lecture paradigm. Also to incorporate the TRC's body of knowledge into the history curriculum. I mean the discussion was around really not losing all the rich information that the Truth Commission has gathered; all the tapes, all the testimonies, all the different stories from different role players.
Okay the other issue around the knowledge question was promoting our current body of history as a national treasure and really with the group for the Truth Commission should put some thought towards how that would be done. Or how we would do that. There was a suggestion of living monuments but not one national monument but monuments that are linked locally. That people can go to and link into other monuments in other regions and discover. So basically the story telling doesn't stop with the Commission. That it carries on and that people as part of well-being or mental health actually have on-going access to that kind of information.
There was a recommendation that stories of torture continue to be recorded and that research continues, needs to happen, is to continue following the Truth Commission's work. Specifically on torture and it's consequences. And that government and private funders should prioritise this area of research in terms of not only examining torture but survival issues of resilience, long term effects of torture, impacts on communities of torture. So there should be a strong recommendation to prioritise that as a research need. Then which also feeds into the fact that on top of that what we thought research, it's another question how accessible that research and accessible the results of that research would be.
In terms of policy - what's the issue on the board? Okay, contribution to policy development. The recommendation was that the Truth Commission should examine ways of presenting new knowledge so the communities can benefit. And move away from the external research paradigm. We discussed that at length. We didn't come up with particularly specific recommendations around that but generally I think if we can phrase it at a later date how research for whom and by whom. In a nutshell we wanted to also in terms of policy the buzz word was we need to democratise the lobbying process. Governments and state services should be able to prove public participation in policy development. There was a suggestion to set up toll free numbers, this would increase accountability of government policy making and the accessibility that people have to it. It was quite an interesting idea to set up a toll free because often government departments say: "We've asked the community to make comment on this." But people actually can't, they don't have the way withal to feedback. So if those departments set up toll free numbers people could ring in. And postal, free postal.
We also hit on whistle blowing protection. I think Wendy's almost shows exactly what we said. Also the role of the public protector doesn't seem to, I think that needs to be reinforced. Because that is a kind of whistle blowing, how can I say, vessel that people have available to them. But I don't think people are aware of that. So a recommendation is that it should somehow reinforce the role of public protector.
And then finally we spoke about endorsing on-going research into the corrupt and racist psychological research that have happened and exposure of the negative effects of this and where the funding came from. And to prevent the disappearance of research documents that seems to be on-going. In terms of the Truth Commission I think it was recommendation that we simply endorse the on-going investigations into these things.
And then contribution to progressive psychology we had, our recommendation concerning that was government and academic institutions must support community mental health initiatives at community level by providing funding, resources and including inputs into policy development. So I think that was the issue around the CBO's and the NGO's and their relationship to government and that really if the Truth Commission can sort of nudge those government to keep supporting those. Because in a lot of these areas that we've been discussing it seems that in terms of community we haven't discussed communities very much. Those organisations that are maintaining a community focus with regard to well-being or mental health. So we can only, I don't know how to pitch that recommendation. But that's what we, basically that's what we spoke to.
And in terms of what's the issue? Enhancing representivity, we thought that representivity was such a broad concept that we couldn't really pin it down, so we didn't even try to. Although acknowledging what the different, what it was actually trying to aim at, which was I think through the training recommendations. It's about really getting the whole spate of South Africans into, this word "well-being" is coming into the conversation too much. But inter-mental health issues and how we do that. But I don't think it's unique to the TRC's mandate, representivity and that kind of affirmative angle. That's what we discussed.
PARTICIPANT:: Are there any other points which other members of group 2 would like to add, which maybe Tulani might have missed?
MR GREY: Sorry just to clarify the point that we made about document (
PAUSE: ) Okay. We took very seriously the point that Wendy made validly this morning that your investigation team is overwhelmed with things they absolutely have to investigate and cannot not investigate. But our concern is both that the TRC has unique powers that's it likely no other body will ever have in terms of search and seizure and subpoena to get documentation. And that in many relevant areas including the whole of the mental health and human rights field, documentation that is very relevant has already been shredded, is today being shredded and will tomorrow be shredded. And we're suggesting that it should be looked at seriously by your investigations division, whether in areas where there have been complaints about institutions or specific parties. Whether you shouldn't use your powers to seize documentation and have copies of it at least placed in archives so that they will be accessible for other investigators who will come on after the TRC. Because if not, the likelihood is that any other mechanisms you set up to succeed yourselves (a): won't have the power to get access to that sort of documentation or (b): when they get there the cupboard will be bare and the shelves will be empty. Thank you.
PARTICIPANT:: Okay. Then let's structure a discussion. Maybe we start off with, ja okay. Wendy is already determining as to where, at what time should this process end. But let's look at a main proposal from group 1 really. What they struggled with, where do we locate, where do we locate our concerns? When we started we said we deal with people really who are survivors of human rights violations, who have appeared before us with what, emotional pain and suffering. So because we should always go back, I know we will take this thing back to our context at the end of the day. And they have looked at, the proposal that they looked at, there was this suggestion of a Department of Human Service which will get rid of Welfare and have a multi-professional health and guidance centres. That was the amended proposal.
And issues which fall under classical psychiatry will remain in the Department of Health with psychiatric hospitals, if they're still in existence and hospital care remaining under the Department of Health. But most conflicts in living will need to be looked at under a human service department. That's one part of the proposal. And that will impact on a Mental Health Act, the future one.
MR GREY: Can I just say, is it a Department of Human Sciences?
PARTICIPANT:: Services.
MR GREY: Services okay. I mean I'm thinking of a rose by any other name. Could somebody articulate what it would be that would be so different about, I mean amalgamating? I mean what's the end point? What is it, where is the suggestion coming from? So that what can happen? So we change the name but then what?
PARTICIPANT:: Maybe somebody who was in group 1 an explain the rationale, where does it come from as it was explained by Victor Nel?
PARTICIPANT:: What they said, there is a, there are people who don't have psychiatric syndrome, who have got psychological problems. So that do not need to go to, you know to be viewed as people who really are mad. These people have got the psychological problems that have not been resolved. So the approach of the service will be more centred towards the psychological problem than being deep=seated psychiatric syndrome. I think that was part of the rationale. My concern with that proposal was that if we are looking at creating that service how long will it take and how long more can these people wait and what are the time frames that we can at least implement this? And we also talk about the pilot study to look at the areas where really there are victims and so on. Where we could start.
DR. ORR: I'm going to try and summarise from what Victor Nel said and I'm not sure myself yet if I agree with everything he said. It's a new concept for me and I would have to think through it. There are a number of motivations for creating a Department of Human Services. I think one of the issues which Professor Nel was very concerned about is that the Department of Health at the moment has control over all the professions and this control is exercised largely through the South African Medical and Dental Council. There is a separate professional board for nurses. But otherwise the SAMDC controls all health services. And he finds it very problematic that the scope of the profession of psychology is determined in effect by the medical profession. And that's not, not the way it should be.
There are no public low cost psychology services in South Africa, particularly in rural areas and this is a huge gap in the provision of services. And even in tertiary hospitals psychologists are few and far between. It's very difficult to render appropriate mental health services in a medical setting and he quoted the U.S. model which I think has been referred to previously in the workshop, of the U.S. Department of Health and Human Services which provides comprehensive care, which includes health care but also looks at issues of welfare, of socio-economic well-being, of housing. In other words all the kinds of services that one needs in order to live as a dignified human being. And I think that was the rationale behind it. Is let's be comprehensive and holistic rather than splitting people up into little bits and pieces which are looked after by different ministries.
PARTICIPANT:: Thank you very much. I should think that's background, it's helpful. Because if you come up with a recommendation having not identified problems and concerns with the previous arrangement it's easy to dismiss it. Thank you Wendy. Michael and then Zanele.
MR GREY: Maybe I'm missing something but I don't quite understand the special status of Victor Nel as a briefly visiting guru to our process. But his proposal as articulated is so full of massive factual errors that I think it would be grotesquely irresponsible of us to support it in any way. Having worked, I don't know about his background, but having worked in the Americas during my years in exile under the Health and Human Services Division I think you'd be hard found, hard pressed to find any expert, let alone any patient or any client in America who feels that the existence of a governmental Department of Health and Human Services has solved any of the problems that he articulates. Or has provided in any way more articulate or more holistic sense of care to people or a better sense of well-being. There is an overall government department with that name but in fact whatever point of access people have still comes under separate divisions. There's still the interprofessional problems of who controls what. None of those problems have been solved where the model he's proposing has been attempted. And his, even his understanding of the structure of the Medical and Dental Council and Professional Board for Psychology seems to be strangely unrelated to facts. So I strongly oppose our support for that. The proposal should be articulated like anybody elses on the free market with whatever factual background, whatever references, whatever arguments there are and should be examined in the broad intellectual and social commerce and not be given any special status.
PARTICIPANT:: (...indistinct) is another trouble maker. Okay.
PARTICIPANT:: I think (...indistinct)
PARTICIPANT:: Wait for the microphone.
PARTICIPANT:: Ja wait, wait.
PARTICIPANT:: Ja I think (...intervention)
PARTICIPANT:: Sorry Zanele, since we are discussing a proposal Wendy has just given a motivation for her proposal which was made around why we should look at a possibility of having a Human Service, Health and Human Service Department. (...intervention)
PARTICIPANT:: I think he knows about it, he was part and parcel of the planning. Look, sorry if I'm inferring something. It is, I said it also and Professor Nel was here, I wanted to sort of, I realised what he said. He talked about problems of living you know. And I was quite a bit worried that in South Africa psychiatry is sort of realised as that area of mad people. I really, when I talk about myself to the community I don't say: "I'm the doctor of mad people." I talk about the doctor of people who have psychological problems and also psychological illness, that's where madness comes in, where there's illness and disorder. But there are also problems (...indistinct) and that is an extreme. So that actually it is quite sad that we look at it that way. And I was wanting to join Nel only where we are looking at your so-called, in my language they are called health centres. Where you have a multi-disciplinary, ja conglomerate you know. From what he in his paper called the stuffing. He said it should include social workers, psychologists, occupational therapists and vocational guidance and rehabilitation workers, youth workers, specialists in treating women. Where are psychiatrists in all that? They belong there too. You understand.
PARTICIPANT:: (...indistinct) doctors.
PARTICIPANT:: Ja as doctors, Actually where are doctors in all this? And I really do not, not want it to be separated in that sense. I rather let's look for the primary health care model. And I do not see how anyone is going to tell the ministry of health and the ministry of welfare good-bye and change or we descend. Rather I should think we should work for conjoining the two ministries. I think that is a most workable option of today actually. It is such a sad thing to see welfare there and health there. In all progress of societies they are part and parcel of one thing. So that your human resources unit should be part of that. It can be added to that and it would be sort of a specialisation in that. But let it not be a branch out. And I remember Tim Wilson, Dr. Tim Wilson in the steering committee of last June, he was worried of creation of this new other structures. We know that we have to deal with the legacy of Apartheid for Christ sakes, that's why I talked of also the pilot work in the two areas in the Vaal and the East Rand. But we know we have to deal with all these people you have seen all this sufferings that are going on. And we know it cannot be dealt with by just welfare and health alone. We need this other space that Professor Nel is trying to create. But let it be part and parcel of the whole or let it be an improvement or should it be revolutionary. I'm getting a little bit worried there that it is, it is been dragged out and made a different thing of itself.
PARTICIPANT:: Can we get other views? I mean people are, it's a proposal, it's on the table. People are free to air their views around this?
LIONEL: While Victor Nel's rationale was given as background within the committee, his proposal wasn't accepted. That, that was in fact, what I tried to do as facilitator is to, to try and get people narrowly to focus on what policy recommendations we could make. And I might want to say that we may try to follow the same method here because we really interested in the end to see are there specific policy issues that we can put before government and the public? What we did focus on is that health and naming has had particular power that will continue to exist unless we don't creatively think about naming and how it maintains and entrenches power relations that have existed in the past. We've also concluded that the hierarchical nature of health and mental health is very clear and
(END OF TAPE 2, SIDE A)
So our policy proposal in the end under whatever, and I'm not going to go into what Victor was correct about or not, has got to do very specific (...indistinct) that we need to look at naming. That we're not going to automatically through our proposals change whole ministries and whole departments. And that we need to specifically for example look at the Mental Health Act which has apparently not changed much yet. It's only a bill, it's under review. And that we should specifically, in terms of policy look at what we want to put in there. We not going to get all of that out here but that should be, you know fledged out later and specifically in relation to that.
So I don't think we're going to come to consensus here where it's suddenly going to be named one thing or another thing but naming has been very important and we should give attention to it.
PARTICIPANT:: That, I should think that helps us to focus a bit. Would you like to air your views around what Lionel has just said? Are you referring to the naming of problems that people present this or the body that will look after that?
LIONEL: The issue with health is that, that, that is where the power was entrenched and in the past few years has been continued to be entrenched and it looks like that would be future as well. In looking at what things are named and how people work together and how hierarchies are established, our recommendation is really that in changing some of those names and in flattening out and levelling out those hierarchies that we may end up providing much better services. That's not skewed only in one direction but it allows the whole spectrum of services in an equal way that patients and clients might need. That's really the focus.
PARTICIPANT:: I should think it will help if around this issue we tried to limit ourselves to those two points maybe. And see what sort of suggestions can be put forward which later on we can formulate towards proposals and recommendations. (
WHISPERING: )
Any other views on these two points? Naming and the review of the Mental Health Act. Still under issues emanating from group 1. I mean for now it's like the whole issue which we started debating we'll leave at those two. That really what's important to examine is the naming of what we deal with and the body which will look after those people and how we impact on the Mental Health Act. Maybe people need to be familiar with what was, were critical articles of the previous act which lead to the status of psychology in particular. It's not psychology, the whole field of mental health not given, not getting the equal status with that of other health professionals, especially medical doctors. So it's like those are two central issues. Yes (...indistinct)?
PARTICIPANT:: I want to support the approach of Lionel but I also want to raise a caution that this is within the context of the TRC and we should be very careful about raising or pushing territorial issues which actually can detract from the basis of the TRC and it's recommendations. Because we can be - alright I'll restrict myself to psychology because I know it better than other areas. If we come here as psychologists and want to use this as a forum for clarifying the future for psychology it will be an abuse of the process. If we raise the past exclusions of psychology in terms of positive contribution that are likely to be made then it's one thing. And I can see that we can end up raising various territorial battles which will completely move away from the primary purpose of the commission. And I think we need to always link whatever we're coming up with in terms on broad sweeps to the particular what do we do to enable people who have been mutilated both physically and psychologically by gross and lesser human violations in the past? Where do we locate an institutional entablement for treatment or rehabilitation, or any other word that's more politically appropriate to use for those people, who have come to the commission. Primarily victims but also what do we do with the perpetrators in our midst? Just leave them there and allow them to perpetuate a culture of socialising those whom they influence?
And it would seem to me that this institution should be an enabling institution with a limited life. Otherwise it can become an institution forever. With a limited life after the commission ends and it should traipse, it should rely on traipse both the ministries of health and welfare, as well as education and maybe trade and industry for economic entrepreneurship. Helping those, that group of people to move on in life and be more productive than they can be right now. So I would urge that type of mechanism. I (...indistinct) without saying we shouldn't comment on the larger issues because I think it's appropriate for a commission like this. Which is very central to the future of our country to comment about the fractured nature of policy making, about the fractured nature or delivery service. I think we should do that but then always go to the specific in terms of those recommendations. That's what I would just do to be focused on. Thank you.
PARTICIPANT:: I don't want to sort of change very much the format of this discussion but certainly in group 2 when we looked at issues of training we also said that there are other stakeholders apart from, for example health and welfare and Saths has sort of reminded me of that when he brought in the issue of trade and industry. But we certainly were saying that if we want to be holistic we shouldn't exclude for example arts and culture, science and technology for example. Because there the symbolic nature of healing and reconciliation, whatever one wants to use, words one wants to use, can happen quite appropriately. And that can impact on legislation. It can impact on training, etc. So apart from, I mean I worry when we say these are the two main departments that need to be collapsed and called something else when other departments in a sense can also play a very vital role in the healing of the nation and moving forward and service delivery.
PARTICIPANT:: Any other contributions in this regard?
PARTICIPANT:: Just one (...indistinct)
PARTICIPANT:: Okay.
PARTICIPANT:: (...indistinct) office of national, the crime prevention office. Now that uses as many ministries as are possible to create an over arching understanding but also begin to look at bigger policy issues. In this case it should be looking at those but very specifically at the deliveries. Deliveries for a particular defined population. And reintegration into the greater society. So that it's very important for victims not to feel that they're just victims. Because those victims have brought us to where we are and without those, in a very selfish way, if we didn't have those victims we're unlikely to have been here. And we need to affirm those victims. Rather than in, often at the best of times there's some what dismissive, supercilious attitude that has come from certain sectors of the commission about victims. Well these are people who really were like the foot soldiers and we'll treat them in that manner but there's almost a second classicism about some of the victims who have come forward. And it's only been the big names and the people who have stood out and been forceful about their roles that have got the type of respect that I think the commission has given.
But in the main my impression is a lot of victims out there have come through a process that has perpetuated a victim syndrome in them. And even the understandings from the commission. I know the section of critique of the TRC that many colleagues here have had. But I think it's important for the TRC to understand some of our concerns. That maybe we're guilty of perpetuating a victimology amongst those people. That there hasn't been the degree of affirmation. Indeed of respect that those victims deserve by moral and here by legal right into the future. It's been like: well these are victims, you know, they've suffered so let's get on with work chaps.
PARTICIPANT:: Ja, okay. That's also in line with the whole thing, issue of naming what we deal with. I should think it's quite pertinent, it's well said. Any other contributions?
PARTICIPANT:: Thank you. I would like to second Dr. Saths Cooper's earlier statements about ensuring that the TRC concentrates on abuse and the past and what has happened. Psychology and psychiatry are the curators essentially of the field of the mind. This is the area we're dealing with. And as a direct consequence we're looking at mental abuse. We're not only looking at the mental abuse suffered by the individuals, the nation has been abused. The people, the citizens of this country have been abused on a massive scale. I'd like to reiterate my, the earlier points that the perpetrators of the earlier, the false studies that suppress, made a massive contribution to the creation of Apartheid and the suppression of black people, that their names should be as well known and as well discredited as the names of the founding fathers of Apartheid; B.J. Vorster and Nico Dedericks and those others. Thank you.
PARTICIPANT:: Okay we'll take one more point and see how we sort of move onto, and move onto the next point. Zanele?
Dr. BAQWA: Yes I wanted to say that I wanted to thank Saths Cooper for clarifying what was tending to be a clouding of the issue at hand, of bringing back the issue to the TRC and also of looking at the history of our violent country. And in that sense really in affirming or healing the problems that you as a TRC and we as a nation have been seeing. Whether in private context or in the television or in our knowledges of what has been happening in our communities, I really do not, cannot see how it cannot be but that they should be created, creation of a programme, whatever name it shall go under. There should be a programme that will be specifically created by the TRC to see for the movement forward of these very people who should be seen, they, not just heard. But to be told that they are seen and we know what's happening to their lives and we want to aid in their integration into society. I cannot see anything more worthy than that. It is full of dignity and it is right. That's just what I wanted to say.
PARTICIPANT:: Okay thank you very much. Before we move on to the next point I just want to say. You'll remember that this morning Wendy's input was exactly on the issue that Saths has raised. I mean basically to say what is important is to be conscious of the TRC mandate. Because we know at the end we will look at recommendations which addresses our focus, our point of focus. The statements we have, people who have come be forward, reporting on their experiences. So I mean, that really is very, very central to our concern.
And regarding Victor Nel's proposal and what has been said, I should think through this discussion we have in a way brought the two views together. And I must say those of you who have looked at our policy document were proposed that people access reparations initially and rehabilitations for a period of six years. And during that period ministries will have time to incorporate in their planning whatever have been initiated. So the idea of the enabling institution with a limited life span, it fits in with our thinking. And of course that it should be intersectorial. Also there's that in Victor Nel's proposal. One can match all these ideas together. So thank you very much. I should think that point has been put together. Wendy?
MR GREY: (...indistinct) continue with
PARTICIPANT:: Wendy, Wendy where's (
PARTICIPANTS TALKING SIMULTANEOUSLY: ) You see, I mean if we had sufficient grounds we can. I mean Wendy earlier on spoke to a proposal which was made May or June, that the Medical and Dental should be proactive.
DR. ORR: Oh ja.
PARTICIPANT:: Ja, and that already has been taken, ja. Can you lead us to the next point please as to how it should be debated?
DR. ORR: Well the next issue we looked at was education and training. I don't think we believe there was anything particularly controversial in what we were suggesting but perhaps the rest of the group might like input. On point which I forgot to make and Paul you should have reminded me about was that of oaths and declarations and how relevant and appropriate they are. I mean it's all very well stand up and say take the Hippocratic Oath or the Declaration of Geneva but what does it mean for your day to day practise and does it make a difference to your ethical or moral conduct as a health professional? And I know CCHR has proposed one overriding loyalty oath which all health professionals will take. The British Medical Association is working on also one oath. It's kind of an update of the Declaration of Geneva. Which all health professionals will take.
But I think in addition to that, simply taking an oath at the end of your period of training without working through and discussing the issues and practically problem solving around issues which those oaths raise it's absolutely pointless. I mean it makes those oaths not worth the paper that they're written on. And I think it's absolutely essential that those things be included in training. And that also part of the job of whatever it's going to be, the watch dog body, the ombudsperson, etc, would be to ensure that, that professionals do in fact maintain the promises which they made in those oaths.
So that the other points that we raised was that we need to look again at the skewing of funding allocation which seems to go primarily towards traditional Euro-Western medical model training and research and it should perhaps be reallocated. Medical dominance has not resulted in good care and we should be looking rather at multi-disciplinary teams where we make the best use of everyone's skills, knowledge and expertise and where the doctor is not necessarily the head of the team. We raised the issue of access and I think this follows on Saths' point. Access for victims to, both to training and education and to services. And referred to the programme which is being introduced in India for the untouchables.
Rural areas need a particular focus. Mental health care needs to be included as part of primary health care and traditional healers needs to be included as part of training and that in training there should be cross-disciplinary training. So that, that we try and break down the (...indistinct) as a hierarchy and flatten it out and have nurses train with doctors and physiotherapists train with pharmacists or whatever. But basically in the training attempt very, very to, to do away with the hierarchy which exists in the present health sector.
PARTICIPANT:: Thank you very much. If I may just ask for clarity. Are you proposing that there should be a more, a module in human rights during training instead of just expecting people to take an oath at the end?
DR. ORR: I think we would want more than a module. I think we'd want human rights and ethical issues to be incorporated into everything that students are taught. I think having a separate module makes it very easy to split it off. And we've used the word split more than once today. And to put it in a box and not include it in the way in which you interact with and treat your patients and clients every day. So while I think you do need specific teaching around those issues, it also needs to be incorporated on a daily basis into what is happening at the bedside and in the clinics.
PARTICIPANT:: Well (...intervention) to Dr. Cooper?
DR. COOPER: I think it's very important to have an oath. However we have these codes right now, okay. And I want to underline the report by Wendy. You need to actually have in a sense a mandated, in a mandated fashion ethical practise to become more central than it is in the health professions generally. That this is not good enough just to have as a curriculum point. You need to interact with the trainers because I think that's where our problem lies. You have all these people teaching at the medical schools and medical faculties and psychology schools and OT and wherever else you may need them, social work and so on. But how do they deal with ethics and with codes which actually ought to rise above narrow interests, narrow ideology and those types of things.
Right now the Hippocratic oath says one should do those things but in the practise it's being violated. And it has been violated and there are notorious examples. And the Medical and Dental Council and MASA have been guilty of actually condoning and perpetuating that system. So how do we address it besides merely saying we need that oath? I think what we need to do is actually have and that enabling institution together with the Human Rights Commission, maybe need to visit the Geneva Code plus the other suggestions made by colleagues during the TRC hearing process. And emerge with a, an code of conduct or an oath that not only health professionals but members of the police, the military and whatever other services and forces are out there, who have been responsible for the gross violations in the first place. Ought to with a slight change be able to adapt for their particular institutions.
So we shouldn't look at it as merely a health sector thing and narrow it down to that because in some ways the health sector was dragooned into playing these roles and they went willingly. Many of them didn't scream at all about it. So I would like to bring that side of it to play. I think it's important to add besides the untouchable situation in India, something that Lionel raised yesterday during lunch and that's the, like the GI Bill, the Veterans' Bill in the Us. It's affirmative towards those people who have paid a price for their country. Very different in terms of the GI's and the American Vets but in a sense they are veterans. They ought to be in our national hall of fame but we only will get the Mandelas and the Mbekis and the Sisulus. We need those names as well added to it. Right, so I would say that we need to use that authority as well. And there are a few other examples I would imagine in South America, not very good ones. But wherever we can do it and your research people should be able to do that. So it's not, doesn't only look at a, another developing Third World non-European grouping, it also includes them, who inform our ethos.
The issue of the training we ought to comment about the intercultural nature of our society and that, that needs to be confronted right up front. It shouldn't be a thing where some lecturer at Wits or RAU just glibly stands up and say: "Take note that we're living in a multi-cultural society." We ought to have something that actually takes people through those things and so that our citizens can understand each other better. And there too I would urge interaction with the Human Rights Commission, but maybe the Gender Commission and the Education Department about looking at the issue of race and inter-cultural or ethic language issues in our society.
With regard to opportunities to training and preference in the trade and industry sector we should also add jobs. Preference for jobs within the public sector. If we do it as an example in the public sector then commerce and industry, the private sector will say: "Well they've had so and so and so and so and they've done well by appointing those people, maybe we should look at some of those people." And I think we should not just look at they must be given opportunities in education but they should be given preference in state sector jobs that may become open.
PARTICIPANT:: Okay we have one more hand but okay.
PARTICIPANT:: As usual I agree with what Saths has said. I'd like to support that and what Wendy was saying. I think from something like thirty years experience in trying to change health sciences education we all agree it's necessary. We are now asking to do what we tried to do thirty years ago. It's difficult. One of the things we need is both a specific place. There has to be somewhere that it is mandated that these human rights issues are included because otherwise one of the general principles that works is; whatever everyone believes, other people (...indistinct) we teach throughout our curriculum actually gets taught nowhere in the curriculum. There has to a place otherwise very often everybody feels free to neglect it. "I didn't include it in my teaching today, I'm sure next week's lecturer will include it somewhere." Everybody feels free to leave it out. But the next and most critical problem is how you include that in the day to day teaching, in the day to day clinical work that everyone is exposed to. And the problem there and what makes that most important is how to translate the lofty principles of the statements of philosophers into reality. It's one thing to have a Solly Benatar give a lecture about the importance of the principle of benevolence. I don't any of us support a principle of malevolence. Though some of our colleagues have acted as if that was their guiding light. But the problem in most instances is how with this person in this dilemma, how can I be most benevolent? How do you apply those principles in particular examples? That a lecturer will not do very effectively in their lectures. That's where both the examples, some of the examples from the victims and some of the perpetrators that are being brought to the commission's notice, can be used in teaching. Because the question is; how did those situations happen and how could they be prevented? And that should be part of the problem the TRC won't finish solving but part of that duty must be passed on. Not only to the teachers, and they need retraining because you can't expect the teachers who spent thirty five years not teaching about this ethical dilemma to suddenly start doing so. Unless something changes in their way of doing it, in their motivation to doing it. And let that problem also pass onto our students to face the challenge of how to find solutions to that.
PARTICIPANT:: Okay thank you very much. I'll ask this group to move onto the next point.
DR. ORR: Well I think that there's overlap in group 2 (...indistinct)
PARTICIPANT:: Oh, okay. Okay Tulani?
MR GREY: (...indistinct) this section. We spent as I said a lot of time on the issue of knowledge acquisition and developing a - how can I say? A culture of looking back for people's mental health. Not necessarily just a generally. And also we spoke about the fact that it does, it does get incorporated in our symbolic reparation measures. But I don't, in terms of mental health I didn't really, there is a link in terms of looking back and collecting stories and story tellers, telling does improve our well-being and sort of ability to integrate the past. But I think maybe, do you want to say some more on that? I don't know whether I articulated it that well. The national treasure of looking back and the monument.
PARTICIPANT:: (
INAUDIBLE: )
MR GREY: My point is I want to come up with the specific recommendation around this story telling.
PARTICIPANT:: A number of us spoke on this issue. I mean firstly what we were talking about was that in terms of trying to provide greater access to services, that we talked about broadening the base of training. And we referred to the submission made by Saths and others around the (...indistinct) that SISA is trying to adopt. It's not necessary .....
(END OF TAPE 2, SIDE B)
PROF SEEDAT: Part of words of Sim Sinde that it should be part of that profession and that people should be able to accept and remind themselves of the events that have preceded ...(indistinct) through the establishment of various - and museums it's not exactly because we're talking about living memorials so people can access these stories but it should be part of the education system, part of the curricula whereby the manner in which these submissions have been made are translated into stories for children, for adults and I'm not sure what I need to say about that.
CHAIRPERSON: No that's good that's clear.
PROF SEEDAT: I don't know how many Commissioners have actually been to the Holocaust Museum in Jerusalem but I would imagine we need to take a leaf out of that book because it is done in a manner that is an experience. You know each person has an ineffable description of it and it's particular to those people. I think we need to look at some central treasury where those things can be documented but not documented in the very tendentious manner in which the university archival stuff is being done now. It ought to be a national monument, it ought not to just say well this is COSATU's role, this was SASO's role and this was the PAC's role and this was the ANC's role, and in order to do that we need to rise above those narrow territorialities in the first instance to create something that is lasting for current and future generations so that on national days like the 21st of March, 16th of June, December 16, we can actually have a place where firstly our people will visit and also definitely it will become a major tourist attraction, it's inevitable given the type of history we have, but we need to think very clearly about it and maybe to look at Robin Island as one site but something more central as well that people can come to and defocus it from the type of parochial narrowness that currently attends these events or these institutions so that everyone can cherish it. We look at stuff that has happened historically to our nation and we don't have a demonist perpetuation like on the 16th of December everyone goes to Voortrekker and the guys who designed it were very clever because you know at a particular time the sun will shine on that spot because it's been determined astronomically and it will shine there but then it becomes the chosen people, die volk's affirmation by God. You know that type of thing. If we can do it as something that we take account of the atrocities that have been perpetrated against children and women that Bloemfontein wants us not to forget for instance, it must become part of that so this, the continuation of the TRC memory should be ensconced in that type of treasury.
CHAIRPERSON: Can I just for clarity, I agree with - I think it's in three places I think ...(indistinct) it's a symbolic drive in place and part of a symbolic reparation. The other part is more a kind of knowledge base for schools and sort of accessible psychology mental health.
PROF SEEDAT: I think what we were saying in terms of the group discussion was that there needs to be a distillation of what these processes were. For example, and that's where we brought in the issue of torture, to understand the nature of torture, to understand the processes not only in terms of the counting but in terms of the effects, the implications because it has to be in a sense that this must never ever happen again and we must be able to recognise when it begins to happen again, and if you don't document that process aside from it being just a sort of story that you are telling, this serves as an important reminder of the issues that you need to confront regularly on an ongoing basis. So that's the second part of it and that doesn't only have to be done by academic institutions.
CHAIRPERSON: Great, any other comments on those comments?
MS MKHIZE: Can I just check something quickly? Is my understanding clear it's like we are dealing here with two points
1. The proposal of a national, something similar to a museum and then the second leg is what can be done in schools at different levels?
PROF SEEDAT: Yes I think it's, there's a sort of not academic in the classic sense but an academic usage of this over our knowledge that we've gained and then also a symbolic sort of accessible side to it. So it's the same issue with two parts, how we use what we've got really.
The next point that I think you didn't raise when there was the lobbying process. You spoke about democratising the lobbying process. Maybe Michael would like to elucidate a bit more on that.
PROF SIMPSON: To be brief we started looking at the issue that there might need to be lobbying for human rights issues, mental health issues in terms of government planning and legislation but that's easy to say and most people would say that's happening already and we know it isn't. What we looked at was the issues, several issues, one was accountability of the legislative process, be it provincial or national, not only that there has to be and I'll mention it in a minute, ways in which it's made easy access for communities and individuals to lobby and to try and influence planned legislation but also a responsibility on the governmental authorities formulating such policies to be able to prove that they did in fact make themselves accessible and that they did seek out access, not just from a handful of people who professionally represent all of us all the time but they've never actually asked us what we think, but to be genuinely accessible. We talked about the value surprisingly neglected by government of having toll-free numbers and free-post addresses so that the average person even in a squatter camp who can get access to any public phone or to any public post box and a pen and paper will be able to have access and of course conversely the requirement of Government to make the drafts, the proposals out. What has also often happened is that too complex a question has been thrown out the community, three people respond and they say we have consulted. You don't put just a very, either in jargon or political correct terms, a complex programme problem out in four or five words and ask for a response but you say this is how we see the problem at present, these are the sort of things we are looking at and then there's something concrete that all communities can attach to and can say that wouldn't work here because of this, we would need something else because of that. So it was that issue or both the responsibility that the authorities should prove that they had made meaningful efforts and the use of trivially simply methods like free access to allow ordinary people the access to those mechanisms and to have hearings accessible throughout the country, to have a hearing in Cape Town where people from the north have to spend an annual salary from the average small places to get down to the hearing is not public consultation and similarly to have one in Johannesburg and rely on the people in Cape Town to do the same is not open access. So there must be other more creative ways made to make it easy for people who are concerned and we hope more and more of our communities will feel free to be concerned and involved, it's not simply a question of using the terms and saying thy were consulted. I'm being told every night that I chose the new logo for the SABC, I don't remember when anybody asked me about it.
CHAIRPERSON: Can I just say I think that we've stumbled across a general point there about lobbying process with Government and it's probably a - I'm trying to get the link with the TRC and this workshop and I think if we did make a recommendation it would have to be around for mental health issues, but I think it's a broad general recommendation, yes.
MS MKHIZE: Ja but maybe if I may say something. I mean the TRC will write a report, it will go to the President's fund, a desk of some kind, the President's office. Obviously people need to monitor how the government is going about in implementing these recommendations so the issue of lobbying is going to be very very pertinent in this process otherwise the TRC process is a farce, because if after we are finished, everything stops then what was in for people, so lobbying strategy, especially lobbying the government with who the democratic policies is very difficult.
CHAIRPERSON: It is, can I just move on, there's two more points. One is in terms of I think Judge Cooper was saying how we are focusing on what happened in the past and Arnold, is it Desmond, Donald, Donald raised the issue of research documents that were disappearing literally off shelves and so the recommendation was to endorse the fact that ongoing research is done into that corrupt racist psychological thinking that he was speaking about yesterday afternoon. I don't know whether he would like to say something more about that but do we feel that that's a recommendation? Wendy.
MS ORR: Can I just respond, I think it was Michael Simpson who raised the issue of the very specific and special TRC powers of search and seizure and subpoenas that we have. I don't want to make promises on behalf of our Investigative Unit and perhaps make promises that we won't be able to fulfil, but if we can be told exactly what documents need to be subpoenaed and where they are, that would make our job a whole lot easier. It's very difficult for us to go on fishing expeditions and wade through shelves and shelves of archives saying well is this appropriate, is this relevant, so if people know of documents which are in existence which would be useful in terms of information and can tell us where those are, then we can use our specific powers to obtain those documents.
CHAIRPERSON: It ought to be, a number of individuals have knowledge of what there ought to be and where ought to be could be coopted for that purpose because don't forget one of our problems that we're dealing with highly secretive organisations so that we would all of us have to be perpetrators to know exactly what documents sit in exactly which shelves but we do know what documents must exist in what places and how to look for them, and I think that is important.
Oh could I mention one other example while I remember I've been meaning to? One example of that is as I have mentioned before, there may be other examples once it has started, but I do know that a Dr Anton Potgieter who was for a time the head of the psychiatric services at 1 Mil Hospital had the extraordinary in my academic experience internationally a privilege of writing a thesis that had something to do with the effects of Trauma, presumably something to do with soldiers that was kept top secret, that was sealed; I don't know who the hell their examiners were but that we were told that he has testified in court that this was secret and not available to anybody. There may well be other such examples and of course in this day and age those studies having been done with public funding and given public recognition at public expense should be revealed.
MS MKHIZE: But maybe when this specific appeal was that if people really are aware of anything that which they think which they think we should investigate they can just send a fax because we are not in a position to set up any structures at this point in time, we can only go by what we have and refer it to the investigative unit and I'm sure even for them it will be easy to consider it, if it's located and
PROF SEEDAT: I'm not specifically referring to Wendy's point but the issue of monitoring the activities of, and in this instance I'll speak about psychologists because our constitution specifically refers to actively striving for social justice supposing policies, they deny individuals or groups access to the material and psychological conditions necessary for optimal human development and ...(indistinct) against any violations of basic human rights and this is written into the constitution as a way of monitoring activities of psychologists who fail to meet these conditions. So within our sort of particular sort of organisation there is a mechanism for monitoring the activities of individuals and perhaps it may be necessary to have this monitoring function included in other constitutions as well.
MS MKHIZE: Did we have that clause in the past during apartheid days?
PROF SEEDAT: No no.
DR BAQWA(?): Thank you. I would like to ask a question whether the TRC if they read in the newspaper something said about patient abusing hospitals, do you follow it? Like in the newspapers, recently in the Guardian and Mail some patient died in seclusion and then currently in Ratong there is a mail nurse who raped a patient and the mail nurse is still working and they claim that they cannot trace the patient to make more accusations? There are a lot of cuttings we have on these violations, that's why I'm interested, we have cuttings.
DR ORR: If I can answer that. Our mandate ends on the 10th of May 1994, so what is happening today does not fall within our mandate. I'm not saying that it's not important but those issues are monitored and investigated but that they would fall under the ambit either of the Public Protector or the Human Rights Commission and perhaps if we do create this health and human rights watchdog body that would be exactly the kind of function that it would serve, but the TRC has no mandate whatsoever to address abuses which are happening today.
...(indistinct comment by unknown person)
Well if you have information which falls within the period of our mandate, yes certainly but anything after the 10th of May '94 must go to the Human Rights Commission.
PROF SEEDAT: May I suggest that some of the colleagues here, there's nothing stopping us joining together and taking those things up. One I would think we need to challenge is the Medical and Dental Council. These things are published on a daily basis. This morning's news, Hillside Hospital, a young boy is sodomized; a few weeks ago this happened and they did some security and last night another boy sodomized, penises cut off, all that stuff. Now, I'm serious, the Hillside Hospital, so you've got the Laratong stuff, we've got other examples. What we should do is liaise amongst ourselves and it's just having a point of faxing to the Medical and Dental Council saying this is there, what are you doing about it? cc that, the Public Protector because it's a statutory body, you see and then to the Human Rights Commission as well, those three and I think we should actually do that because there's too much of a blasé attitude going on about these things.
CHAIRPERSON: Can I just enquire of Group 1, did you cover conditions of care?
MS MKHIZE: Maybe why don't you go through the points? If people feel we have discussed it under 1 and 2 then we can say that.
CHAIRPERSON: Okay I was just raising it in relation to what was said. The last point was examining this issue about government and academic institutions supporting mental health initiatives and how government can be encouraged to shore up initiatives from CBO's and NGO's and organisations that are working on the ground in a mental health capacity.
PROF SEEDAT: If I can just amplify on that issue, it was really around reparations that in order to repay many individuals and communities who have contributed and paid dearly for the status that we have today, is that the support of the community organisations that exist today and continue to work with individuals who are victims of the system and who continue to be victims of the system that the support - there should be strategic support for these groups by the government in order to continue the efforts that they are making currently, they need helping individuals within communities etc and in terms of academics, well that was, I mean I'm not sure how they got in there but really in terms of the government supporting community-based organisations, NGO's etc in terms of the trauma work that they do, the training that they do etc, because they're the only ones that are doing that at the moment on that scale.
CHAIRPERSON: I think academic institutions got in there because someone said that it shouldn't be just these NGO's, I don't know what people thing.
(speaker's microphone not on)
Ja. Okay and that's our points made if anyone's got any comments.
MS MKHIZE: Did you think of including the private sector as well in this?
DR BAQWA: In terms of working with NGO's and CDO's, I mean this is an old problem that's been identified again and again and what's been spoken about now is that there should be coordination. There are some NGO's and CDO's who are busy implementing programs in communities and without notifying the health authorities in order to gain some support and I think that's where the greatest problem is and an appeal has been made to NGO's to sort of make their presence felt, announcing themselves to say this who we are, this is what we're doing, we need support and I think there has been some proven cases where NGO's are working with government people but on a larger scale it's not happening and I cannot say whose fault it is at the moment.
Commenting on the Ombudsbody, I'm glad that there are people who are willing to form ombudsbodies here because Hlengiwe, I'm sure you are my witness, according to the Seven Point Plan of the Mental Health Directorate, it's one of the points to actually create ombudsbody in all the provinces for - at the moment we're piloting psychiatric hospitals but as soon as the two pilot provinces have finished and we see that it's a success, it's going to go on throughout the country and what's definitely going to happen is that all hospitals, Kleenex or whatever in terms of maybe groupings of communities, the pilot will determine this. We will have ombudsbodies to whom all the complaints from hospitals and patient care facilities will be lodged so that they can then start making an investigation and making a case and reporting the whole thing to the Human Rights Commission. At the moment we are told funds are a problem because we were ready to set it up but now I cannot say when it's going to happen. But if there are people who in their capacity are able to create this it would just make things much easier because when we are told okay you can go on with implementing projects then it will just be easy to take those very people who are already busy and just making the government fund it to make up those ombudsbodies which will be multiprofessionals.
PROF SEEDAT: ....make an offer and that is these are not to reduce anybody's involvement but just as a point of immediate coordination. We have an office in Pretoria and we've got a public psychology in the public's interest standing committee and in the past those issues have not been bothered about but this is a very active group. Just to be a sort of facilitator right now and we will work together with our colleague here to make those issues known like to government. If the government funding is going to certain institutions then they take it up and say well what's happening? The Laratong issues; a government subsidy is going, which it is, to Laratong, what are you doing, the superintend about that? So we've got a contact between us as service providers and interested people in this area and it's not psychological, it is a broad health issue. We will come in with our own expertise in the psychological sphere, the Simpsons and the Baqwa's of this world can come with the psychiatric, others with the research monitoring role can come in with their stuff, the nursing people can come in with theirs. So that we, you see if we don't hammer these bodies, the Nursing Council, the Medical ...(indistinct) Council, all these people, they will carry on and you'll find that in a year's time will then be blaming the government, what are you doing and leaving these statutory bodies to just pass muster. So I want to, just as a point of coordination and we from there can create some other structure if necessary.
MS MAGWAZA: If I may, I'm very glad that such a very serious human rights issue is already on the move and I just want to say from my personal experience I've been fighting for the last three years, two years since I came to South Africa, these issues in psychiatric institutions, I've gone to the superintendent, I've gone to the head of university psychiatry departments - actually Professor Robertson in UCT and the dean here, and I have moved heaven and earth and in the end I am embracing my legs and having high blood pressure. So I really want to say, let already what this psychology in the public interest, let it take a move on and take on board the other people who are burning on these issues.
MS MKHIZE: But can I just say something, I mean what do they call you, Nothlanza(?) or Edith. Okay she prefers to be called Edith, not Nothlanza, okay what Edith is saying and what Percy's(?) saying, we need to be very careful. You know we need to be very careful, you know I remember some of us had problems with this ombudsmen as they are set up by the government itself because immediately there will be compromise and what Seedat is saying it's critical to watch not only council's professional bodies but also government departments. I mean Nothlanza is saying government, I mean all government departments, especially the new government, this is not for the media, it's for this gr....(recording stops)... there should be a certain degree of independence if we want them to be effective and to bring about changes.
Okay apparently the request is that we take our food and come back this side so that we can be able to start work at about quarter to two. It's important for us to round off this properly, okay we break and we come back at quarter to two.
HEARING ADJOURNS
ON RESUMPTION
MS MKHIZE: Have you seen Zanele Baqwa? Excuse me please, before we really make concluding remarks on our part, I would like us to briefly review the process. The reason why I was looking for Zanele, Dr Baqwa is because yesterday we had said she could comment on the previous process and try to link it up today. So I don't know what has happened to her and I don't think we will wait for her, what we'll do, we will ask other people who have got comments to make. This is very very important, we don't want to make our own concluding remarks having not given you an opportunity to comment on the process. Those of you who participated previously or who observed what we did, you can comment about that, whether you think this process has been valuable and how you think it should be taken forward. Let's have an open session now.
PROF SIMPSON: I think it's important in view of the submission that we made that the past betrayals to the people of this country are handled so that when we move forward we can move forward with both eyes facing forward rather than with this baggage hanging on behind us and such as the racist studies that Lawrence Anthony went over and the continued existence of organisations that have contributed in massive ways to the oppression of black people in this country, such as the Smith/Mitchell facilities, I think that these things need to be faced up to and handled before we can one hundred percent move forward. So we disconnect with the past knowing fully what it was.
MS MKHIZE: Thank you very much. Zanele while you were out I indicated that yesterday we stopped you and said we'll ask you to make concluding remarks today. We were trying to review the two processes and looking at ways of merging the two. Just comment about the process, what it has meant for you and how you think the process should be taken forward.
DR BAQWA: You ...(indistinct) leave it. When I was having lunch with the two young staffers here actually we were talking about that from their point of view. They were saying that they have no idea of what's happening around here and they work here and actually people meet them in the street, they don't need big guns and then the people ask them..(end of tape)..under representative and I have felt that from the hearings in June we just felt were definitely dominated by Cape Town University alumnae you know, I mean they came from there, Gordon and the rest and a little bit from the Trauma Centre. I work with them, Lesley, Dr Lesley Gordon and London, why do I say Gordon, I don't know, I think London writes newspapers, writes books, novels, very funny novels. Anyway I wanted to, I was feeling sad, I was wondering where are those doctors from the oppressed side who have really worked and seen this, not to say the others haven't, where are they, why are thy not here? And I had actually kept that legal copy in the Star that Dr Dazoo of SASO had commented that the Truth Commission has been disappointing, the hearings don't help, they have been disappointing because he named names like Denise Amzee, like Variava Jura, Variava; these are people that are sort of heros in the struggle that we know, we felt that everything was around Dr Wendy Orr, not that we are very angry, we are jealous children in a family, that this child is the only one that has been given attention. You know jealousy and conflict in a situation, in a family situation, siblings. No it's not that to Wendy Orr personally but we felt that's how things are moving and the whole big South Africa was reduced. I know the TRC couldn't be constrained itself so thin, otherwise then maybe it wouldn't do it's work but we felt the representation of the people who were invited there and who put in submissions was meeting and another thing is that even yesterday if I had not called Dr Simpson and told him what's happening, I think I would have been the only psychiatrist here. But I'm just not talking in terms of being a psychiatrist, I'm talking in terms of who do you bring on board and it's as if you are just doing things symbolically which actually probably the whole activity is about, you know; things are just going to be there and not go any deeper. So what I'd really ask of you as the TRC itself is to evaluate yourself. I don't know if you are doing it as you go, I know you are pressured but do you sit and sort of what we call at home, quality assurance, do you do that with yourself, do you check to see are you going the right way? And it's not just complaints in the sense, it's a need that you are truthful to what you are about. Somebody said that you might become a farce to yourselves in the factor that you're allowing the Dr Benziens to come around and say they are suffering from PTSD because of this and that. It's too open and yet too - too open and sort of in the understanding and in the reconciliation ambit and at the same time a bit unprofessional, a bit limited. But I'm very very honoured to be part and parcel of it, that's what I want to say.
MS MKHIZE: Thank you very much, we will continue taking comments about the process. Zanele has made some comments about what happened in the past and linking it with what she has picked up here. Can people continue making comments about the process, even the subject matter that we have dealt with. Dr Cooper?
DR COOPER: Yes I think that what's very important is how significant institutions and organisations representing the health sector, both statutory and non-statutory voluntary associations are under-represented in this forum. I'm given to understand by Tulani Grey that all the stakeholders were invited but it's an indictment on the health sector, more specifically on the mental health sector that so few direct service-delivery agencies are hear. 1, the Medical and Dental Council is not here. Fair enough I'm here representing the Professional Board for Psychology, there is the Psychological Society here, there are citizens organisations, the Citizens Committee for Human Rights, there are individual NGO's like the Centre for the Study of Violence and Reconciliation and so on, there are other colleagues here as well from Universities and other settings, but it's very significant that this is not reflective of the mental health service area and the question then has to arise; are these people true to what they said in the original submissions about how they tended to be blind to some of the gross human violations; your June session, were they doing it merely to pass muster and get over something that's a little trying now, let's get over and move on? And I think this workshop is intended to crystallise views forward so it goes beyond the blaming to create understanding about the issues that we need to focus on for the future, so that we don't return to the past and I repeat, it is an indictment that many of these agencies are not here, because it says that they're not interested in creating a new mental health and other health delivery system that truly meets our emerging nation.
MS MKHIZE: We will continue inviting comments about the process and the content and after that we will move towards closing the session.
MR GREY: Thank you I was relieved that the first contribution didn't quite go as far as to suggest the firing of the big guns because that could be rather noisy and unpleasant. I'd like to say that you have been struggling with the problem that a process that ideally ought to be extremely inclusive has a number of limitations on it that have limited that process. I know that there are a lot of people who feel left out and have been and I also know that you have made some sincere efforts on the part of all of you to try to minimise that. I think that particularly at this phase you have the problem of the lack of time and resources but for whatever structures grow out of this, talking of the health and human rights watchdog and what have you, it is absolutely imperative that even if the work done in Cape Town is brilliant and comes up with the best plans conceivably produced by man and woman, unless those plans feel owned by the entire community of people who were active in this field, it will have serious handicaps.
I think I'd like to also address a challenge that is often I hear put to the whole Truth Commission and particularly to this Committee and I think very unfairly. I've heard a lot of people, particularly those from the perpetrator and more than ever the bystander community and we must never neglect and I hope you will all remember in your report the vital, essential, life-giving, evil role of the bystander throughout it and they say why are they just digging it all up, why don't we just put it behind us? Well of course you can't put it behind you until it has at least for some time been in front of you, you can't get past it until you have seen where it is and what it is that needs to go past. I think it's important to understand that we're not indulging in mere morbid story-telling when you do, when we do and when we urge from all people to listen to the stories of the victims. It's not merely concentrating on terrible things that happened. One of the things that we are concentrating on doing in this process is gaining the material with which to celebrate the small victories and the transcendence of evil by ordinary people, on the strength of ordinary people and their capacity to do that and that is one of our great national strengths that we need to recognise and value. And we need to understand more of what is happening to the perpetrators because these were not monsters that were slobbering at the mouth like some creations of a Hollywood script writer. The tragedy of South Africa's horrors, as it was of the holocaust and other such periods, was not that there are some special monsters who occasionally do terrible things, but that in certain situations, in certain circumstances, ordinary people; and listening to some of the perpetrators, extraordinarily ordinary people are capable of doing very terrible things and it is only by a proper examination of that that we can have any real chance of hoping that we will prevent this happening before. If we don't know how it happened we won't be able to prevent it happening. The more we try and understand it we may not be able to prevent it, but we'll never have a realistic chance of trying that.
I think Saths raised another very important point that we do need to recognise and record in our findings of this meeting. You have been I think in this meeting as in many others, very broadly inclusive in your invitations and there has been a very relevant response. We should take very clear notice of who is here. I have no doubt in my own field for example, that if you had chosen to hold this hearing in Hong Kong or in Acapulco, or in Vancouver, every single professor of psychiatry would have been here with lavish support from every drug company that they phoned the day before without question. Those who claimed in their initial - those institutions and individuals who apologised that somehow with some sort of scatoma, some temporary blindness they didn't notice with apartheid was happening are in fact showing by their absence that whatever blindness they had, they still have, they are still as comprehensively blind as that. I think we have to be wary of how these individuals have learned this new language, the 12th official language of South Africa, political correct speak. And some of them make those same noises just as convincingly but don't listen to what they say, look at what they do and I remember, I wish I could remember the great author who said it, that the man who said, 'I can't hear what you're saying because what you are is shouting so loudly', and I think that is what our absent colleagues have said and we should hear what they have said. Thank you.
MS MKHIZE: Thank you, any other comments? As we have said, this is an open session for people to review what we have gone through and those who were in the May/June Health Sector hearings can reflect on that as well, including the subject matter that we have dealt with.
The only problem which I foresee for our records is that people don't say who they are, then I don't know what's going to happen. Please let's just make sure that people say I'm so and so from this place..
MS MAKASOMAHAPE: Okay I am Jeanette Makasomahape from Chris Hani Baragwanath Nursing College. From what you have been doing since yesterday I feel that it was not done in vain. It has given us an opportunity to say things we couldn't say before like I said yesterday that sometimes unintentionally find yourself being involved in implementing some of the things because of situations beyond your control. I know that many people have no faith in what the TRC is doing, that it won't bring back their loved ones but I feel to some extent there are benefits in the talking therapy which as we are currently doing and it will help us in the future not to repeat the same things. And then about today, I also feel that we did benefit something. In the past like we said we were not here to engage about a power struggles between the disciplines and so on at the competitions but for the mere fact that the nurses are here today also and did say their say. It means we are heading for the same direction, there is hope, more especially about us recurriculating and having this trans-interdisciplinary teaching which we are planning so that there is no discipline which will be above any other. I think we are taking a step in the right direction.
MS MKHIZE: Thank you, any other comments about the process?
MS RADEBE: My name is Ethyl Radebe, I come from the Chris Hani Baragwanath Nursing College. I feel that being here in the TRC, I was there in the June hearings and I'm here today. I think that in the history of our people we have covered tremendous ground. What the TRC is doing nobody has ever done before and I do take note of the fact that we are few. I think even the TRC Commission itself did comment yesterday that it would we are a small number. I'm just impressed by the amount of content and work we have done, but my future thinking would be, it will be a pity if for whatever the content we have discussed today, we have listened to those voices of victims if torture, it will be the greatest pity in the history of mental health if nothing can be done about these victims and even if it's a small something, I think the ordinary people will appreciate it and we hope that the TRC will note this part of the process very very seriously. We may not have the great things, the buildings but we do have our people who can benefit from the process, thank you very much.
MS MKHIZE: Thank you, any other specific comments besides the process, maybe more about the content, the input which was made and the discussions. We allowed the people to comment about the process because we are fairly open about it.
MR STAFFER: Hlengiwe, Carl Staffer, Lucas Paid Fellowship Centre and also the Survivor/Offender Mediation. I think in summary for myself it's been a fruitful two days, just gleaning a lot of knowledge around what is happening in the field, but I think I have questions on a much more practical level at many times and that is 1, the implementing body that is to follow the work of the TRC. How is that body being put together, what will they be doing, how much of a profile will they be given? The TRC's been given a very high profile, how are we going to also place the same emphasis and importance on this implementing body because where the real long haul of the work of our country is going to be in trying to bring that reconciliation and that transformation. We've got a long road ahead of us in that regard and I think here we're talking about the mental health of our society and the well-being if you want to us that word but that's a future looking thing but it's a long road before us. How are we looking at rebuilding this country and I think again practically what we need to do is continue to highlight what's happening on local levels in communities, small, seemingly maybe low budget and somewhat insignificant that aren't getting exposure, where communities are really working with the hard issues and I'll just name a few of those; the Video Dialogue Project in the East Rand which is using video, having taken an SDU and an SPU commander and given them a video camera and they've gone and told their story from their side with their constituencies with their families, then came together to try to put joint video together and then the process now is after that joint video which was a process of reconciliation just for the two of them and a process of growth and healing, is their having public viewings and these public viewings are bringing the community together to view this joint story that they've written now and then they break in to commissions and begin to talk about what is the future, how do we build the community that was fractured in the past in so many ways? There would be other examples, I'm just going to leave it with that but we need to highlight that, these examples and we need to pick up on them. I think it's about humanising this whole thing, really making this a human thing. The network that I'm with is about seeing how can we bring communities or individuals together who represent survivors and perpetrators, how do we bring them together and talk on the human level? Because some of the breakthrough in transmission is not going to happen until we get into the heart of those who have been part of the process.
MS MKHIZE: Thank you, any other comments? Luca.
MS LUCA(?): I wanted to ask you something, I've forgotten your name. Carl. I just wanted to know what measures have you in ...(indistinct) to protect these people who are bringing together the videos. My understanding and learning is that there are people out there who are out to commercialise the whole thing and revalue the misery behind basically.
MR STAFFER: No I think the effort has been, the video has been as much as possible the video has been the property of a local community-based organisation Consimunye which is made of SDU/SPU's, so they with the assistance of the Media Peace Centre and other NGO's have worked at this and it's trying to stay as much as possible within the community to be an empowering process for them, I don't know what you've heard or what the process - as far as I'm concerned, as far as I know there hasn't been a commercial organisation of this, this has been more of an effort to try to get the community to be into dialogue to begin to talk about some of the issues and there are also current issues now, issues of displacement and housing and that sort of thing that are also brought into the process because those are future points of conflict.
MS LUCA: ...(indistinct microphone off)...wanting sometimes to come forward and tell their story and so on because they say from experience the academics or the people are having self-empowering hidden agendas of coming there, picking up their stories, making money out of it, asking for funds on their behalf and they just leave them like that.
MS MKHIZE: Okay maybe can we move to other comments because we also want to round off this session. Any other comments? Okay Julanie first.
MR STAFFER: No can I just feed back an issue that came up yesterday around the testimony of psychologists? I think it's something that we have to discuss within the committee but I think probably what's going to happen is that we will send somebody to make a presentation to the Amnesty Committee around the issues around psychological testimony regarding taking it to a professional board. I think we have to make a decision on that but I think we we've taken those comments very ...(indistinct intervention) sorry well okay well then we'll hand it back to you as well but I think in terms of our own internal raising the awareness of the Amnesty Committee members, I think we will have a presentation.
PROF SEEDAT: I could not be sitting here yesterday and not take note of the very serious questions raised in Professors Nicholas' comments yesterday and to that end I'm going to take up that case. Professor Nicholas will be giving me the actual copies of the reports and we'll need the names of the psychologists so that it can be investigated a s a p as a matter that is 1, unprofessional and disgraceful because of what I said yesterday that it was based on unscientific knowledge about the diagnosis that was preferred as well as look at the whole attempt to denigrate the profession and defeat the ends of justice. So that will be taken up. How you know the Commission and the different committees want to proceed with it is within your right but I think it cannot be like, we act like the old-day police force and say nobody laid a complaint, you know somebody was killed there and nobody laid a complaint for God's sake man. This is very clearly something that we have to take public note of and act, and to act to protect the profession and the public belief that the profession is worthy of note.
MS LUCA: Did you say as who you are, what cap are you wearing for our records?
DR COOPER: Oh I'm as the member of the professional board I will take it up besides the fact we're here as well as representing the psychological society which is the official body representing psychology in this country. So from both sides we will definitely take it up, I mean my colleagues here. By the way Lionel Nicholas is the editor of the journal and you may find actually there's a need for a special issue in the journal around the mental health sector and who's done what and it's about those silences that we have always noted over the decades coming from this sector and what we need to be doing, we always must start from our own house really rather than pointing fingers and in the past we have been on the side of accusing those people in power. Now that some of us have acceded to that power in some fashion it will be incumbent on us to exercise our responsibility in a fair and just manner, and that's what we have to do and the public needs to see us doing that as well, not believe that well now that all these black people are in those places, they are just going to do those things that were done in the past, so what else is new?
PROF NICHOLAS: Lionel Nicholas, I'm a professor from the University of the Western Cape in Cape Town. I think many of us are disappointed and I include myself that the TRC isn't called Budget Unlimited because I think that often when people come to this kind of process there is the hope that all of the needs would in fact be satisfied. I think particularly this committee should probably be labelled the most limited budget committee in all of the TRC from what I can gather but what is important for me is that in June and here this process stimulated a lot of activity that may be quite hidden from view and from the discussions that we're having here and I know there are processes going on in Cape Town as a result of that because I'm based there and I've also made links with people, I've already discussed bringing out a special issue of the South African Journal of Psychology and doing different writings and so on. So there are other things that are going on as a result of it and I think that the TRC process was also meant to be a process that stimulates something rather than completely sees to everything that the whole nation could probably require. And I know that particular responsibilities lie outside of the TRC, especially the ones that you've mentioned but I think the one responsibility that the TRC might be evading and I think is central to its responsibility is to secure all of the data, all of the information, all of the resources that you have brought together up to now for the future use of the nation and that is I think, very much of your responsibility and not agencies outside of the TRC. Thank you.
MS ORR: Sorry Lionel if I can just reassure you that that's not a responsibility we're evading, we have documentation offices in each place and we have an archival officer, so we will make very sure that all of our material, video, audio, written material is preserved, it will 1, go to the National Archives which I know isn't very accessible, but we're also exploring storing duplicate copies in other more accessible places.
MS MAGWAZA(?): If I may, it's not a surprise that the psychologists have said what they've said about psychology and actually what they've said about psychiatry, I'm not even surprised that Dr, Prof Nel had said this morning of psychiatry as being a discipline of just mental illnesses because it does hurt me now when I'm just sort of reconnecting with the whole process because all I was talking about earlier on was just what I had perceived in the Health hearings per se. But I've wondered where they were, actually not only the psychiatrists but I've wondered where they were, the mental health workers, you know the people who understand the distresses of people, the people who know how a road from one point to change or to healing goes, how they have been very very scarce in the community. How they have not been in the media. I mean I know the society had very resourceful people but in situations like this you'd want to see them out there in the media talking, analysing about what is happening, analysing the TRC itself, the processes, the religiosities, the beliefs and the professionalism, analysing the society generally on what it's about; going into philosophies. So now I want to say openly that I am going to leave here and I'm going to cook up a storm in the Psychiatric Association and if that storm means I'm going to beg for restructuring completely or start something com....(tape ends)..who shared a common paradigm. Am I living in another planet? And I thank the TRC for making us aware of this.
MS MKHIZE: Thank you I hope you're not going to split again.
MR ELS: No I'm Guys Els, on behalf of the Institute for the Study for Leadership and authority. I just want to bring to the attention of ourselves then that at least there are some efforts to try and connect, not split and understand and there Volume 4 of '96 of the Psychoanalytic Therapy in South Africa, this journalises extensively looking at the aftermath of violence and there are quite a few articles in this that I think might help our thinking on this.
MS MKHIZE: Okay I would like really now to say look, I would like to thank all of you. I know you are all extremely busy people for making time to come and share with us in this difficult task. Internally within the Commission Zina has worked very hard trying to bring all of you here. Unfortunately she couldn't participate in this process because she's preparing briefers for the next hearings which are coming up on Monday; Winnie Madikizela hearing, so she's very busy but I would like to thank her in absentia.
Sorry I didn't see her, I asked her why she was so quiet and then she said she'd be in and out and so I thought she was out.
(Indistinct comment from panel member) Maybe that's another reason why she's hiding. And having said that, also maybe if I can just respond to some of the concerns regarding the first hearings we had in May/June and these ones, I remember at one time I flew down to Durban. We went through a process of going around talking to grouping about what we are going to do and at the end we ended up with a few, the people who saw were really the people who responded; and as a Commission we have come to accept that, that not to say each time we like people to come and interact with us they will all be available. We have come to accept that many people who have a willingness and a desire to make a contribution it's sometimes almost impossible especially at this point in time when people who are in positions of power are overstretched. I mean I will take a good example. I don't want to mention anyone boldly but people who are really likely to take over some of the processes, they couldn't come. We heard that they are here, they are in Cape Town, they are in this meeting so it says a lot about where we are as a country and how stretched we are. I'm not using that as a defence but that's a strong factor. Just coming to organising this one I didn't know that Saths Cooper will come. We insisted that we stick to the things which we have thought of. We couldn't get somebody from the Department of Health, we couldn't get somebody from the Medical and Dental Council. Initially we thought they would be represented by Saths but the answer was he might not be available. We decided to have the topic in any way. By chance he walked in when we started. So that's, I'm referring to him because he made it, otherwise I wouldn't like the Media to say the TRC expected so and so and he didn't come.
So that was another factor that many people who had even agreed and made a commitment that they will come, they didn't come.
Regarding communication within the TRC, some of you might have seen our booklet called The Truth Talk. We came up with that booklet mainly because we felt we needed a simplest way of communicating with our staff and NGO's, you can pick it up anywhere but you heard that some people said that they don't know what the Committee is doing, and after each Commission meeting, whenever policies are approved by the Commission we come back and all the officers they are going through a same process, Committees Report to Staff from a housekeeper to a Commissioner in another committee. We report, we say look here are our policy proposals, they have been approved, workshops are put up, publicised internally and externally but it just happened that all the time people feel left out. So that's not a justification but it's something which we have come to live with.
Coming to this specific workshop, or maybe before coming to it, also something which I think is important to share with you, as a Commission I should think we have also realised that we symbolise a difficult part which people don't know how to interact with; people get angry at us, they get frustrated, it's a very frustrating structure. People live with this love and hate sort of feeling. Sometimes they are excited that the truth is coming to the fore but sometimes it's extremely frustrating in the sense that it forces them to visit the memory of the past. Our Committee in particular has suffered mainly because of the things which were discussed here, the status of the profession per se and how our profession somehow colluded with the previous government in human rights violation. As you heard how for instance our theories of racism informed the whole apartheid system and all those things, our Committee becomes a symbol of this bad past and time and again those reflections they end up stifling our work and compromise what the Committee's capable of doing, and I think it's something which we have realised that it's very very important to communicate with professional bodies because if we as a professional grouping don't act on those issues, in terms of making sure that there's an internal mechanism to deal with those colleagues who were part of the system, who colluded in human rights violations and making sure that also we have a strong culture of human rights within our profession, our profession is likely to suffer even more.
Well when we started yesterday, I will remind you of what we said; we said we have had quite a number of people coming before us who had made statements but who had expressed difficult emotions like anger, depression, suffering, complicated grief and all those difficult emotions which go with the past, and we said it's difficult for us to name what we are dealing with; we are not too keen to diagnose those people because we know those are people who are people who were functioning at a high level, they were leaders. If I might steal some of the words which have emerged from this workshop that those people need to be affirmed, that was our feeling as well, that those were not just people who were mental ill but strong leaders who for some reason where their bones were broken by the previous government because of the positions they held and their beliefs. So I should think also we're concerned about a body which will look after them and I'm just picking up those tow because those were two pressing points in our own minds but reflecting on what has emerged here, especially just taking from the reports that we have had from working groups, it's like out of this workshop there is an awareness that the whole question of mental health needs to be looked at very carefully in the sense that it's not mental health in a traditional sense of the word where people are thinking about pathology, but it's a search for an environment which is conducive to peoples' well-being. Of course people here who have looked at survivors of human rights violation as we have them today and also people who will suffer because of the legacies of the past, people like the question of people who's rights will be violated or who will be abused by let's say perpetrators. So that also has been very very helpful for us to broaden a scope of understanding what is in our data base.
And reflecting on what was said I should think that we accept a challenge that as a Commission we have a very limited capacity, especially to investigate allegations that there are documents out there which were written up by experts in our field which are likely to perpetuate discrimination, racism and beliefs about other people that they are less human and they can be treated anyhow. I mean as we have said, if we can be given specific names of those documents, we'll be keen to have a look at them.
The question of professionals who in the past used their expertise in oppressing detainees, it's also a very difficult one especially in instances where it is said they are still in positions of, some of them in positions of power and influence within a new dispensation. Again because of our limited capacity to investigate, it's a question of really appealing to people that look, if you have names that will make the lives of the investigative unit much much easier. And also the question of the body which will take over; already we have recommended that the body which follow up all the recommendations of the TRC should be the President's office. The reason why I mean a comment was that body should have a similar clout so to say, political clout; I should think the President's office, we thought is a critical body because it has the highest authority and a level of accountability in terms of what is done for survivors of human rights violations and also what he matched that there should be a special consideration of people like in other countries. I should think that office is in the best position to really push and make sure that in a work place, in public life in general for a limited period of time, people who are survivors of human rights violations are given special treatment. I know of course some people will question that but given the motivation which we had, it makes a lot of sense to us, especially the fact that that can go on for a limited period of time.
Regarding the question of the body, although there have been different proposals, in some instances it was like people were opposed to each other. I should think basically we appreciate the view that there should be an interministerial or interdepartmental cooperation in addressing these issues and I agree with you that maybe a proposal that we need a human service department might be too radical, given the fact that already government ministries have initiated new plans in this era.
So from our point of view a lot of suggestions which have been generated here we will take forward and incorporate them with our thinking and limit ourselves to our mandate and we are hoping that representatives of professional bodies here will make sure that the debate continues because after we have made our recommendations the very professional bodies which are in existence today, will have a responsibility to monitor and to take forward some of the suggestions.
I've left out an important question of the kind of research which will enable as many people as possible to generate questions around this process after the life of the Commission and what has been suggested especially around the good example which was raised now of a video-dialogue project. I should think it adds to what was said earlier on using poems and all other moods, story-telling of communication that we need to be creative and make sure that as many people as possible are part of the process of telling their stories and revisiting their past. And also an important suggestion which we hope it won't be lost and we have noted that it is the idea of having something similar to a holocaust museum. We have noted that and fortunately the Ministry of Arts and Culture, they seem to be positive to the idea and are wanting to start from the past and link it up with the rainbow nation, what is happening today during this era.
So I will really like to thank you very much, especially people who came from KwaZulu Natal and the Western Cape, Lion and Nicholas and A...(indistinct) Bhana, we thank you very much for coming, not to say we don't value the Gautengers but we really appreciate, especially I know at this point in time universities are very busy preparing marks for students but we thought this is important enough, so thank you.
MS ORR: ...asking yourselves, well yes we've had these interesting two days, what now? What now is that we have to write up the proceedings of this workshop, formulate recommendations and then incorporate them into the overall health sector report which then becomes part of the overall report which then goes to the President and we would very much like your assistance in that process. Perhaps we should just thing about it for a while, but if there are any of you who would like to help in the writing up process, please could you contact Tulani and then what we would also very much like to do is send the first draft of the written up to all of you and get your comments and your feedback back, so I'm afraid it's not over yet, the work has only just begun and we really would appreciate your ongoing involvement and assistance in taking this work forward, thank you.
HEARING ADJOURNS
