TRC Final Report

Volume 4

Chapter 7

Subsection 5

Prisons and health

31 Several of the witnesses told the hearing of difficulties in receiving proper medical treatment while in prison. Mr Henry Makgothi, for instance, described the difficulties he encountered in receiving treatment for tuberculosis on Robben Island:

It was very difficult to gain access to the hospital. The doctor didn’t come often enough, and even then there were so many obstacles they placed in your way before you could get to the hospital; but eventually I did manage to get to the doctor and they sent me to Cape Town for treatment. I was not sent to hospital because I was a dangerous prisoner.

32 The overall picture gained at the hearing was that the role played by district surgeons was controversial and questionable.⁸ Medical services often failed prisoners badly. Sometimes, the consequences were very serious, as with Bram Fischer, a leading Afrikaans advocate, who served a life sentence in Pretoria. His two daughters reported how, prior to the discovery of the cancer which finally killed him, their father was treated with woeful negligence and, indeed, considerable malice by the authorities at Pretoria Local:

Bram had a prostate operation in July 1974. About two months after that he saw a Dr Brand because he had an acute pain in the hip. He was not examined but given an analgesic and some physiotherapy. After two weeks of no relief, the physiotherapist referred him back to the doctor and suggested X-rays or an orthopaedic opinion. Nothing was done.

The pain was so severe that Bram needed crutches to walk. The prison didn’t supply him with crutches, so the other prisoners made a crutch for him out of a broom. Later he was provided with crutches, but he still wasn’t sent for X-rays.

In October, a Dr Groenewald sent him for X-rays and, later in that month, Bram saw an orthopaedic surgeon who warned that the neck of the femur was very fragile and that a fall would be dangerous. On 6 November, Bram fell while trying to shower on his crutches. On 7 November, he asked to see a doctor, who didn’t come. On 8 November, he again asked to see a doctor but the medical orderly said it was impossible to get a doctor. On 9 November, Bram was in great pain and the medical orderly provided some analgesics. On 12 November, Dr Brand said there was no fracture. Bram continued in tremendous pain.

Finally on 15 November, nine days after the fall, Bram again saw Dr Brand and an X-ray was at last done. The radiographer identified a fracture of the femur. On 16 November, Bram was seen by a specialist who confirmed the fracture and advised hospitalisation.

On 19 November, thirteen days after the fall and probable fracture and four days after the fracture was diagnosed, Bram was eventually admitted to the HF Verwoerd Hospital.

33 Evidence was also heard from Dr Judith van Heerden of the University of Cape Town, the author of a study on prisons and health. She said that her research led her very strongly to one conclusion about the provision of health care in prisons:

To provide proper care for all inmates in custody, a strong argument can be made for the complete separation of health care from custodial care. The Department of Health should take on responsibility for custodial health care. This will also do away with the confusion about the role of nurses. Their present custodial role undermines the trust and confidentiality which should exist between patient and nurse.

34 Dr Van Heerden also made the point that, “abuse and the seventy-three deaths of political detainees during the three decades of repression occurred mainly outside prisons, at police stations or at interrogation centres”.