Hospitals & Asylums 






United States of Apartheid: South African Government and Metalworker Unions Strike HA-27-8-10


By Tony J. Sanders


For the wages of sin is death, but the free gift of God is eternal life in union with the Messiah Jesus our Lord

(Romans 6:23) International Standard Version


During my lifetime I have dedicated myself to this struggle of the African people. I have fought against white domination, and I have fought against black domination. I have cherished the ideal of a democratic and free society in which all persons live together in harmony and with equal opportunities. It is an ideal which I hope to live for and to achieve. But if needs be, it is an ideal for which I am prepared to die.

Nelson Mandela, Concluding Remark When Sentenced to Life in Prison in 1964 and When Released in 1990


I am not an ideologue…I’m not.

Barack Obama, at a Republican Convention in 2009


This strike involves the State employees in South Africa demanding an 8.6 percent pay increase and a housing allowance of 1,000 rand ($136) a month, although the government says it can’t afford to raise its offer of a 7 percent increase and a 700 rand allowance. South Africa’s annual inflation rate is currently 4.2 percent. Unions representing about 1.3 million state workers, including the 250,000 member National Education, Health and Allied Workers’ Union say their members struggle to get by on their current salaries and that the strike will continue until their demands are met.  The National Union of Metalworkers of South Africa (NUMSA), representing 70,000 workers, said today that car and fuel retail-industry workers plan to strike from Sept. 1 after employers failed to meet their demands for a pay increase. Numsa members in the tire and rubber industries will begin a walkout on Aug. 30.  The rand fell for a second day against the dollar, declining as much as 1.1 percent, to 7,373. The FTSE/JSE Africa All Share Index shed 0.6 percent to 26,989.63 for a third consecutive decline (Cohen & Smith ’10).


I am writing to apologize for the un-parliamentary language, that weighs so unfairly on the South African Customs Revenue Service, used in my letter to the Canadian Immigration and Refugee Board (IRB) and United States of Apartheid Citizenship and Immigration Service (USCIS) on Tuesday, Aug. 17, 2010 at 2:19 PM Pacific Time or 11:19 PM South African time.  My complaint was pertaining to the postal fraud intercepting my naturalization papers, consequential $600 million treason for border police, temporally linked home invading (rheumatic) torture and prayer for email delivery of the certificate by USCIS and a halt to the hangman tourism of Canadian IRB.  The letter was sent off just in time to kick off the strike on the 18th of August.  Taking into consideration the humor of the Hippocratic oath’s promise that, “I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work”, who could work for a government that had Foreign Relations and Intercourse (a-FRaI-d) with Title 22 of the Civil Code of the United States of 1924 and again with the HIV/AIDS Court of International Trade of the United States (CoITUS) of the Customs Court Act of 1980, when it would be so easy to be FR-ee?  Only the monument engraver I sought to employ to write "Customs Court" in stone on the Courthouse in New York City “in loving memory to the millions who lost their lives to the HIV/AIDS pandemic” (AGE §41c-d).  


Exchange Rate of South African Rand per One U.S. Dollar selected years 1980-1999














Black Market






Source: African Economic Analysis 2001


U.S. Customs and Border Patrol could easily afford this from the $600 million treason that so recently bankrupted the U.S. economy.  This proper use of U.S. dollars could theoretically bring an end to the HIV/AIDS pandemic, whose spread has already been halted and reversed, in fulfillment of the Truth and Reconciliation Commission’s stonewalling on the issue pending dissemination of the pathologic lies of the American and British empires (TRC Vol. 2 Pgs. 517-518 Para. 31-34) and justify an appreciation of the rand to offset devaluation since the ‘80s (TRC Vol. 4 Pg. 47 Para. 115) to lower the price of imported consumer goods and industrial technology as directed by the conclusion to the Atlas 2010: MDGs 1990-2015 and Factbook 2009.


Exchange Rate of South African Rand per One U.S. Dollar 120 Day


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Source: (2010) latest (Aug 26) 7.32033 lowest (Aug 9) 7.21354 highest (May 25) 7.96637


This settlement proposes to work with the government offer of a 7 percent pay increase and 700 rand housing allowance by providing for a progressive pay increase that would benefit lower income workers more than higher income workers.  Governments around the world are struggling to balance their budgets and the South African government’s offer of a 7 percent pay increase, in light of 4.2 percent inflation, is in reality quite generous.  Now it is important that union demands for better wages are met. At the opening of the trial for which he was sentenced to life in jail for acts of sabotage in 1964 Nelson Mandela stated, “There are two ways to break out of poverty. The first is by formal education, and the second is by the worker acquiring a greater skill at his work and thus higher wages”.  The right to strike and collectively bargain is certainly a skill, but the truth of matter is not working doesn’t pay.  It is therefore proposed that the across the board 7 percent wage increase and 700 rand housing allowance be progressively adjusted so that the lowest paid quintile of workers gets the largest pay increase and the highest quintile the lowest.  A sliding scale must be devised, although volunteerism in behalf of an 8.6 percent raise for the average wage earner is more equitable than pure mathematics.


It is important that the actual value of the government’s wage increase be calculated whereas this is the finite amount of energy which can be disbursed amongst the finite number of workers without loss.  The benefit is that as the result of the law of the law of diminishing returns the high paid workers whose wage increase means the least to their standard of living and incurs the greatest cost would get less of a marginally good thing but theoretically the lowest paid workers would get substantially more than even the union demands.  The formula should be that the median paid worker gets the demanded 8.6 percent and 1,000 rand pay increase, and the lowest paid workers would get a 1,000 rand housing allowance and no more than a 9 percent, non-merit, pay increase, while highest paid state workers would get the 700 rand housing allowance, or forfeit entirely such a superfluous intrusion of the state into their private lives, and no less than a 5 percent pay increase for those wishing for the housing allowance. 


Public Service and Administration Minister Richard Baloyi met with union officials “to try and persuade them to understand the government offer,” Dumisani Nkwamba, Baloyi’s spokesman said by telephone from Pretoria. Asked if the wage offer may be increased, he replied, “absolutely not.” Government employees last struck in 2007, when schools, hospitals and immigration offices were disrupted for 29 days, the longest-ever walkout by state workers. South African laws prevent strikes by certain categories of workers who provide essential services, accounting for about a third of state employees. Even so, many nurses have joined the labor action, said Fidel Hadebe, a Health Ministry spokesman.  “The impact of the strike has been quite severe in a number of facilities”, the provinces of “Gauteng, Mpumalanga and Kwazulu- Natal have been worst-affected” (Cohen & Smith ’10).


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Police used water cannons to disperse protesters at Johannesburg’s Helen Joseph Hospital as shown by Cape Town-based e News Channel. Officers broke up a group of strikers who blocked roads to a hospital and a courthouse in the town of Chatsworth in the eastern KwaZulu-Natal province. The government “has noted with concern the violent acts of intimidation and public violence” associated with the strike’’. “Steps will be taken against strikers or sympathizers who intimidate staff or members of the public, or commit acts of hooliganism, destruction of property or violence.”  Police fired rubber bullets to disperse workers who entered the grounds of the Chris Hani Baragwanath Hospital in Soweto township, south of Johannesburg, and tried to prevent patients and doctors from entering (Cohen & Smith ’10). Both striking workers and police are strongly cautioned against all violence and retaliation and to avoid creating situations or giving orders that might incite violence and retaliation.  Striking workers must not retaliate against so-called “scabs” or prevent them by threats, intimidation or violence from going to work.  Police must not brutalize striking workers. 


Apartheid was more than a program of one political party. It was a system of racial minority rule that was both rooted in and sustained by white minority socioeconomic privilege at the expense of the historically oppressed black majority. Apartheid was associated with a highly unequal distribution of income, wealth and opportunity that largely corresponded to the racial structure of society (TRC Vol. 4 pg. 22).  The struggle for trade union rights, for better working conditions and for democracy, in turn, led to a host of specific gross human rights violations (TRC Vol. 4 Pg. 23). While some businesses called for black workers to be given trade union rights after the 1973 strikes, others resisted efforts by their employees to secure these rights, refusing to recognize black unions and, in certain cases, using the security forces to assist them in their endeavor. At decisive moments in the re-emergence of the democratic movement, business’s initial reaction was invariably one of opposition, victimization of activists and union officials, and recourse to the regime’s security forces. The first reaction to a strike or attempt by unions to organize workers was all too often to call on the police. Many violations of human rights occurred as a consequence (TRC Vol. 4 pg. 41).


The Southern African Catholic Bishops’ Conference group said in a statement issued to the South African Press Association. “We abhor the inhuman conduct of denying doctors and patients access to hospitals and teachers and pupils access to their schools.  Care is being denied to the weakest and most vulnerable”.  A pregnant woman who was denied access to a state hospital in the eastern city of Durban gave birth in the parking lot of Netcare Ltd.’s St. Augustine hospital in the city, the company said in an e-mailed statement. Several newspapers said patients had died because they had not been treated or received medication. The health department was still investigating the reports.  “As much as we offer our condolences to those families, we don’t want our members to be blackmailed when they have a legitimate right to strike,” Sizwe Pamla, a spokesman for the 250,000-member National Education, Health and Allied Workers’ Union (NEHAWU) said. “Hospitals by their nature are places that people go to get saved, but it doesn’t always happen that way and it can’t be proven that strikers caused the deaths” (Cohen & Smith ’10).


South Africa must undertake a study of mortality during this strike of health workers to verify this statement in the best interest of the patients.  In 1973 doctors in Israel staged a month-long strike and during that month, mortality fell by 50 percent. A couple of years later, a two-month work stoppage by doctors in the Columbian capital of Bogotá led to a 35-percent decline in deaths. During a “work slowdown” by doctors in Los Angeles protesting against sharp increase in premiums for liability insurance, deaths fell by 18 percent. Once doctors were back at work full time, mortality immediately jumped back to the previous level.  Every year, 1.2 million Britons are hospitalized as a result of improper medical care. In the United States – where 40,000 people are shot to death each year – the chance of getting “killed” by a doctor in a proven case of medical malpractice is three times greater than being killed by a gun and deaths from not being treated amount to only 22,000 (NCO §274(F) pgs. 983-984). The people might be better off without these “essential workers” however the prohibition against striking is not necessarily nullified by their recognition by the Labour Court (NEHAWU 23/8/10).


Members of the South African Defense Force were deployed to several hospitals to fill in for striking workers (Cohen & Smith ’10).  Utmost care must be taken not to create any dual obligations for these military health service workers.  Health professionals have an ethical obligation to place the well-being of their patients at the forefront of their professional commitments.  Military health professionals had a particularly difficult time in upholding international standards of medical ethics and human rights. While they were supposed to follow the same ethical codes as civilian medical workers, they were, at the same time, required to follow orders given by superiors. This created an atmosphere of dual loyalty for these individuals (TRC Vol. 4 Pg. 122 Para. 38).  Dual obligations tend to cause a failure to (a) maintain patient-doctor confidentiality norms; (b) treat their patient with dignity and respect; (c ) examine the patient thoroughly; (d) record and report injuries accurately; (e) diagnose illnesses and prescribe appropriate medication; (f) register complaints (particularly pertaining to assault and torture) (TRC Vol. 4 Pg. 113 Para. 13).


Critically ill patients who were unable to access treatment at state facilities were transferred to private hospitals (Cohen & Smith ’10). With the private health receiving 2/3 of all money spent on health to provide services to 15% of the population, private hospitals will finally have to work for their big profits (NEHAWU 24/8/10).  Because of apartheid restrictions on where people could live and work, it was very easy for the Department of Health to ensure that the distribution of resources favored white people. In 1985, for example, annual per capita health expenditure according to race was R451 for white people, R249 for Indian people, R245 for colored people and R115 for African people. Since black hospitals were regularly overcrowded and white hospitals underutilized, the funding should have been redistributed to provide better overall care (TRC Vol. 4 Pg. 120).  The new situation sounds more like the poverty based discrimination unique to United States although a poster with an infant African child from 1987 proclaimed, “Welcome to America the only industrialized country besides South Africa without national healthcare” (Schaefer ‘07:390).  However, even with the added costs of the HIV/AIDS pandemic South African care was closer to optimum efficiency at 8.7 percent of GDP than the United States weighing in at 14.6 percent of GDP in 2004 (WHO ’05)


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Source: The impact of HIV/AIDS on Southern Africa’s Children: Poverty of Planning and Planning of Poverty 2002


Southern Africa is the epicenter of the HIV/AIDS pandemic. One third of the global population living with HIV is in the Southern African Development Community (SADC) countries where 13.9 percent of the population was reported by UNAIDS to be infected in 2001. In 2001 an estimated 20.1 percent of adult population in South Africa was infected with HIV, although there is great variation among countries: from 0.1 per cent in Mauritius to 38.8 per cent in Botswana.  5 million South Africans live with AIDS and there are 660,000 AIDS orphans and have been 360,000 deaths in a total population of 43.8 million (Whiteside ’02: 2).  The $8-10 billion invested in the Global Fund to Fight AIDS, Tuberculosis and Malaria Fund 2005-2008 increased the number of people in low and middle-income countries receiving antiretroviral therapy for HIV 10-fold.  The HIV infection rate in South Africa declined 15.8% from 21.5% of the population in 2004 to 18.1% in 2005.  This is largely due to a 58.3% increase in number of AIDS deaths from 3,600 in 2004 to 5,800 in 2007. Millennium Development Goal 6 to halt and reverse the spread of AIDS by 2015 is the only goal to have been achieved (Atlas ’10).


South Africans don’t need to die to halt and reverse the transmission of the pandemic.  In most other nations, without such a heavy burden of proof, during this same time period both the number of infected people and number of mortalities have declined, there is little doubt that HIV infection can be cured and AIDS lived with like normal chronic disease (Atlas ’10).  The Truth and Reconciliation Commission and thereby the Department of Justice utterly failed to mention the AIDS pandemic, or convict the apartheid biological warfare program of HIV possession, playing to the crowd control with ecstasy, cholera, botulism, anthrax, chemical poisoning and the large-scale manufacture of drugs of abuse, chemicals, poisons and lethal micro-organisms were produced for use against individuals, and ‘applicators’ (murder weapons) developed for their administration (TRC Vol. 2 pg. 510).  Therefore a crash course in pathological lying is needed - HIV causes AIDS - HIV is hazardous and must subjected to control and prohibited.  The international legal community has made progress convicting infected “free radicals” (Cotran et al ‘94: 11) who unethically spread the HIV infection by the medico-legal accepted modes of transmission, eg. unprotected, uninformed sexual intercourse.  The vertical investigation of the disease pathways needs to look into the “genetic mutations”, the propaganda and conspiracy of silence regarding the genocide of a social unit, usually family or housing, with poison, abetted by the corrupted police, or in the terms of the HIV pro-viral genome the gag, pol and env genes (Cotran et al ’94; 221-222).  Ultimately diagnostic laboratories must destroy their HIV samples, the research laboratory HIV strictly controlled, monitored and the pathogen must be prohibited, not the truth. 


If there were no HIV in the world there would be no AIDS.  Eliminating HIV is complicated because HIV lives in human hosts for their entire lives, according to modern science (PHD ’09).  HIV/AIDS is particularly complicated in South Africa and the United States because of their obvious complicity in the pathogenesis of the pandemic.  South Africa had the audacity to overthrow the white masters, at the time when the Soviet Union dissolved, and all the formerly oppressed republics were afflicted with hard times.  The neo-colonial COITUS claims responsibility for all the new world’s problems and their cruelty seems particularly focused against ideals and good in general because the strategy of COITUS is to make goods bad and their power is to incite sexuality and violence at the social level and if that doesn’t turn anyone on the DEA can enforce it dealing aphrodisiac psychedelic drugs and small arms to their tried and true guerillas (AGE ’10).  The underlying subversive conspiracy is the Democratic and Republican (DR) bipartisan system whose snake oil immediately triggered a Civil War and then an ineffective bipolar world of us versus them, all armed to the teeth about the pathological basis of disease (DR ’09).   


In the election of African-American Barack Obama in the United States in 2008 Barack Obama, for no good reason betrayed his ideals and everyone.  By re-authorizing the Foreign Intelligence and Surveillance Act (FISA) of 1978 in June of 2008 he lost the support of his more savvy constituents.  The next month he intercepted information regarding a conference I was attending and came to town to visit with the black mayor, the colonially subjugated collaborator with the most Confederate prosecutor in the State, and the next day Barack Obama visited Afghanistan and turned a blind eye to the war crimes U.S. N.A.T.O. troops then committed, that took the lives of dozens of civilians.  After being brought to trial in regards to his crimes and the crimes of U.S. Foreign Relations with the COITUS as the centerpiece, Obama betrayed everyone and selected the Senator with most responsibility for drafting the Customs Court Act of 1980, that created COITUS and the HIV/AIDS epidemic and all subsequent foreign and judicial sociopathic policy, such as the Violence against Women Act (and Office) to be his Vice.  Obama declared to the world poison, not tobacco, was his Vice, particularly the one that had killed more blacks than anyone else in the history of conventional weapons.  Who else could be the friend of a black male lawyer whose economy of non-discrimination is a woman? 


Obama’s administration, that “does not torture” as the result of one of his first official acts whereby federal torture statute is ultra vires Arts. 2, 4 and 14 of the Convention against Torture, this must be understood for two reasons.  First, because the United States is a major contributor to the Global Fund for HIV/AIDS, Tuberculosis and Malaria and there has been motion for the United States to re-up their multi-billion dollar contribution in light of the Fund’s apparent success at reducing the incidence and mortality of AIDS, that could help South Africa afford health care workers the raise they demand and/or AIDS victims the welfare benefits they deserve.  Second, as the result of his choice of Vice the free radicals are particularly toxic economic saboteurs whose bailout caused the U.S. General Fund to be a complete failure without precedent and any further bonds, even tiny million dollars sums, such as the $600 million to arm Customs when they should have been on trial for postal fraud and torture, cause widespread unemployment and economic decline.  The solution is for South Africa to sue the United States and Global Fund to change of the name of COITUS.  Like the AIDS patient who must not trust their doctor and needs money to keep on moving and buy good food, wardrobe and bedding; South Africa must both make their lack of faith in the United States clear as Customs Court engraved in stone on the courthouse in New York City and win their tort for the financial benefit of the victims.  So as not to bite the hand that feeds them any contribution from the U.S. must come from the enormous reserve of Recovery Act funds held by the Department of Health and Human Services. 


Appreciating the rand against the industrialized basket case offers an important way for South Africa to reverse the neoplasm of colonialism that has invaded developing nations since the inception of COITUS in 1980.  With their moderately successful economy with a per capita of $10,000, South Africa is privileged to can-sir, while others like Zimbabwe, so recently punished for appropriating the property of white farmers, must suffer the angina of labor without money compensation exceeding $100 per capita.  Appreciating the rand is an important way to dramatically increase the value of money earned and held by South Africans without any obligations arising from the transfer of development assistance from more privileged countries.  There are a number of other benefits that would accrue.  Antiretroviral drugs and other imported goods and industrial technology would cost less.  The price of exports to industrialized nations would increase, neutralizing the commodity price slump harming developing economies around the world.  The only adverse trade-off is that goods and services would be more expensive to foreigners and exports to industrialized nations, and foreign investment would theoretically decline and imports therefrom would increase.  Appreciation would strengthen the domestic economy, help industrialized nations sell goods, and South African life would have more value to South Africans.


Neo-liberalism enriches the foreign owned capitalist classes while disempowering domestic wage earners and setting up a civilian imperialist infrastructure and hierarchy to coopt the hearts of the poor to sustain and fight for the capitalist philanthropists who pay their wages and sell them cheap goods, against the government.  Neo-liberalism is a different form of neo-colonialism than neo-conservatism in that neo-liberals foster informal commercial and economic colonial exploitation while neo-conservatives advocate direct military colonialism for free (Engler ’08).  Medical finance qualifies more as neo-conservative.  The fundamental principle of neo-liberalism is exactly the same as mercantilism – exploit the low priced natural resources of developing nations and sell them high priced industrial technology manufactured therefrom.  Industrialized nations win-win and the developing nations never earn enough money to develop the industrial base needed for import substitution or domestic infrastructure and government (Filho & Chamon ’08).  Devaluating developing nation currencies sustains this biased system and the poor get poorer.  While a cheap currency may foster an export market amongst the most elite capitalists, not to be discouraged excessive red tape from profiting and employing workers, it makes imports more expensive.  For a small victory in the international trade balance the devaluated nation loses confidence in their financial system and their very per capita income in dollar value is a mere $10,000 or $100.  


San groups first settled South Africa around 500 BC and those that took to raising livestock called themselves Khoikoi (men of men).  Around the same time more advanced Bantu speaking people migrated from the north.  They are now the Nguni (Zulu, Xhosa, Swazi and Ndebele).  In 1652 the Dutch East India Company established a permanent settlement, of “Boer” farmers.  The British seized the Cape in 1795, returned it to the Dutch in 1803, definitively took over in 1806, and was recognized as British territory at Vienna in 1815.  The Dutch regained control in the First Anglo-Boer War 1880-81 but lost it in the Second Anglo-Boer War 1899-1902. During this time diamonds and gold were found and immigrants poured in.  The South Africa Act of 1909 brought the country together.  English and Dutch, and later Afrikaans in 1925, were the official languages.  Only whites could vote or be elected.  Blacks were segregated to only 7% later 13% of the land and prevented from skilled labor.  Apartheid began to relax in the 1960s.  During the 1980s South Arica felt increasing worldwide disapproval and economic sanctions.  Blacks engaged in many forms of nonviolent and violent protests, including economic boycotts, labor strikes, political demonstrations, and occasional acts of sabotage.  In a dramatic turn of events in 1990 South African prime minister F.W. de Klerk legalized 60 banned Black organizations and freed Nelson Mandela, the leader of the long-outlawed African National Congress (ANC), after 27 years of imprisonment.  In 1994, South Africa held its first universal election.  Nelson Mandela’s ANC received 62 percent of the vote, giving him a five year term as president. (Schaefer ’07: 474).  The Democratic Party (DP) is for whites.


Apartheid was part of a system of racial-capitalism that is universally condemned although the left claims it helped the economy while the right claims it hurt it (TRC Vol. 4 Ch. 2 Pgs. 21-22). Between 1910 and 1994, government and business (despite periodic differences and conflicts between them) co-operated in the building of an economy that benefited whites. A very high rate of economic growth was maintained in the 1950s and 1960s. Except for the boom years of 1980 and 1981 (primarily a response to the high dollar gold price), South Africa’s growth rate was low or falling during the 1980s and early 1990s as the result of international sanctions against the apartheid regime. The rand was, allowed to depreciate against the dollar (in nominal and real terms) between 1982 and 1986. This policy-induced recession of the early 1980s was exacerbated by political unrest (1984-7) which undermined investor confidence and encouraged capital flight (TRC Vol. 2 pgs. 116-117). Investments performed very badly, unemployment rose and capital flowed steadily out of the country. The mid-1980s were particularly bad years for the economy. Various factors account for this. Perhaps most subversive was the impact of high world interest rates, international recession and the instability caused by the ‘Third World’ debt crisis (TRC Vol. 4 Ch. 2 Pgs. 45-46).


The evolution of the South African health care system, that remains quasi-private, does more than demonstrate the inequality, exploitation and discrimination inherent in the apartheid system, it reflects the true nature of apartheid, that still holds sway in the industrialized north over the south, in the paradigm shift from the segregation of can-sir and angina, in the nation that developed the heart transplant, to equal opportunity dying – HIV/AIDS.  The Department of Health was the arm of the national government responsible for public health services. It provided for care at the local, provincial and national levels, allocated state funds, drew up regulations and appointed senior officials to the hospitals. The Department’s policies appear to have been driven by the political objectives of the national government, rather than a desire to ensure the well-being of all South Africans. The Department helped develop health care legislation that discriminated against people according to race. It enforced segregation of health care facilities and allocated funds in a racially biased way. These policies shaped, and continue to influence, health care delivery and the health of South Africans (TRC Vol. 4 pg. 119).  The perpetuation of the quasi-private health system continues to indicate that South African and United States medical establishments are equally unique in their need for universal coverage and national health service among industrialized nations.


Although the Union Constitution of 1910 gave control of the hospitals to the provinces, there were no specific provisions for the delivery of health services until the Public Health Act was passed in 1919. The Act created a Department of Public Health, but left hospitals under provincial control. It also gave local authorities responsibility for the control of infectious diseases and environmental sanitation. 111 In 1942, there were 2 000 active medical practitioners in South Africa. More than half of them (about 1 100) practiced in urban areas where only 28.2 per cent of the population lived. The doctor to population ratios ranged from 1:5 000 in the rural areas (where mainly black people lived) to 1:380 for urban areas (where mainly white people lived). The infant mortality rate for whites was 50 per 1 000 live births; for Africans, it was estimated to have been between 150 and 600 per 1 000 live births (TRC Vol. 4 Pg. 111, 118). Between 1960 and 1994, the Department of Health failed to use its resources to provide the best possible public health service. Probably the greatest problem in the health sector was the mal-distribution of resources.  The silence of the Department about the effects of socio-economic conditions on the general health of the population was deafening.  Compensation for doctors varied by race, and salary differentials persisted into the 1980s. The Department did little to prevent police from obtaining medical records from hospitals or clinics without the consent of patients. The police used these files to identify ‘anti-apartheid protesters’, which made many people afraid to go to a government hospital to receive care, as they feared arrest (TRC Vol. 4 pgs. 120, 121) not to mention bio-terrorism.


With a few exceptions, medical faculties did not speak out about the unethical nature of apartheid medicine and its adverse effects on training and patient care.  The Truth and Reconciliation Commission continues not to speak out HIV/AIDS and it can be surmised from the system’s similarities with the U.S. system, and high infection rate of soldiers, that university research laboratories are the “keg parties” behind the pandemic.  Before World War II, no black doctors were trained in South Africa, blacks had to be trained overseas.  The outbreak of World War II ended overseas training, however, very few black doctors were trained until 1951, when a school was opened exclusively for blacks. In 1959, the University Extension Act was passed, requiring black students to obtain ministerial consent before they could attend a white university, further restricting black access to medical education.  Between 1968 and 1977, 86 per cent of all newly qualified doctors were white, while white people comprised less than 20 per cent of the population. By contrast, 3 per cent of the new doctors were African, while Africans constituted 71 per cent of the population. Black students could not attend post mortems on white cadavers and, at many medical schools, black students were not allowed to examine white patients until the 1980s (TRC Vol.4 pg. 131, 132, 134). 


Nurses in South Africa form the largest body of health workers in the country and make a great impact on health care delivery.  Submissions and statements received by the Truth and Reconciliation Commission did not indicate that nurses actively participated in gross human rights violations, but they did suggest that acts of omission and ‘turning a blind eye’ were common.  While provision is made for the teaching of ethics in the curriculum, nurses do not seem to identify it as significant to their professional role. In one particular study, it was found that 87 per cent of the research sample indicated that they did not regard the subject Ethos as necessary to their work as registered nurses. The first black psychologist to qualify in South Africa did so in the early 1960s.  By 1998, the Human Sciences Research Council estimated that there were 3,897 psychologists in South Africa, 3,587 (92 per cent) of whom were white. Conditions in mental institutions were appalling and did nothing to foster mental health. Inmates were used as sources of income-producing labor and there are (unproved) allegations that black patients were used as ‘guinea pigs’ in research (TRC Vol. 4 Pgs. 136, 137, 138, 140).


From the early 1970s, there was an attempt to revive the crushed black union movement. Strikes and worker stay aways began to increase in number. Between 1965 and 1971 less than 23,000 African workers had struck. In the first three months of 1973, 61,000 stopped work. By the end of the year, the figure had grown to 90,000 and employers had lost 229,000 shifts – more than seven times the number lost through African strikes in the previous eight years. From cautious beginnings and despite heavy repression, the union movement grew to be a significant force by the end of the 1970s (TRC Vol. 4 Ch. 2 pg. 42). During its heyday of state and racial capitalism, the racial disparity ratio between white and African incomes became much larger. While the per capita income of whites was 10.6 times higher than African per capita income in 1946-47, white income was fifteen times higher than in 1975. If ever there was a period of upward redistribution of income (mainly from Africans to Afrikaners), then it was the period of high growth in the 1950s and 1960s. Given the power structures of white supremacy and racial capitalism, it was a period of high growth with a ‘trickle-up’ effect. The depth of inequality is so great that there is widespread and acute poverty afflicts some 40 per cent of all South Africans (TRC Vol. 4 Ch. 2 Pgs. 45-46).


South African Income Distribution 1975-1991




Bottom 40%

Next 20%

Next 20%

Next 20%

































































Source: TRC Vol. 4 Ch. 2 Para 111


Although racial economic disparities have been reduced or eliminated white domination seems to have merely been replaced by a domination of the rich union workers of the sort on strike today.  Because international disparities exist with the middle income emerging market nation one cannot begrudge the striking workers much, but their wealth is odious to the poor they owe decent welfare.  In 2009 50% of the population lived below the poverty line, 24% were unemployed and actively looking for work, and most tellingly the distribution of family income rates a 65 on the Gini index the second most unequal in the world.  Nonetheless South Africa is a remarkably successful African nation.  South Africa’s $505 billion GDP is 17.7% of the African total, 28% of sub-Saharan Africa although its 49 million people comprise only 4.9% of Africa and 5.9% of sub-Saharan Africa’s population.  In 2009 the South African economy contracted 1.8% in 2009 and the government ran a $16.8 billion deficit that was 3.3% of the GDP however the public debt of 29.5% of GDP is within reason (CIA ’09).  While South African credit is good, credit is bad judgment. The doctrine of odious debt allows successor governments to disown the debt incurred by fallen dictatorships (TRC Vol. 4 pg. 55).  In a democracy where the people are sovereign, sovereign immunity is an issue for the people whose health and welfare it concerns.  


In conclusion, from these figures one can determine that the government is close to bringing the budget within the reasonable limit of 3% of GDP and must not give in to the unreasonable union demands because any money they borrow will come, not only, from profits, but from existing equitable capital, to hurt overall economic growth.  To be fair, the union will have to invent a progressive system of taxation of their own, to ensure the rich pay for the poor to get satisfactory raises, in the thriving middle class of government and industrial workers.  In fact, to satisfy the union, it may not be the union’s rights that need to be fulfilled but their responsibility.  A developed nation must afford a progressive income tax that provides the poor with an adequate safety net.  Inalienable property rights for the rich; be they capitalist or worker, no matter how alienated and tortured their extorted consumers may be, are common propaganda.  Social justice for those alienated and tortured consumers is the surest foundation for success and happy and safe working conditions.  The rand commands high wages in the monument engraving sector but to emerge a fully developed country South Africa must institute a progressive income tax to guarantee an income above the poverty line.  The Government’s policy on welfare organizations is based on the principle that each population group should serve its own community in the sphere of welfare (DSP ’66).




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