A Trojan horse

2013-12-06 00:00

THE University of KwaZulu-Natal’s Nelson R. Mandela School of Medicine, popularly known as the Durban Medical School, is one of the province’s showpieces, a key player in global health, thanks to the presence of the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH) Centre for the Aids Programme of Research in South Africa (Caprisa).

The school was the first institution to provide full biomedical training for black students successfully, thus laying the foundation of the black medical profession, but it also provided a place for political education and a focal point in the struggle against apartheid.

“The story of the medical school is not just a local story but a national story,” says Vanessa Noble, a lecturer in history on the Pietermaritzburg campus of the University of KwaZulu-Natal, and author of A School of Struggle — Durban’s Medical School and the education of black doctors in South Africa.

“For years, it was the only place black students could get their training, but it also led to the broader education of black doctors in politics.”

The list of the school’s alumni now holding public office or prominent in civil society is an impressive one and includes HIV/Aids expert Jerry Coovadia; former health minister now chair of the African Union, Nkosazana Dlamini Zuma; former KZN premier now ANC treasurer Zweli Mkhize; former director of the World Bank now founder of the new political party Agang, Mamphela Ramphele; national Minister of Health Aaron Motsoaledi, and the late anti-apartheid activist Steve Biko, who studied at the school from 1966 to 1972.

A racially segregated society was in place long before apartheid and when, in the twenties, the University of the Witwatersrand and the University of Cape Town opened medical schools, black students were excluded. In a situation where only small numbers of white doctors were available to serve the black population, medical missionaries tried to fill the gap. James McCord, of McCord Hospital fame, who had trained his own black medical assistants, together with his fellow missionary Alan Taylor, tried to get a medical school off the ground in Durban but without success.

“They introduced the idea of the school and proposed a shortened medical degree course of five years,” says Noble. “But the South African medical profession objected.”

Concerns over a lowering of standards formed part of the objection, but it was also about status, says Noble.

“The standing of white medical professionals would be diminished if black doctors with a perceived inferior training were introduced into the system. There was also an issue around black doctors taking work away from white doctors, who, at the time, were treating black patients.”

Post World War 2, when the idea of a medical school in Durban was mooted again, it enjoyed a better reception.

“The health system at the time was providing horrific conditions in which black people were being treated and this made the idea of a black medical school a viable option.”

That Natal should be the site for such a school was due to a number of factors, says Noble. “Durban didn’t have any medical school at all. There were medical schools at Wits and UCT — then Stellenbosch followed by Pretoria.”

Wits and UCT had been training black medical students, although hardly under ideal conditions. Another factor was the large Indian population and the sub-tropical environment of Durban. “This meant patients here presented different health problems specific to a sub-tropical setting.”

Taylor who, with McCord had been involved in the first attempt to launch a medical school, led the forties bid and eventually ended up being the school’s first dean.

The Durban Medical School was officially opened in 1951 as a separate faculty under the auspices of the historically white University of Natal “Not for whites, but to train African, Indian and coloured medical students.”

From the beginning, the medical school was a Trojan horse within the walls of apartheid. “Not only was the medical school … destined to produce doctors of international quality,” noted a UKZN publication marking the 50th anniversary, “it was to provide the anvil on which the tools to fight its creator would be fashioned.”

As Noble points out, the institution, its teachers and students “reflected and opposed apartheid influences in complex ways”. The irony that the medical school was both a product of apartheid and an opponent informs her book, says Noble. “I was looking for tensions and ambiguities. That’s what I like about history — the messiness of it.”

The apartheid government, which had come into power in 1948, laid down strict conditions on how the school was to be run. Taylor and his successor as dean, George Gale, initially envisaged the school gradually opening up to all races, “but government put its foot down”.

From the very beginning, the separate nature of the medical school was emphasised — not least in its location two kilometres from the main university campus. “They didn’t even attach it to the university,” says Noble.

Medical students had a separate residence, the former World War 2 military barracks at Wentworth, 10 kilometres from the school. “The students weren’t allowed to wear university blazers,” says Noble. “They couldn’t play varsity sport — it was, to all intents and purposes, a separate institution.

“Meanwhile, the nationalist government was quietly proud of the school. It was something of a showcase — ‘look this is how apartheid works properly in a separate system’. It was a case of ‘positive’ apartheid’.”

But the worm was in the bud. “These were the brightest students — the smartest,” says Noble.

“In many of my interviews, I was told how at school they had been encouraged by their teachers to do medicine or law. They were the cream of the crop.”

They were also subject to innovative teachers, such as Sidney and Emily Kark, pioneers of community health. “They were far-sighted and introduced social medicine,” says Noble. “This exposed the structural causes of poor health, such as migrant labour and low wages. They were taking on the social factors that lead to poor health.”

The second half of Noble’s book deals with role of the school during the struggle era. “But the word ‘struggle’ in the title reflects struggles of various kinds,” she says. “The struggle of the founders to create this place against all the odds; the struggle of the Karks to introduce new ideas; the struggle of the students to do their degree along with their political activities.”

Another struggle came to light only recently — the African-Indian struggle among students, which came out when mentioned during speeches made at a 60th anniversary function.

“Previously, there had been this picture painted of everyone being unified in diversity. But it wasn’t like that at all. There was a gender struggle as well.”

These struggles are not over. “With the inheritance of a long process of division, these things are still playing themselves out,” says Noble. “The apartheid spirit is still playing itself out. During apartheid, it was the Africans who were the victims, post-1994 the Indians find themselves the victims. At the time of the final editing of this book, racial tensions continued to simmer at the medical school,” writes Noble, “as two further ‘top UKZN academics’ [as reported in The Witness] were suspended from their posts in April 2012. Professor Umesh Lalloo, a pulmonologist and former dean [of the school], and his wife, Professor Razia Bobat, a paediatrician, were suspended ‘pending an internal disciplinary process’.”

“In the book, I’ve played on the idea of struggle,” says Noble. “This book was not a commissioned history and I didn’t want it to be hagiography. It is the story of a place that has not been told before.”

• A School of Struggle ● Durban’s Medical School and the Education of Black Doctors in South Africa by Vanessa Noble is published by University of KwaZulu-Natal Press.

• Stephen.Coan@witness.co.za

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