After over a century of service, has this become the people's hospital they can kick out?

2013-01-25 00:00

Lauded for its service to the poor, the fate of McCord Hospital hangs in the balance as it waits to hear if its government subsidy will be renewed. Julie Parle looks at its illustrious history

AT this time of the year, parents and incoming students ask me and my colleagues why they should study History, what its use is, and whether it offers us any useful lessons for the future. The answers are not always easy and are sometimes not what people want to hear. At worst, knowing about the past can drive deeper wedges between people; but at its best, it encourages compassion and an understanding of the complexity of peoples’ lives and of how we are all caught within cross-currents of power, with difficult choices to make.

I plan to illustrate these complexities to my students by talking to them about a research project that Catherine Burns, Vanessa Noble and I have been involved in over the past several years: a full, robust, and critical (in the sense of showing the bad as well as the good) history of one of KwaZulu-Natal’s — if not southern Africa’s — most important institutions, McCord Hospital in Durban.

Formally opened on May 1, 1909, in 2009 its centenary was celebrated in the Durban City Hall. Present were Zweli Mkhize, who had been an intern there; Blade Nzimande and his wife, Phumelela Ntombela-Nzimande, who had been a nurse at McCord; and numerous high-ranking officials, as well as hundreds of people, young and old, who had been patients at McCord; many even were born there.

Lauded for its 100 years of service to the poor of KZN and especially for its progressive HIV/Aids programmes, most notably through the internationally renowned Sinikithemba Clinic; praised for its steadfast support of non-racial and equal training for black doctors and nurses; admired for its commitment to the values of kindness and tolerance; and, more recently, recognised as an important contact and research site for some of the world’s leading Aids and TB medical scientists, a “second century of service” seemed to be ahead for McCord. But, less than four years later, the hospital waits to hear its fate after announcing last week that it would have to close its doors at the end of March as a result of the provincial Health Department’s failure to renew its subsidy.

Amid widespread reaction, provincial head of department Dr Sibongile Zungu denied on Wednesday that a decision had been taken on a subsidy and that a committee in the department’s hospital services section would meet next week to decide.

This brouhaha, coming hard on the heels of widespread dissatisfaction with the often abysmal state of the country’s public hospitals, has been met with shock and disbelief by many.

What really is at stake here and what can a quick review of 100 years of the history of McCord Hospital illustrate about the bigger issues of South African history? After all, by pointing out that it has been a pioneering institution in very many ways is no guarantee of the hospital’s future value.

One can even speculate that, in fact, its founders, American Congregationalist missionaries James B. and Margaret McCord, might have welcomed the withdrawal of state subsidies from the hospital since the rationale is that, under the national health insurance system, the state will concentrate its resources in public hospitals.

Finally, it seems, the South African state has accepted responsibility for providing decent, affordable and accessible health care for all its citizens, something it has never done before. That — especially for black people — was largely left to the mission hospitals, many of which were established in the late 1800s and early 1900s. In order to be close to the people, most were in the rural areas. Most were forcibly taken over by the Nationalist government in the early seventies, as part of the apartheid plan of breaking resistance to its rule and providing hollow justification for its Bantustans policy.

McCord Hospital survived this onslaught by the Nats, but only just. In 1958, Hendrik Verwoerd insisted that this “native institution cannot remain” and gave McCord two years to remove itself from Durban’s “whites-only” suburb. A 1963 newspaper headline asked “Will McCords Die? For It’s The People’s Hospital They CAN’T Kick Out”. Under Alan B. Taylor, the hospital’s administration hung on, but the battering continued into the seventies. Eventually, the apartheid state ran out of energy: McCord survived again.

Popularly known as McCord’s Zulu Hospital, for its founders were dedicated to bringing modern medicine (which was itself developing rapidly in the early 1900s) to “the Zulu people”, McCord has an illustrious history. It pioneered urban health care for black patients; it was staunchly supported by John Langalibele Dube; it was at the forefront of the professional education and training of black midwives, nurses and doctors; it had local and national luminaries such as Chief Albert Luthuli on its board in the forties; the first black doctors who graduated from the Durban Medical School (itself a product of the efforts of McCord and Taylor) served their internships there.

Significant medical — and political — figures associated with McCord are too numerous to list fully, but include Drs K.N. Pillay, J.L. Njongwe, Mary Malahlele (the first African woman in the country to qualify as a doctor), Dr M.V. Gumede, and Dr Mohammed Mayat (who was a friend of Nelson Mandela and who would disguise him in hospital scrubs when he made secret visits to Durban).

But this has never been a hospital only for Zulus, or for black patients for that matter. In 1949, in the wake of the deadly Cato Manor riots, a ward commemorating Mahatma Gandhi was sponsored by local Hindu benefactors “as a grateful token of their appreciation of the services of the hospital to the needy of the African and Indian Communities …”

McCord Hospital has only been closed once since 1909, and that was in 1917 when its founders (and then owners — they built the hospital with their own money, loans from friends, and from the tiny profits made from the Beatrice Street Dispensary), James B. and Margaret M. McCord went to the United States in 1917 so that James could serve in the U.S. military.

That it was opened at all owed nothing to the goodwill of Durban’s white citizens or medical fraternity, who actively blocked the establishment of a hospital for black patients in the city. It took an appeal to the Supreme Court of Natal and the Privy Council in London before it could go ahead. Even then, rather than be officially recognised as a hospital, it was called “The Mission Nursing Home”.

Determined to keep their fees as low as possible, both McCord and Taylor forfeited their salaries on several occasions to keep the hospital open, and, during the Great Depression, to help fund Inanda Seminary for Girls, the source of its nurses, or on occasion waiving them. During an epidemic of malaria in the thirties, recuperating patients made bricks in lieu of fees. By the forties, McCord Hospital persuaded the liberal elements of the government to subsidise its training of nurses and other services. Since then, McCord Hospital has functioned as a state-aided, but not state-controlled enterprise.

It is the decision possibly to discontinue this subsidy, at a time when international funding for HIV/Aids programmes is in decline, but while average daily incomes of the poor are pitifully low, and while, as officials admit, neither King Edward VIII nor Addington is in good shape, that may mean that McCord closes its doors after March this year.

Neither the Minister of Health nor any official would deny McCord Hospital its place in history. Thankfully, the hindrances to the hospital’s future are not the same as those of its past. Nor, one hopes are there any tenderpreuners after its now prime real estate spot on Durban’s Berea nor competition from private hospitals worried that McCord will be attracting the wrong sort, or taking away its high fee-paying patients. Instead, the big issue is whether there is a place in the new NHIS for independent (although not hugely profit-driven) hospitals that are state-aided.

History offers no easy answers, but our research shows that it was precisely its hard-fought measure of independence that enabled McCord Hospital to withstand the assaults of the apartheid bullies; it was also this autonomy that empowered it to open and run the country’s most progressive HIV/Aids programmes at a time when Aids denialism was supported at the highest levels of the government, including in the Presidency and by the Minister of Health.

Thankfully, Aids denialists are no longer tolerated in the South African government, but history shows very clearly that state health-care policies are never neutral, and when they are bad, they can be very harmful indeed.

• Dr Julie Parle is an associate professor in History at the University of KwaZulu-Natal.

McCORD HAS AN ILLUSTRIOUS HISTORY: IT PIONEERED URBAN HEALTH CARE FOR BLACK PATIENTS; IT WAS STAUNCHLY SUPPORTED BY JOHN LANGALIBELE DUBE; IT WAS AT THE FOREFRONT OF THE PROFESSIONAL EDUCATION AND TRAINING OF BLACK MIDWIVES, NURSES AND DOCTORS; IT HAD LOCAL AND NATIONAL LUMINARIES SUCH AS CHIEF ALBERT LUTHULI ON ITS BOARD IN THE FORTIES; THE FIRST BLACK DOCTORS WHO GRADUATED FROM THE DURBAN MEDICAL SCHOOL SERVED THEIR INTERNSHIPS THERE.

NEITHER THE MINISTER OF HEALTH NOR ANY OFFICIAL WOULD DENY MCCORD HOSPITAL ITS PLACE IN HISTORY. THANKFULLY, THE HINDRANCES TO THE HOSPITAL’S FUTURE ARE NOT THE SAME AS THOSE OF ITS PAST. NOR, ONE HOPES, ARE THERE ANY TENDERPREUNERS AFTER ITS NOW PRIME REAL ESTATE SPOT ON DURBAN’S BEREA NOR COMPETITION FROM PRIVATE HOSPITALS WORRIED THAT MCCORD WILL BE ATTRACTING THE WRONG SORT, OR TAKING AWAY ITS HIGH FEE-PAYING PATIENTS.

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