no room for independent-minded black people like me. It was time to take my jacket and leave.
Knowing that the work I had carried out at the Ellerines’ request could not be faulted on the grounds of unbridled political zeal on my part saved me from undue anger and humiliation. Fortunately, I have never had reason to look back with any sense of regret, particularly since there is no way of knowing what the rest of my life would have become had I been allowed to keep my position.
I acted quickly and decisively by playing what is commonly described as a wild card. Soon after the Ellerines debacle, I approached Professor Lewis Hurst, then head of psychiatry at the University of the Witwatersrand Medical School. My request was simple. I had decided to abandon the practice of psychology in commerce and industry and to pursue a career in clinical psychology. It was a cry for help which Professor Hurst must have found difficult to ignore. The minimum admission requirement for internship training was a master’s degree, which I had. However, the most difficult hurdle, and one that could not be easily overcome, was the colour of my skin. Professor Hurst and I were faced with apartheid laws, which sanctioned complete racial segregation between blacks and whites in all significant spheres of life in South Africa. I could not be admitted at Johannesburg’s Tara Hospital, an established psychiatric training hospital, since in the 1960s all health facilities were segregated on the basis of race.
Professor Hurst approached Professor Robert Lipschitz, the head of neurosurgery at Baragwanath Hospital in Soweto, and in January 1969 I was admitted there as a clinical psychology intern in the Department of Neurosurgery and Neurology. This was an extraordinary decision – as far as I know it was the first time anyone had been placed in a neurosurgery department to serve an internship in clinical psychology, and nothing had prepared me for my role.
To satisfy the standard certification requirements of the Medical and Dental Council I had to work under appropriate supervision at the hospital for one full year. Uncertain as I was about the move, I was heartened by my reception by the professional staff of the department, including the black ward sister and her nursing staff. Professor Lipschitz carried his large frame and professional authority as head of neurosurgery with self-assured dignity. Interestingly, he managed to be both charismatic and reserved. A tall, heavily built man, he appeared worthy of his huge Rolls-Royce, in which he almost always travelled alone.
Gathered around him during the morning ward rounds was a team of outstanding professional men and women made up of speech therapists, occupational therapists, neurosurgeons, neurologists and registrars training to become neurosurgeons. Among them were senior specialists such as Dr Colin Froman, a lively and talented neurosurgeon who was one of the shining lights in those days. Looking back now, I remember how odd it was to be the only black person among the non-nursing professional staff of Ward 7.
Upon arrival at Baragwanath I did not know what to expect. My situation was aggravated by the fact that there was no psychologist in the team to oversee my induction and allocation of responsibilities. In practice this meant that for the first few months I had to take every day as it came. What eased the unfamiliarity of the situation was the fact that from the outset I was offered a room in which to live, in the black section of the doctors’ quarters on the hospital campus. Accommodation there made my life much easier since I did not have to travel from Atteridgeville to Soweto every working day. Nor did I have to undertake the thankless task of trying to find living accommodation in Soweto for the duration of my internship.
I mention the black doctors’ quarters because my experiences there played an important role in my induction into the social and intellectual culture of a racially segregated teaching hospital in the South Africa of the late 1960s and early 1970s. I lived in the company of a small number of black doctors training both as interns and registrars – that is, doctors who were there to complete their training and registration requirements or who planned to qualify as specialists.
We lived in a prefabricated building without aesthetic appeal on the far edge of the hospital grounds. A stone’s throw away from where we stayed lived our white counterparts, in relative comfort in a purpose-built doctors’ residence. I remember the complacency with which our white colleagues appeared to accept the naked racial discrimination that was rampant in those days at Baragwanath. However, we were reassured by the fact that our own living quarters provided us with ample opportunities – especially at mealtimes, when non-resident black professionals joined us – for lively discussions of professional questions, including issues of racial discrimination in the healthcare sector.
I remember some of my colleagues with a tinge of nostalgia today. Dr Joe Variava, a boisterous physician-in-training, was the political firebrand in our group. Another physician-in-training was Dr Dumisani Mzamane, a reserved, soft-spoken man who was a thorn in the flesh of the authorities, especially officials in the provincial Department of Hospital Services in Pretoria. He has since died. In the years after the completion of my internship it was the trio made up of Variava, Mzamane and I who campaigned actively against racial discrimination in salary scales, living conditions at the hospital and opportunities for professional advancement. It was in the doctors’ quarters that a significant part of my early socialisation as a health professional took place.
During my internship year I was not exposed on a regular basis to patients suffering from moderate to severe mental illness, the kind of patients that I would have encountered at a psychiatric teaching hospital. Nor was I under the daily supervision of a senior psychologist or psychiatrist. Such supervision would have been available to me had I been at a hospital catering for white psychiatric patients such as Tara Hospital in Johannesburg or Weskoppies Hospital outside Pretoria.
In the beginning, when the medical team was finding ways to accommodate my needs, I survived on the professional goodwill of medical staff who were in no hurry to make unreasonable demands on me. I kept my eyes and ears open, and it was not long before I learnt about what was described in medical terminology as a ‘bedside manner’ and ‘bedside teaching’. There was a dialect that everyone, including staff nurses and junior doctors, appeared to understand. Colleagues spoke of patients ‘presenting’ with this or that symptom, or with a ‘history’ of some condition or other.
In time I learnt that empathic listening and careful and systematic recording of the patient’s history (as told by the patient) are essential building blocks in the development of a treatment plan and relationship. In addition, Lipschitz and other senior specialists used their examination of patients as a method of teaching. It was during the ward rounds that one was likely to hear about the latest medical breakthroughs as the senior doctors referred to their and other people’s latest research published in journals such the British Medical Journal and several journals in the Americas. During each ward round doctors-in-training were given ample opportunity to present their patients and tell their colleagues what they had found during their examinations.
In the midst of all this order, especially during the first few months, I had to contend with the fact that there was no training plan laid out for me either by the Department of Psychiatry at the medical school or by the Department of Neurosurgery at Baragwanath. How was one expected to survive under such perverse uncertainty? The remarkable truth is that I did survive. As is often the case, there were many contributing factors. On close observation of the work in the ward, I was impressed by the confidence and professionalism of the clinical team in the course of their day-to-day activities. I sensed a common purpose among them and it was as if they all knew what that common purpose was. My curiosity was alerted and the desire to learn sharpened by the professionalism that prevailed.
One of the earliest lessons I learnt in the course of the ward rounds and the clinical conversations accompanying the examination of patients was the way the mental status of patients was assessed. In the work of neurologists and neurosurgeons, a patient’s mental status is one of the primary areas of concern. I noticed that three cardinal abilities were considered relevant: orientation to self, orientation to place and orientation to time. My awareness of the importance of indicators such as these led me to believe
