DATE: 12-06-1997



____________________________________ MS MKHIZE: I will ask Prof Ransom - Prof Ransom I would like to welcome you. Dr Fazel Randera will assist you in making your presentation.

PROF RANSOM: Thank you.

MS MKHIZE: Fazel, I don't know how you are going to do it.

DR RANDERA: Professor, I know you have had a long wait like everybody else and we thank you for your patience. Let me introduce you if you don't mind in the interest of time. You are presently the medical ombudsman for the Medical Association of South Africa.

I first met you were you were a consulting paediatrician at the Coronation Hospital and subsequently you were made Professor of Paediatrics at Madunza before you took on your present post.

PROF RANSOM: University of Pretoria, not Madunza.

DR RANDERA: Pretoria, sorry. You've come to talk about recommendations that were made by the Paediatric Association of South Africa in 1987 published in the South African Medical Journal in that year.

I want you to take us through that, perhaps also reflect on how those recommendations came about in the first place because as you know the mandate of the Commission begins in 1960, we are looking at 1987, 27 years later.

And as we've heard throughout the day and on many other occasions, the violations that we are talking about against children were taking place in the years prior to that. Perhaps you can reflect on that as you take us through your document, thank you Professor.

PROF RANSOM: Thank you very much. It is a privilege to be here and thank you for allowing me to make this presentation.

I was elected to the Executive Committee of the South African Paediatric Association, I think it was in 1984, roundabout there, so I was a newly new boy to Paediatric Association things when Walter Loning, you probably know him, Professor Walter Loning, the Head of Community Paediatrics at the University of Natal, wrote to us, wrote to the Chairman of the Association enclosing a newspaper cutting which was talking about abuses to children in prisons and suggesting that we do something about it.

The Chairman then circulated this letter to all the members of the Executive Committee, asking for suggestions and I thought about it quite carefully and so I wrote back and I said what I think we should do is firstly have a look at the existing legislation and see whether we think it is reasonable or not.

And if we don't think it is reasonable, then I think we should try and help the legislators to produce something that is good for children, because as Paediatricians we ought to know.

And as usual when one makes a suggestion, you get landed with the job. So, they said okay well, carry on. So the first thing I did was to consult as widely as I could. I wrote to the British Paediatric Association, to the Honourary Secretary of the British Paediatric Association and got a very short letter back to say that they had no special policies about children in detention.

I wrote to the Secretary of the Academy of Paediatrics of the United States and I got a lot of help from them as is acknowledged in this document that you have before you, at the back in the references.

They had gone quite a long way towards formulating rights of children who had run foul of the law. I spoke to Professor Sas Strauss and I spoke to all sorts of people. I went to the main library at Wits and I read through the Prisons Act and I read through the Criminal Procedures Act and all I could find in the Prisons Act that protected children, were two clauses.

One that said that they may not be put together with other hardened adult criminals in a cell and another which limited the size of the cane with which they may be beaten. So those were the only two clauses in the Prisons Act which protected children.

This was clearly totally unsatisfactorily and so then I tried to live my medical practice and my life by thinking about how I would like to be treated, or my children to be treated and recognising that one of my children could easily have, is there a problem, no, one of my children could easily have got into trouble. I tried to think of how I would as a parent, a concerned parent, would want my child treated, should he have landed in trouble with the police and the law.

And that was really how this document came about. And I think what I would like to highlight in this document is a philosophy statement where we wrote that a child is an individual who is developing physically, mentally, socially and emotionally. The culmination of this development is when he is in a position to take a full and productive place in society, to his satisfaction and to society's gain.

In most societies and the USSR was a notable exception, this development has been recognised to be optimal in the home environment where the child is under the control and influence of his parents.

Schooling is also an integral part of this development in modern society. And this is the important bit, Chairperson. The State therefore assumes an awesome responsibility when it removes a child from its home, parents and school.

This responsibility is the greater when one considers the possible ill-effects including the psychological, emotional and criminalising effects of detention. So the purpose of the document is to emphasize and categorise these responsibilities and here we put down while it is most regrettable that any child should fall foul of the law, it is recognised that childhood delinquency does exist and that the State is obliged to act for the protection of society.

This obligation however, includes that of minimilising the ill-effects of detention and of rehabilitating the delinquents. And then it goes on as you no doubt, have read.

An important part of the document was the feeling at that time that it was not right for either the police or the department of Prisons to monitor themselves, that there should be someone who was independent of both of those institutions, to be able to come in and have a look and see what was going on without, totally independently, in fact an ombudsman for children who had fallen foul of the law.

Now, after much consultation and after much sending around the country of drafts to the other members of the Executive Committee of the Paediatric Association, to all the members of the Department of Paediatrics at the University of the Witwatersrand where I was, we eventually came up with what is in front of you.

The Medical Association of South African then facilitated I can't remember I think it was probably two meetings, but there was certainly one, where there were senior people, Generals and of that type of standing, from both the normal police, the Security police and the Department of Prisons.

And they sort of sat around, looking and not all that interested and eventually they said well, this is your demonstration and you know, you can do this if you like, but it is against the law as it stands at the moment and we are not going to do anything about it.

So that was very distressing. We really felt that we were powerless to get this into the legislation having gone all that route. When the new government was elected, I thought here is another chance to get what I think is the right thing going. So I wrote, I've got a copy of the letter here, in 1994, I think it was, to Minister Omar, enclosing a copy of the code and saying that mainly in response to what was then a totally unacceptable situation, the South African Paediatric Association published a code for the handling of children in places of detention in 1987.

I enclose a copy of the code in this letter. The Officials of the Departments of Police and Correctional Services with whom we negotiated at the time, were totally unresponsive to this document and the philosophies contained therein. They said that much of it was against the law and that the Department of Correctional Services was in any case addressing the problem of children in detention internally.

Clause 2, the philosophy that I've read out is central to the entire document. We believed and still believe that the place of a child is in the home. And then I emphasized the question of the ombudsman and then I said many people will say that children do not belong at all in places of detention. This is of course true.

But the unfortunate fact of life is that children not only in South Africa, but all over the world, become involved in patters of behaviour which is unacceptable to society, the State is forced to act in these situations.

And I end by saying as this code is fully in line with all the subsections of Section 5.8 of the Reconstruction and Development Programme, I sincerely hope that you will consider bringing it into our statute books, thus ensuring the right of children in detention.

So if he had any questions or wished to discuss the matter further, myself and the South African Paediatric Association are at your disposal. I did not get the courtesy of an acknowledgement, let alone a reply which was really very disheartening to me Chairperson.

Funnily enough that same night I saw Mr Carl Niehaus on the TV and I realised then that he was the Chairman of the standing committee on correctional services, so I sent a copy to him, with almost the same letter and I did get a reply from him and a very friendly, nice reply, but kind of superficial and kind of saying, don't worry, we are looking after the matter.

That was on the 19th of July 1994. On the 6th of January 1995 I wrote another letter to Mr Niehaus and I would like to read this out.

DR RANDERA: Professor, sorry, if you don't mind. Can I lead into that, because you are going beyond our mandate now and I know you want to reflect on the future.

PROF RANSOM: Well, I agree with Ms Scott. Dr Randera, I agree with Ms Scott, we must be certain that this doesn't happen again.

DR RANDERA: Right, and I am in agreement with you. I am in full agreement with you there, but if you don't mind, can I possibly take you through a few questions before you start reflecting on the future?


DR RANDERA: Prof Ransom, can I start off with my first question, sorry, let me just say as a background that as you know, we are actually having a special hearing for the health sector next week and the Medical Association of South Africa has made quite an extensive submission and we will be dealing with that submission in Cape Town next week, so I am not going actually to take up too much of your time.

I just want to come back to this issue of yours in terms of delinquency and requiring places for detention. In retrospect, looking back now and to the time that you actually wrote this document, clearly the emphasis was not on delinquency, what was happening in our country at that time, was as we've heard so eloquently today, was a political conflict taking place.

Young people got caught up in that political conflict. PROF RANSOM: I accept that.

DR RANDERA: And I think we need to in a sense separate the idea of delinquency from this political conflict that we are dealing with.

My question therefore to you is one, how much was the Paediatric Association influenced by what was going on inside and outside the country. If I can actually recollect my thoughts on that period, there was the call for a scientific and cultural boycott that was taking place, there was an international outcry against young people being detained. There was the issue just a year before, where SANDC had changed their position completely about the treatment and the death of Steve Biko in detention.

How much were you influenced by all those issues in coming to this document that you have, that we have in front of us today?

PROF RANSOM: Obviously the huge numbers of children that were being detained because of their involvement in the political upheavals, obviously influenced us. The numbers brought it right to our attention, it was so pertinently, so obviously we were influenced by that. Yes, I hope that answers your questions.

DR RANDERA: Professor, if I can just take you to page 4 of your submission, which is the issue of Medical and Dental Professions and their responsibility. Towards the end of that paragraph you say security regulations which apply at any institution must however also apply to medical personnel.

Can I just say again, I would like you to comment on that in retrospect and also just take into account once more what had happened with Steve Biko in detention and what came out subsequently in the way that the Doctors had behaved and in mitigation they argued clearly that because they were working within an institutionalised structure, the intimidation took place and they were not as careful in carrying out their ethical responsibilities as they would have otherwise.

Now to me that statement is somewhat supporting what happened in many of our institutes because Doctors were caught up. Doctors who worked in these institutes, were caught up in the dilemma. On the one hand they had the ethical principles to live by and on the other, they had the regulations.

Your document is actually coming out in support of Doctors actually going against their ethical principles. Would you like to comment on that?

PROF RANSOM: No, I don't read it that way at all. It is a question of the security of the institution in other words if the child is going to, or the person in detention is going to be able to escape as a result of the Doctor's actions, that is unacceptable, but elsewhere in this document which you haven't and I have been looking for it now, it refers to Doctor's autonomy and it says that no non-medical person should have the right to interfere with a Doctor's decision concerning the health of the patient.

So that would then be diametrically opposite to what you have just suggested, that the Doctors involved with Steve Biko should under no circumstances have had their professional judgement influenced by the prison authorities. So it wasn't meant to say what you are suggesting.

DR RANDERA: So the principle that you are actually arguing for today and at the time was that there should have been complete autonomy by Doctors?

PROF RANSOM: Absolutely. Complete autonomy?


PROF RANSOM: Absolutely, yes. Absolutely.

DR RANDERA: Professor, my last question is again if you like reflecting on the future, sorry let me just go back one point. At the time there was a major call for detainees to have access to Doctors of their choice.


DR RANDERA: Now, again nowhere in this document do I see that as a possibility that your organisation was putting forward. Would you like to comment on that?

PROF RANSOM: Yes, just to go back to what you've said before. In clause number 6.1.3 it is of vital importance that the professional autonomy of Doctors, clinical psychologists, social workers and dentists looking after children is absolute and respected by the authorities. No non-medical person should have the power to override the decision of a medical person or dentist concerning the welfare of a person.

So that was absolutely, clearly spelt out almost in one syllable. Now the question of second opinions and the parents' right to second opinions, is also in here and I've just got to find it.

In clause number on page 6, on the left hand side of the page, the right to ask for a second opinion, the person asked to give a second opinion, should be a registered specialist in the field of the illness from which the child is suffering and should preferably examine the patient in the presence of the institution's medical officer.

If there is not a registered specialist available, the parents must have the right to choose any medical practitioner, so that is clearly spelt out in this document. DR RANDERA: Professor, I have no further questions. I am going to hand over to my ...

MS MKHIZE: Professor Ransom, I would like to thank you very much for coming forward today. As Dr Randera has been asking you a few questions, the Commission is committed in interacting with establishments, professional establishments because we have realised that we cannot take it for granted that today professional groupings will fit in with the culture that the whole country is aspiring for.

So this is the beginning of the interaction which I hope you will continuously cooperate with us in pursuing these kinds of questions. Thank you very much for coming forward.

PROF RANSOM: Thank you Madam Chair and just before I go, a reflection on the future.

Recently a ten year old child, this was in January 1995, a ten year old child died as a result of severe assault in a grossly overcrowded prison cell. Now I am quite sure that you Madam Chair and the Commissioners, will agree with me and the Paediatric Association, this is totally unacceptable. It is the absolute responsibility of the State to provide properly for children and that is what we want to see in the Paediatric Association.

I am no longer on the Executive, but I had recently been in touch with the Chairman, with the present Chairman and any resources that we are absolutely at your disposal. Thank you very much.