The South African Medical Association (Sama) was born out of an intensely engaging social reflection by the pre-1994 South African doctor groups. The then white Medical Association of South Africa (Masa) registered a union for doctors in 1996 in anticipation of a new government which, they feared, could possibly turn out to be champions of reverse apartheid. It was a well-endowed association which merged into one professional association with the black doctor groups. Now Sama faces an implicit secession of its union wing.

It would be irresponsible to shy away from reference to the racial dynamic which prevailed when Sama was born. It took four solid yet fragile years, 1994-1998, for the profession to put together a vision “for the health of the nation” under one banner. The four years essentially sought to find common ground for an altruistic shared commitment to the health of the nation.

If, as some argue, the medical profession is an elite profession, people of privilege, the new Sama became a melting pot of the privileged white doctors and the “privileged of the underprivileged” black doctors. At the time, Masa had what were unimaginable material assets while the six black doctor groups had only meagre assets and debts. A major part of the material assets of today’s Sama is rooted in what Masa leaders, in good faith, contributed to enable the formation of Sama. In humility and honesty, those assets should be accepted as having been significantly due to the sweat of Masa’s ancestors and members.

 Law, conscience and context

The law is generally a reactive discipline, with linear intelligence whose roof is contemporary in context. The old South Africa had efficient laws and constitutions whose intelligence was limited to their temporary, shortsighted contexts of abusive power and privilege. The new South Africa would have been a true miracle, beyond the fragile rainbow illusion, if it did any better. 

It often seems it has not.

Our new South Africa was born in the context of a looming, but sophisticatedly masqueraded global failure of capitalism and liberalism, hot on the heels of the failure of communism. Our country became a global social laboratory out of desperation. A further context was the climate of attempting to undo all sociopolitical evil overnight, through a microwaved Constitution. 

The oppressive historical past was getting replaced in a desperate whizz by a sincere commitment to restoration of rights and franchise. To fast-track such restoration on the labour front, a labour law environment was created which unfortunately led to extreme entitlement both among employers and employees. This sometimes tends toward destructive desperation. 

The question to entertain is whether the largest medical professional association in the African continent is not about to be a casualty of this. Could this also be an omen for other professional associations?

 Shared Stewardship

In a miracle more impressive than the South African miracle, the idea of “unifying paradigms” rather than groupings emerged. Those who negotiated the birth of Sama acknowledged that we were unifying two such paradigms, historically colour coded but not otherwise defined by race. 

One of privilege on one hand and that of relative underprivilege on the other. 

We unanimously agreed to let them get into a 50:50 partnership in governance and developed a visionary determination of the future of the profession. Its unity was to be expressed in the profession’s collective in stewardship of the health of the nation. This was a birthing of the concept of shared stewardship. 

Masa was bringing in 14,000 members and millions in material assets. The six black organisations had a pool of merely 2,000 doctors among them, and insignificant net worth. The push for a united medical profession was commitment to a shared stewardship rather than democratic determination of stakeholders’ power leverage in the merger. To whom much is given, much stewardship is required, but the underprivileged must take equal responsibility. 

 A new revolution needed

The whole country, and not just Sama or the medical profession, but all professions, need a new revolution: honesty and humility. Recent media reports of internal problems of Sama and its labour arm, the South African Medical Association Trade Union (Samatu) are cause for concern. They truly reflect a deep-seated internal organisational implosion. 

Medical doctors join a professional association for myriad reasons with professional services trumping all others. The provision of labour relations services by the professional association for its members who are employed in public service does not detract from this fact.

There are fundamental contradictions in the manner in which labour laws were designed, and the sacrificial ethic, and even the rules and values governing the medical profession. Abuse of the rights culture has a tendency to drift toward a corrosion of social ethics and responsibility. An honourable profession which protects the lives of humanity dares not find itself on that slippery slope.

 Naive opportunism

The non-profit Sama is embroiled in a series of court battles with the administrator of its “trade union” arm Samatu. A small clique of doctors with questionable leadership bona fides took Sama to court and obtained a judgment which imposed an administrator on Samatu. They are shortsightedly pushing for a split of the association, with apparent focus on a claim to the resources of Samatu’s parent body, Sama. 

This push has no members’ mandate but has won the day through the courts so far. Advantage is being taken of what can be reasonably regarded as inept impositions of the labour law on professional associations. These naive breakaway doctors have no genuine interest or laudable track record in representing public sector doctors.

The Sama-Samatu fight is nothing more than a scramble for the financial resources that Sama is perceived to have. The claim to these resources by a factional clique smells of politically sponsored and naive opportunism which amounts to daylight robbery with probable abuse by organs of state, judging by the ease with which they have so far found rather strange traction through them. Or might it be because of the intrinsically linear intelligence of the law? 

Any dishonest runaway with Sama’s resources, will not serve the needs of the employed doctors but the fate of the profession, beyond formal Sama membership, would be prejudiced. 

In the past few years, South Africans have found themselves besieged by opportunistic corruption and greed among those in positions of influence. This presents the medical profession with valuable lessons which are to be taken seriously, for the future of the profession, and perhaps all professions.

 Humility and honesty

The collective conscience of South Africa is increasingly on trial before the courts and commissions. These will not restore humility and honesty. The conflict between Sama and Samatu attests to the deeply complex psychology of South Africa. The nation at grassroots must rediscover its moral values before all social institutions and organisations are destroyed by self-centred opportunism. 

The medical profession has a duty to demonstrate its intrinsic social ethical conscience and set itself above all unionist clamour for rights. What the medical profession achieved when founding Sama was and is still relevant. 

South Africans deserve a medical profession which collectively has a deep social conscience and which resists the temptation to be sucked into politically correct actions in addressing social issues. The professions owe it to the nation to resolve matters without putting at risk the national assets of their united associations which contribute immensely to respective standards, policy and regulation. 

Leaders of the professional associations need to embark on a new social revolution which is to be firmly anchored in humility and honesty. DM/MC