I have been charged with misconduct – for the second time – for criticising the MEC Health of my province, Bevan Goqwana for worsening the health services since he took over. I said if he is running a private ambulance service (evidence is there), ran a private practice when he was Superintendent of Umtata General Hospital, made false claims to medical aids, had stolen drugs found in his surgery and also failed to spend R33 million earmarked for HIV/AIDS containment in the last financial year, then he should be charged and removed. I face five charges of misconduct for bringing him and the department and the country and the Constitution into disrepute. Tell me what you think.

Is a public health doctor bound to talk if he notices corruption and inefficiency, even if he has been warned to shut up or clear anything he wants to say with his superiors? Can a doctor in the public service be an office-bearer of a political party? Is it not better to keep your head down and obey orders? The former MEC Health Dr Trudy Thomas has just resigned from the ANC and has given cogent and powerful reasons for doing so. Another doctor Dr Pat Praciado who worked at Victoria Hospital in Alice was shot dead three years ago when she threatened to expose corruption in the hospital. The hit men were arrested and charged. They in turn accused the superintendent of her hospital of offering R40,000 to despatch her. Today it is the Super who is retired to an opulent farm nearby. The honest police of Alice – corrupt in other cases – could find no evidence to link him to the murders.

Yes, ethics is great, but let us put it into practice a little bit. Let us not be like those Free State ethicists who said recently that the Biko doctors were treated too harshly because, after all, they were just part of the mores of their time. I gathered lots of trouble in the ’60s and ’70s for speaking out against apartheid at that time. The ethical climate has not changed. I am now shunned – as I was then – by ordinary people because they could get into trouble if they spoke to me. Could it be ethically true that the more things change, the more they stay the same?

Dear Costa,

I am not knowledgable enough to comment on the veracity of the charges you aired publicly against the MEC, but clearly similar issues apply to us working as academics. Economic rationalist VCs vandalise currently Australian universities. Unionists like myself picketed our institutions (I understand that ‘we’ don’t do this in South Africa for one reason or other) in protest, for instance against the culling of humanities faculties (I write on this in the May M&Gs education supplement). Bottom line is: if we criticise our institutions publicly for this sort of thing, or if you criticise managers of hospitals in which you worked, they will come down hard on us. Arguably we did/do the ethically correct thing, but their response is predictable. If our criticism is correct and they acted unprofessionally, and unethically, we might be able to occupy the moral high ground. We certainly had/have an obligation to act under such circumstances, but we should not delude ourselves into thinking that they will take it lying down. Eventually we pay a price for this (I once lost a job I badly needed financially for speaking my mind). All we can probably hope for is to generate sufficient publicity and solidarity to carry the day. Unfortunately, there is some empirical evidence that, for instance, whistleblowers have been unable to ever find a paid job in their profession again, even though they won their court cases etc.

There is some good news on the horizon perhaps: My students tend to be furious about what’s going on in public hospitals these days (with regard to availability if HAART for rape victims for instance). When I ask them whether they think that they have a moral obligations as (future) health care professionals to speak out publicly against the government’s stance on this (and other) matter(s) they fairly uniformly reply in the affirmative. How many of them will eventually have the courage to stand up and be counted – your guess is as good as mine.

Warm regards Udo