ONE MILITARY HOSPITAL
This chapter contains material about 1 Military Hospital that does not relate specifically to the psychiatry and psychology services, or the staff and patients of those departments.
BATTLES WITH HOSPITAL ADMINISTRATION
Medical services ran into difficulties when our recommendations reached the hands of the administrators. A senior administrator admitted not knowing what the differences were between psychiatry, psychology and social work, and demanded a three-page report on a patient before she will concede to trying to get a transfer arrangement. It doesn't seem to matter what is written in those three pages, just so long as it is the length that she wants, as an indication that we were taking her seriously.
One patient who had a drug problem was recommended for a transfer to Johannesburg so that he would be able to have the emotional support from his family that he needed to keep himself off drugs. There was, of course, more to it than that, but that was part of the report. The recommendation was turned down by an administrator, and the reason given was that he would be able to get hold of drugs more easily if he was transferred to Johannesburg, so she had arranged for him to be transferred somewhere else instead! There's not much we can do about that, except to tell her that she then becomes responsible for anything that happens to him, which means that if he commits suicide, we can tell her 'We told you so!', and she might take us more seriously for a while after that.
We saw a patient who we believed would function better if he was transferred to another unit and we made a psychiatric diagnosis and recommendation for the transfer. The patient was transferred, and his functioning improved. Normal logic would be that the psychiatrists had made the right decision. Army Administration logic; "Oh, No! If the patient doesn't have problems now, then he didn't have problems in his previous unit, and psychiatry doesn't know what they're talking about, and they're just making work for us, so we will ignore the next twenty recommendations to come from psychiatry - just to show them who's boss." It was amazing! It almost seemed that we needed the occasional successful suicide just to be taken seriously!
In one case, we recommended a transfer, which came to pass, and the person's functioning improved. Next thing we knew he was transferred back to the unit he had been at originally. Inquiries yielded that the decision was taken by administrators who interpreted the situation as; "If his functioning improved at a second unit then it meant that there was nothing wrong with him in the first place, and we're not going to let him get away with messing us around (making us do our jobs) so we'll send him back to where he started out from."
The army has psychologists, psychiatrists and social workers, but the administrators choose when to take us seriously and when to ignore us.
A social worker told me about some remarkable research conducted by the army into attempted suicides; they found that more suicide attempts were made by G3s and G4s than by G1s, so the recommendation was that the categories of G3 and G4, be scrapped, (and that people could only be classified into G1 and G2 categories) after which the researcher presumably believed that the incidence of attempted suicides would drop substantially. (The mind boggles!)
"THEY ALSO SERVE WHO STAND AND WAIT"?
At 1 Mil, I arranged for a Staff Sergeant to make about two hundred photocopies for me. They became lighter and lighter until they were illegible. I pointed this out to him, and he seemed to notice it for the first time, but he carried on with the copying. I told him that we were wasting paper, and saw that the machine was indicating that more toner was required. He seemed to be waiting for me to tell him what to do. I asked him for more toner, expecting there to be some in a nearby store room, but no! The staff sergeant told me that we would have to wait until the manufacturers delivered some. No-one had thought to order stocks of something that would run out.
I heard rumours that one department or unit ran out of ruled paper, so they photocopied lines onto a substantial number of blank sheets. I don't know whether to be horrified by the waste, or to be impressed with the initiative shown.
THE ABUSE OF CONSCRIPTED DOCTORS
Even in civilian life, junior Medical Doctors have a particularly tough time. They have to work ordinary office hours, but in addition have to do casualty duties fairly often. This can involve draining work throughout the night, but they are not allowed time off the next day. No, they have to work the full day the next day. And this was decided by administrators, who work office hours only - and even that is frequently questioned.
This creates the attitude of 'you people are deliberately messing me around, so I'm just not going to co-operate', but we're professional people first and foremost, and we realise that if we were to 'goof off' as much as the administrators (who make trouble for us, and don't do what they should to back us up), its our patients who will suffer - people who are not involved in the conflict - so teeth are gritted, and it is bourne, but the army would have difficulty if professional people did not see themselves as professionals first, with codes of ethics to adhere to.
National Servicemen doctors who are called up to defend their country may end up working to give a free service to dependants of members of the permanent force. Paediatric services to Permanent Force dependants can hardly be seen as defending the country. Admittedly working in a paediatric department is better than walking patrols in the Angolan bush, so the doctors aren't complaining. But the sacrifice is theirs - it is not in the interests of the country to provide a free service to the dependants of the permanent force, a service which is abused because it is free. National Service doctors are being used as cheap labour, and the military has to power to make this happen.
A group of Generals were having a social gathering within two kilometres of the military hospital had a doctor and an ambulance on standby on site just to attend to them should anything happen to them during the party. Were they that frail? Or was it that kind of a party?
A very tasteless and adults-only story coming up next, but its quite classic of what we see of marriage difficulties between senior officers and their wives. This is quite a definitive story, in my opinion, but, once again, not for the faint hearted. The story was related by one of the senior psychologists, who was seeing the wife of a high ranking officer, and the husband was having affairs all around the place. The wife was describing the average morning in her life. Her husband would get up first, and he would dress himself in front of the mirror, admiring himself with all the rank on his shoulders. Wife, lying in bed (hair in curlers, smoking a cigarette?), reckons she is unimpressed, because "I know that he's been wearing the same pair of underpants all week." Then she starts to get up, and sits on the side of the bed, and he comes over to her, and waives his penis in her face, "like a duster dusting off a shelf. ... And then he wants me to put that THING in my mouth. Yecch! Sometimes I think I should bite it. Then he'd have to go along to 1 Military Hospital. What would all the young National Servicemen doctors have to say about that?" (Again, apologies for the poor taste - no pun intended!)
Amongst the Permanent Force (especially among the wives) there is the belief that a doctor's competence is reflected by his rank; when all doctors have done the seven year medical training. No permanent force wives wished to be seen by a Candidate Officer, but will settle for a full Lieutenant, but would rather be seen by a Captain, even though all may be doctors with equal experience and proficiency, or conscripts might conceivably be brighter than people who joined the Permanent Force ...?
Medical services in the defence force are grossly abused, largely because they are free. Most of the abuse come from members of the Permanent Force, while most of the medical services are actually provided by National Servicemen. There are many cases where a Permanent Force member will think nothing of getting into his car - or, more likely - a military vehicle and drive forty kilometres to the nearest military hospital to go and get aspirin or elastoplast, which they could more easily have obtained from their local chemist, but are given free at a military hospital.
I include a story told to me by a national serviceman who had the job of manning a pharmacy at his unit, though he had no medical training, and was not even a 'medic' (In the SAMS). He reported that patients; officers and NCOs would arrive and demand medication, and he would have no choice but to hand it over. He was not a very reliable source of information, and I doubt that he had access to scheduled (restricted) medication. He probably exaggerated aspirin and sticking plaster through his Histrionic personality into scheduled medication. Maybe I'm wrong!
Doctors working at casualty often complain to higher authorities about the apparent abuse of people arriving at casualty at all hours of the night, for relatively minor ailments. The doctors believe that such patients are often attempting to get the next day off work, but the higher authorities (PFs defending PFs against National Service 'upstarts') assure the doctors that the patients are patriotically avoiding reporting sick during office hours. Most other employers allow their workers to attend doctors and dentists appointments within working hours.
There are cases where senior officers (or their wives) try to order doctors to prescribe certain medicines which they like, without allowing the doctor to examine them and decide on the medication himself. Some virtually arrive at the doctor or chemist with a 'shopping list' of scheduled drugs (those that can only be obtained with a prescription) and expect these to just be handed over, because they outrank the doctor. In some situations, the doctor can report such an attempt to intimidate, and the abuse of rank to higher authorities, after which eventually the offender might be politely asked not to do that again. Other doctors do not have the opportunity to report the matter, which is a very unsatisfactory arrangement.
REVENGE IS SWEET
Doctors are not completely powerless, and there are a variety of ways in which they can fight back. One of these ways is to back date a prescription so that it is no longer valid, and other methods are to write a prescription for a day's supply.
A story that I found particularly satisfying - something of a legend in the medical services - is of a senior officer who brought his family into casualty at two o'clock in the morning, just before leaving to go on holiday. He brought them in for a check-up, and the doctors on duty had to be woken up to see them - definitely not emergency cases. The story goes that the doctors had their revenge; they admitted two of his children to hospital with suspected meningitis; apparently this is the best reason to admit someone who is perfectly healthy, because it cannot be proved that this diagnosis should not have been made.
Clive W. was called away from coffee after supper this evening to go to casualty. He says that he hates 'being at the beck and call of idiots'. Most of the casualties at our hospital are by no means emergencies.
Something quite sickening is that although Permanent Force members are able to abuse the medical services in such ways, no dependants of National Servicemen are allowed free medical attention, and even National Servicemen themselves are always suspected of malingering. National Servicemen are paid way below what they would have been earning on 'civvy street', while Permanent Force members are paid well. It would seem to be more fair if a National Serviceman's dependants could get free treatment from the army while the man was actually serving, but this is not on. No wonder Permanent Force members are so despised. One National Serviceman calling another a 'PF' is a term of (light hearted) abuse!
I believe that if a National Serviceman wears glasses, and if these are damaged or broken, they can only be replaced at Army expense if their owner can produce independent witnesses to certify that they were damaged while he was carrying out his duties.
SECURITY AT 1 MILITARY HOSPITAL
1 Military Hospital has a security officer, Major Human (consensus suggests 'inhuman' would be more appropriate) who had been a sergeant major with artillery before he did a conversion force and became a major. He's very deaf, very paranoid and takes himself seriously. Major Human is famed for telling everyone that the ANC is everywhere, and they know us better than we know ourselves - this does not worry me, as I have found it convenient when I have forgotten what time I am due to see such and such a patient, all I have to do is to go and ask one of the gardeners. He says we must check under our cars everyday that no limpet mine has been attached underneath, and we must report anything suspicious to him immediately.
Major Human had a dummy or defused limpet mine, probably a 'surrogate pet' to him, which he placed all around the hospital buildings hoping that people would take more of an interest in security and report it, but no-one ever did. If I had ever found it, and if I thought I could get away with it, I would have stolen it.
People might have become acclimatised to it, saying "Oh, look. There's Major Human's limpet mine. We'd better tell him we found it when we have time." But it might be a real one, which no one would take seriously. The old 'Crying Wolf'.
Major Human might have done better to have set a reward for anyone who could report to him where any limpet mines were found around the hospital, but with National Servicemen's poor pay, the hospital service would quite likely grind to a halt while National Servicemen ought over themselves to scour every inch of the hospital buildings.
Late in 1987, I attended a compulsory lecture on 'Security', given by the obese deputy RSM of 1 MIL. A major theme was "Don't give any information to anyone ever." He mentioned, with delight, a possible breech of security during the time that the Russian pilot of the Samora Machel plane was being treated in 1 Mil, after its mysterious crash in 1987.
He told that some technician had labeled the samples 'Boris', as a joke. This could have had 'horrific' consequences, in that hostile forces might have discovered that the pilot was being treated at the hospital before 'those who know best' decided that the time was right to announce that the Russian pilot was being treated at 1 Mil. (Where else would he have been treated?)
He said that 'Boris' was a Russian name, and anyone could have worked out that Boris was a Russian. No-one who is not Russian could be called Boris. But it was late 1987, and Boris Bekker of West Germany, with no known Russian connections had won Wimbledon, if I remember correctly. Nobody raised this point with the man.
In spite of Major Human's efforts, there was a very relaxed attitude towards security at 1 Mil. I was sitting outside waiting for a bus to one of the military installations in town when I noticed an oriental person wearing a green uniform with the rank of a Brigadier walking towards me. SA military personnel are supposed to extend military courtesies (salute) higher ranking personnel of armed forces with whom SA has diplomatic relations. I didn't know what country he was from, so I just ignored him, as did everyone else.
To infiltrate 1 Mil would not involve blackening one's face and sneaking around in the dark. What with SWATF and all the independent homelands having their own armies who are treated at 1 Mil, we are so used to many different uniforms in the hospital - and are more concerned about who has to salute first - that I'm sure someone could walk into the building dressed as a soviet colonel, and he would be saluted! Problems might arise if you bumped into Major Human, but he would probably be too busy hiding his limpet mine, or trying to remember where he had left it, to notice.
We had occasional lectures telling us to be ever vigilant, and to watch out for anything unusual. Rene V. did a superb send up of this, suggesting that she should report: "Major Human, you are going to be so proud of this Captain. When I was driving to work today I saw a black man that I had never seen before."
One of my clique was Duty Officer at 1 Mil one night when a psychiatric patient relieved the guard on duty ... A guard standing beat outside 1 Mil hospital heard another soldier come up and announce that he was the relief guard. The first guard gratefully handed over his rifle and ammunition, and was immediately taken prisoner with it. He was then marched at gun point to the chief matron who was told that she had exactly twenty minutes to get all the black patients out of the hospital. Somehow the situation was brought under control without violence - did they use a blow dart? The racist was not a South African, but came from Zambia or some such place.
The above are all light hearted stories, but I believe that there was a secure ward, Ward 13, into which all soldiers from the operational area were admitted, as well as all sorts of 'sensitive' patients. Apparently the entrance to this ward was manned by armed guards. I don't think I was aware of its existence while I worked at the hospital.
DIFFICULTIES ENFORCING CONFIDENTIALITY
The rank structure led senior officers to have the impression that they have the right to know all the details about 'what's wrong' with any soldier that 'they had allowed' to be sent to hospital. They are just being curious, and not necessarily interested in doing anything to help the patient. The patient is someone whom they can order around, which to them, means they have a right to know all the gory details. This information is, of course, strictly confidential, but it is sometimes difficult to brush them off.
Other officers phone up to tell us that we don't know what on earth we are talking about, and that the patients is just malingering, and that there is nothing wrong with him. Outside the army we could ask such a person what his qualifications were that enabled him to make such an assessment, but that would be imprudent in the army situation.
All medical records of people seen or treated at 1 Mil were typed into a central computer which was networked to the other military hospitals, and possibly some of the larger sickbays. An advantage to this was that we could get a history of most of a patient's army medical history at the press of a few keys, but the disadvantage was that too many people had this access. True, there were passwords, but one of these enabled one to make a hard copy or printout, and these could be passed on to unauthorised sources.
There were stories of officers from the patients' units arriving and demanding print outs from young National Service privates who operated such computers (already a dodgy practise), and intimidating the youngsters into handing over such printouts.
Amongst the staff, we joked about practical jokes you could play on your friends, like adding all sorts of compromising information to their medical records; like repeated aids tests, treatment for venereal diseases etc.
I will admit that, during free time, I looked up some of my school friends on the computer so see if there was any information on them. I found that a school friend that I had known had been fatally injured in a car accident during his national service, had been treated until he died by a Permanent Force doctor that I bumped into a couple of times a week.
I also found that one of the youngsters that came along on some camps with me in Sasolburg had been bitten by a puff-adder during a bush phase of his basic training. Most of the people I tried to look up were not on record.
Some of the computer-literate staff typed their own reports in to the computer, but most of this typing was done by ward secretaries/data typists. These ladies would often complain that the reports were too long - or contained repetition of what other medical personnel had written, and there were rumours that they deliberately misplaced or 'lost' reports which they considered to be too long.
I always kept carbon copies of my reports, to prove that I had written them, if this was ever queried - is this paranoia. Some of these carbon copies came in very useful with compiling this project.
THE ARMY CULTURE OF THE REGIMENT
When one checked into 1 Military Hospital, one had to join 'The Regimental Fund'. One had to pay membership fees on a monthly basis. No-one seemed to be really sure what the regimental fund was for, but the idea was implanted that if one's wife became sick, then they would send her flowers. This never seemed to happen - even to people who had sickly wives.
Apparently there was an army recreational camp, to which all paid up members of the regimental fund were entitled to holiday - at reduced rates! How would it be to holiday amongst other military personnel, and their R-Kid families. Who would want such a holiday? PFs obviously!
We have standing orders circulating through the department saying things like 'SAMS staff must make sure that they salute appropriate ranks in the Police, Railway Police and Prison Services.' Policy statements tend to be headed with the Afrikaans that seems to mean 'Extracts from the writings of the Surgeon General'
This creates an amusing image to me - that of the Surgeon General sitting down and just writing reams and reams of all sorts of thoughts as they enter his mind, while avid disciples read excitedly through the output and sent copies all over the country. Or else I ponder what was written before and after the extract which I have to initial to show that I have seen it. A letter to his mother, perhaps?
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