Apartheid and the Making of a Black Psychologist - N. Chabani Manganyi

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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 that I needed to master the basic tenets of the clinical conversation.

      As was my habit throughout my career, I read myself into important but unfamiliar knowledge domains. I studied all the neurology and neuropsychology texts I could lay my hands on in order to develop a working knowledge of the brain and the clinical assessment of higher mental functions. Fortunately, such texts were not difficult to identify and to secure in the extraordinarily well-stocked academic bookshops of Johannesburg in those years.

      Three other experiences opened the way for me in my search for more structured and meaningful ways of working with patients, especially within the general hospital setting. First, the University of the Witwatersrand ran one of the most advanced speech and hearing therapy departments in the country, under the able leadership of a no-nonsense elderly female professor, Myrtle Aaron. I had watched the speech therapists working in my ward and in other locations in the hospital, and I soon learnt that their specialty included the diagnosis and treatment of neurologically based speech and hearing disorders associated with brain dysfunction.

      From my earliest introduction to Soviet and Anglo-American neuropsychology at Baragwanath, two areas attracted my interest. The first was what I describe as the neuropsychology of the body, the body image and its disturbances, closely associated with my doctoral research on paraplegia. About ten years later, interest in some themes of the clinical neuropsychology of disturbances of higher mental functions following head injuries took centre stage, a development which was intimately associated with my involvement in forensic and medico-legal work in my private practice and in the South African Supreme Court in the 1980s.

      While at Baragwanath I undertook a close study of Luria’s book. In 1981, following my appointment at the University of the Witwatersrand, I was able to run a properly organised, part-time private practice with rooms in Commissioner Street in downtown Johannesburg. There my work included a significant number of medico-legal cases, often involving adults and children who had sustained head and other injuries during motor-vehicle accidents. It was during this period that, through study and practical application of techniques of neuropsychological examination, my knowledge of clinical neuropsychology expanded beyond Luria to include countless other practitioners, among others Australian neuropsychologist Kevin Walsh.12

      In retrospect, what seems so remarkable are the detailed typed notes which followed my reading of the neuropsychology literature of the day, primarily as preparation for appearances in an inhospitable court environment

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