A School of Struggle: Durban’s Medical School and the education of black doctors in South Africa by Vanessa Noble (review)

On a warm summer evening in December 2013 a small group of individuals met at the KZNSA Arts Café in Durban for the launch of the above book. Vanessa, Julie Parle and I spoke on different aspects of this new addition to the literature on the Medical School at the University of KwaZulu-Natal (UKZN). This is an exceedingly well-researched and impressive history of an institution which occupies a central, if not unique, position in the development of medical education in South Africa. Vanessa has consulted widely and deeply through many continents and from multiple sources to produce this richly referenced and documented study. Yet it was saddening to have seen so few of its graduates, most of whom owe their current comfortable socio-economic status to the medical school, attend the book’s launch. In some respects this may be one of the messages (a curriculum which did not diminish, let alone extinguish, an unrestrained self-interest above all), and there are many more messages, derived from the unfinished goals of education described in School of Struggle.

The book should appeal to all interested in political struggles in general but in health issues in particular, student and staff organisations that opposed apartheid, outstanding historical figures during its establishment, the intractable nature of racial distrust and divisions, the almost unbelievable foresight of its founders in the 1950s on innovative teaching and learning of medicine and provision of health care for the people, and so on through its absorbing story of continuing change and opposition to racism and despotism. There are eight chapters on important aspects of the establishment and development of the UKZN Medical School, with the themes arranged by the period during which the events occurred. It is up to date, with a note on some of the recent international collaborations and pioneering research on HIV, child health and tuberculosis, which have raised the profile of the university globally. In contrast, current conditions of clinical teaching and staffing at the medical school are perilously close to stumbling and falling, it may be an opportune moment to read this account of the past to become familiar with the route which was taken to have ended at such a paradoxical and unfortunate pass.

There are three fine chapters on the earliest history of medical education and health care for black people in this country. The role of McCords Hospital and Christian missionaries in attempting to supply health training and education to black people is described in sufficient detail to convince me of many favourable, but not necessarily all, features of this historical experience; those interested may wish to read Ann Digby’s Diversity and Division in Medicine for greater detail. A major point introduced by the author is that no institution can be evaluated without reference to context. This idea of context focusses directly on the main thrust of the book, and which explains the persistent tensions and hostilities within the Medical School from its establishment to the present day. These tensions are primarily due to the social, economic and cultural fissures which exist between African and Indian students. There are revealing quotes on the role of the ‘liberal’ universities in accommodating students of colour in those early years. A number of very successful and senior black doctors agree on the hypocritical attitudes of Wits and Cape Town. For example, as one observer notes, there was a ‘grudging acceptance’ by UCT and Wits of the extremely few students of colour they admitted. Moreover Wits argued for ‘academic non-segregation and social segregation’. Feelings of resentment appear to have inscribed an indelible scar among some of the graduates from these universities.

There is much absorbing material on some key figures during the post war years in supporting the building of a medical school for black people (Taylor, McCord, Gale and others) and arguing strenuously for the prescient...