at the rural population. FOR Marxists in Czarist Rus sia, China, Cuba and Vietnam, the land question was tightly bound up question But South Africa B unique in this regard in that it has no peasants. South Africa is the one African country where the stage is set for the proletarian revolution, argues SAM MHIONGO. Here he begins a series on the prospects for revolution in South Africa with a look with the peasant the farmers.
dening The particularly the tion. This Rance:
SLAVE WAGE Dispossesproletarianisation CUTTITS labour.
The manufactering •border irens tucen Naral coast.
Such a package, itself meagre supplements the meagre carnIngs of other members of the family who sell their labour to The noose of South African rightes, in the rural areas. Thi administered white, supplies the bulk of the force and administ vealed expropriation of the blacks' land in South Alrica was rapid and ruchless compared eren to England in the time of the Industrial Revoluruthlessness drawa broken down all rural resistThe The only escape route front absolute rural poverty is the cave-warehour or the BE pratory labour system. Agricatering and pass laws. services all rely on this system.
It is the migratory labour laws too that mean that white workers can afford to hire domestic they may rural proletariat is con- a privilege lined by law to these sectors near the Bantustans. Along tre borders beMozamhique and the North Eastern Transvaal, the the sourhern Orange Free State and the Western Transvaal are large numbers of forcien migrants from Mozambique, Swaziland, Botswana and Lesotho. For political reasons mutualty acceptable to South Africa and these neighbouring blackstales the extent of foreign labaur is not TeThis labour plays an impor tant part in the maintenance, and in many respeets the hold ding down, of the native black warkets wapes. Migrants in the urban areas are largels South Africa's own rural blacks - the only exoption being the mining industry where over 80 per cent is wages for farm workers and high rural unem ployment drive rural blacks lo the urban areas despite arrests and deporcations Migrants live specialls built hostels for single people in ghettos like Seeto. But not rest the substandard housing in the aren reserved for the sek urban blacks. Isclated Tram the urban prole tatiat, where they can and have been used by the police to help crush urhan hack resistance.
Cotil the 1950% migrants lived in poor white areas. The deci sion (for reasons of apartheid) to move them to the ghetios creates greater social inter action with the settled black population, so the task of organising a united black resist ance should have easier.
But this cannot ye happen since the working class has no party of its own.
Nest week: foreign migrants and the urban working class.
Apologies We inudvertendly forgot do mention that the minutes of the Zimbabwe Internal seitle ment інна рос0 В а week's issee were made availahle to us by Counter InformaLion Services, of 9 Street, Londen W1. Our apo logies THE POLITICAL sitation in the Middle Fast has meant that Mark Jackson's article Czechoslovnk dissident FrantiKriegel, promised week, hus been held aver
ectos te de a "In medical school, the common image of disease is D assumptions about medicine Inhibit the development of a form of health care more responsive to our needs. We are concerned with doctor:" attitudes lowards patients and other health workers, as well as beliels aDOSE 10E medicine in health care, about how it should be practised and atost the Here wel medel teolgyd ideology"Doctors huve authorils aver 9si health This in justified within the medical ideologs. To challenge the authority of doctors we need to question the underlying ideologs, particularly as it is accepted ly mans ether health workers and peopie generally.
Who Goes to Medical School?
Most medical students have middle class backgrounds, They piten share common assumptions about professional autonomy individual responsibility and their own intellectual superiority. The class bias in entry is largely due to working cionally much smaller numbers. This arises from inequality in education as a whole, where working class children are not given the same opporsunities co obtain the necessary qualifications to enter medical school and are discouraged frod teachers and parents.
Although medical schooh de bot seem to actively discriminare against working class applicanis. discriminate in favour school applicants and children of loctors. Thisis untelated to academic ability, since, for instance, candidates from state schools are on average better qualified in terms of O and A-levels.
The narrow class background of medical sudents and the lact that most come directly from school without any Work experience nourishes elitism. In addition to elitist attitades, students come with ideas about health care which are actively spread by media: the "leadership" role of the doctor, the value of high technology treatment, and curative procedures. Medical education does 113.1 thesc strengihens them.
Doctors' Attitudes Towands Patients and Iliness In medical school, the common image of disease is that something patient, a problem with their physiology or biochemistry INTEICUTO environmental or social factors, Even whiere external factors are reconiscu. they are underplayed. For example, the therele hicera. bad bouslne conditions and inadequate nutrition are known lo nav a batin the onsco but the bacteria is A patent in a teaching hospital is essentially rogarded as a functionting piece of machinery which has to be repaired: This is a bioenpincering* approach to ilness. 11 imples a sharp distinction between the pathological and •ITE which is particularly misleading in the area of mental illness" and chrons disease. The bio-engincering approach assumes that a person can he understood as a set of systems, one llEness:
This approach ignores the subjective and emotional aspects of all iliners, which are just as Creal" as the his ¿hemistry, as well as the social origin of the complaint The modical student learns ta consider patients as n collection Of septoms from which a diagnosis and a course ot trestment can be derived.
"interesting patient' is the onc with a Tare and comnexdis9sc.
Intervention with drogs or surgery is considered the most efective way of treatine illness, chough in realicy these metbods are of limited use with the increasingly commion chronic, generative illnesses and are sometiones dehumanising patients.
Preveniative rucasures are no longer totally ignored in medical education amare uf "risk faciors' influencing the CUECE DESAS UNESC TAGO the patient's personal responsibility, whether the factor is smoking, Lack of by public AND THE POWER FASCIHATED HIM, BINDING HIM WITH SPELL-STRANDS OF DESIRE...
HE BEGAN TO malSOS CANOSAS HECTALO SCULEL only individual solutions sidered, not the necesite for social change you assited eilher that il was SOLE QUE normal, fault or that sou were geoctically Medical students learn to regard The majority of training takes place ir a hospital, where patients are either too ill to be anything but passive or are intimidated by routine and environment, as most of us are. A "troublesome' patient is one who asks too many cuestions. A 'nonpessible compliane" palieni is une who docs nol take the prescribed drups.
Class distinctions can be seen here. While middle-class patients are given more time by doctors in consultarion The TELEVII SABECECOS EECHELICUE more explanation, explanation for their treatrient or ace way. Parients are generally assumed to be ignorant of their Uness and of Haw theis hodies function.
psychuatric Siciology and Psychology Recently sociaing» have been introdnced no the tibdic9 curriculum. There are several reasons why we do not expi ca lo take much change in medical ase considered in individual terms as | atticades oi la their practice as First. many accitudes and assumpEXPERIMENT...
medical school, reinforced, as we are con- have argued above, not so much by the curriculom as by the organsation get ill it is often of teaching and the example of other doctors. Students are niten hostile to sociology or psychology, consideone them irrelevant bo opinion many consultants agree with.
Secondly, the asedical course designed around acumulation of Tacts. that cither sociolosy and perchoingy the hospital are taught in a "factual" way and lese Many polenta. prevaiting medical ideology or in a challenging way and ane detested the majority of students who foo constrained by the next set of exams and want to avaid ambiguits: and psychology remain bodie tEnC working class medical student relationships between society and Ell health or about the importance of a patronising matient's psychologicalstate. But they de not automatically lead to a prenter solitical conminent lowards chans lor to a preater understanding of th patien: who is ill. There is a dancer of bio-engineerute approach and psychologs where thie doctor is simply aware of mere 'sympiom:"
student Medical Ideology and Women wolen are an prevailine social attitades spill over a problem with their psychology or women patients medicine, an herween doctors exams This means health challenging the perhaps helo the think about the HIREHEADIIIHE sociology and psycholony replacing a laugh 100l.
The actitudes of doctor towards cumple how $0.00 The rather In into medical idcologs. Discrimination and prejudice againsc women are clear in cheir subordinare position in health care work and in the treatment of The division of labour la hospitais nurses, posindominanlly a sexual one. The doctor (usually male) assumes the dominant role, retainine control over chignosis well as ircatment, while bther workers (predominantly other lemale, except for portersi take on pecific tasks without real autobomy Until recently, only a small propor tion of medical students wete women In the Last 10 rears, theit entry into modical school has esco te approximately 30 per cent of the intake It is too carly to tell how chis will affect attitudes of the medical profession losas women Aireade 11 Is Cles that women docrors will be sheeled specialities and will be restricted in their careers by th Science absence of child care facilities ans opportunities lor pacl-time work.
Picture-slides or pin-ups of mudes are sometimes used al the beginning of'a lecture to establish rapport with the students'. Blatanciy sexist remarks are olien made, raising a laugh al the expense of women students (who le's not that women aren'1 equal, they're just dumber', DI "ane well-built parient Text books are still written from an exclusively male point of view, ofen with explicit stercotyping. Obscetrics and synacoology text books are the SOCIALIST CHALLENGE 23 March, 1978 page 13 quote from a recent work: The traits" thar compose the core of temas personality are feminine narcisism masochism and passivity;! The sexis in medical educacion becomes transTated into unresponsive, discriminatory medical care for women: the pendency to diagnose many women's complaints as "psychosomatic ig roance shout women siness and Medical Ideology and the Organisution if Health Care hospital-based training of medical students not only influences the way doctors consider patients. it also affects their view of health care orgunisation and relations with niber ensidered to be The himal a nospital treatment The comunity it considered, if at all, to be an amorphous mass outside the hospital. which sende mallunctionase individosis lo Tepaired. Peoplc community are considered to abstract groups ('the elderly, "the disabled') or individual consemers, than MOLERLIAL participants in health care and in political struggies for healthler bving and working conditions.
CALESCUI organisation and priorities of health is thus reproduced by the hospital based organisation of medica. education The sexism of many doctors, their narrow: class background and clitist the barrier bermeen doctors and other health workers. The elitism is reintorced by the total separation of medical frot tursine and (so called) paramedien training, as weli as by tbe hiccarchica! organisation of the teaching hospital with the doctor ar the top antitudes of doctors does not creale the subordination of nurses, physiotherapists, and whereby the doctors retain control of diagnosis and treatinent This is an SUELO CELLISE social relations and institutional spheres of control developed bistorically But, a bellef in their own superiority strengthens and justifies the dominaLion giving most doctors attle interest in trying to change the socsal relations of health care:
Prospects of Change Medical ideology helps prevent the provision of patient centred elective health care, as well as a wider undersanding of how ilines is produced But it is not going to he changed by pressure from within medical schooks For not only does the ideoloay serve the apparent interests of most medical shadems and doctors, DITE serves those of the medical industrial complex'. atle curan wal preventon sald rather than community care encourases expenditure on health related conmodițies La wider sense. by obscuring the production of illness and myssilying health tare medical defleets criticism of a capilalist economy and reintarces our lack of control over pur health.
Altough we do not expect medical ideologs lo be transformed within mediclechoos there will always he a minority of medical studenes and dissatistied the prevailine Al the moment tocy arg isolated. There is a newd for them 10 work rogether and make links with workers, to anderstand what role thes can play in fighting for change in lealth care HEALTH GROUP COLLECTIVE THIS Is aslightly uhhreviated version of an article that appears in the current issue of the magazine Science Cor People, produced by the British Society for Social Responsituity in issue, entirely deroled to health, aiso incledes articles on The social prodaction of il-health"; Siave the EGA': the role of the state in determining health provision: alter native forms of medicine: and a womun's right to choose.
Science Jer People members of BSSRS [Memhersbig Fees are te tor tan memoers ung 11.50 for unemployed and students]:
or on subscription lor D2, from BSSRS, 9 Poland Street, Lenden W1 Individes! copies are 30p plus postage.
support the whole programme of the | These groups, mostly consisting of geneine political divisions. Young SOCIALIST CHALLENGE 23 March, 1978 page 14 the leadership over the hends of the
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patient, passive objects of care.'
chercise or poor housing. Even when | tions are already present on entering that something goes wrong within the individual biochemistry unrelated to environmental or social factors...Medical students learn to regard patients as Where do come