5 April 2002
Programme Director,
Minister of Health,
Members of Executive Councils,
Provincial Finalists, and
Honoured Guests
I thank you for the opportunity to be with you on the occasion of presenting the first National Cecilia Makiwane Awards.
Ceremonies of this nature are truly symbolic events, where a few exceptional individuals are selected for direct recognition, but where at the same time we are all celebrating something much bigger. In this instance, we are saluting a tradition of professional nursing in this country that stretches back for a century and still stands proud today, in a new climate and facing different horizons.
Cecilia Makiwane, despite her old fashioned Victorian appearance, remains a powerful symbol for our nursing profession at this time of transformation. I am sure that all of us are aware that she became the first black nurse on the continent of Africa. In fact she did so just seven years after professional nursing training first became available in this country.
From today's perspective, Cecilia Makiwane's life sounds commonplace or even dull. But viewed in the context of her times and the society in which she lived, she was quite extraordinary.
Cecilia Makiwane broke new ground. She was a pioneer and a transformer. And clearly she had the staying power, the fire within her, that enabled her to complete the journey on which she set out. These are qualities that speak to many of us in this time of change and opportunity.
I would also guess, without really knowing this, that her choice was strongly guided by a sense of morality and Christian values. And to this day the South African nursing profession bears the stamp of its missionary roots.
The nursing profession in this present age of reconstruction and renewal is deeply reliant on two fundamental qualities suggested by the life of Cecilia Makiwane:
In the field of health care, international research achievements are mind-shattering. It is sometimes hard to keep pace - when yesterday's science fiction almost routinely becomes today's reality. At the same time, in developing countries, we are increasingly aware of the degree to which poverty and all that goes with it, in terms of hunger, lack of shelter, exposure to risks and dangers, continues to subvert the health of huge numbers of people. In countries such as ours, we need somehow, to fuse the application of sound scientific interventions with a developmental approach to health.
Since 1994 our Government has taken steps to encourage a more developmental approach by adopting a primary health care-Ied strategy in the public sector. We have made significant strides along the road to implementing this, but we still have a long way to go.
Our developmental approach demands that we respond vigorously to the reality that in good measure, we are confronted by a whole range of diseases of poverty. Our health intervention must therefore be buttressed by a comprehensive programme aimed at the reduction and eradication of poverty.
One of the challenges to nursing in the decades ahead will be to provide training that enables nurses to play a leading role in expanding a full-bloodied programme of primary health care.
Our pubic health system is straining under our complex and heavy disease burden. We are stretched to extremes across three fronts - dealing simultaneously with growing rates of communicable diseases, non-communicable diseases and trauma. We urgently need sound planning and highly skilled practitioners to promote health and prevent illness and to enable patients to manage their conditions more effectively.
The question of country-appropriate interventions for health is closely tied to one of the central projects of post-apartheid reconstruction: that is, human resource development. Nursing has a record of outstanding achievement in this front and can truly say that it resisted the ravages of apartheid better than most sectors. The standards of nursing practice in our country are widely acknowledged - and of course this is what makes our graduates such tempting fruit for foreign picking,
Without detracting at all from this achievement, we need to confront the fact that new and creative human resource strategies are needed for this demanding age.
I believe that the centrality of values and commitment demand greater recognition than ever in the light of the challenges that we currently face. We need to take a leaf out of the book of the corporate world and manage increasingly by asserting what we stand for as a public health service, by building allegiance to our goals (rather than outdated rules) and ensuring that we are proud of the service that we provide, proud that we have chosen to serve the most needy.
The question of the morale of workers in the health service requires to be addressed at a number of levels. In relation to nurses, the wage agreements of 1996 were a critical intervention but there is still a lot to be done to improve working conditions. But unless there is a powerful belief in the value of the nobility of our mission - a revival of the sense of vocation -other changes are likely to be of short-lived value.
I believe that we can derive a real sense of our significance and our duty if we view ourselves in the light of history. We have relatively recently put behind us a bitterly divided past, which degraded our humanity, and we are in the middle of a major exercise in transformation. It is certainly not an easy exercise - it demands harder work than we have ever known; the path is uncharted and uncertain and very few of the benefits are instant.
But those of us who have committed ourselves to public service during this time should know that our effort is irreplaceable. The private sector is often an extremely tempting option for skilled nursing professionals. The opportunity of work abroad - in Europe, the United States or the Middle East - may have great attraction, especially for those at the start of their careers. As Government we would never seek to circumscribe the freedom of movement of our citizens and limit their right to market their skills freely. But I certainly do appeal to your sense of loyalty to this country. I believe that there is unlikely to be a point in our nation's development when your contribution will have a greater meaning. Presently we confront historic opportunities that will not come again and the actions that we take today and tomorrow will have an impact down the line for generations to come.
In this context, health workers and the health services occupy a unique place. We are indeed a country that bears many scars and bruises from the past. They are there for all to see - for instance, in our high crime rate, the recklessness with which we treat life on the roads, the criminal sexual abuse of women and children. They are also manifested in the persistent and deepening divide between rich and poor, which often erodes self-respect and the construction of a people-centred society. Against this background the care that can be extended in the context of health represents a valuable chance to restore human dignity -perhaps not fully, but certainly to a critical degree.
Perhaps nobody grasped this principle of affirming human worth through services as well as the late Mother Theresa. Her very humble approach is summed up in her remark that as human beings "we can do no great things -only small things with great love."
I am sure that the candidates for tonight's award would be able to tell us that they, too, have succeeded by building their services around quite ordinary actions done with genuine compassion. Perhaps they would also tell us that the work often seems endless and the achievements unclear. But occasionally, a glimpse into the heart of someone that you have helped allows you to feel that your work is precious.
Nearly all of us who choose to work in the public sector are committed to the principle of "people before profits". Those of us who arrived in Government after 1994 elections came with a dream of building democracy and undoing some of the terrible injustices of the past. If we are true to these motives, then we will look for our results in the impact that we make on the lives of our less privileged among us. I am sure that many of you here tonight will continue to do so.
Programme Director, I am certain that this gathering is convinced of the significance of the work that we are honouring here tonight. I would like to say to our finalists that I feel profound respect for the contribution that you make to the welfare of our country and people. And I would like to recognise countless other nurses who stand just behind the members of their profession that we are honouring tonight. Our country needs you, it truly needs your strength, knowledge, skill and dedication.
We congratulate the winners of the Cecilia Makiwane Awards and urge others in the nursing profession to follow their example.
Thank you.