Human Sciences Research Council in Pretoria

The interview was held by Madi Gray on 15 December 2006.

Dr Laetitia Rispel, who is now working at the Human Sciences Research Council in Pretoria, tells of how Swedish funding helped the Liberation struggle in South Africa. Furthermore, she tells of her experiences of the apartheid struggle in the health sector, and how she was involved in several anti-apartheid organisations. Dr Rispel also describes the vibrant civil society movement that prevailed during the struggles, and how they were expecting and planning policies for a liberated South Africa long before there was any evidence of a change.

Madi Gray: Today is 15 December 2006 and I am interviewing Dr Laetitia Rispel at the Human Sciences Research Council. Dr Rispel, we are talking about the role of Sweden and the Nordic countries in the anti-apartheid struggle. What was your first contact with Sweden?

Laetitia Rispel: In 1988 I joined a policy unit called the Centre for Health Policy, which is still at the University of the Witwatersrand. Its first name was a real mouthful, the Centre for the Study of Health Policy. That centre was funded in part by the Africa Groups of Sweden. In 1989 we received an invitation to come to Sweden and to use the trip not only to make personal contact with funders but also to give some talks throughout Sweden on the struggle for health and the struggle against apartheid. So it was in May 1989 when I went the first time to Sweden. We stayed in Uppsala and took the train from Uppsala to Stockholm and then we also spent a few days way up north in Sweden in Gällivare, which is the land of the midnight sun.

Madi Gray: Yes.

Laetitia Rispel: We also went to the health services to find out how they were organised in Sweden because they had an interesting model of state welfare, a good welfare system and a good health system, and we used the trip as a combination to study the health system in Sweden and at the same time to make people aware of the health issues and the health services under apartheid.

Madi Gray: Who did you travel with, you say we?

Laetitia Rispel: With another South African, Eric Buch, who is now at the University of Pretoria. He was one of the co-directors of the centre at the time.

Madi Gray: By the time you joined the Centre for Health Policy in 1988, you had obviously been involved in the struggle for liberation for some years.

Laetitia Rispel: Yes, sure I had. I came from the Western Cape to Johannesburg. I lived in Cape Town for a while and in Cape Town I was involved in a couple of organisations. Western Cape politics is also very fragmented politics and somewhat different from the rest of the country. Nevertheless there were certain important lessons that I learned.
One of the issues for the liberation movement, for the ANC, has always been that when you look at the health sector itself the largest group of health care professionals are nurses yet, apart from the few icons like Albertina Sisulu or Adelaide Tambo, there wasn’t a strong movement against apartheid. To a large extent they were part of a reasonably comfortable black middle class but at the same time suffering the same oppression in terms of race, gender and profession.
I originally trained as a nurse in the Western Cape where some of the apartheid issues were acute.
For example there was a course offered at the University of Cape Town called Maintenance of Science in Nursing. There were only two of us taking it who were black and at the time we had to stay far away because there was apartheid in the residences. The white students were staying in the nurses’ home and they could walk through the tunnel and get to the lectures. So it meant that if they had lectures at eight o’clock or nine o’clock they could literally get up half an hour before the time and get there. On the other hand we stayed far way in a township and it took us almost an hour to get to lectures.

Madi Gray: Were you in Athlone?

Laetitia Rispel: Yes. If you had to get to lectures you would either take a bus that left at quarter to seven to get everybody else to the hospital, or alternatively you had to make use of alternative transport. I think those are some of my formative experiences.
There was another issue that was also critical. A group of black medical students organised a Biko commemoration meeting early in 1980 and it served as a catalyst to make a lot of people aware. I think it most probably brought to the fore things around inequality, both in terms of profession and in terms of how people were treated. Groote Schuur Hospital had a clear white and black side. On the black side there were fewer resources and the place didn’t look as nice and as neat as on the white side.
Specifically I got involved in what was called a nurses’ support group, which was established in order to try and organise nurses into some trade union movement that was a lot more vocal about the injustices of apartheid.
It was also the time of the Emergency Services Group, the ESG. In the heyday of apartheid, if somebody came in with buckshot wounds, which the security police were infamous for using, some GPs and some hospitals would alert the security police. The Emergency Services Group was a group of concerned health care professionals who established it to provide emergency treatment and care to victims of political violence.
I had some white friends who were involved in the ECC, the End Conscription Campaign, which was the campaign to stop the compulsory conscription of young white males. I was not directly involved in the End Conscription Campaign except that I supported it and sat in some of the rallies that they organised together with other organisations. That is very briefly some of the organisations I was involved with in the Western Cape.
When I moved to Johannesburg, the Centre for Health Policy was nice in that it was one of the few places of employment that actually encouraged you to be involved in anti-apartheid organizations and I saw it as almost a dialectical relationship between looking at policy issues and being involved in anti-apartheid organisations. Soon after I came to Johannesburg I joined a group called the National Progressive Primary Health Care Network, which was established following the WHO’s Alma-Ata Declaration of 1978.
There was a groundswell of mass movements towards primary health care. It is the foundation for the health system, for a variety of reasons. Then there was the WHO’s ‘Health for All by 2000 Campaign’. Well, 2000 came and went and people’s health had probably deteriorated in some parts of Africa and Asia. I became involved in the National Progressive Primary Health Care Network. The slogan of ‘Health for All’ was one of their rallying campaigns and slogans. Primary health care was seen as the vehicle to achieve that health for all.
There was also the South African Health Workers Congress, which at one stage might have received funding from the Nordic countries. In 1988 the Health Workers Association was a group that believed in the notion of health workers as opposed to separate organisations for nurses and doctors and touted the concept of health workers as an all-inclusive term.
They established the South African Health Workers Congress, SAHWCO, which brought together the Health Workers Society and the Health Workers Association and I was the education officer for SAHWCO in the late 1980s, early 1990s.

Madi Gray: It seems as though there were quite a number of things happening at that time, it was an exciting period, wasn’t it?

Laetitia Rispel: It was a very vibrant time, I think we need to regain that strong civil society movement in South Africa. We’ve lost it and you always need to keep those in power on their toes, remind them about accountability to the people. The electoral system is important but I think it is equally important for civil society to have a vibrant civil society movement, but this is most probably a side issue.

Madi Gray: Perhaps. You said you joined the Centre for Health Policy in 1988. How long were you there?

Laetitia Rispel: For a long time, until 1996, I was there for eight and a half years. After the elections I went into government, I did a stint in the Gauteng Provincial Government and then I came here. I’ve only been here for about ten months. One of the issues is that a lot of old activists joined government and I do think there was a different energy among the activists, they came from the struggle and went into government to make a difference, compared to now when it is becoming more like yet another bureaucracy.

Madi Gray: Yes, a career for the sake of a career and not necessarily because you want to achieve something beyond yourself. If we go back to what you were doing in the Centre for Health Policy, it was already receiving funds from Sweden at the time you joined, wasn’t it?

Laetitia Rispel: Yes. The Centre for Health Policy was established in 1987. I joined them at the beginning of 1988, so they’d been in operation for about six months. They received money from the Africa Groups, I think most probably from its inception. The Africa Groups were very receptive to the idea of having a policy group that was starting to consider what the issues are that are important and how to impose the party’s health policy. How do you begin to shape it, because there was also recognition that there were a whole lot of complexities. Clearly South Africa is not the same as an independent Malawi and what are some of those complex issues that would need to be taken into account when setting up a post-apartheid health system? I would say that that was quite visionary.

Madi Gray: It must have been at the cutting edge.

Laetitia Rispel: Yes, it was. When I think back to the work of the centre, in some instances it put controversial ideas on the table, for example the initial shape of the South African Health System was envisaged as a National Health Service similar to what the UK has, though the context is very different in South Africa because we have such a large private sector. It started out raising those questions around how general practitioners will fit into a National Health System and ironically maybe, 12 years after democracy we still haven’t got a clear policy, GPs are still independent, there are a lot of people moving between the public and the private systems and the health services are not as integrated as in Sweden or in the UK. It started looking at those issues around health care professionals, and at issues around the overall setup and nature of the health service. I started doing work around quality of care, what the broader health system issues are, how you begin to look at them.
Some of the work was on the reintegration of the old KaNgwane homeland into the then Northern Transvaal area. It was very exciting and even if people didn’t always like some of the publications that came out, it gave them much food for thought.

Madi Gray: Sorry to interrupt, but for the people who are going to read this interview can we try to describe where the KaNgwane homeland was.

Laetitia Rispel: In apartheid South Africa there were all these self-governing territories referred to as homelands. KaNgwane was in what is now the province of Mpumalanga and bordered Swaziland on the one side, very close to the Swaziland border. It was an area set aside for Swati speaking people.
Do you know where the Shongwe Hospital is? Do you know where Nelspruit is?

Madi Gray: Yes.

Laetitia Rispel: Most probably less than half an hour’s drive away from Nelspruit was the Themba Hospital that was considered to be part of the old KaNgwane homeland.

Madi Gray: Would it have been close to Barberton ?

Laetitia Rispel: Further east most probably. What is interesting is that KaNgwane was a slightly less repressive area, there was a little more space for activists to operate compared to some other places like Bophuthatswana where it was quite brutal, a lot more vicious.

Madi Gray: Were you working down there or was there a project focusing there?

Laetitia Rispel: There was only a project focusing there.

Madi Gray: Bertil Högberg mentions Bushbuckridge in connection with the Centre, does KaNgwane go that far north?

Laetitia Rispel: No. There’s a border near Bushbuckridge, it’s unclear whether it’s part of Mpumalanga or whether it’s part of Limpopo and it’s never been quite either. We did a short stint of work in some clinics not far from Bushbuckridge, in what is now a coal mining area, and were looking at primary health care facilities.
Some of the work I was doing was a project around planning health facilities in Soweto because there was the issue on Soweto’s integration with the greater Johannesburg area. So there was some planning working on the location of health care facilities in the Soweto area, referral patterns, some work on planning primary health care services in South Africa broadly. So certainly the work that was initially done around primary health care services in South Africa fed broadly into a subsequent document that was put out by the National Department of Health on a package of essential primary health care services that have to be provided at clinic level and at health centre level.

Madi Gray: And that grew out of the Wits Health Policy project?

Laetitia Rispel: Yes.

Madi Gray: You’ve indicated that the money wasn’t all that great a sum but obviously it was able to contribute to your work. It was smuggled in, wasn’t it? Or it was fairly secret?

Laetitia Rispel: No, in this instance there was an interesting arrangement as there was quite a receptive environment at the university. The money was paid into the University Foundation and there were quite good accounting practices. We paid a handling fee to the university but basically the money was paid from the Africa Groups into the University Foundation. In this instance it was completely above board.

Madi Gray: I know that the Africa Groups were approached, I think by the Swedish Embassy in South Africa, who got a lot of requests from different South African organisations to try and help with funding. Initially they were reluctant, but amongst other things the Africa Groups worked in the media area.

Laetitia Rispel: Oh yes they funded quite a lot in that area. The area of Health Policy research was quite a novel one and I think they need to be given credit for trying out something different. It was a lot easier to provide guidance and systems to apartheid victims, or organisations that worked for example with displaced people, and that is why I credit them for having the vision to look at future needs, but other assistance was important also, all aspects were important. How do you look into setting planning and policy issues in a new post-apartheid South Africa? I think that was significant.

Madi Gray: I find interesting that in the late 1980s one was already planning for 1990 to 1994 even though there weren’t that many indications that it would happen that soon.

Laetitia Rispel: Yes, at the time there was a sense that it was really inevitable and that the breaking point would come soon. The Maputo conference was held in 1990. It was a big conference organised before the ANC was unbanned in 1990. The original idea was that the ANC would be able to attend and talk with people inside the country around governance issues and the focus was on health and welfare, but even after the ANC was unbanned, there were still a whole lot of operational issues, so the conference went ahead in Mozambique.

Madi Gray: Interesting. It was still risky for some ANC members to return to South Africa.

Laetitia Rispel: I got a scarf, which somebody gave to me in Stockholm on the campaign to stop the South African attacks against the Front Line States. I should have brought it to show you. This scarf had different languages that said “Stop South African Aggression” or something like that, maybe I should frame it.

Madi Gray: Good idea.

Laetitia Rispel: I think I should frame it so next time when you come I’ll have it here.

Madi Gray: It would make a colourful display.

Laetitia Rispel: I think so, yes. Well the Swedish colours are blue and yellow, so it was blue and yellow.

Madi Gray: Your role in the struggle for liberation was through your work and through your interest in joining organisations?

Laetitia Rispel : Yes.

Madi Gray : If I understand what you are saying, you chose work that permitted you to work for the liberation of South Africa?

Laetitia Rispel: Yes, and it was done to help, because you can’t separate help from the broader struggle.

Madi Gray: No. Your first visit to Sweden was in 1989 and then you came again?

Laetitia Rispel: Yes, in 1993.

Madi Gray: Was that also with Eric Buch?

Laetitia Rispel: No, it was with someone else, a guy called David Mametja who used to work at the Health Systems Trust. I think before he joined the Health Systems Trust, at the time I went to Sweden he worked for an organisation called CHE, which I think was also funded by the Africa Groups. CHE stands for the Community Health Economics or something, and David worked for CHE as a researcher at the time and CHE was doing similar work, but in the KwaZulu-Natal area.

Madi Gray: I’ve heard of CHE somewhere. What did you do on your second visit?

Laetitia Rispel: This was more of a technical visit, we met different organisations, again in Stockholm, but spent the entire time travelling between Uppsala and Stockholm. We didn’t go beyond Stockholm and Uppsala.

Madi Gray: When you say technical, were you studying things in Sweden?

Laetitia Rispel: Yes we were meeting with people from the Health Services and I’ve forgotten the name of the organisation, which is similar to the HSRC, a state institute, they do research and policy and get money from the Swedish government.

Madi Gray: Karolinska Institutet? IMCH, International Maternal and Child Health? I’ve checked with Bertil Högberg, do you remember him?

Laetitia Rispel: I remember the name.

Madi Gray: Apparently on one of your visits when you were staying with Ingvar you had dinner at his place.

Laetitia Rispel : Yes. Is he the one who had a little boy who might have been born around that time?

Madi Gray: No. He has a daughter who today is in her mid-twenties and I think he was alone at that time.

Laetitia Rispel: And there was a woman called Christina who was also very involved with the Africa Groups and I remember her because a year later I got a Christmas card from her. Then there was a woman doctor who subsequently came to South Africa and worked in the rural areas of the Eastern Cape for a while, if I am not mistaken.

Madi Gray: Not Dr Ingrid le Roux from Lund? She’s been in Cape Town for years, married to Pieter le Roux at the University of Stellenbosch. She started Philani, among other things a weaving project to help mothers earn an income.

Laetitia Rispel: In the Eastern Cape?

Madi Gray: No, in Khayelitsha in the Western Cape. It must be a different Ingrid. Ingrid is quite a common name.

Laetitia Rispel: Yes, it is. I remember Ingrid’s face very clearly, a thin blonde woman, but you find a lot of blonde women in Sweden.

Madi Gray: And a lot of them are thin. We’ve talked a bit about the support you received and how it was used, were your contacts with Sweden entirely through the Policy Centre?

Laetitia Rispel: Yes.

Madi Gray: Either in your visits to Sweden or things that Swedes or Africa Group people did when they came here, what are the highlights, things that stand out in your memory?

Laetitia Rispel: One of the things that I’ve always appreciated about the Swedes and the other Scandinavian countries is that, now I am trying to find a way of putting it diplomatically, they weren’t very imposing from the perspective of their ideas. My sense is that they were always willing to listen and were interested and they were willing to learn about Africa. There is a potential downside because sometimes people have this romantic notion of African society and African cultures while especially when it comes to women there are some oppressive practices that need to be changed and one shouldn’t romanticise these things. But if I look at the current context of funding, the Africa Groups and the Swedish funders have always had fewer demands attached. Some funders come and have an agenda and no matter what you want to do, you either take their money or you leave it, and it is like the classic case of beggars can’t be choosers. I’ve never had that feeling with Swedish funders. I’ve always thought they were easy to deal with, they were willing to listen and they were really willing to let Africa and Africans decide how they wanted to do things as opposed to an imposed agenda, from the outside which says you will do this, that or the other. There is that sense of their not imposing and putting conditions on our activity that for me is probably the most significant aspect. They’ve also been very solid in their support of the liberation movement.
There were two other aspects. It is on a personal note but I always think about it when I see the South African flag. The first time I was in Sweden I noticed how proudly people were displaying their flag. There was one couple that we went to where it was the little boy’s birthday and they had the flag on the cake and when the candle was blown out the flag was displayed and it was the first time I had a nostalgic sense and wished for the day when I would have the same feeling, to look at the flag and feel proud. The other was on one day in Stockholm where there were small children marching across a bridge. It’s a long time ago but I think the issue that they were marching about was around the environment.

Madi Gray: Very likely.

Laetitia Rispel: And so there was this group of most probably six, seven year olds marching and shouting Swedish slogans about the environment and I thought that was really a very good way of civil participation from an early age onwards to make children aware and give them the freedom to express those opinions without fear of retribution. I think those were the issues that really stuck.

Madi Gray: Did you have problems? You mentioned Swedish funders are open to ideas but sometimes problems crop up even in the best of regulated families.

Laetitia Rispel: Yes. Perhaps because I wasn’t in a management role in the Centre, if there were maybe problems then I didn’t know about those. But my sense was generally that it was an easy relationship with few strings attached. There were reporting requirements, but the University generally is good with reporting and the University is a very old and established institution and so it knew that it had to keep good and clean books. So no, not as far as I know. It doesn’t mean that there might not have been issues, but not to my knowledge.

Madi Gray: How was the cooperation actually built up? Did you decide that this or that needs to be done or was it done in consultation? How did it happen? There seem to have been several different projects, clinics and policy studies.

Laetitia Rispel: To a very large extent we determined our own agenda and it was just reported via annual reports. There was one occasion when Ingvar came to visit when he wanted some meetings to be set up, or when somebody from the Africa Groups might have come out when we hosted them. That is to a certain extent different from a current funding agenda, which is very much in the area where there is funding and the funders set the agenda and there’s been lots written about that. So no, we had our own agenda to set, which of course is any recipient’s dream. So the contact was a lot through written reports and some personal contacts, some visits.

Madi Gray: In both directions?

Laetitia Rispel: Yes, initially because of the Apartheid system we went there. Ingvar was the first to come to South Africa. Wasn’t it towards the end of 1993? Contact was mainly through reporting and the personal visits we made on their invitation.

Madi Gray: Did they come as individuals or as representatives of the Africa Groups?

Laetitia Rispel: They came here as the Africa Groups and our invitations were from the Africa Groups and we were asked to send a number of representatives, so we were hosted by the Africa Groups.

Madi Gray: Yes. Did you have important personal relationships with Ingvar because he was your main host?

Laetitia Rispel: Yes.

Madi Gray: Were there other important relationships or, if you look back on your visits to Sweden, how was your contact with Sweden in general?

Laetitia Rispel: The interesting thing was that Ingvar had been involved in the Africa Groups for a long time and in one sense Ingvar was the Africa Groups. We stayed in his house. Ingvar also had fixed ideas about how things should or shouldn’t be done, and to a large extent our relationship with the Africa Groups was mediated by Ingvar.

Madi Gray: Right.

Laetitia Rispel: And the people that we met and the people that we went to were people to whom Ingvar sent us.

Madi Gray: Do you remember the name of the people in Gällivare?

Laetitia Rispel: No I don’t. In Gällivare we stayed in a guest house and had dinner at a couple’s place and it was amazing because we were walking back one night and it was ten o’clock and the sun was bright. Somewhere in my archives I have photographs I took with a pre-digital camera where I took the midnight sun from where we were staying, and it was weird because it was still quite cold by our standards.

Madi Gray: Fabulous! We’ve covered a lot of questions. Did you find the Swedes naïve or gullible?

Laetitia Rispel: No, but maybe I was quite naïve because when I went to Sweden in 1989, it was the first time that I had ever stepped outside South Africa, so it was exciting for me to go there. On a lighter note, Ingvar had an obsession with churches. On that first visit to Sweden, we were there for almost two weeks, and by the end of the period both Eric and I thought that we were going to scream if we went to another church. I mean the architecture is beautiful. I always think of that trip as the trip where we went from one church or cathedral to the other. Ingvar took great care to take us from one to the next, I remember the Swedish countryside and driving in some instances for quite a distance to find a little church to be shown and sometimes we would take postcards of it but I think I must have at least 20 photographs taken either outside or inside a church. It’s just one of those interesting things.
When I went to Russia three years ago, the Russian architecture is also very interesting because it’s influenced by Asia. Some of the Asian architecture you can see in the orthodox churches, where in Europe it is very much like a triangular or paramatal set, there you have the onion shape in some of the cathedrals in Russia, which is from Hindu temples or mosques. So I thought of that time in Sweden. When I see beautiful cathedrals I always think of Ingvar.

Madi Gray: Have you had any contact with Sweden since 1994?

Laetitia Rispel: No I haven’t. I was at the Health Policy Centre until September 1996 and went into government in 1996. I know that Swedish Sida has redirected some of their work to HIV-AIDS and I think it is one of the contacts that we at the HSRC need to explore in the new year, looking at diversifying some of our funding beyond the UN.
But no, I haven’t had any contact with Sweden for years. It was very interesting to get this email from you because there was an activist period before I moved to government and you get so stuck in the trenches.

Madi Gray: Which part of government were you in?

Laetitia Rispel: I was in the provincial government in the Health Department. Your life almost comes to a standstill, so from a personal point of view it’s been interesting because I somehow feel I’ve come full circle and it is both nice and nostalgic at the same time.

Madi Gray: A full circle because you are once again dealing with some of the issues you dealt with before?

Laetitia Rispel: Yes.

Madi Gray: For instance?

Laetitia Rispel: Yes, like looking at health issues as an outsider looking from the outside in. Certainly I think the experience in the government has been worthwhile. The danger though is that you get so stuck in the trenches that it becomes sometimes a self-fulfilling prophecy. It would be interesting to talk to people from the anti-apartheid movement outside to get their perspective on how things have evolved in South Africa in the last ten years, twelve years. Well what is your view, just as a matter of interest?

Madi Gray: I think South Africa is doing amazing things but there are also huge problems, some of which we’re not touching. But we’ve come an enormously long way.

Laetitia Rispel: Sure, in comparison.

Madi Gray: What you’ve given me is one of the examples of one of South Africa’s greatest strengths, the creativity of its people.

Laetitia Rispel: Yes, oh yes. But Madi, it was lovely meeting you and maybe we’ll meet again. t was nice talking to you.

Madi Gray: Thank you very much, Laetitia, for the interview, for giving up your valuable time and for your participation. It’s been very interesting.