Dr Pravesh Bhoodram Department of Correctional Services

In the diverse multi-cultural ‘melting pot’ that is South Africa, western-trained healthcare professionals frequently encounter difficult consultations with clients who present with Cultural Syndromes both at work and in communities, counselling employees who are suffering from vicarious trauma due to coping with unethical management decisions on a personal level. In the context of the recognition of Traditional Health Practitioners under the Traditional Health Practitioner Act No 22 of 2007, employees are demanding similar treatment for those who suffer from Cultural Syndromes, like those who are diagnosed with Western recognised illnesses. At the same time employee assistance practitioners are faced with having to consider ethical decisions in their own professional lives.
We asked Dr Pravesh Bhoodram for his insights, in keeping with his Eduweek 2019 presentation:  How to deal with fallout of unethical management decisions.
Q:  What is the prevailing Cultural Syndrome that informs ethical behaviour in South Africa?

When one looks at the South African scenario it seems like paternalism rather than rules and regulations is colouring what is considered ethical.  Evidence from the state capture commission seems to justify people’s perceptions that if you have served in some capacity in helping to liberate the country then everything that you do thereafter, ethical or not, should not, and will not, be subject to any form of questioning.  This appears to be the general trend in South Africa as it has been in our neighbouring state – Zimbabwe.  The sentiment seems to be that, ‘if you were involved in South Africa’s liberation then you may do as you please,’ and has become has become part of our culture.

Q: Is it safe to say that cultural syndromes are belief systems that have passed into affecting the common way of thinking within a society?

Yes, what happens is that culture is defined by people over a period of time.  It is what happens when an action becomes acceptable in that it is not questioned, or prosecuted, or addressed in any way. It becomes part of that culture, entangled in what is acceptable and what is not, and it becomes a challenge.  We have a theory in ethics called The Slippery Slope Theory, where if you are on a slippery slope and don’t address the minor things that are causing you to slide, you reach a point at which you cannot address anything.  And so the problem builds and it grows.

In an organisational context, after a while small lapses that are not corrected seem to pass without anybody noticing and they become part of that culture and over time begin to erode the culture of the organisation. Take late coming – if everybody comes to work late after a while nobody seems to notice anymore and it becomes part of a culture of it being acceptable to be late.

Q:  How do you correct a detrimental Cultural Syndrome?

In South Africa if you haven’t committed a serious crime you may not get the attention of the police.  They will tell you straight out that they don’t have the time or the manpower to address the minor transgressions like petty theft – an example in action of The Slippery Slope Theory.  When Mayor Rudy Giuliani was asked to stem the tide of crime in New York his first step was to look at minor transgressions no matter how small they were and he decided that if he did not address them then there would be no way that he would be able to make any impact on the bigger crimes that were being committed.  This is how he was able to change the philosophy of addressing crime in the whole country.

There is no other way in dealing with unethical infractions but by addressing the smaller ones first. The challenges faced by SAA where mismanagement has led to the decline in revenue for the already cash strapped industry who has survived on government bailouts over the past few years is topical at the moment. Where do you start with rectifying this? Do you start by dismantling SAA, which is happening as salaries may not be paid?  This solution doesn’t address the transgressions that have happened.  At some stage we may find that certain people are found guilty and will be prosecuted, but at the lowest level what will have happened is that a culture of mismanagement has been inculcated and made almost justifiable in this work setting.

Q:  How is trauma felt by employees due to being subject to unethical management decisions?

The effect of all the trauma the staff is affected by is not direct.  It is vicarious because in many cases a decision made by someone in authority cannot be questioned and if you do question a decision then you run the risk of being harassed or intimidated. What happens is that decisions, which have to be translated into action, are acted upon by employees at the lowest level, and these employees are not given any support in terms of whether the required actions are justifiable or not – they just have follow orders. This becomes a huge challenge, especially in the public service sector, because decisions are made – and generally they are political decisions – that have to be carried out irrespective of whether they are ethical or not.

“I faced a dilemma to disclose what my friend was doing or turn a blind eye and I turned a blind eye because of my friendship with the person.”

Q: What are the employee dilemmas that EAPs are faced with as a result – and on a personal level?

To answer your question this is an example that I used in my Eduweek presentation:  An employee and their friend work in the same department and the friend has been falsifying their travel claims. The employee feels they have both an obligation to their friend and their department. If they decide that they will turn a blind eye to the falsification of the claims and their manager finds out and dismisses the friend, they may well be referred to an EAP before they are also disciplined. The employee’s dilemma, as presented to the EAP is, “I faced a dilemma to disclose what my friend was doing or turn a blind eye and I turned a blind eye because of my friendship with the person.”

 

In another example, your manager may run a business on the side and not disclose it. Senior managers often become directors of companies. Do they disclose this fact?  As a result you, as an employee, may find yourself in an ethical dilemma:  Do I do what my managers do?  As an EAP you may run your own private practice as well. Do you choose not to disclose it and continue with your practice, or do you disclose it because you have an ethical obligation in terms of your professional registration?

In many cases people chose not to disclose, because for them the decision is not about ethics – they focus on making a financial decision, and a decision made on that basis is totally wrong.  I have noticed that there are many EAPs, managers and employees for whom money is the most common motive in conflicts that arise.  One has to be able to differentiate between: a bribe, a gift, a kickback, and what is a self-dealing; along with what is fiduciary duty, what is favouritism and what is nepotism.   If you look at typical examples in the Zondo Commission, these things have been totally disregarded and the profit motive is money – and when money has come into the picture, ethical considerations are rarely taken into account.

So, when a practitioner doesn’t understand that a bribe is something that is given with an expectation that they will do something in future, whether it is right or wrong; and if they don’t understand that a gift that is given to them, which they don’t declare, may lead to doing something unethical later, and that the kickback they get is something for work already done that may be unethical – then they are not able to make an ethical decision. Perhaps they do understand that their obligation, because of their registration with a professional body, is to disclose, but money could well become the profit motive in their decision.

To combat these dilemmas you have to start by teaching people to go back to basic ethical principles – and to provide them with ethical training. This is why EAPA-SA, in line with the new CPD system that we will adhere to from 1st January, have instituted a compulsory requirement that every single member will have to go for at least three hours of ethics training, annually, to maintain their membership of EAPA-SA as a professional body. Basic ethics training should be compulsory, across the board, for any professional association. We have to start somewhere.

Starting in 2020, EAPA-SA will be offering ethics training at the association’s new offices.  The training schedule will be published in due course, and I will be conducting the training.  As we did not have time to cover enough detail in a 30-minute presentation I have been asked by several Eduweek attendees to hold a full 2-3 hour ethics workshop, which I will deliver next year, at Eduweek 2020.

Pravesh Bhoodram

Pravesh Bhoodram

Education

Dr Pravesh Bhoodram is a pioneer in the EAP field in the Public Service in South Africa having assisted 23 National Departments in implementing an EAP. He has served as an EAPA SA Board member since 1998 in various capacities: president, conference convener, finance chairperson and strategic planner. He became the first South African to receive a Special Recognition Award from EAPA International (Vancouver 2001) for his contribution to the profession in South Africa.

He is presently serving his second term as a Community Representative on the Allied Health Professions Council of South Africa where he has chaired the professional Board for Ayurveda, Chinese Medicine, Unani Tibb and Acupuncture. He is responsible for Strategic Planning for Council and chairs the Finance Committee. Dr Bhoodram is a Board member of the Leisure and Recreation Association of South Africa and will assist in organizing the 2016 World Leisure and Recreation Conference in South Africa.