By Eileen K. McCluskey

Special to the Gazette

Carol Steinman, 10-year manager of Harvard's Faculty and Staff Assistance Program and an expert on substance abuse in the workplace, recently won a grant that took her to South Africa.

Last March, Steinman was sent to the University of Cape Town's (UCT) Industrial Relations Department by the nonprofit organization Medical Education for South African Blacks. Steinman said, "My mission at UCT was to teach workshops to supervisors about substance abuse in the workplace as a stimulus to develop a substance abuse policy for UCT."

Witch Doctor Rivals

"I knew a lot about substance abuse in the workplace, but nothing about this issue in South Africa," noted Steinman, who spent two of her four weeks in Cape Town exhaustively researching such topics as resources for treatment, health care coverage, and available self-help groups.

Steinman discussed the basic facts her research revealed: "For those who are working, there is health care coverage and private treatment available; for those without health insurance there are state-run counseling centers that will evaluate their needs and make the appropriate referrals. However, access to care is not available to enormous numbers of people. Many in South Africa are uninsured, with limited access to basics like telephones and transportation, not to mention information about things like treatment centers."

Taking a deeper look at societal and cultural issues, Steinman consulted at Addington Hospital in Durban, a major state-run institution. At Addington, Steinman examined factors that contribute to the difficulty in treating medical conditions in South Africa, at least with Western-style resources. One prevalent factor comes in the form of witch doctors, or Sangomas. Said Steinman, "Sangomas far outnumber physicians in South Africa, and they exert enormous influence over many people. They're credited with cultivating resistance, by some South Africans, to the use of professional medical services."

Steinman also spent several hours walking through a squatter camp in Cape Town. She described the squatters' homes as "lean-to's of any fabric you can find, on dirt, in rows, by the thousands. The people who live there have no running water, no electricity, no phones, no bathrooms, no address." Steinman noted that the only transportation available to camp residents is a group taxi system; UCT employees who live in the camp must depend on this mode of transportation to get to work.

Workshop Dynamics, Accomplishments

Steinman conducted two-hour training sessions for supervisors, which provided information such as the major characteristics of an addicted person, types of treatment available, codependence, and helping an employee return to work after treatment.

Steinman commented that, "Most of the workshops were very well received. They opened discussions about how best to respond to addicted employees. Some of the participants volunteered to work on the UCT policy, and this was one of the major goals we'd set for the workshops.

"There was one session, though," said Steinman, "that was especially productive, even though it was also the most challenging." The Industrial Relations Department (IR) invited a group of shop stewards to attend this particular workshop, along with the usual supervisors. The shop stewards, who were all black, are advocates at UCT for the lowest-paid employees. In this workshop, it turns out, the shop stewards were the only black attendees; all of the supervisors in attendance were white, unlike the multiracial supervisory makeup of the other sessions.

Said Steinman, "In the middle of this training, the shop stewards responded very negatively. They said that they felt the trainings were an attempt to start firing the lowest-paid workers who are known to have drinking problems, and they feared they would be excluded from the dialogue to create a policy."

Beyond Apartheid

Steinman described what happened next: "It just so happens that the IR representative, who was with me at all the workshops, is black. He assured the shop stewards that their fears were unfounded.

"The discussion of all their concerns, and the IR rep's responses, used up the entire second half of the training. But as a result of that dialogue, this session resulted in creating an amicable agreement for continuing discussions, between IR and the shop stewards, toward the creation of a policy. So this was probably the most constructive workshop of all."

Steinman felt that a central challenge for UCT, in their efforts to craft a helpful substance abuse policy, is "to create trust in an environment where it was severely limited under apartheid."

Stepping back from her discussions of the workshops Steinman commented, "My overall take on the South African situation is the fabulous implications and hope engendered by the end of apartheid, legally. However, that doesn't mean it has ended for people emotionally."