Dateline: Capetown

Dan Roche

I said this would be a two-part article, and I lied. I’ve decided to continue on for another installment, or perhaps two, covering my class’s recent trip to Africa. Because, how often do you get to do something like that? Not lots. So I’m going to talk about it more than I thought I was, because there’s more than I can think of to talk about.

I figure, well, we know what our problems at home are. What makes life suck for people on the other side of the planet? Maybe we can think first about how our own situations differ, and then look for some aspect of our humanity – guts, good humor, hard work, ingenuity – that help us to rise above the situation and helps others also.

While we do share similarities, differences must be respected, so we went over there to learn, not to talk. One chooses their words carefully when advancing notions about “causes” of sub-Saharan Africa’s HIV epidemic. But, one can feel fairly sure stating that South Africa’s President, Thabo Mbeki, has exacerbated its impact in his own country. A UN envoy said in 2006 that official policy was “more worthy of a lunatic fringe than a concerned and compassionate state.” A slapdash thumbnail sketch of Mbeki might be like a left-wing George Bush: he is stubborn, ideology-driven, obsessed with politics. His decisions are informed by isolated advisors rather than a broader consensus that decide highly sensitive matters unilaterally despite extensive protest. Each felt public esteem plummet precipitously during their times in office. Both, also, were re-elected despite their controversies.

Mbeki came into office a popular man, Nelson Mandela’s hand-picked successor. The Treatment Action Campaign, initiated around the time Mbeki was inaugurated, and asked the government to provide the same affordable antiretroviral medicines other countries had access to. The 1996 South African Constitution promises each citizen access to health care (including reproductive health care, with sexual assault a consideration here), that the “state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.” It continues, “No one may be refused emergency medical treatment.”

It can be argued that HIV presents just such an emergency- not just in individual cases, but nationwide, and TAC has stated that they only want the government to follow up on its mandate.

We left District Six, and the past, in a somewhat somber mood, to meet with Nombeko Mpongo and the problems presently plaguing her country. Nombeko is a young HIV-positive woman from Guguletu who coordinates benefits for municipal workers stricken with the virus (she also runs a support group out of her church in Cape Flats, and works with TAC). She hosts a television program, “Beat It!” The talk she gave was in turn hilarious and gravely serious.

Nombeko contracted the HIV virus via a sexual assault that occurred when she was 24. After a long depression she decided to stay alive for her son. He, she notes, is 16, goes to university, and is known to some as “DJ Caramel”. Nombeko credits her continued survival to her faith in God and to TAC, who made her ARV treatment possible.

I’ve delayed explaining the lengthy standoff between TAC and the South African government, and why the government fought allowing cheap ARVs, because it is a deceptively simple state of affairs. TAC took the government before the Supreme Court of South Africa to fight for availability, and won in late 2003. The President and his advisors fought access for years and, many claim, dragged their feet in implementation for some time afterward. His health minister, Manto Tshabalala-Msimang, who is at odds with world medical opinion (but in step with freelance quacks like Dr. Matthias Rath) sets public health policy, as far as I can tell, according to an ostensibly anti-Western, pro-African political agenda. I say ‘ostensibly’ because both Mbeki and Manto declare desires to see “Western” pharmaceutical companies butt out of national affairs, so as to encourage “African solutions to African problems”, while disregarding findings made by South African scientists.

So, the South African health care program is embroiled in controversy. The day after we saw Nombeko, we visited Dr. Sweetness Siwendu at the Brooklyn Chest Hospital, a tuberculosis clinic, in Ysterplaat on the city’s outskirts. If Nombeko was the spirit of resilience, Dr. Sweetness gave a face to the frustrations an exhaustingly overworked caregiver feels. TB is a prime opportunistic infection among HIV-positive South Africans, and extremely drug-resistant cases have proven a formidable challenge to doctors and nurses. BCH, founded in 1872, is a clean, lived-in, bleak facility where many of the region’s cases are brought. There is little attention given to TB treatment, and since TB itself is so little understood, treating it is a trying endeavor.

Siwendu’s task has lately been assisted by medical students performing community service with little feel for the work. Funding is scarce. Many of her patients are there on quarantine after neglecting or refusing to follow their treatment regimen so that their bug mutate, hardcore noncompliant cases. There were several child inpatients, some orphans. Our group was extremely saddened to see these little ones and have to move on. May God bless Sweetness, because she needs any help she can get.

We then met Dr. Linda Gail-Bekker, who holds a PhD in TB immunology from Columbia, at the University of Cape Town, one of Africa’s premier universities. She offered fast-flying nuggets of incisive analysis and sly, innovative treatment ideas. Among them were cell phone notifications to patients: “TAKE YOUR MEDS”. She noted that while the government had trouble providing electricity, cellular phones rapidly penetrated the market, and it’s true – even in very impoverished areas, one can see Vodacom outlets nestled next to the tuck shops.

In many ways, the new South Africa is burdened by the old, with a majority mired in poverty, looking for a future. An energetic new South Africa may emerge, but history and a beleaguering present are working against them. One can only hope they succeed. The odds are steep.

Next week I’ll talk about the brassy, somber, singing, dancing, high-fiving, no-nonsense, compassionate, political, hardworking TAC activists we spoke with at the Similela Rape Crisis Center, the Khukuleka Men’s Support Group, and the Khayelitsha headquarters who informed us, cracked us up, and made us cry.

Oh yeah, some other stuff too, if I get around to it.