Across the African continent health systems are greatly impacted by the burden of neglected disease, endemic malaria, HIV/AIDS, and other environmental difficulties. Very often these health crises are exacerbated by the lack of enough trained health workers to administer treatments, provide care, and build the capacity of health systems. Africa Health Placements is one such organization that brings in foreign and local health workers to fill the gaps. Placements are long-term and the needs are real. In 2009, I finished an academic paper titled “Why there is No Doctor” about the lack of health infrastructure, doctors, and the impacts of HIV/AIDS in South Africa.

South Africa has pioneered some of the most advanced medical procedures in the world. In 1967, Christiaan Barnard preformed the first human-to-human heart transplant, but still the majority of the South African population is without adequate health care. Cosmetic and plastic surgery has grown a “medical tourism” industry in South Africa while rural populations wait for doctors.

(Photo Credit: Amazon)

History has set African health care up for failure. Lack of trained health workers places a massive burden on many African health care systems, inadequate or non-existent infrastructures make provision of basic needs like food and water impossible, debt and limited budgets move health care to a lower financial priority, medications are expensive and multinational pharmaceuticals want to make big profits, colonialism, apartheid, neo-colonialism, and the effects of an oppressed history perpetuate inadequacies in health care.

The varied record of health in Africa over the past century is inseparable from the history of change in control over political institutions and change in the organization of economic production. In the early years of colonial rule some governments relied on forced labor; in parts of colonial Africa, especially in the eastern and southern parts of the continent, male workers migrated from rural homes, leaving their families behind; in the postcolonial years class differentiation has become more pronounced, with some workers permanently separated from their roots in the countryside.[1]

Feierman and Janzen are right on target again in describing the scene of African health in relation to colonialism, politics, and history. African countries inherited health care systems from colonial authorities, but very often there was no health workforce to fill the void of colonial medical professionals. One Frenchman wrote,

La suele excuse de la colonisation c’est la medecin [the only excuse for colonialism is the doctor] – Hubert Lyantey (1926)[2]

If nothing else colonization was a positive in establishing health care systems and providing professional doctors? I wish I could agree, but mission societies that often ran health services relied on negative images of Africans.[3] The famed Dr. Livingstone was a doctor with the London Missionary Society and is best known for his explorations of the continent that allowed colonial empires to penetrate further into and conquer the African interior.

The slow demise of colonization did not end Western interference in Africa. Well into the 1980s and 1990s some African populations remained under the oppressive control of Western and minority populations. This control led directly to the ill health of those populations, notable South Africa and Mozambique. Black South Africans were denied basic health care services, training, and other needs.[4] South Africa fought a proxy war in Mozambique that specifically targeted the destruction of health care infrastructures. In African countries that gained earlier independence there were other powers to face.

[...] the IMF and World Bank have much to answer for. [Their] policies have eroded Africa’s health care systems and intensified the poverty of Africa’s people. – Salih  Booker[5]

Structural Adjustment Programs (SAPs) and other policies forced by Western institutions made the development from colonialism to independence that much more difficult for African countries. As Hunter writes, these policies often increased the poverty of African populations as opposed to providing for their basic needs. Health became a lower priority as African countries fell into debt because of loans from the IMF and SAPs of the World Bank. Even today with the economic recession African governments are cutting their health budgets to make ends meet. Health services should be the last item cut from a budget as health is central to all other human development.

Health is a major issue in Africa as the basic needs becoming increasingly difficult to provide and there have already been numerous reforms and attempted mechanisms to provide adequate health care.

[2] Hunter, 136.

[3] Ibid, 144.

[4] Hill, 6.

[5] Hunter, 47.

Previous entry: a first glimpse: zonke

13 May 2008

South Africa is much the same and different as many African countries that I have visited. Same in the sense of the smell of burning oil and gasoline, shipping containers as buildings, the red dirt, the friendly people, passenger vans as taxis, crazy driving, dogs for security, chickens and goats roaming everywhere, and the seemingly common practice of taking things as they come. The differences and nuances come in the country’s history – white minority oppressive rule. White people are not unheard of in this area of Africa and South Africa specifically – uncommon, but not unseen. You get a sense that you are always being watched, but in a different way than what may be experienced in other African countries without such a history. It is more of a, “why are you here” look instead of the, “oh! You are white.” The history of white oppression and the current issue of white organizations taking away from the communities makes the dynamic similar in skepticism, but different in why.

Today there was a meeting of the parents and guardians of the children at the center. I was not surprised to see that the majority of the guardians in attendance were women. The meeting was excellent in that it is incorporating the families and parents with the work of the center, since everyone is working towards the same goal – the children’s future. ‘China’ and another man [Mr. Ndaba] came today – they both work for the Library system and are self-proclaimed educators. For the success of the center it is also vital for the teachers to be interested and involved in the activities of the center. Parents, guardians, librarians, educators, teachers – the center requires a community coalition invested in the children’s future if it is to be a success as well as a strong positive for the future of the community.

In a sense community development has been hindered by the negation of education. Bantu education Acts left the black majority behind and now its effects perpetuate into inadequate schools in remote informal settlements and townships.

We had a tour of Zonkizizwe. There are 2 clinics for the 6 zones of Zonkizizwe Proper. Health services are free, provided by the government and are much used by the residents. I hope to be able to closer look at the health impacts of development and education in Zonke. It seems a pressing issue for many families and children is nutrition [malnutrition] and access to food. I have not yet been able to tell the extent of HIV/AIDS in Zonke, but that will be essential to understanding health and development in South Africa.

As much of what I have seen in African communities there is an incredible potential and energy to make change and improve for the future. The key is now facilitate that for those communities to actualize it themselves. “It takes a village to raise a child” – this idea really seems to be at the root of the African heritage and essential to future understandings of development in Africa. (This is a large generalization, but the basic idea of family structures and how that plays out is important all across Africa when working in development).

Back to the meeting: it was a great way to get community feedback and evaluate progress, programs, and potentially identify actions for the future that can be implemented. The issue I see in coming in the near future is employment. We can only do so much to supplement education, we cannot run schools. When students don’t pass the test for university there needs to be something in place to give them the skills to get trained and employed. My thinking now cuts to the idea of green-collar jobs/ green jobs/ green economy in the US to fight poverty, promote conservation, and cut crime and unemployment. A similar model must be able to work here. We hope to also start a book club in conjunction with the libraries and maybe the schools – this will be important to fostering and sustaining the coalition of teachers/ educators.

29 August 2008 Reflections:

The guardian meeting helps to build a community coalition that is dedicated to one another. People in the community who may have been facing issues alone can now come together and see that there are others also facing the same issues. The meeting also makes a family of those benefiting from the center. This also serves as an evaluation of the center’s activities where guardians can say what is working, what isn’t, or give suggestions of things they need. What is really important as part of these meetings is that the suggestions of the children and youth served by the center are used for everything. Their ideas, suggestions, and needs are utilized in decision making since it is their center – no one else owns it. As a very related issue, the center is starting a Young Intern program to train youth at the center to become the next staff members. So those who directly benefit from the center will soon become the next staff who will be able to give suggestions straight from experience.

Previously posted on the When not in Africa. . . blog.