After the end of apartheid and the wholly democratic election of a new government in 1994, South Africa was hailed as a beacon for democracy. Its new constitution was even widely celebrated as one of the world’s most progressive. Since then it is safe to say the nation has struggled to deliver on the promises made by its leaders to alleviate the poverty in which millions of its citizens live. Despite these ongoing struggles, however, South Africans have fought vigorously for a more equal and free society and won many battles.
On Tuesday, unfortunately, they lost a crippling one.
In a country hailed all over the world for its largely peaceful transition to democracy just 17 years ago, this is an unequivocal slap in the face to all who spent their lives fighting for equality and human rights for all South Africans.
Fortunately there is substantial civil and governmental opposition to the bill and this is definitely cause for hope that it will not be signed into law next year as currently planned. Mass protests were staged all over the country on Tuesday, which was deemed “Black Tuesday” by the South African news media and the opposition parties in Parliament are planning to petition the Constitutional Court to review the bill’s constitutionality.
Archbishop and Nobel Peace Prize recipient Desmund Tutu summarized the collective feelings of South Africans describing the move by the ANC as “insulting to all South Africans to be asked to stomach legislation that could be used to outlaw whistle-blowing and investigative journalism… and that makes the state answerable only to the state.”
I would argue, however, that the bill is insulting not only to South Africans, but also to proponents of democracy everywhere; and it has to be stopped.
Calls for greater focus on women’s rights and access to health, better health systems to save the lives of those under 5 years, and fears over growing populations in African countries marked the week. As the G20 meets, many call for a stronger resolve for funding and focus on “development” efforts in the face of financial crises, while others call for cuts to foreign aid.
In his keynote address at the mHealth Summit, Bill Gates noted that, “The key thing, the most important fact that people should know and make sure other people know: As you save children under 5, that is the thing that reduces population growth. That sounds paradoxal. The fact is that within a decade of improving health outcomes, parents decide to have less children.” Gates hopes that there will one day be a international registry of births facilitated by the ubiquity of mobile phones. Along with recording births with mobile phones, Gates sees the potential for a vaccine database to ensure that all newborns are vaccinated thus increasing their chances to live past age 5.
Issue Analyst, Brittany Griffin, answers the question of her post with a critique of Nicholas Kristof’s call for more access to contraceptives in African countries. She makes an effort to ask why some women in Africa have as many as 5-6 children, highlighting economic reasons as well as the impact of diseases. She nots that if we are to address population issues, then we need to address overall inequalities around the world.
The Gauteng Province of South Africa reported that interventions implemented by the Department of Health and Social Development has yielded positive results with declining mortality rates for both mothers and infants. ”The reduction in maternal deaths indicates that the department is making encouraging progress to achieve the Millennium Development Goals target of 100 deaths per 100 000 live births,” said the department’s MEC Ntombi Mekgwe.
An inspiring endeavor that will undoubtedly change the face of epidemiological research is being completed by a student. Jonathan Smith is an epidemiology student at Yale University who recently completed his thesis research on the HIV/TB epidemic in South Africa. He not only collected quantitative research, but also took the time to learn and understand the community. He is putting his work into a documentary film, but needs more support in order to make it a reality. The stories that he has to share are deeply moving and have the potential to make a big impact beyond the communities where he completed his research.
1. As a student from a Western country, why do you feel it is your place to tell the stories of South Africans?
I really like this question – I don’t feel like it is my place at all. I am showing these stories, not necessarily telling them. My role in this project is to be a vector for their stories to unravel by themselves – then to stay out of the way! I think often times people do not appreciate the contextual differences in disease – any disease – and think what solutions work for ‘us’ will work for ‘them.’
This became real to me when I was living with Mr. Mkoko. I struggled to make headway in HIV education, prevention, and testing, at first, but eventually broke through with some success. Not by imposing what I was learning from school on them, but by working together, understanding the cultural beliefs of the community, and taking those beliefs seriously (not casting them aside as ‘stupid’ or ‘wrong,’ although they were indeed dangerously misleading). Because of this, I was formally accepted as a ‘brother’ into their community – even given the tribal name Masheshay’nike. This meant I was no longer an ‘umlungu’ (‘white person/outsider’) and that they now would respect my views and thoughts as one of their own – I worked with their traditional healer in a pseudo-scientific, quazi-clinic capacity that promoted proper prevention strategies and testing without undermining their traditional practices. This was an intense amount of work,
but if I were to just go in there and say “this is right, you are wrong,” I would have been shut out immediately.
2. Since there have been many fully funded large scale studies completed by international organizations, how has your work been received coming from a student?
For the film, I think being a student really helped me. People were really willing to help since I was just a student. I think it made the industry executives and government officials a little bit more relaxed – i.e. this was ‘just a student project,’ as opposed to a mainstream film, if that makes sense. Several production companies let me use their studios for interviews for free, international universities accommodated me, and people favorably responded to interview requests all because, honestly, I think they remembered what it was like being a struggling student.
3. How has your work been received in the epidemiological community since you are using a mixed methods approach as opposed to sticking with traditional quantitative research?
So it’s a little tricky – there are two things occurring simultaneously, but independently: a research project and a film. I am simultaneously working on a mixed-method research study at Yale that incorporates both qualitative and quantitative measures to indicate contextual factors that lead to increased TB and HIV vulnerability among this population. In other words, what other forces are at work that increase disease vulnerability and allow this cycle of disease to perpetuate. The film itself, while technically independent from the research, further investigates the lives of people caught up in the very cycle that I am researching. So puts a face to this and hopes to shift the conversation away from the data and more towards the person. Hopefully combined, they will really demonstrate a need for change – the data will explain that this is a widespread and serious problem (i.e. not some crazy activist film), and the film will demonstrate that for each ‘number’ that we quantify in the research, the impact goes well beyond just the statistics. So one does not negate or undermine the other, they actually go hand in hand to augment each other.
As far as reception from the academic community, people have been very receptive to the idea. I work with a number of professors at the University, and we are currently trying to figure out how we can expand on this idea, how to replicate it in other issues, as well as metrics to gauge its effectiveness.
4. What impact do you hope to achieve with the completion of the documentary? What will your research and documentary be able to do that “million dollar” studies have failed to do?
What I think any research project on this issue has yet to do is place accountability. I’m in no way against the million dollar studies – we need them to highlight the problem. But over the past few decades, we have used this research to define the problem now with surgical precision – we know what it is. We know why. We know what needs to be done. We know how to do it. We know certain methods will work. But nothing is being done. Why? Because there is no accountability. Its not just ‘big mining’ dropping the ball – its everyone. Governments, the industry, and the unions could do more.
Even researchers. Because rates of TB and HIV are so high, researchers now use the mining
population for cohort studies that have nothing to do with the population itself, they just know they will get the disease so it would be an easy cohort study. They are literally human guinea pigs for epidemiological research. We are dancing a fine line of ethics when we treat a population int his manner.
I hope the film will educate and empower civil society to place accountability on the decision makers to actually get things done – to make the appropriate policy changes or actually enforce existing ones. I hope to string together motivated individuals and organizations to say, “Now we are watching.”
The AIDS Healthcare Foundation (AHF) has put together an amazing event to promote HIV testing and treatment among young people in South Africa. In a country where there is still a large stigma towards testing for HIV, especially among young people, this is a powerful example of using youth cultural influences to get the message across. AHF also offered free testing and counseling at the event.
What strategies have you heard of to get young people involved in their own health? Do you think hip hop can change people’s minds about testing for HIV?
This past summer I was fortunate enough to spend three months working at an NGO in Cape Town, South Africa. So of course I was expecting to be bombarded with questions about how my trip to South Africa was upon my return home. Somewhat contrary to my expectations, however, I was repeatedly asked how my trip to Africa was. I thought this was especially peculiar because when my sister returned from her study abroad in Italy last summer, no one asked her how her time in Europe was, people always asked about Italy. Most of the time I would specify that I had traveled specifically to South Africa and tell them about my trip. At first I figured that the people asking had just forgotten where exactly in Africa I was staying but when it happened more and more frequently I began to think that this question wasn’t necessarily indicative of people forgetting where specifically in Africa I lived, but instead of a widespread view of Africa held by many in the West as a uniform, homogenous continent. Basically that the differences between places like Egypt and South Africa, Madagascar and Mali are negligible.
This image of a uniform continent without much variance between countries doesn’t just develop on its own, either. It is informed and perpetuated by a number of different mediums we all encounter on a daily basis: our education system, entertainment industry (movies, TV, music, etc.), NGO’s and the non-profit sector, and, perhaps most importantly, the media. All of these institutions reflect biased notions of Africa, for better or worse, and it is up to us, as consumers of the information and discourses they sustain to separate fact from fiction, whole truth from half-truth, and imagined Africa from actual Africa.
This recognition of our own individual biases informed by our experiences as Westerners is the first step in the very important process of breaking through negative and imagined stereotypes on Africa and discovering the truth about a continent with as much diversity, if not more, as anywhere else.
And by the way, my time in South Africa was absolutely amazing. It is truly a beautiful country in so many ways.
In Africa, NCDs are anticipated to overtake mortality from all other diseases (combined) by 2030
With the UN Summit on Non-Communicable Diseases just 3 days away, everyone is scrambling to have something to say. Many organizations are talking more about their work with HIV and cervical cancer, rates of obesity increasing in South Africa, and even Michigan has been talking about its high rates of tobacco use and the effect that has on the health care system. Will NCDs take precedence over infectious diseases?
The Deputy Minister of Health, Dr Gwen Ramokgopa noted, ”We need to ensure that the NCDs don’t reach the [level] of HIV and Aids.” In a country like South Africa, already struggling with managing a weak health care system in rural and peri-urban areas and the onslaught of HIV/AIDS, the advent of increasing cases of NCDs is troubling. How can a system already taxed to the extreme handle so many chronic conditions when it doesn’t have the capacity. South Africa has one of the more advanced health care systems on the continent, so this is an indication of how other countries health systems might fair as NCDs become more prominent.
In a newly launched program aimed at assisting the South African government to improve quality of and access to primary health care services; fight HIV/Aids and TB and improve maternal and child health – goals which are informed by the National Service Delivery Agreement, South African priorities and the NSP for HIV and Aids (2011 – 2014). This is a welcome boost and Health Minister Dr Aaron Motsoaledi spoke of re-engineering the health care system to be more comprehensive with programs focused at the District level and within schools.
The government plans to subsidize farmers in order to help Namibian access healthier foods. Currently the best options are expensive imported products and for many low-income Namibians this is just not an option. “This trend is not unique to Namibia. Countries like the United States of America have tomes of research that show that the poorer you are the fewer healthier eating options you have.”
“It’s all a matter of behaviour change; if the water is treated and if all partners sensitized the population in the use of latrines, there would be no problem” said Vénérand Nzigamasabo, head of the department of disaster management and assistance to vulnerable people at the Burundi Red Cross. Cholera outbreaks aren’t breaking news in African countries, but in the past year there has been an increase in the number of outbreaks. Many times people talk about water supply and sanitation, but its not often that you hear someone talking about cholera related to behaviour changes. Efforts to contain the outbreak continue, with the Red Cross announcing it would distribute more hygiene kits – comprising jerry cans, soap and buckets – next week. ”The treatment of water at home is also envisaged since water-trucking is very expensive,” Nzigamasabo said.
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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.
With the growth of health sectors across the world one of the most critical areas moving forward is how to pay for health care. South Africa’s NIH is facing resistance with its national health care scheme. A few years ago Ghana was working on a similar national health insurance plan. In many countries there are innovative micro-health insurance programs some like Mpesa that are available on your mobile phone. What will be the future of health financing in Africa. This video from a Kenyan news agency looks into the meeting of African Health Ministers talking about health insurance for Africa.
(Photo Credit: International Foundation of the Red Cross)
This week saw the continued striking of Nigerian doctors as well as empty promises of stretched health ministries and US food aid. Our blog hosted a bright discussion on HIV/AIDS in South Africa highlighting the issues of Gender Based Violence and the use of pornography to influence health behaviors and education. Please let us know what you think in the comments, we’d love to start a conversation! If you are interested in submitting a guest post – submit here.
Marie Musa, 37, is devastated. After the mother of four gave premature birth, her baby boy died a few hours later – because the hospital did not have enough incubators to rescue the infant. In August, the same month that Musa’s baby died in hospital, James Bamie Davies, commissioner of the customs and excise department of Sierra Leone’s National Revenue Authority (NRA), announced in a government gazette an auction of medical appliances, including eight incubators. Only the public outcry that followed the announcement of the auction in the gazette, did the Ministry of Health and Sanitation spring into action and recover the goods.
As Uganda joins the word to mark World Food Day today, Isaac Khisa looks at Uganda’s strides in ensuring that every citizen has at least a meal a day Uganda today joins the rest of the world in celebrating World Food Day but with millions of its population still malnourished. According to United Nations Food and Agriculture Organisations, nine million Ugandans are still facing hunger with many affording only one meal a day. Uganda population is now estimated at 31 million, meaning that about 30 per cent of Ugandans can hardly find something to eat.
About 4 000 children die from diarrhoea in Zimbabwe each year due to poor hygiene and unsafe drinking water, a United Nations senior official said last week. In a speech read on his behalf at the annual commemorations of the Global Hand-Washing Day held in Mutoko last week, Unicef country representative Dr Peter Salama said hand-washing is the single most effective and inexpensive way to prevent diarrhoea.
Two-thirds of the African nation of Benin is underwater, with at least 43 people killed and nearly 100,000 made homeless. Heavy rain began falling at the start of October, and the Rivers Oueme and Mono soon overflowed. Thousands of hectares of land, mostly used for growing rice and other vegetables are now underwater. “Here, the water isn’t going away. We have it up to our knees and now it’s as high as our thighs,” said one resident. “The water, it’s everywhere, and it’s very difficult for people to escape.
Health minister Dr Aaron Motsoaledi will today sign the “real deal” with nine provincial health MECs and eight ministers, giving South Africans a shot at “a long and healthy life”. The Negotiated Service Delivery Agreement (NSDA) gives a frank, but brutal assessment of South Africa’s healthcare system and at the same time commits “not to keep doing things as usual” in finding solutions.
South African adult film producer, Tau Morena has just released his newest film, “Mapona,” the English translation being “naked.” This adult film is unique for two unexpected reasons. First, the film makes an empowering political statement about race and South Africa. For the first time in the South African adult film industry Morena employed an all-Black cast. Although the majority of South Africa’s population is Black, this is a first for South African adult films. Second, the film promotes HIV awareness, education and prevention. Although unpopular in the industry, the cast was asked to wear condoms in the film, in addition to being tested for HIV prior to shooting. The South African adult film industry is the first in the world to make such a powerful and blatant health statement. 
Other sensationalized publicity campaigns have proven effective at delivering a health message. In Bangladesh, the Bangladesh Rural Advancement Committee (BRAC) launched a similar campaign a few years ago. BRAC’s founder, Fazle Hasan Abed, started a nationwide campaign addressing the increase in HIV infections. Abed’s campaign “condomized” the country with a wide supply of birth control and safe sex education programs. He placed ads all over the country, handed out condoms in public places such as restaurants, stores and especially focused on brothels throughout Bangladesh. BRAC’s campaign dramatically improved the HIV-related health of the country in an effective and radical way. This campaign is similar to Morena’s new film because it brings important and oftentimes stigmatized health issues into public view.
Although “Mapona” is a new, progressive and interesting way to address the HIV epidemic in South Africa, is pornography the medium that should be used to make such a public statement? Using the medium of pornography as a social platform to supposedly promote racial equality and HIV awareness (both of which have a very dependent relationship) is a paradox in itself. Using an all-Black cast to promote HIV awareness in an adult film could very well perpetuate the colonial and racist stereotypes in the hyper-sexualized images of Black people, especially in an African context.
Does Morena’s highly publicized film reflect a progressive and effective social statement, like BRAC’s HIV awareness campaign? Or is it a publicity stunt that, in the end, defeats the primary purpose of racial and health equality for Black South Africans?