Alex B. Hill

why there is no doctor: scapegoating "tropical workers" (5)

(photo: At the Lesotho border)

As early as 1913, international migrant workers have been brought into South Africa to fill out the labor supply, especially in the mines (42). These workers were called “tropical workers” because they came from countries like Malawi and Mozambique that had more tropical climates and diseases. The mines faced a labor shortage starting in the 1930s and by 1934 over 2,000 “tropical workers” had been brought in on an experimental basis (43). The South African government had difficulties with “tropical workers” bringing in disease and spreading it before 1930 and so there was a certain stigma associated with international laborers. Early tropical workers were blamed with bringing tuberculosis and spreading it within the mines. However, working conditions in the mines and biological susceptibility were not taken into account. Regardless, tropical workers were associated with tuberculosis and that reasoning led the South African government to be wary about reintroducing tropical workers in 1934. The success of these workers and lack of increased disease inspired the South African government to lift the ban on hiring workers above the 22nd parallel in 1937 (44). With the lift of the ban, the numbers of tropical and international migrant workers increased significantly.

Tropical workers entering South Africa numbered 40,000 by 1948, the start of apartheid (45). Between 1988 and 1992, around 13,000 tropical migrant workers from Malawi were repatriated because over a two year period 200 of them had tested positive for HIV (46). The tropical worker who was scapegoated for the spread of tuberculosis was now labeled as the culprit for the spread of HIV to South Africa. Later it was understood that the South African mining industry was working on stabilizing its mining labor supply and HIV/AIDS was used as a way to clear out international migrant workers.

Nevertheless, the increase in numbers of tropical or international migrant workers to South Africa expanded the area where high-risk behavior related to HIV/AIDS could have an impact. The international migrant worker movements from the mines to their home countries and any locations in between likely contributed to the increased prevalence of HIV similar to studies that have proven the same for internal labor migrations. The reach of apartheid’s policies stretched beyond South Africa’s borders and contributed to the deepening of the HIV/AIDS crisis within the country as well as the southern African region.

Notes:
42. Packard, Randall. White Plague, Black Labor: Tuberculosis and the political economy of health and disease in South Africa. University of California Press. 1989, 229.
43. Ibid, 230.
44. Ibid.
45. Ibid.
46. Chirwa, Wiseman Chijere. “Aliens and AIDS in Southern Africa: The Malawi-South Africa Debate.” The Royal African Society. African Affairs 97:53-79, 1998.

Coming next: HIV/AIDS in South Africa

why there is no doctor: high-risk migration patterns (4)

Health, Research

(photo: traffic in Johannesburg)

Apartheid worked on a model of strict population control for increased economic gains. Removing millions to overcrowded townships and Bantustans far from city centers developed a system of forced migrant labor. Both men and women had to leave these areas to find any economic stability for their families.

It has been estimated that one third of the adult male population in the Bantustans is absent at any one time, contributing to the low level of farming. Many women are also forced to seek work elsewhere to support their families. In general they are excluded from seeking work on the industrial areas of South Africa and the majority work as domestics or in agriculture (32).

The migration of Black populations to find work had adverse effects on the health of individuals, families, as well as communities. The movements of people from rural to urban areas became entrenched in the economic system where state interventions actively controlled and mobilized labor migrations (33). In 1990, a study in KwaZulu-Natal province found that men who were migrant workers in the mines had twice the HIV rates as non-migrant workers, while women who attended prenatal clinics in the province had twice the national level of HIV infection (34).

During the period of 1993-1999, there was a significant increase in migrant labor. This can be explained by the ending of apartheid laws creating an increased mobility of populations of workers. In 1993, 32.6% of rural Black Africans were migrant laborers (35). In 1999, almost 40% of rural Black Africans were migrant laborer and 34% of all these migrant workers were women (36). This period also marked the ending of apartheid laws, the first democratic elections in South Africa as well as the doubling of HIV prevalence rates (37). Recent studies have shown that labor migration patterns did not change with the ending of apartheid, but rather increased. A 2003 study concluded that,

Migration continues to play an important role in the spread of HIV-1 in South Africa. The direction of spread of the epidemic is not only from returning migrant men to their rural partners, but also from women to their migrant partners. Prevention efforts will need to target both migrant men and women who remain at home (38).

Professor Lurie and researchers from Brown University, Harvard Medical School and Imperial College London used data collected from nearly 500 men and women living in bustling towns and rural villages to create a mathematical model that shows that migration of South African workers played a major role in the spread of HIV mainly by increasing high-risk sexual behaviors. Very often young men would leave the rural Bantustans in order to earn a living in the urban areas and mines only returning home once a year. With the lifting of travel restrictions on Black South Africans after apartheid this “circular movement” increased (40). Professor Lurie said,

Our model showed that migration primarily influences HIV spread by increasing high-risk sexual behavior. Migrant men were four times as likely to have a casual sexual partner than non-migrant men. So, when coupled with an increase in unprotected sex, we found the frequent return of migrant workers to be an important risk factor for HIV (41).

Notes:
32. Seedat, Aziza. Crippling a Nation: Health in Apartheid South Africa, 18.
33. Posel, Dorrit. “Have migration patterns in post-apartheid South Africa changed?” 4-7 June 2003.
34. “HIV and other STDs. Chapter 3, Part 1” Population Reports. November 1996, 20.
35. Posel, Dorrit. “Have migration patterns in post-apartheid South Africa changed?” 4-7 June 2003, 3.
36. Ibid.
37. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
http://www.avert.org/aidssouthafrica.htm
38. Lurie, Mark N; Williams, Brian G; Zuma, Khangelani; Mkaya-Mwamburi, David; Garnett, Geoff P; Sweat, Michael D; Gittelsohn, Joel; Karim, Salim SAbdool. AIDS:17 October 2003 – Volume 17 – Issue 15 – pp 2245-2252.
39. Ibid.
40. Ibid.
41. Ibid.

Coming next: Scapegoating “tropical workers”

why there is no doctor: cleaning black spots off of a white land? (3)

Health, Research

Forcing people to live in separate racial areas of South Africa was the driving piece of apartheid’s “separate development” policy. The pockets of the Black population that lived among and near White city centers were called “Black spots” and the government actively worked to clean them out. During the 1950s and 1960s the first “forced removals” occurred after the passing of the Group Areas Act established these racial areas. More than 860,000 people were forcibly removed as a way to divide and control racially separate communities as resistance grew towards apartheid policies (23). Sophiatown of Johannesburg and District Six of Cape Town are just two examples of vibrant multi-racial communities that were destroyed by South African government bulldozers once they were deemed “White” areas (24).

Between 1960 and 1983, over 3.5 million South Africans were forcibly removed (25) and until 1984 another 1.7 million were under threat of removal (26). Blacks were removed to distant segregated townships, sometimes 30 kilometers away from places of employment in the central towns and cities (27). As a result ‘informal settlements’ formed as shantytowns closer to places of work, but many were destroyed. Farm laborers were also displaced by mechanized agricultural. As a result farm laborers were segregated into desperately poor and overcrowded rural areas and were not permitted to travel to towns to find new jobs (28).

Removals represented the “essential tool” for apartheid to work. Creation of the Bantustans stripped Black South Africans of all legal rights in South Africa and their welfare was no longer the problem of the South African government. Hundreds of thousands of other Blacks were dispossessed of land and homes where they had lived for generations in these “Black spots” now designated as part of “White” South Africa. Entire townships were destroyed and their residents removed to just inside the borders of Bantustans where they now faced long commutes to their jobs (29).

In other words, removal of people is not simply a physical act; it is part of a process and a strategy that seeks to push increasing numbers of South Africa’s people into ever more remote and inhospitable areas where, broken and fragmented by the experience of removal and all that it means, people are left to exist under conditions of increasing apathy and powerlessness (30).

One UN report on the forced removals noted, “that the demolition was executed in total disregard for the health and well-being of every individual concerned, in the most inhumane manner” (31). The forced removals created poverty situations where the infertile Bantustan lands had to sustain an overcrowded population. This policy of removal, coupled with the apartheid policies on health services in Bantustans and for Black medical training, shows the dire health effects on the Black population. These terrible health conditions later translate into environments easily susceptible to the spread of HIV/AIDS.

Notes:
23. “Forced removals” South Africa: Overcoming apartheid, building democracy. MSU African Studies Center.
http://www.overcomingapartheid.msu.edu/multimedia.php?id=5
24. Ibid.
25. “Forced removals” South Africa: Overcoming apartheid, building democracy. MSU African Studies Center.
http://www.overcomingapartheid.msu.edu/multimedia.php?id=5
26. “The uprooting of millions, forced removals.” For their Triumphs’ and Tears. ANC, 1983.
http://www.anc.org.za/books/triumphs_part1.html#3back1
27. “Forced removals” South Africa: Overcoming apartheid, building democracy. MSU African Studies Center.
http://www.overcomingapartheid.msu.edu/multimedia.php?id=5
28. Ibid.
29. Ibid.
30. J Yawitch, Betterment. “The myth of homeland agriculture” SAIRR: Johannesburg, 1981, p.86.
31. ‘Forced removals in South Africa 1977-1978’, paper prepared by IDAF for the United Nations Centre Against Apartheid, No. 44/78, Oct. 1978, p.9.

Coming next: High-Risk Migration Patterns

the social enterprise: irony and alternative

Development

Over the years SCOUT BANANA’s work has been termed “social entrepreneurship.” Unfortunately, the definition of the social enterprise has slowly become muddled and confused with other ideas. During a discussion last month a friend said that calling someone a social entrepreneur was like “cutting the balls off of a socialist.” He may not have been as far from the truth as I once thought. As the term becomes more prevalent within aid and development we must delve deeper into the history of social enterprise and decide what it really means for the work that we do.

Jeff Trexler wrote an excellent poston the history of social enterprise. He writes that a social enterprise is essentially “a venture with a social purpose.” As many wrongly believe the ideas of social enterprise did not come from capitalism or corporate business models at all.

“In socialist jurisprudence, social enterprise was a term designed to replace the capitalist notion of businesses dedicated to the pursuit of profit. The social enterprise generated revenue in excess of the costs of production, but profit-making was not the goal of socialist business–rather, its fundamental organizational purpose was to serve collective benefit. More over, in keeping with Marxist/Leninist ideology, the social enterprise was owned & controlled not by private shareholders–a hallmark of bourgeoise capitalism–but by workers themselves, from the workers immediately connected to the enterprise to society as a whole.”

Jeff continues to write that “social enterprise” migrated to Western minds and charities much the same way that “civil society” was reborn and co-opted. Meaning “citizen’s society,” the term was used to unite individuals against centralized government power. Now the term is best understood as a descriptor of anything “non-governmental.”

It seems that “social enterprise” has drifted just as far from its original conception. As a social venture that was meant to give power back to people and allow them ownership, much like a cooperative, “social enterprise” has best come to represent corporate philanthropy and cause marketing campaigns. Both of which are focused on turning profits and not helping people. Julia Moulden asks, “is making a difference only for the rich?” She easily gives examples that it is not, but is it? As far as the foreign aid/ international development arena it appears that social enterprise is geared towards engaging wealthy Western populations in feel good campaigns, like Product (RED), that are best defined as image marketing campaigns for corporations to try and look better as a way to bring in more customers. Lucy Bernholz has termed this business model “embedded giving” where “commerce is used to generate funds for a cause.” She writes:

“Embedded giving is just one more example of the blurring of sectors and roles between commerce, philanthropy, and public good. […] Maybe today’s teens and kids who have seen so much embedded giving will grow up to expect that every product and every service comes with a charitable affiliation.”

SCOUT BANANA’s work was first called “social entrepreneurship” in 2004 when I was selected as one of Netaid’s Global Action Awardee and was asked to contribute to a discussion on SocialEdge about young people and making a difference. Then, I was not too sure what the term meant or why it might be significant. More recently Spotlight Michigan has highlighted our work and called us a “social enterprise.” They select “innovative” companies and organizations in Michigan to feature on their website. Their criteria breaks down into three categories: creativity, risk-taking and adaptability. In the true spirit of a social enterprise we are an organization built for adaptation because we operate by members involvement and input. We have always been called creative for our fundraising tactics, use of yellow and bananas, and our ability to connect people. The risk-taking is another story. We never faced any risk in our venture to make a difference. If we failed the only people who would potentially suffer were those relying on our support to access basic health care. Alanna Shaikh wrote an excellent piece on how “global health is not about altruism.” While our actions may have been seen as risk-taking, we really work to create accountable, long-term relationships with communities developing their own sustainable solutions.

Personally I define social entrepreneurship within its original conception; a socialist structure (for social good) that is meant to give power and agency back to people as well as present an alternative to ineffective governments. Civil society still exists because honestly the government can’t do it all and often are not very good at meeting the needs of people. SCOUT BANANA sees the world’s problems as a simple equation of connecting communities; linking the necessary social capital (people and ideas) to social problems. We embrace the idea of “social enterprise” by focusing on presenting an alternative to government aid schemes and other big philanthropy and development programs that go for the quick-fix, band-aid solutions without being people-focused to produce long-term social change.

Is SCOUT BANANA a social enterprise? Yes and no, it depends how you define the term. If you are thinking of an organization cooperatively owned and operated by its members, focused on providing an alternative to what hasn’t worked, and supporting community-based solutions that do work – then, and only then are we definitely a “social enterprise.” In her Spotlight Michigan article I think Caitlin Blair put it best: “A society of entrepreneurs and innovators simply could not exist without social entrepreneurs because where business entrepreneurs typically work to enhance markets, social entrepreneurs completely transform the necessary infrastructure and attitudes of a society.”

See our features on Spotlight Michigan:
profile
article
photo essay

Written for the SCOUT BANANA blog.

why there is no doctor: the health system via apartheid (2)

Health, Research

In order to fully understand the extent of the HIV/AIDS crisis in South Africa and the reasoning for its rapid spread without a response, the history of the health care system and apartheid must be researched. Creating a timeline (see Appendix A) of the health care system in South Africa will be critical to understanding current inadequacies and failures. Looking more critically at the policies of apartheid will also allow a better understanding of their effects on the health of the population, especially the Black majority.

Looking back to the Union of South Africa under Jan Smuts (8), the beginnings of government control of health care systems can be seen. In 1919, the Public Health Act marked the beginning of health service structure in South Africa where policy and procedure is delegated to specific provincial authorities by the central government (9). In the early 1940s there was talk of creating a National Health Service (10). However, when the National Party (Afrikaaner) came to power in 1948, apartheid laws were enacted and the health budget was cut “drastically” (11). This may seem a minor note, however this translated into the policy of “separate development” that left traditional homelands or “Bantustans” as well as Black townships to come up with their own health care services.

[…] the health services aid in the reproduction of the Black labour force according to White economic needs. The provision of health care for Blacks outside the bantustans is geared towards the urban population as the supplier of a large and increasingly skilled, Black workforce, rather than the Black population at large. Secondly, the health services support the commitment to ‘separate development’ in various ways. […] They help to establish the credibility of the bantustans and their leaders, and of the representatives in the new segregated parliament. They also provide a lever with which the government can pressurize bantustan governments into accepting ‘independence’. […] Thus health policy is shown to be an instrument of the state’s twin imperatives: reproducing the conditions of capitalist accumulation and maintaining White supremacy. (12)

Following the legal creation of apartheid, the health system continued to evolve. The year 1951 brought the Bantu Authorities Act, which established traditional homelands for the majority of South African citizens. This action took away the rights and citizenship of 9 million Blacks. In the same year the Prevention of Illegal Squatting Act continued the forced removal of Black South Africans and began the destruction of basic health services that had been established (13). Up until 1970, health services run in Bantustans by mission stations and churches were under the control of ‘local government’ authorities (14). However, following 1970 all health services were placed under the control of the South African Department of Health (15). Along with the removal of people living in the wrong areas and the destruction of health services in those areas, the South African apartheid government was slowly taking control of all aspects of health service to the Black population. In 1973, the Department of Bantu Administration and Development began to gradually take control of all mission hospitals (16). This increased government control led to severe staff shortages as mission doctors did not want to be under the authority of the South African government. This was called an intermediate progress step before completely handing over financing of health services to ‘homeland’ governments. Within the health care system of apartheid South Africa, the notion of “separate development” quickly came to mean absolute government control.

The South African Institute of Race Relations made a Survey of Race Relations in 1982 and quoted a doctor talking on rural health services in the Bantustan homelands,

[…] gave some credibility to the homeland administration itself by enabling it to promote services to local communities. The separation of rural health services into homeland health services allowed the government to manipulate health statistics to give the impression that the health status of SA’s people was improving. An apparent fall in the rate of tuberculosis notifications between 1975 and 1980 was a result of the exclusion of statistics from Venda, Bophuthatswana and the Transkei. […] the separation of statistics also allowed the SA government to claim that most infectious diseases were occurring ‘outside of SA’ and were the responsibility of the appropriate homeland authority, not the SA Department of Health. (17)

The quote from this doctor working in the Bantustan health services shows the direct contradictions of the “separate development” policy within the health care system of South Africa. The doctor talks about how the South African Department of Health takes no responsibility for health statistics in Bantustans (1982), but since 1970 the Department of Health had controlled health services. This contradiction is an excellent example of the apartheid policy’s effect on health, an effect with a planned negative outcome. In interviews in 1983, doctors in the Department of Medicine at Baragwanath hospital in Soweto, Johannesburg noted the inadequacies of health services for the Black population:

[…] described the overcrowding and shortage of medical staff as having reached a ‘breaking point.’ Journalists who visited Ward 21 found that its 40 beds were occupied by 89 women and one child. […] ‘There are not enough doctors and too many patients to do things any other way here.’ Bedletters, giving the crucial medical and drug history of each patient, often got lost in a confusion of movement as patients moved outside the wards during the day to give the doctors greater freedom to work inside. ‘Sometimes I haven’t been able to find out what medication a patient was receiving,’ on doctor said,‘People are not being treated properly here.’

Health, access to health services, and control of health services was an active aspect of the apartheid government policy. The greatest impact of apartheid policy on health infrastructure for South Africa was denying proper training for Black health workers. At the end of 1981, it was estimated that 93% of the medical practitioners in South Africa were White and the ratio of Black doctors to patients was 1 to ever 91,000 people (18). While these numbers do not reflect the direct availability of health services, as much can be gathered. The numbers do show the availability of medical training for certain populations. Along with issues of access to training, there was also the issue of distribution of doctors. Approximately 60% of the population lived in rural areas, but only 5% of doctors practiced in those rural areas (19).

The medical profession of South Africa is White dominated. Medical training was offered at the major provincial universities. Black Africans were allowed to train at just three of these universities until a new medical training center was established in one of the Bantustans as a way to phase Blacks out of the White medical universities. Under the provisions of the Extension of University Education Act of 1959 a new medical training center was establish and the Minister of Education and Training (formerly Bantu Education) had the power to vet all applicants (20). It was policy to limit the number of Blacks as part of ‘Bantu Education’ (21). As Dr. Verwoerd stated in 1954:

The education of a white child prepares him for life in a dominant society and the education of a black child for a subordinate society [. . .] The limits (of Native Education) form part of the social and economic structure of the country.

This unequal access to facilities translated even deeper into medical education as there were restrictions for Black medical students even at the ‘mixed’ universities. The discriminatory laws translate into an inadequate medical training: Black students cannot attend post mortems of Whites, were not allowed to attend ward rounds in White hospitals, and Black students were asked to leave the room when White patients were used for clinical demonstrations. These issues related to access to training were seen across the board for doctors, nurses, pharmacists, and within professional medical organizations. The issues ranged from access to training, lower salaries, and lack of promotion.

Health in South Africa was not departed from the apartheid policy and was an active tool in ensuring political, economic, and social control by the White minority government. The only way to fix health care in South Africa depended on ending apartheid and discrimination and increased government attention to health problems (22). The effects that apartheid policy had on the health system of South Africa, specifically for Black South Africans, laid the groundwork for HIV/AIDS to rapidly spread and take such a heavy toll. Some of the active policy actions that contributed to HIV’s spread were forced removals and migrant laborer movements, both internal and international.

Notes:
8. “History of South Africa.” Wikipedia.org.
9. Seedat, Aziza. Crippling a Nation: Health in Apartheid South Africa, 63.
10. Ibid.
11. Ibid.
12. Price, Max. “Healthcare as an instrument of apartheid policy in South Africa.” 1986. http://heapol.oxfordjournals.org/cgi/content/abstract/1/2/158
13. Seedat, Aziza. Crippling a Nation: Health in Apartheid South Africa, 63.
14. Ibid.
15. Ibid.
16. Ibid.
17. Ibid, 69.
18. Ibid, 84.
19. Ibid.
20. Ibid, 86.
21. Ibid.
22. E. O. Nightingale, K. Hannibal, H. J. Geiger, L. Hartmann, R. Lawrence and J. Spurlock. “Apartheid Medicine.” Committee on Health and Human Rights, Institute of Medicine, National Academy of Sciences. Vol. 264 No. 16, October 24, 1990.

Coming next: Cleaning Black Spots off of a White Land?

why there is no doctor: introduction to an epidemic (1)

Health, Research

Subtitle: The Impact of HIV/AIDS in the Post-Apartheid Health Care System of South Africa

Introduction to an Epidemic

Everyone in the car remained silent as we passed a sea of gravestones on the way to Zonkizizwe, an informal settlement south of Johannesburg (1). The cemetery seemed to extend for miles. This was the reality of HIV/AIDS in the peri-urban, informal settlements. It is a reality that is not far departed from scenes in rural homelands as well as the urban townships of South Africa. I was not new to the HIV/AIDS epidemic, but I was new to the experiences of those living in an informal settlement under apartheid, struggling with the crippling impact of HIV in an area where I never even saw a doctor. Why were there no doctors?

It is estimated that one in five South Africans aged 15-49 are infected with HIV. Since the last UNAIDS report in 2008, 5.7 million people are living with HIV in South Africa and 1000 people die everyday from HIV/AIDS related causes (2). The cause of death for 71% of people aged 15-49 is now AIDS (3). Some people have even noted that South Africans spend more time at funerals than they do at weddings. There are an estimated 1,400,000 orphans as a result of HIV/AIDS (4). The numbers of those infected does not reflect the real impact of disease because the impact of HIV/AIDS extends further into families, friends, and communities.

Life expectancy has fallen considerably in South Africa as the prevalence of HIV/AIDS spread rapidly from 1990-2003 (5). This time period is marked by violent, but positive changes in government rule and policy. The first case of AIDS in South Africa was diagnosed in 1982 among the gay population, so why was the most rapid spread during this time period (6)? Many experts and professionals posit that this rapid spread of HIV and the lack of a response to the epidemic in South Africa is due to the political turmoil of the 1980s into the 1990s. However, this represents a failure to look deeper into the history of South Africa and its health care systems.

While violent conflict had a direct effect on the response to HIV/AIDS in South Africa, a number of other factors with greater impacts based in apartheid policy led to the rapid spread and limited possibility for a comprehensive government response even if there were an absence of violence. South Africa has a difficult history of formulating a response to HIV/AIDS: from apartheid health policy to AIDS denial, from a failed treatment program to the absence of doctors and adequate health infrastructures.

In the March 2009 elections, health was a driving factor for many voters and appeared on many political party platforms. The African National Congress (ANC) ran with promises to cut HIV infections by 50%, launch a National Health Insurance program, and ensure decent wages for health workers (7). With such a far-reaching crisis at hand, politicians must formulate a better, more comprehensive plan to address the effects of apartheid history combined with the current strains on the health care system if they are to effectively combat HIV/AIDS. Why has the response to HIV/AIDS been so poor? Why was HIV able to spread so quickly in South Africa? Why is there no comprehensive treatment program? Why are there no doctors?

Notes:
1. Personal account of Alex B. Hill who interned at Vumundzuku-bya Vana ‘Our Children’s Future’ in Zonkizizwe (Proper), South Africa from May-August 2008.
2. UNAIDS 2008 Report on the Global AIDS Epidemic http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/
3. Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa (2006, November), ‘The Demographic Impact of HIV/AIDS in South Africa – National and Provincial Indicators for 2006’
4. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
5. UNAIDS 2006 Report on the Global AIDS Epidemic, Chapter 4: The impact of AIDS on people and societies
http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2006/default.asp
6. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
7. Cullinana, Kerry. “Healthy election promises.” 31 March 2009
http://allafrica.com/stories/200903310649.html

Coming next: The Health System via Apartheid

global health is everyone’s responsibility and human right

Health

From the UN Declaration to Amnesty International, between Paul Farmer and William Easterly it seems that everyone has a different understanding of what constitutes a basic human right and the cause of its absence. Michael Keizner has been building the discussion on health and human rights on Change.org’s Global Health blog while NYU Professor, William Easterly has recently entered the debate as a response to Amnesty International’s position on poverty related to human rights. This fueled a response from Amnesty International, which stated that Easterly was “pretty off base.” Easterly followed his Amnesty International response with an end to his “human rights trilogy” by asking Paul Farmer who should be held responsible for satisfying the right to health care?

The World Health Organization (WHO) states health as a human right as:

“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”

It seems that Easterly’s human rights criteria is trapped in an old international law paradigm where there must be someone at fault or someone to blame. He also forgets that health is directly linked to food. You cannot have good health and not have food. Effective aid, not seen in today’s aid schemes, based in sustainable practices (not just buzzword reporting) that supports an individual’s right to develop themselves should look comprehensively towards the needs of a community of individuals. The ideas of human rights, foreign aid, and development should be less focused on international systems and more focused on building strong communities that meet their own human needs: health care, food, water, etc.

Within this debate of health and human rights, where does SCOUT BANANA fit. As an organization that makes and stands behind the statement that:

“global health is everyone’s responsibility and every individual’s human right”

Paul Farmer has the right idea, as Easterly quotes from his Tanner Lecture in 2005:

“only a social movement involving millions, most of us living far from these difficult settings, could allow us to change the course of history….troves of attention are required to reconfigure existing arrangements if we are to slow the steady movement of resources from poor to rich—transfers that have always been associated… with violence and epidemic disease… whether or not we can say “never again” with any conviction—will depend on our collective courage to examine and understand the roots of modern violence and the violation of a broad array of rights, including social and economic rights”

This is exactly similar to SCOUT BANANA’s understanding of health as a human right and a responsibility. It is a right where we do not attempt to place blame or hold the past accountable because those become frivolous exercises that produce no results. When we delve deeper into the root causes of issues, for example the driving forces of slavery, we must focus on a responsibility to not repeat the past and make ourselves accountable in the future.

There is no way that the entire European population and its descendants can be held accountable for the evils of the slave trade. While the same ideas of human rights did not exist in the time period of slavery, it is similarly difficult to place blame on systems (and populations) that drive the causes of poverty and lack of access to health care. Many people that I work with on development projects feel guilty that they are so privileged and wealthy compared to the communities that they work with that are so poor. SCOUT BANANA teaches its members to not feel guilty, but instead to feel responsible. Understanding personal privilege related to the oppression of certain populations within societal structures can assist in creating positive impacts. Human rights don’t necessarily have to be about placing blame, but rather developing an understanding of responsibility.

So Professor Easterly when you ask who is responsible for satisfying human rights: it is you, it is me, it is all those who dream of making a difference, and it is also those who lack the very human rights that we hold dear. Placing blame is not a concrete step forward, learning from history and recognizing where our privilege fits can be a first step towards effective actions. I too see Paul Farmer’s vision of a movement of millions, near and far, taking actions to shape a better future where human rights are everyone’s responsibility and every individual’s human right.

From the Article 25 of the Universal Declaration on Human Rights:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Written for the SCOUT BANANA blog.

why are there no doctors?

Health

(photo: empty waiting room at Zonke Clinic 2, no doctor)

Over the past 8 years Africa, international development, and health care have been the focus of my work and studies. Just last year (it’s been a year already?) I completed an internship in South Africa at a center for children and youth affected by HIV/AIDS called VVOCF (Vumundzuku-bya Vana ‘Our Children’s Future’). The internship was a completion of my ‘field experience’ requirement for my International Relations major at James Madison College and was supported by the Young People For internship program. The paper that I wrote as an investigation, analysis, and report has been by far my most rewarding piece of academic work, but also my most depressing.

To work with a community on difficult issues is one thing. To witness harsh realities while working within that community is another. But to know the historical and present reasons behind those issues and harsh realities is yet another – and it is painful only be able to watch. Sure you could argue that I and others spent time working with the community at VVOCF, but in truth all we can do as outsiders is watch. We will never live long-term in the community and we will never fully understand the issues that we study and claim to know so well.

My blogging well in South Africa took a hit because of the lack of internet access and since then has been limited to posts of some of my academic papers for classes. What will follow this post will be a series of posts copied and pasted from my final, field experience paper. I hope that it can be a resource for others. I also hope that it is a deeper look into an issue faced by a community with plenty of room for further research, learning and understanding.

There will be roughly a dozen posts on the health care system in South Africa: effects of apartheid, impacts of HIV/AIDS, issues in Zonkizizwe specifically, and conclusions. Be sure to check back later today for the first post.

history channel perpetuates misperceptions of africa

Development, Featured

Reminiscent of the 1800s, a new History Channel show describes a team of explorers, dressed in their colonial khaki, set out to discover the perils of the African continent.

Four modern-day explorers retrace the most famous search in history through 970 miles of hell. They face countless dangers from predators and insects to disease and nature’s own fury. Check out the television event of the summer!

Miles of hell in Africa, oh my! Don’t forget the natural danger!

Between Zanzibar and Ujiji, there are 970 miles of high seas, steep hillsides, scorching plains, fast-moving rivers and mud-filled swamps. Danger lurks around every corner, and any step could be their last.
(Expedition Africa, History Channel)

The webpage for the expedition show describes how the explorers will be following in the footsteps of the great explorers, “heroes” to some of these ‘modern-day’ explorers, Sir Henry Morton Stanley and Dr. David Livingstone.

Stanley a Welsh journalist, who spent a number of years of his life in the US, is best known for finding Dr. Livingstone after he was thought lost in the African bush. Regarded as one of the premier African explorers, a little known fact about Stanley’s African exploration is that he laid the foundation, through his exploration, for the takeover of the Congo (now DRC) by King Leopold II of Belgium. The King was interested in spreading Western civilization and religion to the region as well as claim land. This has led to a still destabilized region where some of the longest running African conflicts are located. Allegedly his expeditions were marked by violence and brutality. He is quoted, “the savage only respects force, power, boldness, and decision.” On a health related note for the central African region, the spread of trypanosomiasis is attributed to the movements of Stanley’s enormous baggage train.

Livingstone’s African exploratory era was marked by the greatest European penetration of the continent. He began his African explorations as a Protestant missionary, but supposedly did not force his preaching on unwilling ears as his main interest was exploring. He was known to travel lightly and was able to negotiate with local chiefs. Livingstone was a man in love with the continent and popularized the search for the source of the Nile. After being ‘found’ by Stanley he refused to return without completing his mission. Just 50 years after his death, colonialism exploded across the continent and was able to penetrate further into the interior due to his work. However, this also allowed missionaries to provide education and health care services to more central Africans. Livingstone was also a staunch abolitionist and made many friends among the African chiefs and populations.

Both men are examples of the Western colonial mindset scarring the African continent. While Livingstone was perhaps a step forward in Western engagement of Africans, Stanley is far from a figure to emulate. The History Channel fails to take note of the important contributions these men made to the destruction of the continent. Instead they focus on the meeting of the two in a popular media tale of discovery in the African wilderness.

Four Westerners with varying experience with the African continent will be followed on their journey that will pit them against the harsh natural environments of Africa. But, this show isn’t about Africa, learning about African peoples, remembering African history or highlighting the difficulties faced in Africa. The show makes generalizations about the continent and perpetuates the myths of Africa as primarily a place of danger. It focuses on Africa as “the unknown, the interior of Tanzania.” If I’m not mistaken people have been living on the African continent longer than any other place on earth. It may be a dangerous, unknown hell full of nature to outsiders, but it is far from a mystery to those who live there. The show seems to be all about these four privileged individuals and the story of their personal journeys. The explorers are worried about mosquitos, disease, death, and surviving. Rightly so in some regards, but what if the story included the people that actually live there?

When will Africa cease to be represented solely by its nature, its dangers and its forgotten history?

Written for the SCOUT BANANA blog.