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

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

why are there no doctors?


(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.

the week in african health

Nyala, Kalma camp, South Darfur - March 2007 (MSF Photo Blog)

The impact of conflict on the environment and then the subsequent, direct effect on human health cannot be overlooked. This internally displaced peoples (IDP) camp in Sudan shows the seriousness of that impact.

Your Old Cell Phone Can Make a Difference in Global Health

Everyone in the global health sector is writing about the incredible reach of SMS technologies working for health in developing countries, and rightly so. Hope Phones has partnered with FrontlineSMS to provide old cell phones to communities in need through SMSmedic partner organizations.
More:
Your Old Phone Can Change the World

TeleMed
A service that I just recently came across is one that is not being as widely talked about. TeleMed is different from FrontlineSMS: Medic because it connects local health care workers directly to patients in need via SMS technology. SMS: Medic is focused on health infrastructure. TeleMed does not have a website up yet, but is definitely one to watch:

Paul Farmer and the US Government?

The other big talk within global health is whether Paul Farmer will take a job within the US government. Some have expressed great hope for potential reform others voice their plea with him to continue his incredible community based work outside the bureaucracies. My opinion is that Partners in Health has developed into a strong organization and does not depend on Paul Farmer to further their work. If he wants to take on the inefficiencies and inadequacies of the US government and global health, then all the more power to him.

Southern Africa: Global Financial Crisis Leads to HIV Budget Cuts

Broken promises abound as the economic crisis deepens and the right to health falters, but activists are coming together to ensure that funding for health and HIV are not cut. International donors are expected to slash budgets for health due to the economic crisis and health experts fear that this will lead to, “less food security and quality of nutrition, which will in turn put more stress on already weak health systems.” Paula Akugizibwe, regional treatment literacy and advocacy coordinator of Windhoek-based AIDS and Rights Alliance for Southern Africa (ARASA) in Namibia demanded, “We need to ensure that African lives do not become a silent casualty of the global financial downturn. Our lives are not cheap or expendable. We expect health to be prioritised over weapons, sports and lavish politics.” Tanzania was the first sub-Saharan country to announce a 25 percent cut of its annual HIV/AIDS budget.
Other budget cut impacts:
Guinea: Medicines Running Out

Zambian High Court to Hear Groundbreaking HIV Case

On Wednesday, the Livingstone High Court was supposed to hear a ground breaking case about whether mandatory testing for HIV and discrimination solely on the basis of HIV status is constitutional in Zambia. Unfortunately two days later news came that the trial was postponed until mid-July. Be sure to keep watching this story.
More:
Trial postponed until 15 July

HIV Prevention and Behavior Change

Mara Gordon writes on Change.org’s Global Health Blog about a direct campaign in Tanzania discussing behavior change. “This campaign is partially paid for by the President’s Emergency Plan for AIDS Relief, U.S. government money to fight HIV that’s notoriously had lots of conservative strings attached. Had I seen this ad a year ago, I probably would have dismissed it as unrealistic abstinence-only propaganda. But behavior change works. Behavior change – in combination with access to condoms, comprehensive sexual education, open discussion about HIV and sexually transmitted infections in general, all that good liberal stuff.”
More:
Changing Human Behaviors: Sexual and Social
During a course on Africa’s environmental history I wrote about the need for changing human behavior in both the sexual and social arena to make a real impact in HIV prevalence. The major social change is the response from Western institutions and organizations in how they talk about HIV/AIDS and Africa while seeking to change sexual behavior.
Lesotho: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission
Health workers note an encouraging response to the PMTCT program. The number of facilities providing PMTCT has risen from nine in 2004 to 166 by the end of 2008. The number of women who received PMTCT and subsequent antiretroviral (ARV) treatment increased from 421 in 2004 to about 5,000 by end of last year, according to 2009 National AIDS Council statistics. “The primary health care coordinator at St. James Mantsonyane Mission Hospital, Khanyane Mabitso, says stigma and cultural beliefs make it difficult for medical personnel to follow up on HIV-positive mothers and their babies.”

Progress on health-related MDGs mixed

Many advances have been made in health. Some argue that these advances have been dwarfed by the HIV/AIDS epidemic, the economic crisis, or the failures of African governments. The WHO report shows that the only statistic with concrete results was the number of children dying before the age of five. Is this a solid example of the failure of big plans and blanket goals for development?

Sierra Leone: ACC Recommends Reform At Health Ministry

The Anti-Corruption Committee report provides a number of recommendations for reform all focused on improving the health care delivery services in Sierra Leone and eliminating the risk of corrupt practices in the health services across the country.
More on health service scale-up:
Chad: Paving the Way for Better Obstetric Care
Government meetings with UNICEF to help scale-up of health services for better obstetric care across the country.

Ten Things You Can Do to Fight World Hunger

The Nation provides an interesting set of things you can do in your everyday life to fight world hunger. They properly focus on how food, a basic human need, has been commodified in our global capitalist structure. “Our planet produces enough food to feed its more than 960 million undernourished people. The basic cause of global hunger is not underproduction; it is a production and distribution system that treats food as a commodity rather than a human right.” When in February I wrote that agricultural experts had said the food crisis of the last year was over evidence from this past week point to the contrary.
More:
Tanzania: Food Shortage Unnecessary
“Tanzania has since independence sang the song of ‘Agriculture is the backbone of the economy’, but little has gone into strategizing and implementing viable actions towards surplus food production.”
Kenya: UN Agency Makes First Local Food Purchase from Small Scale Farmers
The United Nations World Food Programme (WFP) has for the first time bought food from small-scale farmers in Kenya under a new initiative aimed at boosting agriculture by connecting farmers to markets.
Zimbabwe: Another Year Without Much Food
Rwanda: Nearly Half the Country’s Children Are Malnourished
Kenya: Over Three Million Face Food Shortages

Africa: High Level Engagement with Continent Has Started

Speaking at a gala reception in Washington marking the beginning of “Africa Week,” Carson said: “Most of the Obama administration’s Africa team is in place, and we are gearing up. We will continue to build on and strengthen the strong bipartisan consensus in Congress and among the people of America that has motivated U.S. policy towards Africa. Over the next four years, we will be focusing our efforts on strengthening democracy, promoting sustainable development, resolving or mitigating conflict, and dealing with transnational issues such as climate change and agriculture,” he pledged. While Obama has built a great team, the White House has yet to announce any Africa Policy, greater control and influence for the Bureau of African Affairs, or take any serious (or effective) action for the continent.
More:
Tanzania: Obama, Kikwete Meet in Oval Office on Africa’s Conflicts

World Bank Resumes Zimbabwe Aid

Zimbabwe owes the World Bank and the African Development Bank more than $1bn, how much potential does renewed aid really hold for the country. If the debt is not forgiven there will be no way the country will be able to rebuild necessary infrastructures for health, water, etc. There are countless case studies to show this historical fact. It must also be noted that Western sanctions were a huge detriment to a country in need, maybe this marks a turnaround?

Originally posted on the SCOUT BANANA blog.

the week in african health

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“No weapons” MSF in Nasir, Upper Nile State, South Sudan

More:
A Tale of Two Refrigerators
Fighting has renewed in southern Sudan, but its not just between militant groups – aid groups fall victim to needless fighting as well. Diane Bennet writes on William Easterly’s Aid Watch blog about the 2001 peace in Sudan and how it was a ripe time to treat disease and build health infrastructure. Unfortunately internal bureaucracy and politics became the largest hurdle.

Sudan: Darfur – Thousands Flee to African Union Safety
More recently, South Darfur has become the seen of violent clashes between government forces and militants. It is important to never forget the impacts that conflict has on health services.

Africa: Public Health Care Must Lead

Oxfam International has released a report [access here] “challenging the myths about private health care in developing countries.” The report emphasizes the role that private health care can play in developing countries, but reminds us that there is no way a scale-up of private health services will reach poor people in need. Key recommendations are to increase funding for free universal health care infrastructure, rejecting ineffective practices of the past, and combining efforts to fuel effective initiatives – sounds a lot like SCOUT BANANA

Global Health: Mobile Phones to Boost Healthcare

Revolutionizing access to health knowledge, the efforts of the Mobile Health Alliance (mHealth), supported by the Rockefeller Foundation, the UN Foundation, and Vodafone Foundation are making a mark across the African continent boasting 51 existing or to-be-implemented programs in 26 countries around the world. Harnessing the potential of growing technology in ‘developing’ countries for the purpose of health can only signal a major shift in access to health care across Africa.

Getting the Continent on Obama’s Agenda

It appears that Obama’s administration is stacked in the favor of Africa and in favor of better international development practices all around. With Susan Rice serving as Ambassador to the UN action against genocide may be bolstered, Gayle Smith more likely than not will be tapped as USAID Director, she was a major proponent of the HELP Commission creating a cabinet level position for foreign aid, and a well known name among insiders and outsiders in African affairs, Johnnie Carson, is expected to be named head of the Bureau of African Affairs of the State Department. The future of US relations in Africa has incredible potential and hope to change.

Zimbabwe: Staff Return to Hospitals, But Not to Work

As a massive cholera outbreak tears across the country, medical staff have returned to their posts, but the nature of their strike, that began in 2008 over poor working conditions and wages, is now “more like a sit-in.” In a country so crippled by Western exploitation and resulting politics, a strike of the health workers in the face of a rampant disease outbreak does not bode well for a vulnerable population.
More:
Too Much Cholera, Too Little Food
Over 80,000 Zimbabweans Infected with Cholera

Africa: U.S. Naval Engagement Offers Health Dividends

Imagine the potential of the US’ military might if it was dedicated to coordinating naval and health care workers from 13 countries to bring aid and health services to communities in need. This becomes a reality with the African Partnership Station Initiative and Project Handclasp. I can only dream of a day where initiatives like this are more a norm than a surprising gesture of good will.

Mali: Raising Money and Hygiene Standards

One of the most innovative programs that I have read most recently is the work the Dutch based Gender and Water Alliance which is employing women to make soap as well educate and use it to increase hygiene and combat preventable diseases. Health benefits, a source of income and empowering women!

Food Crisis Over, Say Experts

Supposedly the global food crisis of last year is over! Agricultural experts from Africa and Asia are saying that we are no longer in a food crisis and that there needs to be an increased production of rice in Africa in order to keep the food crisis at bay. In my opinion, as long as we continue our unsustainable and capitalist practices that commodify a basic human need, we will remain in a global food crisis affecting both the US and Africa.
More:
Rwanda: Food Production Up, Thanks to Green Revolution
Thankfully the increase is not due to the ‘Green Revolution,’ but instead to increase in practices that are focused on protecting the environment.

South Africa: Treasury Blamed for Shortage in Aids Drugs

Years of controversy seem to have brought the blame down on the South African Treasury. With an extensive bureaucracy, it is no wonder that the ARV roll-out program has taken much longer than it should – as many die without the proper medications. While the numbers of people enrolled in the ARV program has increased significantly there still exists a problematic policy of access. Access hinges on wealth, CD4 count, and location. To access the government’s ARV program your CD4 count has to be less than 300, which is at a point where you are already very vulnerable. This creates an issue of sustained treatment because it forces an irregular regimen. If your CD4 count is above 300, you will have to pay. Many cannot pay and if you live far from a government hospital access is just that much more difficult because of taxi fare and time sacrificed for travel. It seems the health and wellbeing of its citizens is not a high budget priority of the South African government.
More:
Rapid HIV evolution avoids attacks
Much like the flu virus, HIV mutates and evolves in response to treatments. This really exposes the South African ARV program as highly ineffective.
Duncan discusses HIV/AIDS in Morocco
Little known to the world, the HIV/AIDS crisis grows in Morocco.

Originally posted on the SCOUT BANANA blog. 

the week in african health

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Ethiopia a scene of over-grazing and desertification, making it difficult for both people and animals to survive. (From the MSF Photo Blog)

’There’s no reason only poor people should get malaria’

In an action that surprised many audience guests, Bill Gates, released a small number of mosquitoes into the crowd at the TED conference. Gates quit Microsoft last year to focus more on his philanthropic work. He spoke of the need, and his commitment, to put more funding towards developing drugs to combat malaria, one of the highest killers in the ‘developing’ world.
Watch the video:
More:
Mosquito Genes Linked To Insecticide Resistance May Be New Target in Fight Against Malaria,
Insecticide malaria impact clue

When there is no village doctor

It is estimated that every fourth medical doctor and every twentieth nurse trained in Africa leaves the continent for better job prospects and better pay in wealthier countries. The UN Global Health Workforce Alliance warns that the economic crisis could further increase the medical workforce crisis across Africa.

For David Werner, who wrote the widely-translated 1970s village health care manual, “Where There is No Doctor,” medical specialization is not the best answer. “Experts come in and think they have all the answers, and end up drowning out solutions villagers could devise themselves.”

Need to Focus on Maternal, Child Health – Top AU Official

As the African Union meets in Addis Ababa, Commissioner for Social Affairs Biencé Gawana said in regards to the AU’s proposed launch of a continent-wide program,

“We will launch a movement to promote maternal and child health in the continent,” she told reporters. “It will be an advocacy campaign… together with partners like UNFPA [the UN Population Fund] and UNICEF [the UN Children’s Fund].

With 500,000 women dying in childbirth each year, Africa has some of the highest rates of maternal, infant, and child mortality. As part of the solution the AU report noted: “One of the main challenges in the promotion of maternal, infant and child health and development is access to health care facilities and services, especially at primary health delivery level and [in] rural areas.”

Zimbabwe: Cholera Infection Rate Climbs As UN Cleared to Assess Crisis

On Monday the WHO reported an increase of 2000 cholera deaths in Zimbabwe. The report was released just as President Mugabe agreed to allow a top level UN assessment team to tour the country to find solutions to curb the cholera pandemic as well as the current hunger crisis. Food security continues to plummet in may areas of Zimbabwe as many worry they will not receive aid in time.
More: Zimbabwe Cholera Statistics Rise Again As New Malaria Fears Grow,
Zimbabwe Diary: fighting cholera

South Africa: The Quiet Water Crisis

There is great concern with the cholera outbreak in Zimbabwe, but what the South African government may be missing is its very own growing water crisis. With an aging infrastructure and rising demand, the potential for deadly bacteria to be released into its water systems is high. When Mandela’s government took power in 1994, an estimated 14 million South Africans lacked access to clean water supply and 21 million people lacked proper sanitation. Although the numbers have changed drastically, the Department of Water Affairs and Forestry (DWAF) reported in 2008 that 5 million people still lacked access.

Twestival and Charity: Water

Last year SCOUT BANANA conducted a ‘Year of Water’ Project to benefit the work of Charity: Water. The organization is now utilizing the social media tool, Twitter, to raise a large amount of money to build wells across the world. Charity: Water began its work by supporting well projects across the African continent.

South Africa: ‘Development Must Adapt to Water Resources We Have’

98% of water resources are being used in South Africa. Water security is becoming an issue as pollution from mining has been difficult to clean up and no other water resources remain unused.

Obama Lifts “Global Gag Rule”

Also known as the Mexico City Policy, this move is being applauded by women’s and productive rights groups across the globe.
More: Obama Reverses U.S. Ban on Abortion-Linked Aid

University Partnership Aims to Fight HIV/AIDS More Effectively

Backed by an almost $5 million grant from the Bill & Melinda Gates Foundation, John Hopkins University is growing a partnership with Makerere University in Uganda in an attempt to combat the growing HIV/AIDS epidemic. The partnership is only in its initial steps.

Originally posted on the SCOUT BANANA blog. 

steel villages and concrete fences

13 May 2008

Everyone waves from their steel-corrugated shacks, children smile and get excited, parents and elders are welcoming – looking out over the shanty town roof tops that extend as far as the eye can see in each direction you can’t help but wonder that within this poverty and desolation mixed with laughter and happiness – what potential can be harnessed, what community action can be inspired to make South Africa’s future brighter by and for those who live here.

The government built lavatories and sinks for the informal settlement so sanitation is good. They provide building materials for brick houses through the Reconstruction and Development Program (RDP), but where are the education improvements? the health support? the food subsidies? A government can’t do it all and so places like VVOCF exist!

This all made me think more about the African health worker crisis as I see the direct result of it, the effectiveness of government funded health care, and the access to nutritional information and education.

agency in community development

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.

when not in southern africa. . .

I will now begin filling in the gaps from my summer travels. I was only able to post four times during my three months in southern Africa.

My travels began in South Africa;s largest city, Johannesburg and took me to a community development project (which became an official non-profit organization (NPO) this summer) in an informal settlement known as Zonkizizwe. Shortened to Zonke, the settlement was started during the apartheid years as a place for people commuting to live closer to their mostly inadequate jobs as farm hands, domestic workers, miners, and other menial jobs. The settlement is surrounded by farmland from which it owes its birth. The former Afrikaner farmland now houses close between 150,000 – 200,000 people (estimates are not clear). There are now other Zonkizizwe areas known as extensions. Where I was is called Zonkizizwe Proper as opposed to the five other extensions just nearby.

Zonke was a flash point of much police violence related to forced eviction from the settlement and inter-ethnic violence related to pitting African peoples against each other to keep the unrest away from the apartheid regime. As a result of this politics is a much deferred subject in the settlement and many people will tell you that they will have nothing to do with politics. South African apartheid police supported Zulu warriors, as members of the Inkatha Freedom Party (IFP), to attack settlement dwellers and take their homes and possessions. If you ask people on either side, the victim and attacker are always switched and just goes to show the ruthless nature of the apartheid government at the time.

As a direct result of the intense fighting, violence, and death witnessed by the residents of Zonke, the community came together during the xenophobic attacks to say that they would not tolerate any violence when they, as youth and young adults, had seen so much violence already. Zonkizizwe means “all the nations” in Zulu and was a term that held true when times got rough around the country and just 10 kilmetres away in nearby Thokoza (Tokoza).

As an African Studies major specializing in international development it was very interesting and powerful to be able to work directly with people on the ground in Africa and see the various stages of ‘development’ within an informal settlement becoming formalized with the new change of government pursuing liberal democracy. As part of the formalizing Zonke has a taxi rank, a new Library, and a new Secondary school. There are a few sections of paved road and street lights also present in the settlement. There is also a large police station (some things left over from the apartheid regime still remain – the overlarge and ineffective police force is just one example). Two health clinics exist in Zonke, however health care is extremely inadequate. I never saw a doctor, nurses and specialists without formal training often diagnosed patients and supplied them with a simple blue painkiller tablet (pill) for most ailments. There will be much more on this subject later. A large administrative center also existed with a Social Development office responsible for dispersing grants from the government and helping with social services. This administrative center used to be the South African police staging area during apartheid, utilized to execute raids on the undesired informal settlement.

The majority of my time was spent at a center for children and youth affected by HIV and AIDS. Most of the children had already lost either one or both of their parents to HIV/AIDS. Many were now living as orphans in child-headed households where their eldest sibling is now in charge or they live with guardians, some so indifferent it seemed that they wouldn’t care if the child died tomorrow. The center was a place where kids could be kids and try not to worry about running a house, taking care of a sick family member, and a place to learn and grow. I ran after school programs with the local staff of the NPO and two other students. The staff was so dedicated and passionate about their work that it was easy to get just as invested in the children of the center. I was able to get excellent workouts from lifting kids all day, up and down, spinning, throwing, catching, chasing, etc. . . whew children. We worked with ages 3 to 21 so I now feel more than ready when I have kids myself. Our programs included arts and self expression, writing, English, homework help, sports and fitness, health, HIV/AIDS, and anything else we could think of to do with kids. Never have I seen such difficult circumstances pushed aside with such desire and hope, that often the resilience of the children made me forget how hard their lives were – with an empty house, a new child, no food to eat, an abusive guardian, a dead parent. . .

I spent some time in the mountain kingdom of Lesotho and learn much from local people and Peace Corps volunteers. I also spent a week in Mozambique visiting a friend finishing a year in Peace Corps where I met many great Mocambicans, international development and aid workers, went to some great beaches, and tried out some Portuguese. There will be many insights and reflections on my experiences in these countries as well.

I saw many things that are difficult to articulate into words, I heard so many stories that I feel it is not my place to repeat, I experienced so much that I will not be able to share for the simple fact that I, myself, can not yet understand. I feel like I left South Africa with many things hanging and left undone, what was most painfully left hanging was my heart. . .

Be sure to check the highlighted dates to be sure to follow my travels in southern Africa over the past three months.

Check out the few posts from South Africa:
what are we to do when our children are dying? (before leaving)
ten hours from amsterdam
a first glimpse: zonke
eruptions from fault lines: race is class
hangin in joburg

eruptions from the fault lines: race is class

What follows below is a chronology of my journal entries leading up to and during the violence. My thoughts and analysis will be limited by internet cafe time

“The greatest legacy of apartheid is the enduring poverty. And the vexing reality that lives just beyond view is this: apartheid lives on in South Africa. It endures in the profound contradictions of the white wealth and black poverty […]” (16)
– David Goodman in Fault Lines: Journeys into the New South Africa

Economic power and privilege still only reside in the white suburbs of South Africa: Sandton, Alberton, Greater Johannesburg, etc. Mandela came to power by political concessions, but not economic privilege – apartheid lives on. Why is it that the countries of great leaders fall into such contradiction. Mandela’s rainbow nation – trapped in pseudo-apartheid, Nkrumah’s Ghana in the throughs of neo-colonialism. . .

18 May 2008
We left for Florida at around 1pm. No this is not the Florida of beaches, spring breaks gone wrong, palm trees, or tropical weather accompanied by ocean spray – this was the Florida of South Africa, a former white-only suburb now mixed with multicultural paradox. We went to visit with Pat and Sharon who used to work with the VVOCF Center and who Rachel, our intern coordinator, stayed with last year. They left the Center under confusing and troubled circumstances – with white South African fervor and knowledge of systems and black South African desire and quest for understanding conflicting on constant miscommunication. At any rate it was very interesting to see a former white-only area. With the gated houses that are common of many elite and wealthy communities in Uganda, Ghana, and South Africa that I have seen. On our way we passed the cushioned suburbia of Alberton yet again nestled neatly in the foothills without a view of the townships or informal settlements to taint the eye. I can’t help thinking – Is this South Africa? – with the supermarkets, sprawling malls, and neatly divided rows of red brick roofs and the beauty of modern Dutch architecture all packed into the pockets far from the reality of oppression and poverty of another South Africa. The collision of “first” and “third” world landscapes and lives is something to write more on later.

(Pat and Sharon talked with us about many things, but what I will write here is relevant to this entry.) They talked of the growing violence and offered to be our escape route if we ever needed to get out of Zonke. The recent violence in Alexandra and xenophobia spreading to other settlements. Thokoza just down the road is on of the latest flashpoints in a travel advisory email that Rachel received today.In today’s City Press there was an excellent article on the violence in Alexandra and what that means for African unity. Here are some quotes from Ngila Michael Muendane’s article:

“Constitutions can be written over-night, but mindsets can linger for generations unless there is a programme to educate the public.”

“The anger of Africans against one another is caused by two factors, namely low self-esteem and perceived deprivation.”

“Taking the spirit of African renissance to the grassroots is what it is all about.”

Muendane made sure to note the history of dividing African people in colonial times and during the apartheid of South Africa into Bantustans which then later pitted ANC against IFP, Zulu against Xhosa.

I feel no threat from the violence in Alex. (My name was used as the short version for Alexandra, the newspaper headlines where worrisome: “Alex has disgraced Africa” – crap what did I do?)

20 May 2008
The violence is no longer just so far away in Alexandra and nearby Thokoza. It is much closer. The students at the center held a debate on Friday about whether Zimbabwean immigrants should be allowed into South Africa. It was very heated on Friday and was decided that it would be formally debated on Monday. Some of the community volunteers (China and Mr. Idaba) were coaches for the teams and gave too much of their personal opinions. Today we found out that one of the girls at the center is Shonga, from Zimbabwe, and felt threatened by the debate. Especially with the recent violence directed against Zimbabweans I am not surprised. The girl’s aunt had confronted the parents of students who had made comments about not allowing Zimbabweans and the center was blamed for promoting the troubling conflict. The center must be seen as inviting and inclusinve for everyone and so this is an issue we will address asap. The violence is now spreading to the center of Joburg and in other settlements – expected to hit Cape Town area soon. Celumusa talked about what that it could happen here, even though the community held a meeting saying that there would be no tolerance for violence. It is still a near possibility.

At the debate, they asked my opinion. Reluctantly , I prefaced by saying that I was not a South African and I was no where in any position that should influence their thoughts. I said that Zimbabweans should be allowed and related it back to the issue in the US with the Mexico border. Granted South Africa needs to develop an immigration policy because as of now there is none. The European/ imperialist imposed borders, the colonial divide and conquer methods, and the need for accepting societies have led to this – eruptions from fault lines. Nigerians are also much despised here because they are often drug-runners – but again, as in Ghana, generalizations are made.

I am still not afraid, but worried of what I might experience. I am not a target because I am not taking jobs, or money, or housing, but a mob mentality is far from predictable in a land devastated by foreign controls.

Later on 20 May 2008
Exacerbated conditions of poverty pit African against African in overblown, colonial ethnic divisions that a new government has called a rainbow, but has failed to deliver on its widesweeping promises. Language of oppressors is turned by the oppressed against the oppressed when a classic Romeo & Juliet dramatic conflict is taken too far. Whether called upon or not, a pox will befall all houses involved. A pox has already plagued and now is grown into new strains that infect the already colonized minds of those oppressed.

The people at the center have already seen so much violence. Bongani is five years older than me and has told us his story – he has seen so much violence. All I can think about constantly is how as a child growing up, I knew nothing of the struggle in South Africa. I grew up carefree – everyone I meet here around my age grew up0 in conflict and violence.

21 May 2008

the power is out
i know only one rout
i hear children cough
sickness wearing cutoffs
dogs bark in the street
i can hear a drumbeat
accompanied by horns
i hope the streets – not adorned
with the xeno violence(ts)
spurred by past and non-repents
boiling over to town
where no one holds crown
as “all the nations” converse
of a tolerance perverse
a whistle breaks the night air
as at the full moon, i stare
holding witness to fire
if a situation so dire
as the minds conflated
are not soon deflated
a witness i will be
to death upwards of three

dog, drum, whistle, and trombone
tension grows that i do not condone
zonkizizwe now a freeway
for all peoples and times
who compose many rhymes
of their homes and history
wrought with death and misery
a time like this is telling
of a new constitution spelling
rights and freedoms with letters
when clamped still remain the fetters
of three hundred and fifty years
of sadistic white men’s careers
bent on separation and greed
there is now such a need
to turn the power on –
so that the division may be gone
from this country of contradiction
mixed in violence and conviction
of a founded, free, and failed peoples
grasping tightly now to steeples
that will give them life after
or so says the pastor
but heaven and hell are now
if you just read the Tao (Dow)
Jones is falling fast
as the chills of the past
haunt the night of regrets
while placing our bets
a hand descends upon yours
before taking the tours
you fall hard and WHACK,
through the fingers and cracks
the invisible hand
can no longer stand
without a body and mind
that is conscious and kind
recognizing the truth
bearing forth from its roots
the Power is ON

– Alex B. Hill (21 May 2008)
As township violence grows, informal settlements banish their brothers – 30,000 & kill those undesired (30+), I pray nothing happens in Zonke.

The above poem was written a few nights after the xenophobic violence spilled over into a settlement down the road, Thokoza, and other larger areas, greater Johannesburg and Durban. I could hear drums, and horns, and whistles and I was not sure why else a commotion was growing into the night, but I was worried that this signaled the entrance of others into Zonkizizwe who were determined to kick-out all foreigners. Zonkizizwe had become a place for all people to live. Many foreigners fled to ZOnkizizwe because they had heard that it was safe and no violence would be tolerated in Zonke. Others from nearby said, if Zonke people do not kick-out foreigners, then we will go to Zonke.

I have heard and know so many personal stories and problems, but it is not my place to sit here and repeat them. A child that nearly became a failure from family neglect and stigma, a woman wracked with passion facing community neglect, young adults up against every kind of unknown anmd unseen danger. Is this South Africa? Can hope really spring from so much pain?

The violence is worrisome, but if nothing happens here tonight then the worst is past. There is much noise tonight (in poem) and so I am troubled – all should be well. Sixteen areas are affected now including a home burning in Durban. I can only think back to reading Fault Lines, which highlighted glaring contradictions in the “new” South Africa. The author assessed that much needed to change when writing in 1997 if this “new” rainbow nation was to take hold and be successful.

The current violence is a direct result of the “new” South African government’s failure to deliver on promises and assist people in recognizing that a 350 year evil takes more than 10 years to reverse. History can only truly be flipped on its head by your elementary and high school textbooks that fail to teach you the truths of slavery, the horrendous extermination of indigenous peoples of america and the blaring evil that was apartheid with US support. We claim to know and study history, but what do we really know? Who is teaching you history? (His)story – who’s story are you learning? What story will you hold on to and teach your children? His, hers, or yours?

22 May 2008
The Sowetan
“The struggle for the few resources among the poor is a cause for hatred.”

“Mbeki deploys army to quell violence – People have realised that they cannot eat votes, live in votes, or wear votes.”