Xenophobia changes Cape Town

It started on Friday afternoon. My boss Nathan, noctantely asked me to go upstairs to help Fatima in the AIDS Law Project. There had been a few small reports of xenophobic violence Cape Town the night before and Fatima needed establishing if there had been any more. A week ago, in Johannesburg far on the other side of the country , violence against foreigners erupted killing dozens. Newspapers the next day bore a harrowing picture of a burning body. The photographer who took them had posted a moving narrative of his experience, "I could not believe what I was taking pictures of..", his emotions and confusion chocked the final words of his webcast. But Cape Town so far had seemed to escape this horror.

Then reports started filtering in to TAC office. 200 people had arrived outside Cape Town police station. At Cape Town central train station hundreds refused to move. TAC campaigners went out to these locations and came back looking panicked and breathless as they reported the numbers were increasing and people were petrified. I started writting up names of Cape Town locations and numbers people collecting at them on the white board as phone calls came in. What about Hout Bay someone asked. Someone else said they knew a journalist there. I rang them, he said he didn't know if there has been violence, but the hardware store had just told him they sold out of axes today. A sick heavy feeling hung in my stomach.

Meanwhile thenumbers of people not going home increased to thousands. At 10:00pm I found myself ringing around trying to arrange transport for the 400 plus at Cape Town central train station to a series of methodist churches in Wynberg which had rung saying they were opening their doors. I tried getting busses to move people from a contact we had at "disaster management" at city government and things like University of Cape Town bus drivers. Others worked on other locations and started recruiting volunteers to prepare food. At midnight the transport had not arrived and it become a constant rally of calls between the transport people and the different churches they filled up with people coming from other areas. At 2 in the morning two open trucks arrived at the station. But people did not want to get on. I rang the churches back apologizing and asking if they could stay open a little longer. Andrew, a TAC person at the station, phoned back saying there was much confusion, some were too scared to get on as they didn't trust where it would be going, others had decided to stay at get the train straight to Johanesberg and out of the country as soon as possible.

Finally, after much discussion, many boreded the trucks and at 4:00am. I got driven home by Hennie, a volanteer from another NGO, and crashed out.

A woke up a few hours later to a strange new Cape Town. Around 20000 people were no longer living in their homes and were in de-facto refugee camps in churches, community halls and outside police stations. While no killings were reported there had been much intimidation, looting and beatings but it only took the mildest reports of violence in Cape Town to cause people to flee their homes. I spoke to a guy from Zimbabwe a few days ago and he had told me that on the train that Friday evening he was threatened numerous times to be thrown out the door.

With a stinging head ache from the tiredness I went to the TAC office. I was instructed to go with Andrew to pick up 2 huge empty 60 litre pots which had curry in the night before night from an industrious Muslim volunteer organization. A hundred people still thonged at the entrance to the platform hoping to get a train to Jo'berg and escape out of South Africa. Back at the TAC office and stepped into a whirlwind of of busyness. TAC were simulations trying to keep abreast of new reports of displaced people and requests for help and mount a relief effort of food and blankets. An office usually used to press conferences and research become the centre of a humanitarian relief program. The day became a blur of phone calls, a constant rally of eager volunteers pored though the offices and there was, to be honest, widespread confusion about what was happening. Despite and somewhat amazingly food and basic needs were sent out across cape town.

The photos above show the white board Firday night, the train station and an impromtu meeting on Sat (the office was busier than this most of the time). This is only the first two days, I am going to try and wrtie about the rest of the week since, tomorrow.

Hoare Hut

I just spent a totally surreal weekend in the Hex River Valley. I joined my housemates and the University of Cape Town mountain and ski club (apparently there is snow for skiing in SA if you try hard enough to find it) on their annual social. Suitably it takes place on top of a mountain!

It was a beautiful sunny day, blue skies, calm breeze and probably the sound of birds humming contently after eating tasty sun-warmed grapes from the vineyards if I had listened hard enough. Just before the top of the mountain I glanced back at the vineyard banked valley in the summer scene below. Then climbed over the peak of the mountain into putrid rain and a vicious wind bringing with it volumes of mist and chilling me to the bone. In the space of an hour and half I had intentionally walked straight into a little bubble of a UK winter (Well, as bad as a remember them being, which is fairly horrific :-).

I had also run up the mountain with my pack on. An annual tradition of the club is a race for the mad or naive (or both). By the time I got to the top the race leader was out of sight and I had left the others a while ago. I found myself on top of the mountain floundering over rocks in thick mist, only able to see 20 meters ahead and desperately in search of UCT's hut marking the end of the race. I passed a non-UCT hut with the a placard reading, "in memory of ... who died here". It did nothing for my confidence.

Not too long later I got to the UCT cabin (unfortunately for the cabin its named Hoare Hut). I was welcomed by five students who had come up the night before and were contently brewing tea - human contact suddenly made everything seem less dramatic. I also had turned out to have won the race, the leader had unfortunately taken a wrong route at the top of the mountain. The other two racers came in ten minutes later, sweat steaming off their backs as they snuck into the warm hut.

The surrealality continued when everyone in the hut donned formal clothes (I had a nice black shirt and white tie thanks to my housemate Jan AND a ridiculous fur coat that was once a wear-wolf costume (not enough space to explain) and we ventured out to greet the other walkers with bubbly as they reached the top. 30 plus people stayed the night in the hut with the bad weather swirling around outside. In the morning we walked down back into sunshine.

The weekend was a good break before for the start of the week. I spent today hunting for the contact details for all the politicians linked to each area in which TAC has a branch. It’s a job of website scouring and being the recipient of broken promises as local government staff promise to - but don’t - fax contact details!

The cries went up!

I've relocated to The Lancet Student website for this blog. It's a new site set up by the medical journal The Lancet for students, yes, quite obvious from the name. I like the site, it has loads of articles on global health issues. My blog is about the TAC march I went to in Khayelitsha last weekend.

If the above link no longer leads to the blog try here.

A change of profession?

I've been following the story about the Chinese ship full of guns, bullets and rocket propelled grenades set for Zimbabwe with glee. The ship has failed to its make the delivary because South African dock workers refused to unload it. My anti-arms-trade-campaigning-medic-friends will enjoy today's spoof agony aunt in the South African Sunday Times:

Dear Sis Beatrice,

We want our son to enter the medical profession like his father. But, with all this hoo-ha about the Chinese ship with the weapons for Robert Mugabe, he now wants to be a dock worker. He says their decision not to unload this terrible cargo of war probably saved more lives than any doctor could. He is just seven years old but he is frightfully stubborn. Any suggestions?
- Roberta

It is nothing more than a childish fantasy. The boy will change his mind.

Starting to work at TAC

This is not the first time I have written the blog when I am excited. And, really, I tend to only write it when I am! Today, I’m not going to alter this obvious bias about my time in South Africa as this month I started at Treatment Action Campaign.

I have had a long (one-way) love affair with TAC. I cant even remember when I first heard of TAC, it must have been when I was studying International Health, or more likely Tom (Yates) pointed me their direction. They have informed my views on campaigning, politics, civil society action and the centrality of patients in health campaigns so much it feels like I've always know of them. For people who haven’t come across them before TAC, they are the South African HIV/AIDS campaign. Internationally they become famous for being in court against 32 pharmaceutical companies (represented by the Pharmaceutical Manufactures’ Association) in 2001 and winning. Pharma were trying to stop South Africa importing cheaper generic drugs from countries like India which had generic drug factories (a process called parallel importing). Because of TACs arguments and activism Pharma withdraw their case, retreating from the upswelling of public opinion against them with their tail between their legs. The case also had international ramifications on drug prices. Back in South Africa, in a what seemed a bizarre turn of events of at the time, South Africa Government then stalled in providing Anti-Retero-Virals (ARVs). A discourse of AIDS denial arose, which questioned the scientific basis for HIV causing AIDS, dangerously promoted good nutrition as an alternative to ARV drugs as opposed to an important addition and delayed and sometimes refused to provide ARVs to the public. TAC has been fighting government denial and reluctance to provide treatment ever since. There have been some epic battles both in the court and in the streets which means that ARVs are now increasingly available. But of course there are still fights to win.

So, it’s quite obvious that I was excited to be starting to volunteer with TAC. The national TAC office is in centre of Cape Town. It’s the middle floors of a stone walled office building a few meters walk from the main tourist through fare cluttered with slightly pretentious cafes. The office is a busy place, phones constantly ringing, frequent visitors and decorated with old campaign posters. I think I walked in during one of their busiest weeks for a while. TAC’s magazine Equal Treatment had just over a week to go before its deadline. I was plunged into chasing up articles, helping write a few, fact checking, finding photos and getting last minute interviews.

The next issue of Equal Treatment is going to be on immigration. Due to the ongoing situation in Zimbabwe over a third of Zimbabwean’s have now left their country and most are in South Africa. While some have friends or family who can help, most face complicated legal barriers, cant find housing and have no way of getting healthcare or earning money. I was involved in writing about some of the more sobering situations people are in: the living conditions in the detention centers which have been slammed by human rights organizations for their lack of healthcare, overcrowding and physical abuse that happens within; and about the high risk of young girls getting raped as they travel to South Africa, or, and I think the distention is almost academic, having sex with men in return for food, accommodation or travel.

These first week’s work were punctuated by a couple of protests against gender based violence. TAC has been following the case of one of their members Nandipha Makeke who was raped and murdered over 2 years ago. There have been long delays in bringing her attachers to justice with evidence being lost and over 20 court apearances. In responce TAC have rallied outside the court for every hearing. This week the magistrates finally sentanced the accused to 20 years. So I sat in the press conference TAC held to publise it and we all made our way to the court house as a final bit of protesting. Despite the seriousness of the issue TAC protests are lively events. There is lot of toyi-toying - singing, chanting and dancing to all the old antiapartheid protest songs.

The second protest was also outside court to support getting a court interdict against a man, Yanga Janet, who has been intimidating people with “HIV Positive” T-shirts in a part of Khayelitsha. A few weeks ago he shot one TAC member (not fatally). As far I understand the interdict is a bit like a restraining order that allows the police to arrest Yanga the moment he does anything threatening. It’s related to the rape case. Yanga is part of the gang that murdered and raped Nandipha Makeke. The TAC members who have been directly threatened by Yanga are now camping out in a “secret location” organised by TAC!

Since this lively start I’ve been stuck into admin tasks - like phoning all the Exclusive Books shops in the country to see if the last edition of Equal Treatment arrived; cutting pages from the old TAC website and pasting them into the new one.

I am really enjoying the work at TAC. As a doctor, I think my dream working environment would be a clinic with a revolving door leading to a busy advocacy office :-)

Ultra!

It was ultra long and ultra exhilarating to finish! Last weekend was the two oceans ultra marathon. 7000 people started in Cape Town and headed straight to the coast were the route cuts across the peninsula to the other coast for a series of hills. First up Chapman’s peak, and then a steady climb out of Hout Bay before eventually finishing at University of Cape Town 56km later.

In the dark at 5:30am it was a tough start into a biting wind. It is billed as the world's most beautiful marathon, the memory of it now conjures up quite dramatic images of roads winding along cliff edges, but at the time I remember just thinking "this is tough".

Just before half way a fellow runner whipped up conversation!...I nodded and yeses but couldn't manage much more! The hardest bit was, surprisingly, the downhills, it felt my legs were getting electric shocks with each jarring step. And then the last 10km were tough, cramp was setting in and it was void of supporters as the race went through the forest. The finish though was such a relief and so exciting to know I'll finally done it. Highlights were housemate supporters on bits of course and running though drinks stations with pumping music (my pace seemed like it doubled in the music). Your name gets printed onto the top of your number, so lots of ”come on David” all around, I just wish now I had written on my race entry form that my name was Forest :-)

I got round in 4 hours 31 min - so not too bad for a first attmept. I sprint finished but on top of my mild dehydration as soon as I stopped I felt faint and dizzy. I lay on the floor to avoid falling from fainting. However, it was enough for the medics to insist on dragging me onto a strecher and monitor by blood pressure for a while. After the race the best thing I did was get a massage (free), apparently the race had caused loads of micro tears in my muscles which caused inflammation and the massage pushes out the inflammation and allows blood back in. In any case felt amazing.

It has been an exercise filled month (apart from the last week when I've done nothing). The weekends I've been doing lots of long runs in preparation and 3 weeks ago I did the cape argus cycle tour. Its 31000 people cycle race around the cape peninsula (108km). Brilliant atmosphere. I did it on a 700 Rand (£40) bike from cash converters - it squeaked ominously all the way round.

For pictures of me looking like I'm in pain follow this link and type in the race numbers (so far too stingey to buy them):

http://www.actionphoto.net/ap.aspx
Race number 40140 for the Old Mutual 2 oceans marathon 2008
Race number 18619 for the Cape Argus Pick and Pay cycle tour 2008

Meanwhile I've finished the first stage of the TB adherence research. I’m now waiting for Salla, my supervisor/collaborator to anaylse the transcripts as well and then we will plan who and where to interview next. Too early to say really, but lots of interesting things about TB associated stigma coming up and how support from the Treatment Supporters works(people who visit patient in their homes) it seems like a strange mix of authority and caring relationship. Originally the research was meant to have all been done by now but things all ways take longer hey. Its been a real journey into the world of qualitative research which can be confusing and intangible but is ultimately illuminating.

The third photo above is from the child TB training conference I went to, the department I was at Stellenbosh with ran. Main message was: Child Tb has been ignored for years because children are that infectious, but everyone overlooked that the fact it kills them! The conference was trying to address this oversight and train lots of doctors up to deal with child TB better. The pic is from the cultural show on the last night.

Tomorrow marks a new stage as I start at the Treatment Action Campaign. I am going to try and do the research and TAC at the same time. I spent the last week visiting my parents and bro in Jo’berg and reading up on TAC - staggered by how many success they have had, how much policy they have changed..cant wait to see what its really like.

A comedy about Apartheid

Last night I went to see a play, a comedy, on of the lives of people under apartheid, called “Woza Albert”, named in reverence to the 1950s ANC leader Albert Luthuli (and nobel peace prize winer). Even living on South Africa, it is easy to forget what living in apartheid must have been like.

It stared only two actors, adept at doing their own sound effects (they did a great train), accents and dashing behind a clothes rail at the back of the stage to grab another costume. The play gave a montage of characters and a snapshot of their lives under the constraints of the regime.

What the play showed again and again, is apartheid's devastating impact on people’s psychology; how they saw themselves and how they felt. The play’s gambit was that there was news that Christ had made a second coming and arrived in South Africa. As the play progressed the characters eventually met him, or at least who they thought was him, and ask him to fulfill their hopes. Having seen how unfair and tough their lives were, you expected emotional pleas along the lines of ending apartheid. But, for example, the two guys who were making bricks for their “baas” asked Christ for “more bricks please - let it rain down with bricks”, the women eating food in the rubbish hoped to, “find more chicken in the bins, let the while man put some more chicken in his rubbish”. Despite the plays numerous attempts at making light of the whole situation (including mooning the crowd repeatedly in one scene), overall it was heart sinking, and tragic. In fact the idea that people were making comedy of it made it much more uncomfortable and shocking.

Seeing the play explains better than most history books, why Steve Biko, a student from Durban, leader and intellectual heavy weight of the South African black consciousness movement is often heralded as the other side of coin to Mandela. Mandela addressed the structural barriers of apartheid, he gave people back their civil liberties; Biko addressed the psychological impact of apartheid, he challenged the real lived experience of feeling inferior. It is that inferiority complex that also explains, in part, why there was little resistance to apartheid for years. And, most worrying, its a psychology that people still talk about remaining.

I was surprised to see a play that billed itself as a comedy about apartheid. Is it now OK to laugh about apartheid? I didn’t really get an answer, this comedy still had a dark and disturbing underbelly!