Year in South Africa

Xenophobia changes Cape Town

2008-06-02T13:17:00.000-07:00

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

2008-05-13T01:47:00.000-07:00

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!

2008-05-09T00:41:00.000-07:00

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?

2008-04-27T06:08:00.000-07:00

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

2008-04-23T23:51:00.000-07:00

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!

2008-03-31T13:47:00.000-07:00

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

2008-03-02T09:56:00.000-08:00

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!

Lunar Eclipse

2008-02-25T04:07:00.000-08:00

Magical morning on the top of Lion's head for the lunar eclipse...

Click on a photo above for more pics. The tiny spot above and to the right of the moon is apparently Saturn.

The moon didn't really disappear but became colored with a red hue, meanwhile this incredible carpet of cloud came into the city and we sat taking it in and eating French toast!

Once upon a time at Parliament

2008-02-17T11:02:00.000-08:00

Pics top to bottom: ANC president Jabcob Zuma and next to him is Tokyo Sexwale, dancing ladies, President Thabo Mbeki and you can guess the rest. Click on a photo for more pics.

Hello, today I'm going to co-write my blog with Maya (Cape Town housemate). We have just got back from one of the biggest days in the South African political calendar: the opening of parliament and the president's state of the nation address. We are going to try writing alternate sentences/paragraphs; it should be a great distraction from Maya's job as "person-behind-the-desk-of-the-internet-cafe-"......

Dave and I woke up at 6 this morning to go and pretend to be ultra-cool BBC reporters - he the tape runner and I the fixer - so that we could watch the festivities, look at really big hats and interview scummy politicians. Despite Dave spilling the coffee (clumsy boy) we arrived with croissants and coffee for everyone to ingratiate ourselves for the trouble we caused by being impostures of useful beings.

There was certainly lots of politics - but more of this later... At South Africa's opening of parliament, there were none of the boring grey suits of British MPs with an occasionally bright tie, but predictably the color of their party, instead there was a riot of color! The MPs wore African traditional dresses with bold patterns and energetic colors, feather stacked botats and even fairy wings. As the MPs milled around outside parliament greeting each other after the summer break like long lost friends, the media crushed around the best dressed to snatch a photo. One MP and his wife that got much attention for him dressed in a sharp suit and cravat and handkerchief which matched her shiny polka-dot dress, donning shades that would have been equally at home at the opening of the Oscars. Along the concourse towards parliament's doors a drum group beat confident rhythms and flung their bodies in energetic dance of foot stamping, groin rolling and arm shaking. Maya and I dared to try out having one foot on the red carpet, every inch of which was being unconsciously swept in anticipation of Mbeki's arrival.

Dave why do you say unconsciously swept? doesn't make sense really?

Haha! ......conscientiously

I looked on in amazement as Dave, with his tiny digital camera, shouldered aside the real cameramen with lenses the length of my arm and nobody complained. Our incredibly stylish bright blue bibs, which not only matched my blue dress but also claimed we were technical somethings for RSA parliament, were clearly working well. Not only did they allow feats such as Dave's (a bit like David taking on many Goliaths all at once and without the added protection of the invocation of God) but they also served to make us invisible and i watched as the gazes of the politicians, looking out for friends or people to network with, slid right off us as if we were covered in grease. We were summoned back to the tent to watch Dave's dad do a live interview and Dave and I were told to tell the SABC in the tent next door that they had to be quiet, much to their chagrin. Without even time to discuss it before we went live one of the crew, a black woman with curly braids, looked on in enforced silence with folded arms and an irate expression. I anxiously bit my lip and hoped she'd get over it. I didn't want to take her on, very sure of who would come out on top. I had learnt early on never to try to argue with an angry black mama - especially if you were brought up polite and English.

Mbeki's arrival was signaled by.....you're never going to guess....a Scottish bagpipe band! As I pinched myself to check this was real, Mbeki strolled along the (rad) red carpet (surprisingly short in real life) and turned at the column-flanked entrance to parliament to hold his hand on his heart for the rousing South African national anthem. He then spun on his heel and disappeared into the parliament house.

Maya we never finished, lets carry on like it was last Friday...

OK cool...As Dave and I ran around looking for the hard copies of the speech (now posted on the net here) the BBC team clustered around the recorder concentrating on what was being said. We made it back in time for page 5 of the 15 page speech and watched as Peter and Jackie highlighted sections, read ahead and made comments in the margin ready for the summary which Peter would have to write almost immediately. Then Dave went off to take photos of the MPs coming out of the doors to parliament and once again I saw wee Dave right at the front of the fray (no sense of original sin clearly).

Meanwhile Maya, and my Dad, were making the most of the short period of time between the MPs spilling out of parliament and slinking into their cars to interview the most important. Frantic interviewing took place! Maya, mike holder extraordinaire, first quizzed Tokyo Sexwale and then Jacob Zuma. Why were they relevant? The most important background to the speech is Mbeki, current president, is, in fact, no longer head of the leading party, the ANC. In December, he lost the vote to Jacob Zuma in a bitter leadership battle. It is described to have split the party, so now MPs are described as pro or anti Mbeki - Sexwale is anti-Mbeki. He criticized Mbeki's lack of comment on crime and HIV (Mbeki dedicated one line to the issue - especially shocking when an average Mbeki sentence is 5 lines long). Jacob Zuma in interview was impossible to draw into making anything other than vague positive comments, keen in appearance to be working with the Mbeki. When asked what he would give Mbeki out of 10 for the speech, he just giggled infectiously and replied “I’m not a teacher!”

Maya, what’s Sexwale's role? He once thought about running for head of the ANC after Mandela and now a businessman and but still powerful ANC member right?

Sexwale is South Africa's most liked businessman. Charming and polite he ran for president this year as he was nominated. He is VERY rich and extremely polite and charismatic. Many woman thinks he’s really good-looking. But very important guy in ANC.

Great. :-) I was meanwhile grabbed by the cameraman to hold the mike and quiz the leader of the opposition, Helen Zille. I was told to ask her what her impressions of the speech were. She cast a long steely stare right back at me, her icy eyes framed by her dramatic upward flaring hair, and she fired out her points in machine gun style. She said Mbeki wasn't a leader of the country but a middle manager in charge of an inefficient administration. And, by doing, stuck the knife into one of the most controversial issue facing South Africa at the moment...that there are now two centers of power: president Mbeki and Jacob Zuma as leader of the ANC and she is using the resulting confusion to dis the legitimacy of both.

After that most people left. Dave and I went off to pick up lunch (being the lackeys) and then I went off to my guitar lesson and picked Dave up later. In the meantime Dave watched his dad do a five minute interview with Helen Zille which must have been fascinating. On Mbeki, I have been feeling desperately sorry for this man who has spent his entire childhood, university, exile and post-apartheid adult years being prepared for or actually running this organization by whom he had now been rejected in a most embarrassing manner. He is not easily able to swallow his pride methinks and if he manages it, dusts himself off and proceeds to use his great intelligence for good in our country I shall be most impressed and relieved. However I think it more likely that he will disappear to nurse his wounds in solitude which is a great shame as we shall have lost an intuitive and useful mind.

Oh well.. moving on to dealing with our next crisis. Energy and Business Unusual:)

But luckily no power sharing in this internet cafe Maya! Get back to work! :)

Christmas to start of a new year in Cape Town

2008-01-22T06:50:00.000-08:00

Its been along time since I've posted on the blog. I'm going to go for the short and the long approach (as promoted by Eddie Armstrong, cheers Eddie!)

The Short: Back, legally, in Cape Town, after a people full Christmas, Birthdays and bureaucracy. Running a marathon in March.

The Slightly Longer:
I've been back in Cape Town a week now after the holidays in Johannesburg. Christmas was busy with a 7 guests plus 4 Biles' (guests included Rachel,elective medical students from Edinburgh, a TAC volunteer and another family). Christmas eve we went to the midnight mass church service at the church that is currently home to a few thousand Zimbabwean refugees and where by Mum has been working (I think I blogged about the church when I first arrived in SA). The experience deserves a whole blog post really, but the service was hot, busy, spontaneous and with the church now doubling up as people's home, a huge proportion of the congregation were sleeping - heads nodding on the pews and bodies strewn down the aisles. Following Christmas we went down to Cape Town to celebrate New Year and my brothers 21st!

I then briefly went back to Jo'burg to deal with visa issues. My visa was running out. UK people get 3 month permits every time they enter the country. So one way to get another permit is to go over the border and come back. A plan recommended to me by Home Affairs person in Cape Town among others.

So I drove to Swaziland, where I waited and read my book for 2 days while the visa ran out and then came back into the country.

However, they have changed the rules and I only got a 7 day permit! If you stay over your permit you get deported, banned, finned, or a combination. I very nearly had to fly back to England on the next flight out. It would definitely have been great to see everyone for a few days! Instead, I spent a very stressful 3 days charging round Joburg, getting medical checks, forms and finger prints; filling out a mountain of paperwork and trying to understand the cryptic rules of Home Affairs. I am now the proud owner of a receipt for an application for a type of visa. Hopefully this will keep me here for a while!

So, with my status legal (well as legal as I can be, an actual visa would be nice) I am back in Cape Town. I have moved into a new house I am sharing with Rachel and some UCT students. Its in Observatory, the bohemian/student part of town and really enjoying the change from living on campus.

Not having any photos of me running around Home Affairs looking stressed, this is a picture of the next marathon I started training for this week. The reason I did the Winelands marathon in November was to qualify for this one, the two oceans. It's an "ultra marathon" and so has an extra 14 km on it, making it 56 km (34.8 miles). Starts early on March 22. The route winds its way around the mountains on the Cape Peninsular sweeping past the Indian and then the Atlantic ocean.

The 5000km roadtrip

2007-12-24T04:20:00.000-08:00

Arriving in Namibia’s Etosha game park, after over hours of barren landscape, not many people (Namibia is the most scarcely populated country in the world) and certainly no animals and met with yet more dust, the chance of seeing any wildlife seemed dismal.

Fortunately a small number of water holes spread across the 22000 square km of national park keeps a surprising number alive. We didn’t quite see the full cast of the lion king, but did see rhino, giraffe, gazelles, oryx (great horns), gunu’s, ravens, waterhog, zebra and a highlight was some mating lions...meters from the car!

We also met the Afrikaans version of crocodile dundee. Apparently he had caught a leopard once with his bare hands! He had been there for 9 months building some new facilities in the camp site. We spent a very surreal evening playing 30 seconds (south african version of articulate) with him and his family. Us uni student took the game a bit too seriously I think - croc dundee picked up cards on his go and could hardly speak from finding the whole thing so funny! Mad!

From the heat of the desert we headed to the coast for a few days enjoying the cool (almost British) climate and a bit a sand boarding (top trick I pulled off was: flipping my legs over my head and head planting myself in the sand). Then we were off to Sossusvlei and some of the largest sand dunes in the world.

Leaving Cape Town and off to Namibia

2007-12-23T01:32:00.000-08:00

There is a a lot to catch up on. At the end of November I finally ran a few of the focus groups for the TB research. It turned out to be a difficult endeavour. The first one went ok (though patients painted a very cheery picture of the program of which we are sceptical of being the whole truth), the second and third got sidelined by mistrust. The NGO that organises the treatment supporters, the people who visit patients once a week and the cornerstone of this new approach, organised a meeting at the weekend before with a similar intention to me: to evaluate how the program is going. However, apparently payment was promised to the patients for their transport to the meeting but when they arrived they were told there was no money. The patients were fuming! So when it came to my meeting a few days later, understandably no one trusted I would pay them, or felt inclined to make the effort. The fourth focus group suffered from being too close to Christmas, despite being in the last week of November. Many of the residents in Khayelitsha travel to the Eastern Cape to reunited with family for the festive season - family who are scattered else where across SA, or still live in the Eastern Cape.

So with no way of interviewing holidaying patients I thought I may as well make the most of this early break. I headed off to Namibia!

We piled into my car, Rachel, her friend Ali visiting from Ireland and Mark, a medical student from Namibia I first met in a karaoke bar in Cape Town and made the hot and dusty 14 hour journey to Namibia’s capital Windhoek, fuelled by lots of coca cola and Rachel’s RnB collection.

Windhoek feels like little more than a large desert outpost. Its surrounded by kilometers upon kilometers of sand and dust which seem to threaten to sweep in and overwhelm the city at any moment. Though its a fascinating microcosm of apartheid and some of the problems of fledgling independent countries. On the Sunday Mark’s dad took us on a tour of the city. We saw the university, the pharmacy which he runs, the charming but distinctly out of place old german colonial administration centers and churches, the remnants of the cities very own mini safari park, the controversial named Robert Mugabe Avenue and Mark’s old school. What stood out the most however was the new presidential palace, currently under construction. It's a 500 million Namibia dollar (35 million pounds) gold-plated fenced, marbled floored, extravagance. This is not even the final cost, ministers said recently that the final cost "cannot be know until its finished". To make matters worst, many of the labour jobs have apparently been given to Chinese people, following a Chinese government donation and subsequently being awarded the building contract. For a country thats got 40% unemployment, to be honest, its sickening. Of course its important for a country to project a positive self image, but driving literally 5 minutes to the other side of the city and witness people living in wooden shacks the inequality is untenable.

Windhoek is also a map of apartheid, only having gained independence from South Africa in 1990. It is obvious to see where the lines of separation were drawn between areas of the city asigned for different races simply from the standard of houses. While buidings such as the University, originally built for a the small white population, are now used and open to all, the socioeconomic legacy of apartheid means the populations living in each area have changed little. One new change has been the influx of people to the captial, now no longer constrained by pass laws. On the outskirts of the city you can see informal houses dots the hillsides to and beyond the horizon.

The reaction of white people to this is confusing. I don’t think I have yet quite got a handle on it. While generalizations are dangerous, I think it can be a mix of guilt, defensive pride, feelings of responsibility not extending far beyond family, and apart from anything it is percieved to be hard to engage in post-apartheid’s socail issues leading to dissolution at the current state of affairs. Racism is not an obvious phenonemon, and all to easy bandwagon to jump on and especailly hard to see under the cloak of, righlty so, being PC. It's difficult for example to decide if expressed disappointment at the new government is because they are not actually doing a good job or as a slight - “we ran it better”. I wonder how far some sectors of the white community have reversed their thinking, thinking which they grew up with, and now how it now affects their function in their communities.

Pictures above:

The new presidential place
Windhoek's informal settlement
Decerning look from Rachael Phillips
Funky Town, the entrance to the old “coloured” area of the city.

Winelands marathon: No wine but ended up legless.

2007-11-20T06:41:00.000-08:00

Last weekend I ran the Winelands marathon in Stellenbosch. It was my first ever marathon and what an experience!

If a visitor had happened to be arriving in Stellenbosch - for some unknown reason - at the ungodly hour of 5:00 am, they could have easily thought all was normal in this quiet town, home to the Cape’s best wines and white colonial buildings. However, if they had come across the road beside the running track they would have been a little shocked find it packed with 600 plus people in tiny shorts, jogging on the spot to keep warm, and dance tunes blaring out over a PA system. I was nestled in the centre of the crowd. There was tangible excitement - and nervousness!

And we were off! The race weaved its way out of town and climbed a gentle hill through the vineyards. A gentle mist still lay between the vines as the dawn sun strained though the clouds above the mountain behind us. A beautiful start to the race.

Quickly the runners spread out and for most of the race I was running alone, with a few people always in view ahead and behind.

I had been advised to take it steady to begin with. So the first half of the race felt like waiting for the time and km to pass, before the inevitable hard work to come.

As expected, the second half was a real battle to keep the pace going. I got myself through twenty minutes of it by refusing to let a runner behind me to overtake me, putting in little spurts every-time he tried to pass. When he finally overtook motivation took a real low, made worse as the course became constantly undulating!

At this point I had to have a good chat with myself! First my "inner voice"got angry with me, later I just tried relaxing and not thinking at all, both seemed to work.

When the number of km to go stopped being in double figures, excitement at the prospect of completing grew more and more. My legs felt weird though, it was like rolling my hips over two wooden planks. As I approached the finished, there were more energetic people cheering us on at the water stands, and it was strangely motivating overtaking runners on the half marathon (these people were mostly overweight and them walking not running). I also resorted to the tactic of cheering myself on! With 1 km I got v excited and managed a sprint finish.

I did it in 3 hours 8 minutes. It put me in 44th.

I was exhilarated when I realized I had finished, my legs though felt like they were going to snap out of their joints.

The week running up to the marathon was characterized by overeating. The day before was extreme, worried mainly that my metabolism was just burn though any food in the first half hour, the day before I ate: 2 large bowls of muesli, 6 cearl bars, 8 white bread sandwiches, 3 plates of nibbles at a TB public meeting at lunch time, 2 chocolate muffins, then 800 grams of pasta, and another (small) bowl of muesli at 4:00am. I was seriously close to overdoing it. I hardly slept the night before, in a constant sweat, and feeling like I was going to be sick at any moment. When I was standing on the start line there was a definite hard, heavy, lump at my stomach. Possibly i over did it!

Getting through the marathon was in part due to my Norwegian vitamin friends. As nutritionists they have had great advice! They didn't have any part in the overeating - that was purely my fear of hunger driving me - but gave much much appreciated motivation!

It was a wonderful experience and I think I am quite up for another one at some point!

Global March for TB

2007-11-20T06:11:00.000-08:00

“VIVA new TB treatment VIVA” screamed a TB nurse perching on the back of a lorry above a 3000 plus crowd, who chanted back: “VIVA!”. She was followed by equally energetic speeches about the need for new, effective and simple TB diagnostics; new funding into TB research; more HIV treatment; community based care; and even vision and leadership on TB. Music boomed out from the enormous speaker system, on the other half of the lorry come stage, and the sea of red campaigning t-shirts below jived and sung!

The Global March for TB treatment was just warming up. The Treatment Action Campaign (TAC) - most famous for taking Phizer and the South African government to court in 2002 to secure treatment for mother to child transmission of HIV - had impressively bussed 1000s of their campaigners from around South and Southern Africa, to coincide with the international TB conference starting in Cape Town the next day.

I climbed a tree to get a better view. Still dressed in hospital gear: shinny black shoes and blue non-iron shirt, I must have looked ridiculously out of place!

The march set off from the outskirts of town, below table mountain, towards the international conference centre. I joined Rachel (she has just arrived in Cape Town to work with TAC, for those who don’t know her, a great friend since I met her while doing International Health) and flapped a banner asking for improved TB treatment around.

The march went along the main highways of Cape Town and eventually arrived at the conference centre where more powerful speeches were given, including speakers from Latin America and Malawi, and a memorandum was delivered to the head of the conference organizers.

The march marked a new move for the TAC into TB advocacy, who have historically focused solely on HIV. Most HIV patients die from TB, so its a much needed move. And something to get excited about: lack of political action is a big driver of the TB epidemic, and TAC have an impressive track record of getting HIV up the political agenda. Hopefully they can do the same with TB!

It's also politicized my research - TAC are calling for more community based care - its just how the we describe the intervention I'm helping to evaluate.

A new direction

2007-11-05T00:09:00.001-08:00

At last a break though! I was trundling along trying to move beyond the planning stage, when I met a lady who is researching a similar topic area as me. We talked about us working together and, following a few weeks of waiting, last week she finally agreed that I could work with her. So I'm off in a new research direction.

You remember I talked about the model of adherence support for HIV treatment was very different to TB? Well, this lady, Salla Munro has implemented the HIV model with TB patients. My original plan was to compare patient experience of HIV and TB treatment support, to ask theoretically what use the HIV model would be for TB. Now I’ll be helping to evaluate how the new model was worked with TB treatment- in practice.

I’m excited because it means I have someone to work with and can hopefully learn lots about qualitative research along the way. It also means I have jumped past the hurdles of gaining ethics approval and securing permission from clinics to do research - usually both arduous tasks.

My responsibility is to organise focus groups with patients to find out how they have experienced taking TB treatment, and then analyse the data with Salla. There are 5 clinics in various parts of Cape with the new intervention. Plus we'll be looking at two clinics with, the classic, direct observation. The work is expected to take until March.

So this week I’ve been getting an introduction to the clinics. They are all in Cape Town's townships. Busy places, much informal housing, and home to millions of Cape Town's poor. On Wednesday I visited 3 of the clinics and in the process got: a new name (Loorwarzi - Xhosa for knowledge), 3 marriage proposals (I think it was a joke, I said no in any case) and met, no exaggeration, 60 new people (treatment supporters, clinic staff etc). The next two days I’ve been heading back to the townships to explore the possibilities for a venue for the focus groups.

Overall though, its great to be out of the office and getting stuck into something new.

Is it a rabbit?

2007-10-26T13:24:00.002-07:00

Apparently there is a rabbit in the moon here! We dashed up Lion's Head after medical school yesterday evening to have a look. Unfortunately it was too cloudy to see the full moon properly, but it was a great sunset. I will have to try again next full moon!

Rugby world cup in South Africa

2007-10-26T12:51:00.000-07:00

I’ve been lying for weeks. I’ve been telling people here I am a rugby fan. But given the way rugby has creeped not just into every conversation but ever part of life, I think any other option would have been cultural suicide. You can’t tell a proud South African you don’t care either way, including the non-sporty lady from across the corridor when she comes into work dressed in green and yellow.

As the only English person in the hospital, however, has meant I have endured being the butt of all jokes. Its been endless, ever since England took a thrashing the first time round....and its still ongoing.

The build up to game here was mad. On Saturday afternoon I was on way to the beach for some surfing and ever few minutes a car or pick-up would zoom past, windows down, springbok flags out, hooting and cheering like mad. South Africans thought they had already won.

I spent the game its self in a pub just by campus. 50 or more South Africans, 15 or so elective students, who by this stage been caught up in the excitement and gone back on promises to support England, and me. It was lonely. And possibly dangerous - I kept my accent down. I was still though contented that I didn’t really care about rugby, however on kick off I suddenly started to really care! What’s that about!

I spent part of the game chatting to one of the good looking (self proclaimed too) Norwegian students. Having never seen the game before she was shocked at the violence, “do you have kill someone to get a red card?” but also confused, “why don’t they punch each other?”.

Hope its wasn’t too depressing in England after the game. Needless the celebration afterwards here was crazy, people running in the street and springboks shots flying everywhere (green Aftershock stuff with Amarula).

Sunday I escaped for a run. I went from Cape Town along the costal road on the west side of the cape peninsula to Hout Bay. I was meant to be running for one hours and turning round, but on getting over the pass before Hout Bay I saw the beech in the distance and felt I I had get to it. It was beautiful. However on getting back I recalculated in the extra distance I had run and it appeared I had unintentionally ran a marathon. Puts me in good stead for two weekends time I hope!

The running, though, didn’t allow me to escape the rugby. I tried to buy a drink on the run back only to be told I could have it for free as a commiseration prize. After the run I went to buy a burger (I know, but I was hungry). Passion for rugby in South Africa is followed by an almost equal passion for meat, but I never suspected when trying to buy the burger I would be confronted with the choice of a green role for my burger, it glowed fresh from the its radioactive dip.

So its been a hectic time dodging national pride and “What do you do to an Englishman who has just lost...” jokes. Luckily, they haven’t noticed the England vs Russia football results....yet!

Escaping the city

2007-10-20T04:34:00.000-07:00

Last weekend (I am really behind on updates) I went to the Cederberg mountains. Its a cross between the surface of the moon and an English country garden and it's achingly beautiful.

Saturday we climbed one of the mountains to an impressive rock arch. It was a real adventure, crawling though rock crevasses a person wide, climbing under fallen boulders and chasing baboons. I went with a group from the elective house at the hospital.

Sunday I couldn't sleep (damm birds - i wasn't feeling nature) so I did a run. Clocked in 28km and spent the rest of the day absolutely exhausted.

The one best things about the weekend was a man called Gheret who ran the lodge we stayed at. He's lived in the mountains for 35 years and has perfected relaxing and thinking. Had some great long conversations with him about all things South African. On the morning before the hike he made these incredible hand drawn maps for us, just like treasure maps without treasure!

An ordinary weekend?

2007-10-08T08:55:00.000-07:00

This weekend, I met one of the most powerful people in the world! Angela Merkel the German chancellor visited my hospital as part of her African tour.

It was mayhem, with reporters, and cameramen jostling to get her photo and avoid being trampled on by her 20 plus entourage as she swept into the hospital.

She was here to visit the "Hope" centre, a German-NGO funded project that does community HIV things. An elective student working at Hope had tipped us all off that she might be coming a few hours before. And so a cold, quiet Saturday afternoon suddenly became very exciting. We put on our white coats and they seemed to blag us through all security measures, and even us get us sitting a few rows to the side of Angela in "Hope's" power point presentation.

I didn't understand anything she said but she seemed very clever and energetic. Unfortunately, I wasn't able to ask she was going to meet the 12 billion dollar gap in the Global Fund for AIDS TB and Malaria (though to be fair she did give 10 billion dollars to the fund with Brown last week). The German elective students were very happy to meet her (see picture!). One got interviewed by national radio.

We also met Oliver Beirkoff (scored against England to win Germany Euro 1996 - I had to ask i know nothing about football) and the German finance secretary. I also met the SABC's (South African Broadcasting Corporation) presidential reporter. He has interviewed Thabo Mbeki countless times, so had fascinating chat about AIDS denilism and the Zimbabwe issue. To follow on from the earlier blog post about Mkeki he may be more misunderstood than we give him credit for. The reporter thought Mbeki felt he had been unfairly misinterpreted when he highlighted the links between AIDS and poverty years ago and no longer spoke about AIDS because he was reluctant to be misinterpreted again.

Marathon running

2007-10-08T08:32:00.001-07:00

Last week the inspiring Ethiopian runner Halie Gebrselassie broke the marathon world record. A good as week as any to enter a marathon of my own.

I've, possibly naively, entered the Winelands marathon (no drinking during, only after). It's on November the 10th so with only a few weeks training to get under my belt before, the chances of beating Halie's staggering time of 2hrs, 4 min, 55 seconds are slim!

The picture above is a view from the top of the hill I've been running up nearly everyday. My hospital, Tygerberg is one of the tall buildings just right of centre.

What am I doing?

2007-10-01T11:12:00.000-07:00

I was on skype to my friend Tom the other day and he asked, "what are you actually doing out there?" I realized I haven't actually said yet...

At the moment I am trying to research how patients can be helped to take their TB medications. Its a big issue: TB is the third biggest killer, and despite decades of attempts to control it the number of people with it are rising. In some parts of South Africa only half of patients finish their treatment. While patients in the West don’t do much better on most treatment, the consequences of non adherence to TB are serious: illness, death, transmission to others and the build up of “super bug” TB that’s resistant to all medication.

TB treatment is hard to take. Its a 6 month course, has horrible side effects and its heavily stigmatized in society. However, the treatment for AIDS is similar, but,the rates of the adherence are higher. Why?

Big part of it might be the way health programs help patients take their meds. TB has relied on direct observation, getting someone, usually a nurse to watch you pop your pills, in theory, every day. But big trials have shown this doesn't work, in developed or developing countries. AIDS treatment has relied on education, lots of counseling about what being in treatment will involve, treatment supporters, support groups and community campaigns. In fact there have been some impressive and inspiring projects that have used this approach to get really high rates of adherence. MSF have run one of the most famous projects in one of poorest the townships here in Cape Town, Khayelitsha.

So this is where the research comes in. I’m hoping to ask patients how they experience HIV and TB services to see what lessons can be found to improve TB adherence in the future.

Currently I’m at planning stage, but its been an interesting journey so far!

Penguins!

2007-09-17T10:24:00.001-07:00

England are losers...

2007-09-17T10:01:00.000-07:00

Friday 14th September

...but it was a cool location to watch the match. The funniest thing about the entire cricket game was ever time there was a four, a six or a wicket loud music would be pumped out over the tannoy. Then, two girls and two guys would spring up onto a mini stage at the front of the seating stand and thrust their pelvises, wave their arms and grin inanely in a crazy dance! The dancing even incorporated "umpire moves". When Australia were batting they hardly left their stage. I would love to see Lords get them in.

Cuba and vineyards

2007-09-16T04:01:00.000-07:00

Wednesday 12th September

Today, I met the a group of South African medical students who have spent the last 7 years studying medicine in Cuba. They were there as part of a South African government funded scheme aimed to get more doctors equipped and prepared to work in rural, under served areas of South Africa. They have just come back, and now dealing with the culture shock and prospect of starting final year medicine here. I joined them on their orientation to get back into South African medical school life and today was their trip to a rural hospital.

It one the best med school trips I’ve ever been on. It involved a trip to vineyard on the way to the rural hospital, and on the way back! (Included tour of the cellars in photo). The ladies who run the rural health health department, Ukwanda, thought it would be a good way to get them keen on working in a rural setting when they qualify.

After 3 hours packed into the med school minibus we arrived at Ceres valley. It’s an incredible setting, the hospital encircled by jagged mountains. We met Hans one of four doctors there. The challenges of rural medicine are significant: they serve 94000 patients over an area of 80km, by 200km, an HIV prevalence of 15.2% with 30 beds, 4 docs, and a team of nurses. The UK has about 600 patients per doc. As a doctor in a rural hospital you have to be a generalist, Hans will do everything, trauma, performing Caesarean sections (from anaesthesia to delivery), paediatrics, HIV treatment, geriatrics, neonates... part of a exhausting routine of over 80 patients in a morning.

I was fascinated to meet the students who had been studying in Cuba. Cuba is put on a bit of a pedestal in Global Health, boosting one of the highest life expectancies in the world, despite being one of the most economically poor in the world. The Cuban students were explaining how infectious disease “hardly ever occur in Cuba - it’s all prevented”, “there you are basically treating healthy patients”. There seems lots South Africa can learn from Cuba, but they felt that some of the key elements of the success are intractable from communism. In particular they thought you couldn’t get doctors to work where ever they were told, so every one has a doctor living near by, without communism.

There was an animated debate about how you can enforce or motivate more doctors to work rurally, and equally importantly not leave the country entirely. And they know what its about - they all bonded to work for 5 years in their home community once they have done two years as a junior doctor. Cuba seems to have left many of them with strong views about being motivated by treating patients, not money, but at the same time a few have aspirations to work in Canada. Whatever happens they have an impressive grasp of public health and are an interesting lot. The dean here joked that the next health minster will come out of this group!

Ukwanda

2007-09-10T13:11:00.000-07:00

I’m based in the department for rural health. It’s called Ukwanda and is a 4 staff team in the heart of Stellenbosh medical school. You see that tree to the left of the photo...the office is directly behind it, one floor down. The team mostly organize medical students placement to rural areas - sometimes up to 500 km away from Cape Town. But they have a very broad social view of health, which is partly why I'm here.

In fact, the one word Ukwanda, translated from Xhosa means:

“Grow advantageously and develop within the context of the community.”
It’s said: ooo (gutturally like a monkey, lips out ) - kw (a clicking sound from top of mouth) – and - a. I’ve been practicing much to the rest of department's amusement!

So their hope is that after students spend part of their degree out in rural areas that more docs, and other health people, end up have a grasp of community development and working in rural areas professionally. In the times of global health worker migration, with rural areas beocoming void of health professionals, this is a big deal. However, I’ve joined them to learn about and research TB. I’ve been straight into work and so far thoroughly enjoyed it.

And I spent the weekend getting to know the international student crowd out here on elective.

First week done!

Jo’burg to Cape Town

2007-09-10T12:46:00.000-07:00

I took the train 1393 km from Jo’burg to Cape Town though barren dusty fields, snow capped mountains and sweeping vine yards. I arrived the next afternoon in CT city centre, laden with 2 enormous back packs on my front and back, perched on the top of my mountain bike - crazy foreigner look guaranteed.

I spent the evening with a family friend called Firle and her house mate Adam. Adam turned out to be a stunt man. I watched his showreel dvd he gives to companies who want to hire - imagine watching 20 movies in one go but only the crazy action scenes back to back. The most impressive one was him driving a car off the end of a half built motorway flyover. And the lift to the medical school with him the next morning - I survived!

The Lion King

2007-08-29T14:02:00.001-07:00

I went to see the Lion King last night. It was fabulous. I feel, I just want to write a list of superlatives!

Have you seen it? If not, you really should if you get the opportunity!

I've been on Safari, but this had far more color, much more excitement, music, singing and dancing animals than I've ever seen from a top of a landrover.

My favorite character was the lady in the picture, the baboon witch doctor, v funny and a voice powered by twenty lungs for sure. My brother's was the grass; honestly the grass was hilarious. It was fascinating seeing all the humans manipulate the puppet extensions to make them animals, which float, spin and leap onto stage with whirling scenery and intense African drumming. There was even a to scale elephant!

The show has been hailed as The Lion King's return home - don't tell anyone, but its based in the east African savanna - in any case it's immensely popular, the audience were often clapping mid scene and the jokes in Zula or Xohsa went down well. It was wonderful!

A friend's farm

2007-08-26T13:46:00.001-07:00

"Dad, where are we?"
"Well, the middle of nowhere really."
And that's where we spent the weekend!

Thursday: Bureaucratic tour of Jo'burg and Divas

2007-08-26T11:49:00.001-07:00

After talking about the difficulties of negotiating South African Home Affairs department for Zimbabwean refugees 2 days ago, today, I got my own personal experience.

I discovered that Stellenbosch University, where I will be doing my elective, need my visitors permit (stuck into my passport in the airport) to have written ‘medical elective’ on it. I got it done starting at 7am and finished by lunch - a minor miracle I think. However, it did involve driving an hour north of Jo’burg to what was hopefully a quieter Home Affairs office, only to be sent back though rush hour traffic to central Jo’burg office. There, neither counters 6, 8 nor 12; nor room 102 (or did they say I should go to 101) nor 112 on the second floor could help. I was slowly starting to feel like Asterix in ‘the twelve tasks', where the chaotic bureaucracy of Athens proves more challenging for him and Obolix than defeating a ghost army (it involves Asterix running around ALOT and Obolix struggled to carry all the forms they got given). I was finally told to go to the airport?!? They insisted I must go inland! Persistence, or maybe desperation, prevailed and an immigration officer eventually agreed to meet us, laughed at me, and scribbled on my bit of paper.

This evening, I went to see Miriam Makeba in concert. The 75 year old star, famed for being the first South African to speak out against apartheid at the UN, belted out her repertoire in a tent (a very big one) erected for the occasion in downtown Jo’burg . Most of her band seemed related - it included a granddaughter, a great grandson and even a few ex husbands!

Wednesday: The battle for science

2007-08-26T11:30:00.000-07:00

A great mystery: why is Thabo Mbeki, president of South Africa, in denial about the AIDS epidemic?

It is killing one thousand South Africans a day, infection rates are rising,it is expected to remove the most economically productive people from the population and cost effective treatment, and the money to buy it, exists. Yet, Mbeki has resisted the role out of ARVs at almost ever step, despite court cases enforcing him to do so, publicly denied the link between HIV and AIDS and put in place a health minster, Manto Tshabalala-Msimang who has promoted beetroot, african potato and quack’s herbal remedies, over ARVs. A few months ago Manto fell ill and her deputy, Nozizwe Madlala-Routledge, took over. She was a much needed relief, publicly tacking an HIV test in her first week in office and kick starting governments program to tackle the epidemic. This week Mbeki sacked her; claiming a trip to an international AIDS conference in Spain was unauthorised. The press and NGOs have been up in arms in response. So, answering why is Mbeki in denial has never been more pressing.

I went to a talk on Wednesday by someone who doesn’t know either. But she has looked closely at the rise and effects of Mbeki’s denialism. Nicoli Nattrass, a professor in economics, thinks that the most devastating effect has been over the value of science. Under Mbeki not only have alternative therapies been promoted publicly before ARVs but the institutions that should be responsible for protecting the pubic from unscientifically supported medicine have been sidelined. For example it was in 2002 the Medicines Control Council rightly impounded untested pills promoted by an American Matthias Ratth at the port when they arrived, only for the decision to be over turned by the Health Minster. There are a whole series of quacks selling treatments unregulated across the country. Many of the government broads responsible for managing the epidemic apparently lack scientific expertise. This has left patients confused about which treatments work and public health messages based on the science of the epidemic treated with ambivalence.

The actual reasons for Mbeki denial continue to rage. Is it two fingers up to western ideas, part of his African renaissance, accepting only “ Africa solutions to Africa problems”? Is accepting the scale of the epidemic untenable to Mbkei because answering why the epidemic has been so severe in Africa is so difficult and prone to value judgments? Has AIDS hit his personal life? Is he too proud to admit he was wrong in the past? Or does he truly disbelieve contemporary science? What ever the reason is, the way forward is not only to speak out against Mbeki’s denialism and government inaction but also to promote the understanding of science and the institutions which uphold it. For example alternative remedies need to go undergo randomised control trials, and there needs to be much more public education about the epidemic and the reasons for its scientific basis. The professor drew parallels to the Republican war on science in the US and the situation echos the campaign led by Ernest Hart, editor of the BMJ, against quacks at the turn of the 19th century in the UK. Complacency, it seems, about the founding principle of science cannot be assumed at the early part of this century either.

I'm here!

2007-08-24T02:14:00.000-07:00

I don't know quite what I expected in my first 48hrs in the country, but possibly not stepping off the plane and into an epicentre of one of southern Africa's most pressing political crisis: the effects of Roberts Mugabe's Zimbabwe!

On Tuesday, I visited Johannesburg's central methodist church. It has become home to over one thousand asylum seekers and economic migrants - the majority from Zimbabwe. During the day the many floors of the church are bustling but apparently at night, almost every floor space and stair well of the 4 floor building is filled wall to wall. This week the UN indicated that the exdous from Zimbabwe is set expected to increase, building on the 3 million people who have already fled the country (about a quarter of Zimbabwe's population). They indicated much more will be need to be done in response - quite!

I was at the church to attend the clinic which runs once a week. My Mum, being a nurse, has recently started helping run the clinic. The church's population have a range of health problems. Many came complaining of colds but some attended with suspected AIDS illnesses and TB, often in the last stages of their disease and having never having seen a doctor before.

Treatment and referral is complex and involves a combination of identifying other friendly clinics, ringing other doctors for favors and negotiating the South African home affairs department to obtain refugee status. Refugee status is important for patients to secure easier access to treatment and increase a chance of finding income and food. For example, one man we saw came in was severely underweight, panting for breath just sitting in the clinic chair and complaining of a cough and night sweats.... TB was highly likely and HIV probable. He was drawn a map to a local clinic that does not charge user fees for HIV and TB testing. Then told to come back with the results to be able to visit a clinic run by the 'Sisters of Nazareth', a Catholic church funded clinic, on the other side of town who could start him on ARVs. Meanwhile he was advised to go 55 Km to Pretoria to start the process of seeking aslyum. There are many personal stories in the South African press.

Politically, it is hard to assess what the impact of the church has been or will be. Locally, there are apparently rumors of discontent about the church being used the way it is, and the bishop is quick to upturn myths about refugees - indicating for example there are enough teachers living in the church to run a small school. Nationally, it has been used, unsurprisingly as an example of a growing humanitarian crisis. In fact, Paul Verryn, the bishop of the church was part a protest about the South Africa government's lack of support for this vulnerable population, earlier this month. But definitions such as refugee are difficult. Legally, many in the church are there often because they simply could not find food in Zimbabwe and so be classed as "economic migrants" as apposed to "well founded fear of persecution" needed to be proved for refugee status. Politically, the South Africa government defining them as refugees and starting "refuge camps" may upset its current attempts to conduct "quiet diplomacy" with Zimbabwe. You can read about the unfolding of the debate here. Meanwhile, the church will continue to be a de facto refugee camp in the heart of the city.

If you're interested in visiting the church too....

.....watch this v ideo, it gives a good insight into life in the church. (yes, no prizes for recognizing the jorno may be related)