The African Reality Tour - Part Two

Shashank recently wrote a post about "reality tours" in the slums of Nairobi such as Kibera - now not just a quick n' easy source for a story on african poverty ... but also a tourist destination for pity tours ... guaranteed to make you go home realising how lucky you are .... but all seemingly rather sordid with liberal intelligentsia up in arms at this semi-schadenfreude ....

Its an argument i've often had with myself .... i've worked in slums in Peru, India and townships in SA .... but i've also visited them as a "tourist" - including the favelas of Rio and Soweto near Johannesburg .... and i think it is an important thing to do and acknowledge - the favelas aren't even on city maps of rio - and tourists visiting these areas are the only recognition such cities-within-cities get .... aside from the aforementioned press reports of crime, violence and deprivation ....

Khayelitsha is one of the largest townships associated with Cape Town - over 500,000 people live there .... a remnant of the apartheid government ... its inhabitants are poor, black and typically unemployed. Most homes are corrugated iron shacks without plumbing or electricity .... crime and violence (murder, rape and domestic abuse) are rampant and HIV rates hover around 30% ....

Most white South Africans have neither reason nor inclination to be in Khayelitsha .... but the townships are a vital part of the SA culture and way of life .... and despite the crime and poverty - these communities are very tight knit groups who support and celebrate with each other. There is great passion, pride and spirit in the townships and it is unfortunate that others outside don't get to see that part of them. All they often get to see is the miles of shack-like communities lining the highways to/from the airport. In turn - the township dwellers don't think that the affluent and the white bother about or even acknowledge them or their problems .... they feel alienated, rejected and justified therefore in turning their rage against those who ignore them ....

MSF (Médecins Sans Frontières - Doctors without Borders) provides ARV treatment to HIV patients in Khayelitsha and runs a clinic there called Simelela .... and amongst other things, the clinic also serves as the Rape Crisis center for the community. Two of my colleagues, Eric and Carter (young yankee interns on a programme run by Princeton in Africa) volunteer at the Simelela clinic on their free time. Recently MSF and the TAC (Treatment Action Campaign) held a march in Khayelitsha in protest against the levels of violence against women called "Take Back the Night" .... only because the nights are so dangerous and crime-ridden .... the protest march had to be held in the day ....

NOTE: Another organization in the area is called "One in Nine". Only 1 in 9 rapes are reported and only 1 in 9 rapes get a proper trial. Much of the crime is "black on black" happening in the communities in which the women live and committed by men they know. The longer we all ignore these women, where they live and what they endure ... the longer it goes on ...

How do you solve a problem like Mugabe?

Robert Mugabe turns 83 today ... and despite recent rumours of ill-health he's promised to party like a 28-year old at his birthday party on saturday ... and even worse to stay on as leader until at least 2010 .... celebrating this news with a lavish extravaganza despite the fact that today the shops in Harare have run out of bread (again), people are out bartering their last possesions for something to eat and the whole nation is seething with discontent at the fact that a bag of maize costs about 4 months worth of average salary ....

Its horrific and flabbergasting that the leader who took over the country from the Brits in 1980 in a wave of hope and goodwill (he's even been decorated by the Queen) has driven the breadbasket of africa and possibly one of the most beautiful countries in the world into complete and utter devastation ...

Inflation rates are 1600% (the highest in the world) and unemployment rests at about 80% .... fuel food and foreign currency are as rare as hen's teeth ... and violent land expropriation to the "war veterans" has left ravaged farmlands incapable of harvest ...

Case in point: a zimbabwean friend of mine took a loan out when he left 10 years ago to study at Harvard medical school and do his PhD there ... essentially 10 years of probably the most expensive education that money can buy ... and he returned this summer to pay off the entire loan with a $100 bill .... and he still got change back ...

The average life expectancy in Zim has fallen to 34 years (some estimates are less than 30 years) - the lowest in the world (the only countries comparable are Lesotho and Botswana due to heinous HIV rates of around 40%) .... hospitals are closing for lack of materials and medical schools closing because students can't afford fees ... doctors are in their 8th week of strike as are teachers with other workers close behind ....

Some estimates put over 3 million people facing starvation in Zimbabwe .... its democracy is in tatters and some of the most draconian press laws and worst civil liberties records in africa (which to be frank is not setting the bar very high ...)

As many of you know - the main opposition party (the Movement for Democratic Change) has been persecuted, hampered and its leaders imprisoned ... the brave bishop of Bulawayo - Pius Ncube - remains one of the few unbowed voices in the country despite horrific harrassment ...

Many are praying that this could be the turning year for them ... as the Zim economy crashes further .... there is no way of avoiding the fact that Mugabe is slowly driving the country deeper into catastrophe with no intention of ever stepping down ... and maybe just maybe - a winter of enough discontent could start the beginning of the end ...

Its unclear if anything anyone does in the west can divert Mugabe from his course ... sanctions, censure and alienation seemed to have had little effect ... and sadly the one african nation that may have had any influence - namely the south african government - remains doggedly silent and by default supportive to this grand-master of african politics (he staunchly helped the ANC through their stuggle against apartheid) .... perhaps all we can hope for is for those 83 years to catch up with him ....

Come on Dover! Move Yer Bloomin' Arse ....

I had my own Eliza Doolittle moment recently at the annual cape town J&B Met ... our answer to Ascot (or the Kentucky Derby or something if you're a yank) .... apparently its been going for the past 30 years or so and is definitely a "Big Deal" socialite event on today's cape town calender ...

People plan their outfits for months in advance according to the annual theme (this year - Black White and Bling) ... and go completely overboard despite the melting hot summer .... everyone vies for one of the coveted hospitality tent tickets .... the whole day is about people watching, drinking and general flouncing around in finery ... with the horses coming in a poor second ....

This year rather nicely for me - Shashank was in town visiting ... and very serendipitously my mate Priya (a local radio DJ) was not only doing her radio show from the Met .... but was also responsible for judging the best dressed couple competition (for anyone who turned up in theme) .... so you'd think the stage was all set for me to win the first prize of a week in mauritius or several 1000s worth of diamonds as second prize etc etc .... but no ... sadly one of the - let's say idiosyncracies of dating an american .... is that his version of dressing up in black white and bling meant essentially a pair of khaki shorts and t-shirt ... yay me ...


That minor disappointment aside - the day was a cracker .... we had a huge picnic with several of my mates .... potloads of wine .... the weather was typically cape-town-beautiful ... and most importantly i/we won big including over 400 rand from one free bet .... although if we're being honest (and not to be all cockahoop) - we'd have won more if shashank had listened to my other race suggestions ... but we'll say no more about that except to note every time we've been gambling together we've won ... and that doesn't tend to happen when shashank gambles solo ...

Still we spent the winnings on the rest of the weekend generally pretending to ourselves after several hard weeks in the field (me in hiv-ridden township SA and S at the Somalian border etc) that we weren't really in africa at all - organic farmers chi-chi markets, gallery openings, yummy yummy food and wine tasting (and a lot of wine-buying) ... Cape Town - the Paris of Africa indeed .....

A Very Un-Valentines Day

This country has a horrible way of biting you in the bum .... just at those moments when you start thinking that a corner has been turned and that there is hope for this country after all ....

I spent yesterday schlepping around hospitals, clinics and GP surgeries in rural mpumulanga (province of SA where Kruger national park is) .... following up on patients, training doctors, etc etc ..... and i suddenly realised quite how much had changed here since a year ago.

At my first training session in this area over a year ago - only three patients turned up, they bolted the doors of the hall and were clearly terrified of being seen there and hence "outed" as being HIV positive ... they wouldn't even leave the room at the same time and certainly wouldn't be seen with any of us foreigners - a sure-fire sign of having AIDS (the only outsiders that come to these parts are do-gooders) ...

A year on - we have to barricade ourselves into the room to avoid the huge mass desperate to to get onto ARVs .... having wider access to treatment and witnessing others in their community actually getting better has definitely reduced stigma and given them hope .... the message has trickled through that knowing whether you are postive is no longer an immediate death sentence and so more people get tested ... and the numbers needing ARVs keeps rising ....

And so it was a rewarding moment realising that a year of our programme had made such a difference to a community .... and importantly to see the patients who had been so pitifully ill just a few months before actually job-seeking and looking well ....

I returned home to my B&B feeling as though I was finally doing something worthwhile .... and over dinner with two of my colleagues we earnestly talked about things getting better for this country after the twin scourges of apartheid and HIV .... and so in between courses we got up to get some fresh air and walked onto the front street ... to be greeted by the sight of a gaggle of young girls all dressed up to the nines ....

This sadly was not some asbo-inducing fest of fourteen year olds gathering for valentines day and just hanging out on the street .... instead these girls were flashing at the passing truck drivers (this being a big timber region and transport route with lots of trucks) ... and if any of them stopped at the traffic lights ... they would clamber onto the bonnet shouting to the driver all the things they could offer him and the price ....

Horrified and yet somehow also fascinated - we ran down to the nearest girl to ask her why she was doing this ... and it was just wrist-slittingly depressing to hear that it was the only way any of them could make money and that often they were sent out onto the street by their families ....

We asked her if she'd ever heard of HIV (of course she had ... there's not a a soul here under the age of 50 here who hasn't) .... and if she used condoms (of course she said she did .... note to all doctors about people telling us what we want to believe ...) ..... and sadly like the good HIV doctor I am - I was of course NOT carrying spare condoms to dish out to all and sundry on the street ....

But within a few minutes - she had a client .... who said that for sex without a condom he'd pay her three times the going rate (about 300 rand - less than 30 quid) ... she looked at us and shrugged her shoulders ... it had been a quiet few days and she wasn't going to turn him down - she needed to eat .... we tried to plead with her and even offered to match the money ... but in a flash she'd hoisted herself up and the driver was shouting obscenties at the interfering foreigners about trying to make him eat sweets with the wrapper on ....

I looked up and noticed he didn't have a seat belt on .... and so here's the rub ... how do you get a nation to start using condoms and avoid a fatal threat which will affect them 5-10 years on ... when you can't even get them to wear a seatbelt to protect against an immediate threat? How do you get people to value their lives when they have so little to look forward to at age 14 that they sell their bodies and potentially their long term health for under 50 dollars?

Where for art thou?

Just so that people don't think from reading either my or Shashank's blogs that Africa is all war, epidemics and car-jackings (although maybe his life is that exciting) .... here's a pic of my weekend having a picnic in the park with mates priya, shaun and lisa before watching open-air shakespeare .... and whilst the acting wasn't quite up to regents park (just imagine Juliet with an Afrikaans accent) ... its still very nice just to pretend that civilisation is just around the corner ....

Another hope bites the dust .....

I feel a bit sheepish since i've been meaning to write about microbicides ever since the Toronto conference last summer (and yes i DID do more than just accessory shop there). I even had a snappily titled post all set up in my head in honour of Gates and Clinton, the chief celebs that i followed around star struck ... although admittedly rather typically never got around to actually writing the post ...

But to summarise post haste - the overwhelming themes at the conference were:-

1) that the face of HIV globally is now the face of a woman (especially a poor black or asian one)
2) that the funds committed to provide ARV treatment to all that need it are never ever going to suffice (despite the best efforts of Gates, Buffet and dare i say George Bush) .... and
3) that the pendulum needs urgently to swing back to prevention efforts (as opposed to solely treatment advocacy) .... BUT a very different kind of prevention this time ...

Stephen Lewis (possibly the greatest Canadian ever) made an impassioned speech regarding the fact that funds such as PEPFAR, originally the largest fund donated to a single disease are now already woefully inadequate for the current state of the pandemic, much less for the projected numbers in a few years time .... three by five might would need to be fifty by ten at this rate .... an inconceivable burden of disease ....

But the one positive message that shone through was that finally sisters might be able to do it for themselves ....

We all know that condoms don't work (correction: condoms could work if only men could be persuaded or even volunteer to wear them) .... and that vaccines are still the same ubiquitous 20 years away that they were 20 years ago .... but microbicides were presented as the possible salvation of every woman in the developing world wanting to protect herself surreptitiously .... (the other breakthrough touted was that some ARV drugs could be taken on a Friday night to protect someone having unprotected sex until sunday night .... a whole new take on "something for the weekend - sir" and not unsurprisingly top of the agenda for the MSM contingent at the conference .... speaking of which I had never seen such a circus at a conference ... there sections for grannies against aids, prostitutes, transvestites, transsexuals, multisexxuals ... frankly anything went and had a stall or an advocacy group .... ).

So it is with great sadness and disappointment that we learned earlier this week that the trials into microbicides had been universally halted in all research centres across Africa because the provisional results showed that women who had used the gel actually had higher rates of infection than women who used the placebo gel .... bloody typical ....

Now it could be because women with the microbicide took more "risks" with the confidence of the gel whereas the placebo group somehow managed to make their men wear condoms or even that the gel candidates were somehow placed at greater risk through some other means (barrel scraping) ... but it does look like the great white hope of a female-centric method of protection has bitten the dust .... a disaster for women on this continent ....

I've just got home from a day in an antenatal clinic in Kwa-Zulu Natal where 80% of all the expecting mums are HIV positive ... someone pass the Prozac and quick ....