Having my bones thrown ...

Its been a tough few months for me recently with lots of upheaval ... and the last few weeks have been especially rather hectic - planning my departure from SA, almost getting chucked out of my house by an evil landlady (and then leaving anyway), killing my liver with the Harvard/KSG boys in Namibia ... and the list goes on ...

If i'd been in London or in Boston ... i'd have booked myself into a spa, had a massage ... perhaps drunk a few bottles of wine ... well .. i've done a lot of that here too ... but i figured ... since i didn't have a normal doctor here in Cape Town (and yes - i know that i am one ... but i knew i didn't have an infectious disease ....) .... i would go to an African doctor - a Sangoma ....

Now Sangomas have a bad rep in the HIV NGO community ... most of our patients consult traditional healers before they seek a medical opinion ... and often mix muti (essentially plant and animal bits) with their ARVs ... which makes an awful mess as you can imagine .... and we "normal" doctors have been guilty of demonising their efforts and role in the fight against AIDS ...

Added to that several have been convicted recently of kidnapping and killing children for various essential components of witches brew ..... and so .... i chickened out a bit of the whole authentic experience ... and found myself a white sangoma instead .... i claimed so that language wouldn't be a problem and a white healer would explain any cultural differences to me .... but really it was so that i didn't have to sacrifice a goat or drink ground up baby bits ....

Julia the Sangoma - couldn't have been nicer .... true she did have her special healing hut (or Ndumba) and she did wear the traditional gall bladder of the goat that was sacrificed at her initiation ceremony .... but she explained everything fabulously .... and was suitably understanding about my being an allopathic doctor ....

So we sat on an animal hide (? goat) mat .... sent out smoke to honour our ancestors .... and she threw my bones .... interpreted my dreams (even though to be fair i didn't remember any) ... and told me about my life ..... i can't tell you what she actually said - thats between me and my ancestors apparently - but she gave me some very sound advice as well as lots of very african perspectives on very western woes .... and then she grated, sieved, chopped and chanted over some muti to help me .... just to reassure any squeamish ones amongst you - all in the form of baths .... with no blood no sacrifice no animals (at least none that i could see moving) and certainly no human bits ....

I tried the first treatment today .... it looked a bit like a science experiment ... and smelt - well - like a biology experiment .... so am keeping my fingers crossed that nothing too untoward happens .... the second treatment to be taken at the full moon is a protective spell ... i may be a crass sceptical western doctor .... but i kind of like the idea that i have African spirits watching over me too ....

Unjustifiable Firing ...

Apologies .... this is old news really (my excuse - I've been away in Namibia - which was quite the news/internet black hole) ... but the ripples from the very shameful sacking of our deputy minister for health Nozizwe Madlala Routledge continue to reverberate strongly throughout South Africa ...

About a year ago - I was at a debate at the University of Cape Town - when Ms Madlala-Routledge was finally able to step out of the shadows and gagging orders placed on her for years by Mad Mantu (our Health Minister .. aka Dr Beetroot/Garlic/Anything but ARVs) .... she spoke on a platform with Zackie Achmat (of TAC) openly criticising the misguided stance and policy of denialism of the SA National government on the issue of HIV ... it was the first time any government minister had broken ranks with President Mbeki on this subject .... the entire audience gave her a rapturous reception acknowledging the momentous speech she had bravely given .... Zackie openly praised her saying that individuals like Nozizwe were the reason that he (against all criticism) remained a member of the ANC ... warning that further attempts to stifle her would seriously destabilise south african democracy ....

In the months that followed - she took advantage of the fact that Mad Mantu was having a liver transplant (scandal! for alcohol-induced liver failure).... and she became the main driving force behind the first sensible South African 5-year plan to roll out antiretroviral therapy across the country .... all of us in the HIV-NGO community rejoiced .... finally the country seemed to be coming to its senses ....

Sadly ... perhaps even typically ... in response to her passion and courage ... Mbeki chose to fire Nozizwe a couple of weeks ago (on Women's Day no less) ... allegedly for attending a conference in Madrid without permission (even though just a year ago the Deputy President flew to Dubai on a junket using a presidential jet ... for which she wasn't even reprimanded) .... but there's no doubt she's been binned for not toeing the party line and going head to head with Mbeki/Mantu (whose shadowy husband is perhaps one of the most powerful men in SA - and allegedly rules the country from behind the scenes) and the rest of the ANC inner circle cabal ....

There are many injustices about the firing of Madlala-Routledge .... however the most concerning is that in a country where over 1000 people die every day from HIV/AIDS - President Mbeki has yet again put a question mark over his government's commitment to fighting HIV and the AIDS treatment plan that Madlala-Routledge championed ... thus potentially denying the right to life for a large proportion of our population ....

The following petition was put together by Zackie and the TAC ...

http://www.thepetitionsite.com/3/support-for-nozizwe-madlala-routledge

Battle at Kruger

Some of you may have seen this already .... but its just reached us here ...... incredible!

Its all about sex baby ....

Excuse my geekishness .... but it was fascinating week for AIDS in the news this week ... with two stories in the two of the biggest media players in the world ... telling almost opposite stories ....

The New York Times published a piece dramatically entitled Plague of Nations reviewing a recently published book (The Invisible Cure by Helen Epstein) ... which highlights the work of an American researcher - Maxine Ankrah - who had investigated in the sexual behaviour of Ugandans in the late 80s and 90s ... and found the cause for the precipitous drop in HIV rates in Uganda ... namely that Ugandans had stopped having affairs and remained faithful to their partners .... President Museveni had called for a "zero-grazing" approach to sex ... and hey presto .... Uganda became the HIV prevention world's poster-child country .... and PEPFAR's main stick to beat countries into abstinence submission ..... and of course the donor funds pored in ....

Epstein then makes the point that some (dopey) UN AIDS researcher ... apparently misunderstood Ankrah's work ... and wrongfully attributed the Ugandan miracle to increased condom use (just imagine!!) .... and then used this misguided conclusion to set global policy of promoting condoms (and thereby more sex!) around the world ....(inevitably as with all US media sources - the bungling UN gets relatively short shrift ....)

Now - the NYT/author of the Invisible cure don't want to sound racist here .... and acknowledge that it is not that Africans are shagging voraciously around the continent (there has to be something to do after the sun goes down right? ... when there's no telly) .... and the article quotes recent studies that have shown that Africans do not have more sex or even more sex partners than people in other parts of the world .... yessiree ... those blacks are apparently NOT out there shagging everything that moves (whatever those hip hop videos or white supremacist pamphlets tell us) .... in fact (according to my mate Tim who studies this ... a phd in sex ... ) the average number of sexual partners over a lifetime is pretty much equivalent across the world .... at 6 .... (high? low?!!)

But instead - the crux of all this is that - Africans are more likely to have concurrent relationships (ie have sex with more than one person at the same time .... naughty naughty ) .... which tend to be associated with less condom use and more risky sex ..... whereas in America apparently - these lifetime 6 partners are more likely to occur one after another sequentially ... and serial monogamy is associated with lower risks of HIV transmission .... even if they don't use condoms ....

The Take Home Message - Abstinence and Being Faithful are the key to preventing HIV (and hence the invisible cure ... geddit?) ... which sounds scarily anthemic of PEPFAR ....

In sharp contrast .... the BBC ran a piece essentially declaring abstinence programmes ineffective in stopping "risky sexual behaviours", following the publication of a study from Oxford in the British Medical Journal. Hmmmm .......

This study's message was that if promotion of abstinence in developed countries did not stop sexually transmitted infections or pregnancies - then it follows that such programmes have even less chance of working in developing countries where people have even less choice or control over sexual decision making ... and hence are pretty rubbish at preventing the spread of HIV.

The Brit media did not hold back in making a few pointed jibes at the US and the PEPFAR ideology of abstinence (condoms, needle exchanges, safe practices for prostitutes etc are all subjects non grata in the wonderful world of PEPFAR) ....

The accompanying editorial in BMJ went further .... and highlighted that whereas abstinence only programmes had largely failed - interventions promoting condoms had been hugely successful when targeted appropriately .... suggesting sarcastically that the US prioritises such interventions for its own specific populations where HIV transmission is amongst the highest in the world (blacks, hispanics, prisons, druggies, Men-who-have-sex-with-men etc) ....

Ouch ... is this the end of the US-UK special relationship? Has the Beeb become anti-american? Since when has the NYT been a government ideology mouth piece?

What it does highlight however is quite how politicised this pandemic was, is and will continue to be. Interestingly - Human Rights Watch - an organisation with a pretty good reputation (and - predictably - not the Bush regime's favourite NGO) published a report in 2005 urging Uganda to resist the US-driven anti-condom agenda condemning the false morality of its basis and requesting that future interventions be based on real science. The articles published this week show yet again how hard it is to find science or reporting that is unadulterated or unbiased .... and how little we have progressed ....

Getting rid of Mugabe ....

On my monthly jaunt to Edendale hospital this week .... I met some rather lovely Zimbabwean doctors .... and as one story led to another ... I mentioned my tale of trying to seduce Mugabe's personal physician to bump him off quietly ... and we spent the rest of the evening wondering about the various ways that Zim might be able to rid itself of its national-saviour-gone bad .....

On the eve of Zim's last election (2005) - the very brave Bishop of Bulawayo (Pius Ncube) admitted he'd prayed hard for the death of Mugabe in order to end the suffering of Zimbabweans .... not what you'd expect from a man of the cloth (just imagine the Archbishop of Canterbury wishing ill-fate on Tony Blair) .... but clearly God wasn't in the mood to listen then or now ..... since sadly the 83 year old looks in truly rude health (unlike the rest of his countrymen who can only expect to live to ripe age of 38) .... and capable certainly of fighting the next "election" .....

Succession seems unlikely since he hasn't actually even chosen a successor within the Zanu PF party - but in all likelihood - anyone else who heads Zim with his blessing won't be anymore than a grotesque puppet (he was apparently thinking of installing an ex-girlfriend as the next leader - a woman with the rather charming nom de guerre of Spill Blood) ....

People power sadly is also unlikely to dislodge him .... only a few of these African "Big Men" leaders have ever gone willing or peacefully .... true democratic handovers of power remain rare here ..... and military coups are seemingly the traditional african method of succession .... associated with the prerequisite bloodletting and ensuing civil wars, tribalism and rebel conflicts ..... which also (thankfully) is probably not going to be the case for for Zim (the security system is too tightly controlled by Zanu PF .... and Mugabe has definitely been adept at greasing the right palms within the country) ....

All our opinions that night agreed on one point - that we were all keeping our fingers (nay all appendages) crossed .... that South Africa would finally abandon its position of quiet diplomacy and general lap-dog-ness to leverage its influence on Mugabe ....... and that this would only be possible if the tide of public opinion here started to turn ....

Only three months before the last Zim election - the New African magazine ran a poll of the 100 greatest Africans of all time .... rather predictably - Nelson Mandela came top and Kwame Nkrumah came second .... but horrifically Robert Mugabe romped home in third place .... ahead lets be clear of Desmond Tutu, Sam Nujoma (Namibia), Wole Soyinka, Joaquim Chissano or Samora Machel (Mozambique), King Shaka and so on ... it would be laughable if it wasn't so tragic ....

Thankfully - two years or so on .... the veil of Mugabe as the Pan-African Hero has been dropped .... perhaps his abuses of human rights regardless of skin-colour have started to destroy his image as anti-imperialist warrior against the anglo-american conspiracy to keep the black man down .... or perhaps Zimbabweans have learnt that they mustn't die silently like the Darfurians and instead leaders like Tsvingirai have started to use media better ..... for somehow the stance of Mbeki is now being openly derided .... and other African leaders such as Ghana's John Kufour or Zambia's Patrick Mwanawasa have started to question the continent's silence ....

As Zimbabweans flood into South Africa .... and as the crisis in Zim starts to damage South Africa socially, politically and economically .... the general man on the south african street is finally starting to question both his own national leadership and the leadership of the seeming paradigm revolution against the white man ....

Everyone here is talking about Zim .... and for once - open criticism is being voiced without a fear of being labelled a traitor to the black cause .... it is quite a monumental change ..... it could be the legacy that Mbeki is so desperately seeking before the end of his term in office .... and the incomparable Desmond Tutu perhaps said it best .....

We Africans should hang our heads in shame ..... How can what is happening in Zimbabwe elicit hardly a word of concern, let alone condemnation from us leaders of Africa?