For whatever reason, my pictures are not showing up. Just imagine that I posted two pictures of South Africa, one with locations of mines and the other with provinces color coded for HIV rate. Now imagine that the mine-containing provinces superimpose perfectly over the provinces with highest HIV rates. Wow, imagination rocks you guys.
Although I had heard a great deal about the Duke Engage program before I applied to Duke, I had never once seriously considered applying for one of its programs. I believed that the cultural and social lessons of Duke Engage would not apply to my science and mathematics based education. Nonetheless, when October came around and Facebook began throwing Duke Engage back into my world, I explored the option.
The Cape Town program immediately changed my mind about Duke Engage, much to my chagrin.
I saw in the program not just an opportunity to gain experience working with health-focused NGOs (such as the Treatment Action Campaign) but also the unique opportunity to experience a nation ravaged by HIV and other infectious diseases, topics which have interested me since before-I-can-remember.
So I applied. I got in. And here I am, an Engineer in South Africa. I put emphasis on my major because it forms the lens through which I have so far experienced South Africa—one of public health, sanitation and disease prevention.
My more scientifically based approach to this trip has given me a great insight into many of the locations we were lucky enough to experience, such as Soweto and Alexandra townships in Johannesburg, Gauteng. Alexandra more than Soweto is a sea of shanty houses intermixed with crumbling buildings and open toilet facilities utilized by too many of its hundreds-of-thousands large population. While others may have connected the situation to a discussion on post-Apartheid socioeconomic outlooks or a conversation about poverty, I was interested more intensely on the public health situation in the township.
Earlier this year, mainly second semester, I began building a much better understanding of public health issues through Dr. Sherryl Broverman’s (Brovvvesss!) course, AIDS and Emerging Diseases. The course emphasized modes and factors of transmission as well as a general understanding of the HIV epidemic in South Africa’s townships. These lessons helped me a great deal to understand the health situation in Alexandra.
Alexandra has very little if any public sanitation in place that we could see. The restaurant we ate at had a hole in the wall that customers could use to relieve themselves though I highly doubt the average resident has such a luxury. We saw surgical centers on the road that consisted of no more than a tarp laid across three wooden poles stuck into the ground. Such a lack of sanitation is a prime breeding ground for diseases like Typhus, Dysentery and Cholera. The sanitary situation in Alexandra only underscores the underlying socio-economic factors of health disparities in South Africa. Put quite plainly, if you’re pooping into an open sewer, or getting an operation on the side of the road, you’re going to have a bad time.
Continuing aboard this train of thought, it seems that healthcare is almost a non-reality in the townships, from what I have learned through personal experience and discussions. The most shocking part of the story, however, is that healthcare in South Africa is, in most cases, absolutely free. Yet, the services are still unattainable for residents of the township who lack either the transportation or the education to utilize social services (or both). Moreover, the dearth of health professionals in South Africa forces any patients who make it to these free providers to wait DAYS in order to receive treatment.
The inconsistency of the health system in this country (I understand that my lens is quite narrow and that this situation is present in many other countries as well as South Africa) is incredibly debilitating especially with regard to the management of AIDS here. The ARVs (Anti-Retrovirals) used to hold HIV in check require strict adherence lest HIV build immunity to them (HIV has no replicative error checking proteins, so it mutates rapidly allowing for rapid viral evolution). In a newsletter distributed by the TAC (Treatment Action Campaign), the General Secretary Vuyiseka Dubula notes an epidemic of un-stocked clinics and long wait-times that predispose patients to inconsistency in their ARV treatment. The AIDS epidemic here is a hydra of an issue—there are so many different issues that are not taken care of and that cannot be taken care of with an under-stocked and at times unreachable health system.
In the West, we quite often lose sight of how important sanitation is to preventing disease but South African’s are quite aware of their situation. Just the other day my office workers and I watched a roaring crowd of toilet-bowl-clad protestors march down Adderley Street demanding a revamping of the public sanitation in the main local township, Khayelitsha. The populations within the townships only reinforce the gravity of the situation—the high population densities in South Africa’s townships make them all tinderboxes for infectious disease. All it would take is a small number of infected individuals to start a wildfire infection that would spread throughout the population.
Speaking of wildfires, an incredibly ominous aspect of the townships is the proximity of the houses—they are quite literally on top of one another. The only thought that went through my head, and a thought which still disturbs me to bring up again, was that (and I quote mental-me): “all it would take is one uncovered fire to raze this entire community to the ground, and kill thousands.” I’ll just leave that thought in your minds.
By far the most interesting area of the townships, though, are the hostels, places which Dr. Broverman’s class taught us to view as the ground-zero of the South African AIDS epidemic. One of the compounding issues for the AIDS epidemic in South Africa especially was the mining industry that initiated a phenomenon called Circular Migration
Basically, mining companies would hire migrant workers from the provinces of South Africa and house them in hostel houses. These hostel houses would inevitably attract sex workers keen to exploit the newly introduced source of revenue. In turn, many large sexual networks formed around the hostels with the miners and the sex workers forming a web of sexual interaction. This heavily branched network made all its participants incredibly vulnerable to HIV when it entered South Africa and quickly spread the virus. So now the miners and sex workers were infected, but how did that impact the rest of the country? This is where the circle closes. The workers returned home, eventually, and entered into new sexual networks there—infecting their families and communities. Knowing the role that these hostels played in the establishment of the AIDS epidemic made me shudder. The day after we visited Alexandra I brought up two maps of South Africa. One map showed the HIV prevalence by province, and the other showed the location of mining deposits in the country. The overlap was reinforcing and disturbing. The provinces with ore-deposits were also the ones most impacted by HIV/AIDS. Most prominent among these provinces is KwaZulu Natal, the location of a large portion of South Africa’s deposits and also the most HIV-ravaged province in the country.
HIV statistics per province
Look at the two pictures to the left and superimpose them in your mind. It’s quite fascinating.
Mining fields (brown). Compare this to the provincial map.
So far, South Africa has been an amazing experience. Being able to witness places like Alexandra has been an amazing opportunity, especially to put some of my public-health education to use. Yet, I recognize that my experience has been one of a pseudo-tourist, experiencing abject poverty and a dearth of health services during the day and finely cooked meals and hot showers at night. I recognize also that I just writing down these observations will not change the situation in South Africa. I recognize that something needs to be done. I’m still not sure exactly how to do it.