in South Africa...

Hi all,
Just wanted to say that I’m having a wonderful time in Cape Town, working with the Treatment Action Campaign ( ). While here I’ve seen terrible poverty and great wealth; incredible activists; a frustrating government, interesting people, amazing history, difficult problems; and much more. I watched the activists I’m working with leak a government report that says that antiretroviral therapy would be cost-effective; then, in the news, the government condemned the leak as “theatrics” and continued to stall on whether they would roll out public sector access to antiretrovirals.
It is easy to be smug in the US about the South African government’s failings, but it’s worth pointing out that this debate is possible in part because the South African constitution says that everyone has a right to healthcare to the extent that the government can reasonably provide it. The American system, of course, provides no such right.
Along those lines, it is an incredible privilege to be among so many people who believe in a vision of a just and equal society and are actively arguing, debating, and working towards achieving it.
Meanwhile, I’ve been working on a booklet and training modules about the basic workings of the body. I am finding that it is terribly difficult–and also very interesting–to try to explain things like DNA and RNA and liver function at a 5th grade level. However, people here are incredibly hungry for information and education, and inspiringly disciplined about acquiring it, and it is also great to know that whatever I produce will really be used by people with HIV and their allies.
I’ve been working on some other projects too–hopefully more about those later.
I have to go now–I have a dodgy internet connection and not much time to write, hence my absence from OPM for a while–but just wanted to say hi, to say that I’m doing great, and that I thoroughly recommend going abroad somewhere while you study medicine. It has reinvigorated me and inspired me for the coming year. More soon.

Wow! That's great!
Details! We need details!

Joe, this is great stuff! Anytime you can write more about this is the right time. Take good care…

For the day, I’m staying at the place of a friend with a good internet connection, so a bit more.
From the traditions of the anti-apartheid struggle, in S. Africa you use the term “comrade” to mean someone who is in the struggle with you. (Suffice it to say that the mainstream political spectrum here starts and ends rather farther left than in the United States.) I haven’t met the folks from the TAC branch in Uitenhage, although I’m hoping to; below, I’ve attached a powerful statement they issued a little while back, prompted by the illness of one of their comrades.
TAC first started as something like the AIDS activist groups in the North; a small group of mostly college-educated activists doing small direct action protests and legal work. It didn’t take long, though, before they began to become something much more classically South African–organized along the lines of many of the grassroots organizations that fought apartheid. Now they organize local branches of people who run support groups, educate each other, and work as political activists both on local and national levels. From what I can see, the great majority of TAC’s members are unemployed or underemployed, and of African descent. And they are largely either HIV+ or have people close to them who are HIV+. TAC members die each month because they can’t get antiretrovirals.
The HIV+ leader of the group, Zackie Achmat, could get drugs from friends who would buy them for him, but he has pledged not to take antiretrovirals until they are available through the public sector. His health has been in a slow decline for some time, and this pledge becomes more and more frightening as time goes on.
But although I understand why the US and European media has often focused on Zackie, who is a compelling and brilliant man, I think that people like the activists who wrote the letter below are even more incredible. They unfortunately don’t need to take a pledge not to take antiretrovirals; they simply can’t get them. They are literally fighting for their lives.
>===== Original Message From TAC News Service =====
TAC Uitenhage Branch Holds Vigil for Sick Comrade

17 July 2003
About fifteen members of the TAC Uitenhage branch held a night vigil
which ended at 12pm today for one of their sick comrades. The aim of the
vigil was to highlight the urgent need to make antiretroviral therapy
available in the public health sector. The Uitenhage branch has written
a statement which is reproduced below.


Statement by the TAC Uitenhage Branch

TAC activists picket through the night to demand antiretroviral
treatment for fellow comrade

We are picketing at this hospital through the night to demand that our
comrade be given proper treatment. She’s been ill and all indications
show that she needs antiretrovirals. Ntombomzi was admitted yesterday
after getting fits and being confused. A proper diagnosis has not yet
been made, but doctors suspect Cryptococcal Meningitis. While a proper
diagnosis will help for Ntombomzi to be given treatment for the
particular illness she has at the moment, we know that without
antiretrovirals to fight the HIV directly, our comrade will get other
Ntombomzi Ranawe was one of the first people to start a support group
and a TAC branch in Uitenhage. She lies at Uitenhage Provincial
Hospital, which is a state hospital and where antiretroviral treatment
is not available. We are doing this because we want to show to
government that people are dying. While the leaders of our country play
with nice words to delay implementing this treatment programme, we on
the ground are dying.
This cannot continue in silence. From now on, every death that could
possibly have been prevented must be noted. Like the deaths of people in
Sharpeville, like the deaths of those who died during the apartheid
struggle, our deaths must be noted. It must be written down in history
books as a human tragedy, a direct result of the failure of political will.
We stand here today with hope that our comrade will get well and come
out of hospital. We hope that our government will speedily finalise a
decision to start implementing a treatment programme with antiretroviral
therapy as supported by the joint Health/Treasury task team study so
that she and many others who need this treatment can get it.
We also hope that the Eastern Cape government will start to lead us in
this province in addressing HIV/AIDS. Recent reports show that our
hospitals in this province are dying in front of the government’s eyes
and that our AIDS programmes are not working.
There is a shortage of staff, medical equipment and medicines and people
die unnecessarily. This cannot continue. We ask our Eastern Cape
government, particularly health MEC Dr Goqwana, to act on the
recommendations of these reports and not to force us into Civil
Disobedience. We also demand answers as to what the province’s operation
plan is for treating HIV/AIDS.
What we are doing here today will continue until our comrades get
treatment. Next time we will pitch a tent here at the hospital and sit
here a whole week. We refuse to die in silence while politicians delay
decisions that could save lives and give hope. We will fight for our
dignity and our rights!

It is always so good to hear from you and read about all that you are doing! I can only imagine the wonder of seeing all that you are encountering.
While my husband often accuses me of being too far left when it comes to some things, when it comes to medical care I don't believe there can be such a thing. Everyone needs access to medical care! And it looks like the people in South Africa are well aware and willing to fight for their needs.
Be careful while you're there and stay healthy! Let us know when you return. Can't wait to hear more NPR stuff.

Thanks so much for sharing your experiences with us! The HIV/AIDS epidemic in Africa should be acknowledged around the world. I feel strongly that here in the US we are somewhat ignorant of global problems. Furthermore, there is often a lack of activism. It is truly an honor and an opportunity for you to advocate for something that you believe in strongly. I look forward to hearing more. Be safe and take care.

As usual, your words are wonderful. I am there with you. You are truely one of the most gifted writers that I have ever known. Keep writing about your experiences and keep us up to date. I am transitioning to second year of residency with a bang. I can hardly believe how much I have progressed as a surgeon. I love what I do and I love to operate. I can hardly believe that I actually get paid to have this much fun. Sounds like medicine is taking you around the world and I can’t think of a better person whose eyes to see all that you are experiencing. I look forward to everything that you write and it was a blast meeting you in DC.
Natalie cool.gif

It’s really inspiring to hear about the grassroots organizing! I WISH we had more of that here in the states. Keep us posted on what you’re doing, and how the movement to make these drugs available is progressing!

It is easy to be smug in the US about the South African government’s failings, but it’s worth pointing out that this debate is possible in part because the South African constitution says that everyone has a right to healthcare to the extent that the government can reasonably provide it. The American system, of course, provides no such right.

This is interesting. Don’t most countries consider health care a basic right? Does anyone think the American system might eventually change in this regard?

Joe, I have missed “hearing” your voice! I am so glad to hear your stories - not that it is joyous listening by any means. Thank you for educating me - your poignant close-up observations really bring this situation home to me in ways that newspaper articles can’t begin to touch.
I hope you get the time to write more. Your writing is always so thought-provoking - thank you.

Thank you so much for sharing your experiences!!!
Take care!

Wow, Joe, sounds very interesting and totally different from the US.
Coincidentally, my husband is at Kruger now with a class of mammalogy students. It's a small world!

I love hearing your stories too! Keep them coming. You are an inspiration to all of us.

Great news yesterday here in South Africa–the first part of the fight for AIDS treatment for all is won. Now comes the hard part–doing it.
For Widest Distribution

TAC Response to Cabinet Statement
Cabinet Statement

8 August 2003

There is cause for celebration and optimism. Government has decided to provide anti-retroviral therapy in the public sector in South Africa.
The Treatment Action Campaign (TAC) welcomes the Cabinet’s instruction to the Department of Health to develop an operational plan within one month to provide ARVs in the public sector. The Cabinet endorsed the findings of the Joint Health and Treasury Task Team Report that between 500 000 and 1.7 million lives will be saved with anti-retroviral therapy. It also reaffirmed the science of HIV/AIDS pathogenesis and treatment.
This is a critical step to develop a more comprehensive treatment and prevention plan for managing the HIV/AIDS epidemic. Properly implemented, this will restore hope, dignity and life for millions of people in our country, and, hope throughout the continent. This will also give doctors, nurses and communities the opportunity to work together with government to build a better health care system that meets the needs of all people in South Africa.
The TAC National Executive will formally suspend the civil disobedience campaign and reconsider pending litigation early next week. We welcome Cabinet’s bold step today but we also remember the anguish, pain and unnecessary loss of lives over the last four years.
The end of policy and political vacillation reveals the real hard work to all of us. TAC pledges to put its full weight and support behind the successful implementation of all interventions aimed at alleviating the HIV epidemic. We will work with government to save lives and build a better health service. The private sector, drug companies, civil society, international agencies and individuals need to redouble our efforts to improve prevention, treatment and care. We salute the efforts of every person living with HIV/AIDS, doctors, nurses, scientists, government administrators and all people who contributed to the report and the struggle for a treatment and prevention plan. Let’s get to work!

Cabinet Statement
Cabinet today convened in a special meeting to consider the Report of the Joint Health and Treasury Task Team on treatment options to enhance comprehensive care for HIV/AIDS in the public sector. A summary of the Report can be found on the government website, The full Report will be posted on the website early next week.
The Report deals with various challenges, including in particular, a programme to administer anti-retrovirals to enhance the quality of life of those who have reached an advanced stage of the Syndrome, and it proposes various scenarios in dealing with this matter. The Report proceeds from the premise that new developments pertaining to prices of drugs, the growing body of knowledge on this issue, wide appreciation of the role of nutrition, and availability of budgetary resources do enable government to consider this enhanced response.
The meeting reiterated government’s principled approach that antiretroviral drugs do help improve the quality of life of those at a certain stage of the development of AIDS, if administered properly.
Further, Cabinet noted that, as we consider details pertaining to this enhanced treatment programme, it is critical that we do not lower our guard as a nation, because there is no cure for AIDS.
It also noted the assertions in the Report that a primary challenge in our situation is to ensure that the 40 million South Africans who are not infected with HIV stay that way; and that those who are infected but have not as yet progressed to an advanced stage of AIDS lead a normal life through proper nutrition, healthy lifestyles and treatment of opportunistic infections. In other words, not everyone who is infected with HIV would need antiretroviral treatment.
Cabinet decided that the Department of Health should, as matter of urgency, develop a detailed operational plan on an antiretroviral treatment programme. The Department will be assisted in this work by South African experts as well as specialists from the Clinton Foundation AIDS Initiative who have not only offered to contribute to this effort; but have also been of great assistance in commenting on the work done thus far.
It is expected that this detailed work would be completed by the end of September 2003.
Government shares the impatience of many South Africans on the need to strengthen the nation’s armoury in the fight against AIDS. Cabinet will therefore ensure that the remaining challenges are addressed with urgency; and that the final product guarantees a programme that is effective and sustainable.
8 August 2003
Issued by: Government Communications (GCIS)