xenophobia? teiken die regte skurk

OK, dis maklik om te oordeel: 'n jong, gesonde zulu man met 'n pik of assegaai op die koerant se voorblad pronk onder die opskrif - XENOPHOBIA. Daar's hy, hy's skuldig en trots daarop! Vang hom! Maar as mens bietjie dieper delf is daar baie kante tot die storie...en is die ou met die assegaai en die ou met die tyres om sy nek eintlik 'n produk van jare se afskeep deur die regering eerder as 'n fanatiese moordenaar en 'n toevallige slagoffer.

Volgens die UNHCR het daar in 2007 amper 30 000 zimbabweers in SA aansoek gedoen om toevlug status. Maar meeste mense meld hulle self nie aan nie. So hoe seker is ons hoeveel buitelanders in Suid Afrika toevlu soek oordat hulle geen ander uitweg sien nie?

As daar regtig drie miljoen zimbabweers in Suid Afrika is, waar is hulle dan? Drie miljoen mense is baie. Hulle kruip nie maklik weg nie. Duidelik is iemand lankal besig om hulle groeiende teenwoordigheid te ignoreer. En n paar ander al lankal besig om vir hulle groeiende teenwoordigheid plek te maak. Volgens Refugees International is dit so duidelik soos daglig dat die zimbabweers net eenvoudig geignoreer en tot nou toe hardhandig aanvaar word. Maar niks konkreet of offisieel word gedoen om hulle teenwoordigheid of af te keur, of goed te keur nie. Die regering weet nie wat om met hulle te doen nie, so nou doen hulle maar eerder niks nie!

In 2004 was daar reeds groot probleme. Duisende zimbabweers wat probeer aanmeld by immigrasie word nie eens die kans gegun om die vorms in te vul nie. Van 5000 mense wat in 2004 vorms kon indien vir toevlug (asylum seekers) is slegs 20 goedgekeur.

In 2004 was daar reeds n agterstand van 80000 aansoeke wat nog nie geprosesseer is nie. So dis regtig moeilik om te besluit hoeveel van hulle in die land is, en onmoontlik om hulle te beheer of beskerm. Tans is daar n agterstand van 100 000 aansoeke wat wag terwyl ongeveer 30 000 goedgekeur is.

En volgens die verslag deur Refugees International:

"While the senior management of the Immigration Department acknowledged that Zimbabweans have the right to be considered refugees, Refugee Reception officers were unable to state whether or not Zimbabweans had the right to political asylum in South Africa. Staff in the Reception Office said that Zimbabweans were not a priority because "there is no civil war in Zimbabwe, so there is no reason to apply." Other Zimbabweans told us they were denied access to the process because they did not have valid passports.

"Even the UN agency in charge of refugees could not agree. The Office of the UN High Commissioner for Refugees (UNHCR) in South Africa was also unable to provide a clear determination as to whether Zimbabweans qualify for asylum. They were waiting clarification themselves from Geneva."


Volgens Human Rights Watch se verslag in Augstus 2006 oor Zimbabweers in Limpopo:

"Documented and undocumented migrants from Zimbabwe are vulnerable to human rights abuses in South Africa and occupy an ambiguous space in the law with respect to certain rights guarantees. Their constitutional rights to personal freedom and security, conditions of detention which are consistent with human dignity, and fair labor practices are infringed upon by violations of immigration and employment laws and also deficiencies in these laws. Their inability to access adequate housing presents challenging issues of unsettled law, which will require further adjudication."

Nou, hierdie sterk opinies oor die penarie van Zimbabweers in Suid Afrika help nog steeds nie om die ou met n assegaai in n beter lig te plaas nie, maar laat ek dit so stel: As die regering al reeds jare lank versuim om hieraan aandag te gee, wie is besig om aan die kortste ent te trek?

Wel ek voel daar is twee groepe mense wat benadeel word. Daar word verwag van die township inwoners wat reeds met skaars hulpbronne sit om plek te maak vir die vreemdelinge om iewers te bly, sonder dat hulle enige teken kry van die regering af dat hulle probeer om die probleem op te los nie. Die township se water, krag, skole en gesondheidsorg moet vreedsaam met mense gedeel word wat geen bydrae lewer nie, en ook geen hulp as toevlug soekers kry nie. Dit word ook dag tot dag deur die polisie duidelik gemaak dat die vreemdelinge geen regte het nie en uitgebuit kan word.

Aan die ander kant voel die Zimbabweers dat, hoe haaglik die omstandighede nou ook al is, dis beter as in Zimbabwe en hulle "grin en bear" maar en gaan vir seker nie teveel geraas maak nie in geval hulle gedeporteer word!

Solank Mnr Mbeki se daar's geen probleem in Zimbabwe nie, hoef hy nie aan die Zimbabwese vlugtelinge toevlug te gee nie, en dus geen oplossing te soek vir die 3 miljoen mense wat letterlik nerens anders kan heen nie.

Baie mense voel dat ons regering reeds nie vir sy eie mense kan sorg nie. Dis waar, maar ons moet ook nie vergeet nie, daar is internasionale gemeenskap van hulp agentskappe wat gereed staan om hierdie mense te help. Maar solank hulle iewers in n township skuil oor hulle bang is n polisie radar tel hulle op, kan hulle nie aanspraak maak op die hulp wat hulle toekom nie.

So, ek voel dis onverskoonbaar om mense te begin doodmaak oor hulle van n ander land is (hier sit ek self in n vreemde land) maar dit is ook belangrik dat die township inwoners hulle stem dik maak en die regering begin verantwoordelik hou vir n probleem wat nie na die armste mense in die land oorgeskuif moet of mag word nie. Hoe vinnig sal Sandton, Waterkloof of Durbanville se inwoners begin toi-toi as 3 miljoen zimbabweers skielik op hulle grasperke kom tentopslaan?

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Imran Khan's freudian slip

In the Newsweek magazine of 11 Feb 2008, Imran Khan gave an interview which was published in "the last word" on the back page. In it he discusses Pakistan's descent into bloodshed and chaos. I just couldn't ignore the many similarities with a country I hold dear...

To quote "...There's an economic meltdown taking place. There are blackouts. Factories are closing. Unemployment is increasing. There's a huge fiscal deficit. A trade deficit. A wheat deficit. This has never happened before...I cannot understand it. Last year was the bloodiest year in Pakistan's history.."

and it's just there at the end where you need to replace Pakistan with South Africa to have a great summary of what the beloved country is going through.

Since coming back to Ireland after 3 weeks in South Africa, over Christmas, an amount of dread has been growing in my heart. Dread for the people and country I love so much.

I feel that because people in South Africa are in a certain sense trapped in the situation (everyone's mom and granny isn't quite as movable as the young people already overseas) and because South Africans always feel that they have lived through worse times, unbelievably, a false realism and optimism still prevails despite overwhelming facts to the contrary. Facts that point to the imminent decline of another wealthy african state to below-the-breadline corrupt africa.

And sure, the rest of the world is in an imminent economic recession and not even China is gonna live up to its potential this year, but the rest of the world is not becoming a suburban warzone. That is happening to only a handful of countries. Iran, Pakistan, Kenya, South Africa and the like.

This is breaking my heart. It's not I-told-you-so revenge typing. It's a tired sadness. I don't know how to think about South Africa anymore. I so wish to go back one day, live in a rural community, start a school, build solar panels for the poor. But, seriously? Is that dream even worth harbouring anymore? Or am I just leading people astray through my own false optimism? While safely tucked away in Ireland where I can happily walk wherever I like after dark it's easy to dream happy dreams about africa.

Good gracious, even God had the common sense to tell Joseph to flee to Egypt when he realised that his son's life was in danger.

But some small shard of hope still wishes, trusts, prays that sometime in the future our country can heal, and grow. I just don't think that time is now. There are too many angry and hungry young people seeking revenge for their own miserable lives in Godforsaken countries, seeking refuge in our country. These tsotsis are above the law and they know it. They now rule the country.

Cry, the beloved country.

What a soppy, miserable post. No need to comment, I just needed to get it off my chest. I needed to publish my own reality check. It makes it more real.

The starfish dilemma

www.who.int

The age old story contained in every "Chickensoup of the soul": a man walking along the beach comes across another guy, throwing starfish back into the ocean one by one. Asked why he even bothers since there are about a million washed up on the shore that will not be saved, and with millions more in the ocean he isn't really making a statistical difference; the wise, patient man replies "it made a difference for that one".

Now this is what all young doctors and hopefully people in most professions aspire to. Making a difference in that one person's life, saving a life, influencing it for the better or giving someone a second chance is so inspiring! But in modern society, we are forgetting the true meaning of the starfish story. In pursuing healthcare the way we are today, we are not only making a difference for that one, but also neglecting the others left over because of the way in which we are helping the lucky one.

An example: South Africa's exemplary health minister recently underwent a liver transplant. Now while the reasons behind her transplant are covered up and top secret, many aren't. For an alcoholic with liver failure to be allowed on to a transplant program that person needs to prove being alcohol free for a year. That's not too difficult and depending how much money or political power the person has, the timeframe is adjusted. A liver transplant costs $350,000. Now I am not joking. Please see the website for other complicated healthcare procedures. www.crossgrove.com/ces/cihospitalcosts.pdf

Now when a government allows procedures like these to slip into the healthcare budget of a developing country, eyebrows should start raising. How, it should be asked, can it be allowed to push that much money towards one person, a person who caused his own condition knowingly, to the detriment of basic care for so many others. The fact that it makes a difference for that one, at this point, is inexcusable.

Chris Hani Baragwanath Hospital currently spends only R7m on new equipment purchase out of a budget of R1.1bn. Some newborn babies are put into cardboard boxes because there are no incubators for them. It is being argued that too much money is being spent on admin but in the same way it can be argued that health care is not being prioritised correctly.

In healthcare there is an important and oft forgotten saying "prevention is better than cure". How did we eradicate smallpox? By vaccinating everyone. How much did it cost? Less than a dollar per person. And how many lives did it save? More than two million. Prevention is cheaper, less invasive and more far-reaching than curative medicine.

Now it's not only childhood illnesses that can be prevented, saving governments thousands of dollars to use towards other, more pressing causes. The most interesting thing about prevention is its knock-on effect.

Here's an example: Get out of your car and switch off your telly = walk around for an hour every day --> prevent pollution and obesity --> prevent global warming(with all its disastrous health effects including heatstroke, malnutrition and migration for people you don't even know) and also heart attack, stroke, diabetes, colon cancer, hip fractures and all their side-effects for yourself.

Contrary to popular belief, this is well documented with studies done to prove it. See The Lancet for more info.

Another example closer to home: Stop alcoholism --> prevent alcohol induced injuries such as car accidents, fights and falls and sexual assault --> prevent the need for urgent CTscans, brain and orthopaedic operations. Also prevent unwanted pregnancy due to irrational behaviour, alcohol dependance, depression and suicide.

The elderly are a difficult example to explain without sounding ruthless. It's much easier to think of yourself in ten, twenty or fifty years' time. And then it's also very thought-provoking to hear how doctors feel when posed with the scenario for themselves: If you are 80 years old, had a stroke, are unable, to walk, talk or even write, would you want to be kept alive at all costs? My answer is no. Standing at your elderly relative's bedside, making a decision for her is much more difficult. But my decision would still be no. Modern healthcare innovations cause many such patients to survive up to five years with a feeding tube and catheter, a myriad of medications and confined to bed. They are also exposed to numeruos hospital admissions. The costs are great, but the human suffering brought on by the condition is not allayed through the costs. This is a pit no-one should drag an elderly relaive into.

Last example. Mandatory testing for HIV --> prevent undue spread of the disease and improve cmpliance with treatment --> prevent mother to child transmission, skin cancer, malnutrition, TB, meningitis, pneumonia and gastro-enteritis: the diseases that are currently laying SA's healthcare to waste. --> prevent the death of countless teachers, police, nurses, doctors, politicians, businesspeople and labourers that have skills to enrich the country.

There are a couple of reasons why societies are not willing to take a few simple steps to markedly improve the health of their people.

Politics. It's hardly ever about money, as it is simple to see that the savings involved in implementing simple preventative healthcare measures are vast. It's more about the money in the politician's pocket. If the alcohol company is allowed to advertise and sell freely, he will ensure the politician's campaign is well funded, same with the motor industry and a good few other industries!

Human nature. We are such trusting beings. So, if my president doesn't censure my alcohol use, why shouldd I? If it was bad for me, government would have regulated it, wouldn't they? If my president doesn't beileve the virus exists, what is the testing for, then?

Family bonds, or the lack thereof. It is only when there are relationship issues between family members that you would feel guilty about stopping treatment to allow them to go in peace. How many times have you spoken to your family about what you would want when you are not able to talk for yourself? Will they feel empowered to make the right decision for you? I can promise you this, no doctor I have spoken to wants a feeding tube. They all say the same thing. "I will go in peace."

Cowboys. The first heart transplant surgeon is about as useful to the average person as the first astronaut who landed on the moon. He is a celebrity. It was a major breakthrough. But was it neccessary? And to what cost? Everyone needs the best chance in life. But if I'm saving your life to prove how amazing I am, and to the detriment of a thousand others that could have been saved for a 1000th of the price, what are my primary pursuits?

In 1970 the WHO set up the Health for All in 2000 goals. These millennium goals are still not achieved even though the world has more than enough resources, money and capacity to do so. The correct channels are the only missing ingredient to vastly improving world health.

So, to conclude, instead of blindly throwing healthcare at the sickest person, it should be worked from the bottom up, to ensure that less and less people end up needing less and less healthcare. Maybe a starfish that has been washed up on the beach is already too weak to save. Maybe it's more important to ensure the others stay in the ocean where they belong. I have decided to start focusing away from the current dilemma that the current starfish is finding itself in, and maybe rather start curing the system that got it there.

over and out.

1000 mense in SA sterf vandag! Onvoorkombaar...

Vandag is n vent dag. Hierdie vent is 2 jaar "in the thinking" en dateer uit my gemeenskapsdiens jaar in Bethlehem,dit gee 6 fundamentele redes hoekom SA se pogings om HIV die see in te dryf so misrabel misluk. Die post is in engels geskryf want ek het dit op helium gepubliseer en hulle spellcheck aanvaar nog nie afrikaans nie. Geniet dit.

Talking about the effect of AIDS on Africa is like talking about the effect of global warming on the arctic ice cap. The full force of the situation only hits you when you're in the thick of it and realise that, probably, the tipping point has already been reached and the cascade is unstoppable.

When you stand in front of a giant glacier and watch it crash in to the sea, the inevitable catastrophe sends shivers down your spine. Walk into any government hospital in South Africa today and you get the exact same effect. Chilling. Walk by the myriad of fresh graves in any graveyard in South Africa and you would be excused for thinking the country is at war. Maybe it is.

The effect of AIDS crosses all boundaries. It is redefining culture, economics, religion, political stability, education, health and healthcare.

1. Not only are Africans faced with the dilemma of having to face up to the fact that their traditions are no longer protecting them against evil but their very definition of intimate relationships is also being redefined. A woman is getting AIDS from her husband, he got it from a far off city where prostitutes and shebeens have been a way of life for a long time. Women are giving it to their children. Who else is supposed to nurture and care for their children? Who else can take on that role. No-one, nature has us up against the wall.

2. Inevitably the economics of any country ravished by AIDS will suffer. The very workforce, the drive of the economy is dying, and with it competition, consumerism and all efficiency. South Africa's saving grace thus far has been the large amount of "reserves" not partaking in the economy at all. A country with an unemployment rate of 25% and no doll has a few willing hands to spare. Not for long, though. In certain areas the shortfall is already being experienced.

3. The education sector is badly understaffed with most schools not running at full capacity. 20% of teachers are HIV positive. This has a direct effect on the quality of the country's future workforce and thus on it's competitiveness in the global arena. An individual's education is the only thing that gives him/her the power to choose a different way of life than the well-known road of poverty, child prostitution and crime.

4. Not only is the healthcare system being stretched to the limit by the influx of new patients, many healthcare workers themselves are infected, on treatment, dead or dying. 1000 People die of AIDS in South Africa daily. The recruitment cannot keep up with losses because few of the unemployed masses have the right qualifications to work in healthcare. Many basic nursing duties in primary level clinics are already being carried out by volunteers with no training receiving no payment. This, of course increases their chance for infection too. The devastating effect of TB in conjunction with AIDS falls beyond the scope of this article.

5. Religion and traditional beliefs also have to be redefined. Many know of the furor caused by the spread of the superstitious belief that raping a virgin will cure you from AIDS. Many of South Africa's girls lose their virginity through rape, not some. The deputy prime minister's stint in court when he proclaimed that having a shower will protect him from any infection didn't improve the world's view on SA's arrogance and ignorance. Women need to prove fertility before being offered marriage, how can condoms then be a viable option for them? Many people still go to the local sangoma or church for miracle cures before going to the hospital, inevitably arriving "at death's door" due to procrastination, leading to the widespread belief that hospitals are the cause of death.

6. Many government policies directly oppose HIV prevention strategies. An impoverished woman cannot get a state subsidy for herself, only for her children. Her children only get grants up to the age of 14. Now, how in their right minds are these young girls going to abstain from trying to reproduce? Furthermore, the state pays a subsidy for AIDS but not for HIV infection. It also pays a subsidy for active TB which stops once treatment stops. Now, it is understandable that the government needs to draw the line somewhere because there is only so much money available in the national treasure chest. But to the man om the street it is pretty obvious that he is being paid to be sick.

Government is going about the management and prevention of AIDS the wrong way, it started much too late and is dragging it's feet unneccesarily. Government had to be taken to court by the TAC to be forced to start antiretroviral therapy for pregnant women, prisoners and finally the general populace. It does seem like an easy equation to let the people who are the biggest burden on government subsidies and healthcare and invariably then the country's economic stability rather just die. On the other hand, it also sounds alot like genocide if the health minister backs up her decisions by maintaining the disease simply doesn't exist.

The future for AIDS in South Africa looks rosy. The future for the people of South Africa? The Chinese have a saying- may you live in interesting times. It's up to you to figure out if it's a blessing or a curse. The battle against AIDS happens on a one by one basis. You make your decisions. You choose. You choose who you sleep with, you choose who to trust with your health, you choose to take the medication offered to you, you choose which charity to support, you choose to pay your taxes, you choose for whom you vote. Remember, you choose.

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