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South Africa: rants

posted by Brett - he traveled to South Africa during July and August of 2008 for hands-on experience in public health, one of his concentrations at NYU's Gallatin School of Individualized Study

We have finished the proper classes and are into our shadowing/internships. The classes ended with two lectures. The first was given by a well-known South African documentary photographer, Paul Weinberg. He is most well-known for his collections on Bushmen. I am really interested in some of the stuff that he does because he situates himself in the rural areas for several months at a time, understanding the culture and style and everything as he shoots. It is pretty streamline with the work I would like to do in Romania.

The following lecture was from representatives of Sonke, a local NGO that is doing a lot of work towards gender equality, but especially in terms of men. They are addressing the domestic and sexual violence issues, trying to make sure that men are good partners. I think this is good, because the marginalized (women and children) always have overwhelming support systems, to the point that services are marginalized for men. I think this is true across the world. Straight men in the states are marginalized in terms of sexual and reproductive health services. Let’s take that position for just a moment and throw in a twist. The twist is called HPV.

Over half of women in the U.S., and likely around the world, will have HPV by the time they are 40 years old. It’s pretty much a given at this point. Where are they getting it? From men. Straight men. 500,000 women a year die of cervical cancer. 100% of those cervical cancer deaths are linked to the few strains of HPV that can cause cervical cancer (in the U.S. those strains are mainly 16 and 18, whereas here in South Africa I believe they are 16 and 32). As you may know, HPV also manifests itself with the unsightly, but mostly harmless, warts. This has become rampant in gay men in the U.S. Penile and anal cancer incidence and prevalence have both risen due to HPV, as well. In gay males, at least, because that’s the only group of male people that studies have really been looking at. What this means is that there is probably an overlap between MSM and MSW. This is how many STI’s are transferred between genders, sexes, what have you. If so many women are getting HPV, why are we treating and vaccinating women, and not men? In South Africa, Gardasil has not yet even been placed into the public market. Privately it may be possible to get, but certainly not in the public facilities. But why is it that I cannot be “ONE LESS”? Am I left to be “ONE MORE,” that will be left to the wayside? Though I have never intentionally used them to my advantage, I have seen the white, Anglo-Saxon, Protestant, male and straight traits to be of benefit. But I still cannot get a vaccine against HPV? Mexico and Australia say I can.

Bottom-line: when one group is marginalized, we are all marginalized.

My above sequence may not work for everyone’s mind, but in my ADD head, it works out just fine. And that’s cool with me.

Anyways, I started my shadowing at ARK (Absolute Return for Kidz) today. It has very little to do with kidz. It is a British organization, and I’m sure in the beginning it was geared towards kidz and their caregivers, but while talking with Dr Peter Bock, whom I shadowed today, he simply said it would be too unethical to focus only on caregivers and children. The mission statement is for the stakeholders and for money. What is cool, though, is that ARK is responsible for a huge amount of the ARV rollout in South Africa, something like 12% of those on ARV’s are on therapy due to ARK’s facilitation. ARK is best at resources, it seems. They supply clinics with things they need, be it a desk or drugs. They do much of the hiring of nurses and doctors for clinics, they create exit strategies and sustainable practices for NGO’s to transfer clinics to the DOH, and they are facilitating several studies. Today we went to a provincial clinic in a township to check on how the growing PMTCT program is going. PMTCT is Prevent Mother To Child Transmission. In case you aren’t aware, not all babies are guaranteed to have HIV if they are born to an HIV+ mother. PMTCT has become one of the hottest prevention programs in the country, especially with regards to breast feeding. There is a lot of data showing that exclusive breast feeding does not transfer HIV to the baby, which I think is good because it means that the formula companies can start to step off! They are giving way too much formula to these people that can’t effectively use it. If a mother is HIV+ and is supplied with formula and doesn’t have clean water, what is she going to do? She needs to breast feed then. But if the next week she has clean water for the formula, what will she do? Not breastfeed and she will use formula. Then if she breastfeeds again, what happens? The baby will be HIV+, almost guaranteed. But 98% of women, whether they need it or not, are opting for breastfeeding, because it's a free handout! It’s like those tampons that they are giving to girls in Africa; IT DOESN’T WORK! STOP!

The inability for companies or organizations to have any foresight is severely damaging the lives of people in places like South Africa, Russia, Iraq, all of these places. Understand the culture and the lives before you give money or resources, or before you rent an office in the city to take a car into the village. These unsustainable practices like formula, like democracy, like trying to outlaw FGM; these are bad things! College kids that have just graduated with a degree in economics and want to start a random NGO in another country and have smiling kids in pixelated pictures on their shitty pamphlets talking about how they have started a community knitting club and donated cotton machines in Ethiopia need to understand what they are actually doing! The same is with FGM, female circumcision, or however you like to phrase it. This practice cannot be outlawed, nor should it be! Enforcing and ENDORSING these policies does two things: shows a fundamental lack of understanding or regard for a culture and its practices that have been deeply embedded in the culture for longer than many countries have existed, and secondly completely uproots the existing structure of society. I am all for humanism, equal treatment for everyone regardless of blah blah blah, but no way will I walk into the Bush trying to instate that notion. Let them understand the safety issues, then teach them about how to either continue the practice safely, or better yet, how to substitute the practice with another ritual. At the extreme I could even say mild scarification. Yes there is some pain involved, but it isn’t sexist, and that’s all we need.

Anyways, that might be all I have for today.

I took tons of pictures of real penguins a few days ago.

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