Industry without art is brutality

Industry without art is brutality

Ruskin’s quotation is blutacked to the computer in Eastbourne Sexual Health Clinic’s room 11 , the HIV clinical room, a weak play on ‘ART’ (antiretroviral therapy) and a reminder that there is an art in effective healthcare.

Week two raced past with visits to eleven primary health clinics and to Kalafong Hospital’s Immunology (HIV) Clinic in Tshwane (Pretoria). I wrote about the numbers last blog – they are similarly immense wherever I go. Now I’m swimming in numbers too: an alphabet soup of data entry with three dozen semi-structured interviews and a focus group already conducted.

Sister Jostina outside Kameeldrift Clinic

FPD mobile HIV testing outside Nelmapius Clinic, Tshwane

Allotment garden & gardeners outside Eersteruste Clinic – a common feature of South African primary health clinics – the produce is distributed to the community.

On Saturday David drove the short distance from Pretoria to Johannesburg, through the gleaming skyscrapers of South Africa’s financial hub to the Apartheid Museum. Like the Holocaust Museum in Washington DC it’s a testing visit. The tour begins with an arbitrary separation: me through the entrance for ‘BLANKES / WHITES’ David through ‘NIE-BLANKES / NON-WHITES’. We walked through separate corridors of pedantically absurd yet sinister former-public signs that once separated people in every daily activity imaginable, along lines of race. SA’s sign industry was brutal. The tour articulately documents long-established pre-apartheid racism and maltreatment of black and other non-white people before walking visitors through the apartheid years, allowing its rulers’ and administrators’ extraordinary prejudice to speak for itself.

Witnessing the bravery and sacrifice of those who opposed the regime made my eighties ‘activism’ in the UK seem token: buying Free Nelson Mandela, angrily boycotting (Paul Simon’s) Graceland and marching in protest outside South Africa House pale beside the suffering of those who stood up to apartheid and the shocking exhibition of cruelty and violence they suffered that are commemorated here. I was fascinated to see familiar images from recent history and relieved to exit with a feeling of optimism provoked by the final displays, which led to the dismantling of apartheid and free elections. As we drove back through the central business district and Sandton on the N1 David provoked a difficult reflection: what would I do in the face of extremity..? I wonder, how brave would I be?

The exit from the Apartheid Museum

Outside Emalahleni (isiXhosa for ‘a place of coal’) Clinic

On Sunday I picked up a white Ford Figo for my first drive, 100km east to Witbank. The Protea Hotel Highveld’s lobby is orange and brown with explosions of white heat in Dan Myburg’s atmospheric art photographs of local heavy industry. Driving around the area, there are deep black gouges of open cast mines blasted into the landscape, mountains of slag, cooling towers and chimneys discharging steam and smoke from power stations, pot holes the size of the Great Rift Valley caused by the ceaseless round trips of heavy, articulated transporters that clog the roads as they lumberingly move the coal from mine to furnace. I’ve yet to see the vervet monkeys or meerkats that ran in abundance across the wilder roads of Eastern Cape. There’s industry but – unless you’re Myburg – little art here.

After a productive day in the clinics of Witbank, its surrounding townships and nearby small towns, today was spent in Middelburg ‘Home of Stainless Steel’ and the Steve Tshwete / Emakhazeni sub-district. In fact the landscape was far more agricultural. The challenges for people living with HIV include miners negotiating time to collect antiretrovirals and remote farmworkers even reaching clinics. After seeing a patient who’s HIV is stable and well-controlled after three years’ successful treatment being issued only thirty days’ pills I discussed issuing longer prescriptions with today’s roving team: if one hundred patients like him attend clinic every month, they’ll need 1200 appointments a-year; shifting to six-monthly follow-up would release 1000 of those seemingly needless appointments, relieve some of the burden on clinic sisters by reducing clinic queues and solve some of the patients’ barriers to attendance and retention in HIV care. If mineworkers cannot collect their ART there’ll be no industry.

There may be no sign of wild mammals but as we drove past Mpumalanga fields the cows were followed by gleaming white ‘tick birds’ (cattle egrets) and I’ve seen guinea fowl & two long-tailed widowbirds barely more airborne than the Wright brothers’ Flyer at Kitty Hawk thanks to the weight of their extended tail feathers.

With Manwick 2011

With Manwick 2014

In other incidental news, I bumped into an old friend from 2011, Manwick Banda, a Malawian waiter at The Willows opposite the FPD offices. I’m back in the gym thanks to Protea Highveld’s deal with Planet Fitness. South Africa being a society of extremes, from Jo-burg’s millionaires to the poor in in formal settlements and no matter how industrious my workout, I wonder if I’ll ever join the elite that are inadvertently targeted on Tshwane municipality’s website:

Mission
To enhance the quality of life of 911 people in  the City of Tshwane by promoting and
Protecting the health and wellbeing of  our people through leadership and best practice
In rendering accessible,  affordable, sustainable, equitable quality, efficient and effective
Services  in a manner that builds partnership.
Population served: year estimates 2007) based on the 2001 census figures.

(My italics) Surely a typo for all that escaped the proof-reader?

http://www.tshwane.gov.za

To work soon and another day witnessing the enormous strides being taken to provide ART to millions in South Africa. My evaluation may reveal the art behind such industry.