With the election of Thabo Mbeki, 1999 marked the beginning of an era of government-endorsed AIDS denialism. This ideological view denies the link between the human immunodeficiency virus and acquired immune deficiency syndrome. Given the political history of Apartheid and its mark on South African society, it is not difficult to see how former president Thabo Mbeki and his Minister of Health, Manto Tshabalala-Msimang, exerted political power over South Africans and corrupted ARV distribution efforts of organizations like the TAC. The more important question was why they took such measures regardless of local, national, and international pressure to acknowledge widely accepted information regarding HIV, AIDS, and ARV treatment.
|Courtesy of popular South African cartoonist, |
In South Africa, denialism centered around fear of a global pharmaceutical conspiracy, critique of African sexuality, promotion of indigenous solutions, such as Virodene, and poverty as the key determinant of the epidemic. Mbeki’s reasons, though falsifiable, are plausible if perceived through the eyes of a leader of a country with a history of mistrust and of a continued movement to reclaim pride in the South African nation and its sacrosanct traditions. Regardless of Mbeki’s motivations, the former president’s ideological and political beliefs concerning the HIV epidemic dictated the course of treatment for millions of people in South Africa.
Established in 1965, The Medicines and Related Substances Control Act was the principal piece of legislation governing the regulation and distribution of medicines in South Africa. While the act prohibited the sale of “medicines subject to registration unless registered,” the registration of medicines was left to the Medicines Control Council, whose integrity was compromised after leaders had been dismissed after disagreeing with Mbeki’s stance on Virodene and other African “medicines.” As a result, medicines were not effectively regulated and quackery ran rampant throughout South Africa.
|The average price of olive oil is R 62.68 |
A loaf of white bread costs R 9.2
Traditional HIV medicines endorsed by the South African government during the AIDS denialism era included beetroot, garlic, lemon, olive oil, and the African potato. These medicines were promoted by Tshabalala-Msimang in addition to good general health and nutrition. This stance on HIV treatment presented problems for public health workers. While all of the expensive ”cures” recommended by Tshabalala-Msimang ranged from being ineffective to harmful for patients with HIV and AIDS, nutrition was and will always be an important aspect of health. The topic of nutrition is one of many overlapping premises of western and traditional health, but I was ignorant of this strange relationship until the about halfway through our time abroad.
The past few weeks, the other interns at Sonke and I have occasionally ordered take-away lunches at a fresh food café on St. George’s Mall in Cape Town, called “Crush.” Upon first entering the café, Jill commented that she felt like she was back in the States at a west coast bistro and Anita affirmed that the shop would get a lot of business if it were on the Hopkins campus. As we sat waiting for our mozzarella and tomato sandwiches I took a closer look at the menu board. The types of food sold in the store were marketed much like the traditional remedies on flyers circulating around the city and throughout the townships, with suggestive menu items that “boost your health” including “immune-boosting juices” like the Revitaliser, Pear & Ginger Cleanser, and wheatgrass shots. Interestingly enough, expensive bottles of olive oil were displayed strategically next to the cash register and Hippocrates' quote “Let food be your medicine and medicine be your food” was written in large orange bubble letters across the right side of the menu board. I began to laugh, thinking “wow, Dr. Manto would have loved this place!” Confusion quickly overtook any humor in the situation. How could clever advertising schemes and homeopathic mumbo jumbo appeal to both AIDS denialists and western-educated Hopkins students? What is it about traditional medicine that appeals to everyone around the world, regardless of cultural or educational background?
|Crush Menu Board|
I have come to the conclusion that there are no simple answers to these questions. Anyone who tries to tell you otherwise is just as guilty of peddling misinformation as quacks selling bogus HIV treatments. I have, however, identified a few aspects of traditional medicine that are attractive to me as an American student of healthcare policy and management. First and foremost, traditional medicine is often more accessible to South Africans. This is largely because of the long queues at local clinics, the cost of traveling to the clinics and missing work, and the mistrust of the public healthcare system. Traditional healers are known for being great listeners and generally spend quite a bit of time talking with their patients. This fosters powerful, trusting relationships that appeal to patients at the most basic human level. Healers also take a more holistic approach to healing. They view the body not just as a conglomeration of medical problems and machinery, but as an individual being with physical and spiritual needs.
If I am not mistaken, these are aspects of healthcare that patients report are lacking in most hospitals stateside. Like it or not, traditional medicine has its place in health systems around the world, regardless of the physical evidence (or in some cases lack thereof) supporting its effectiveness. Until evidence-based medicine is made accessible and affordable, traditional remedies will continue to be the first line of defense for many populations around the world.
Written by Maggie Storm