This is the last posting to be written in my incarnation of Director of HEARD. It is a time of change, and the passing of Nelson Rolihlahla Mandela has really shaken the country and me. It is taking time for this to sink in, but I will try to write about it.
Domestic Funding For the HIV and AIDS Response
Commentary: Global Fund Observer
There are just two years remaining on the clock for developing nations to achieve the Millennium Development Goals, including Goal Six, targeting the global fight against AIDS, TB and malaria. While some progress in some parts of the world has been made, it looks increasingly clear that the goal – of halting and reversing the spread of HIV; of achieving universal access to treatment by 2010; and of halting and reversing the incidence of malaria and other major non-communicable diseases – will not be met. Click here for the complete article.
Governance and Gales
At the end of October I was involved in a series of Board meetings. The first was my final one as Executive Director of HEARD. This was held in our offices on 18 October. It was a bit unusual for us to hold it in Durban as we usually met in Johannesburg. This involved the least travelling for the Board members.
Lakes and leaves
Most of the postings on my website get started or finished on aircraft. This is no exception. It was started on the flight from Amsterdam to Johannesburg. Unfortunately I was sitting in economy (well to be honest, premium economy, right at the front, with enough room to do yoga poses should I want to). The reason it was a problem is that there is no power at these seats which meant I had a limited amount of computer time.
I left Durban towards the end of August and went to Norwich to be home for Rowan’s birthday. My proud boast, until last year, was that I had never been away on a child’s birthday, although the footnote is that sometimes I left or arrived on the day. I hope I am back on track now.
On Scots and Skye
Ailsa and I have just returned from a few days break in Scotland. We went on the web and found reasonably priced tickets from Norwich to Edinburgh with Flybe. This was surprising given the Edinburgh Fringe was on, but we booked and planned a trip. We flew up to Edinburgh on Monday and picked up a car and drove to the Isle of Skye. Google maps said the journey could be done in five hours but, given two stops, for tea and supper, it took us close to eight.
The first few hours were familiar territory as last year we went up to Inverness, Aberdeen and Edinburgh. This was really enjoyable but grey. On this drive we turned west 20 or so miles north of Pitlochry and immediately entered a world of lochs and mountains. The whole trip was defined by colours. The grey of cloud and mist blanketing the mountain peaks like a shifting table cloth; the reflections in the water which in turn ranged from gun metal grey to deep blue. The hill and mountains were green and purple, the peaks barren and rocky and scars of shale tipped carelessly down the sides.
Ailsa had been on the web and found a self-catering apartment on the Ullinish Peninsula, a place called Fir Chlis. It has its own website and the pictures there are brilliant. There was one big room and bathroom, but immaculately furnished, decorated and very well provisioned with essentials in the fridge and a generous mini-bar with low prices. We arrived just before 10pm and collapsed into bed.
The next morning we woke up to the most amazing view with sea, islands and cliffs. The apartment had big picture windows and so it was possible to lie in bed and look out at the scenery. Because we had driven there in the dark it was even more wonderful when we woke up. There was a full moon reflecting on the water on the clear evening, quite ethereal. And just for our entertainment, rabbits with their noses pressed against the window, although they rejected the carrots!
There was some light rain on Tuesday, and indeed the only rain during the entire trip. We walked from the studio to the end of the Oronsay Peninsula, crossing a tidal causeway en route. The view from the top was amazing. Looking south were the bay and lighthouse, and with a scattering of white isolated crofts nestling against the hills with the Cuillin mountains glowering in the distance. Out to sea was the Isle of Waiy, a green lump in the ocean with its skirting of cliffs. In the distance were the outer Hebrides, I think, the Island of South Uist. It was beautiful and energising. This was a good two hours of walking and scrambling. Excellent exercise and stunning scenery.
After the morning’s walking we headed into the little village of Straun for lunch. This was at a little second-hand bookshop and café Mor Books and Windrush Café. It is an atmospheric place with some unusual ‘customers’. The owners seem to do a huge amount including refashioning and selling local clothing – wonderful tweed jackets. We were served a simple but excellent lunch of cheeses, salads and home-made chutneys. The restaurant in Dunvegan was run by an interesting Scotsman from Glasgow. He had spent his life installing suspended flooring all over the UK and possibly Europe. He said he loved the area and when he stopped installing flooring he moved up to Skye and took a lease on the Misty Isles Hotel. This has a number of terrible reviews on Trip Advisor but I had the freshest and nicest haddock I have ever eaten, that day’s catch straight off the boats.
We drove across the island to Portree after lunch on the first day. From there we spent the rest of the day driving round the top of the island. This was my first experience of driving on single track roads. These are winding narrow roads, snaking up down and along the hill sides. There are passing places every 50 yards or so but driving is very slow and wearing. The worst part is seeing a white van looming in the rear view mirror. One knows it is a local tradesperson who knows the road and is cursing the tourists in front ‘Who don’t know how to drive!’.
Words fail me in trying to describe the Island of Skye. It is the most astonishingly beautiful place and the views to Scotland and the other islands are outstanding. The colours were constantly changing and the blues of the sea and sky contrasted with the purple heather and green bracken. There will be a few photographs on my website in the course of the next couple of weeks. I am going to post some pictures of the scenery and two of myself. The reason for photos of me (the first was taken in 1978), is the mustard coloured corduroy hat with ear flaps, (just reading that makes it sound really unattractive, but I really thought it was cool when I bought it as a student all those years ago). It has been part of my life for 35 years. This is, I think, something of a record and the hat is just as tasteless today as it was then.
Norwich 1978
Scotland 2013
On Wednesday we headed for the village of Elgol on one of the southern peninsulas, pausing on the way to walk up a mountain beside a stream. This was about an hour’s walk going up and little bit less coming back. It had poured with rain the previous night although the day was bright, sunny and warm. We did try to take a foot path beside a loch, but it was completely flooded hence the ramble up the mountain. Parts of the path were extremely boggy and I sank to the ankle in the mud at one point. We both had plimsolls or ‘takkies’ on our feet and inevitably they got wet, or in my case soaked. This came back to haunt us as we drove to Edinburgh. We could not work out why the car initially smelt like a farmyard, and then as the journey went on it became more of a septic tank odour. The pong from the shoes was unbelievable. They were banned to the boot of the car and then wrapped in several layers of plastic for the flight back to Norwich. Lots of washing and some bleach may rehabilitate them.
Waterfall the Road to Egol Scotland
View from Apartment Ullinish Skye
At the end of the holiday we took a slow drive back to Edinburgh, staying there on Thursday night at a Premier Inn near the airport. The route was through Fort William, across the Rannoch moors. We stopped in Stirling and walked up to the castle but as it was evening were not able to go in. Again stunning views and a Presbyterian little city that was beautiful in an austere way.
In total we drove over 750 miles and really enjoyed it. The weather was kind, the scenery amazing, the people very friendly, and the accommodation excellent. I would certainly go back to that part of the world without any hesitation.
It was interesting to try and get a sense of how the economy works in Skye. It seemed in that part of Scotland every second house is a bed and breakfast. Every café has a second-hand book section. Many of the people running the tourist businesses seemed to be expatriate English folks, who had come up to Skye with some capital and lots of dreams and optimism. There were a fair but not excessive number of visitors, and this must have been one of the busiest weeks of the year. How do they make a living? I suspect that in the winter the inhabitants must stay with each other and read their books in front of the fire. Clearly money is not the only motivator for the business people. Equally it must be tough to be a local person without money or a job with all these apparently well off visitors clogging the roads, taking pictures and standing with their mouths open.
Scotland has a reputation for midges, small biting insects that can make life miserable. We watched a photographer on the beach doing the midge dance. This consisted of setting his camera up on the tripod then slapping his face and neck followed by a flapping movement. The next step was to move the camera and repeat. Fortunately the breeze kept them away for most of the time. Unfortunately I seem to attract them more than most people! So I quickly learnt the ‘midge two step and five flap’ and am available to share this knowledge.
Seaweed Skye
Back in Norwich it rained at last. The garden really needs this. I travel to Waterloo on Tuesday and will be there for about a month. The next instalment of the new episode!
Cradles of Humankind: Maropeng and Delhi
July was a busy month and I did a great deal of traveling. This began with a weekend in Johannesburg with school friends. We have been getting together every so often for about seven years now. Owen and I flew up to Johannesburg to see David who had organised a packed weekend which included a visit to the Cradle of Humankind at Maropeng ear Pretoria, listening to Prime Circle at Gold Reef City and going to the Apartheid Museum. The flight up was easy, it was negotiating the wonderful Gautrain ( the rapid transit link between the airport and Sandton) that we found tough. It is an amazingly efficient mode of transport but is hi-tech.
The Cradle is essentially a museum looking at early human history and I found it a little disappointing. Perhaps if we had also visited the Stilfontein Caves, the site of the archaeological dig, it would have meant more. It might also have been that I was caught out again by the Highveld winter. The trouble is that when one flies from Durban in winter the temperature is usually around 20° and in Johannesburg it is 10 or more degrees cooler. I did not have enough warm clothing but now have a new t-shirt from the Cradle, which I bought and put on under my shirt in the store. It is neither very nice nor very warm but did the job.
The Apartheid Museum is amazing and extremely moving. Having lived through much of this, I found myself moved to tears at various points in the walk around. It was also interesting to realise how much the government of the day had kept from its citizens and the world. I was in England when the Soweto uprising began and vividly remember a fellow student from the township, with whom I had chatted in Afrikaans, saying that he could no longer speak the language. Looking back at a time when news was not instant, (I had to book a telephone call to my parents in Swaziland if I wanted to talk to them), it must have been extraordinarily stressful. The end of ‘legal’ Apartheid began soon after we arrived in South Africa, but was protracted and extremely brutal.
At the end of the weekend I went to Pretoria, using the Gautrain again, to facilitate a meeting for the British Department for International Development (DFID), looking at their AIDS position paper. This was the second in a series of three meetings, the first one having been in London. The Permanent Under-Secretary for State, Lynne Featherstone MP, was at both meetings. It was interesting to see how little formality there was around her participation as compared with many other nationalities’ ministers who have security entourages and inflated egos. Is this a sign of mature democracies?
The following week I hopped on an Emirates flight to Dubai and then connected through to Delhi to run the third and final DFID workshop. I left Durban on Tuesday night and got back on Saturday evening. These seemed long flights but I watched four films, two of which I would recommend, and did a fair amount of work. It is probably 14 years since I was last in India. Delhi is transformed from what I remember. The parts of the city that I saw were clean; there was little pollution; and a sense of hope and progress. Even the traffic seemed to move better. The hotel was slightly shabby, but as one would expect there were huge numbers of staff with infinite talents, including the ability to repair my computer, which did not want to talk to their Internet wireless system. I was able to get to one of the ‘Emporia’ shops and buy some shirts, bed sheets and a few gifts. I also bought a carpet which was packaged on the spot in a hessian bag for shipment.
Emirates is a great airline and I was deeply fascinated to see the multinational composition of the cabin staff. These included a number of South Africans of all races. My ability to speak Zulu is very limited but I did greet the obviously Zulu named stewardess (a name like Ncgobo is a giveaway). What was particularly striking is that these people, mostly in their 20s, do not have the hang-ups about race that I do. They are simply young professional people doing a great job, in an accepting environment. It was so refreshing. This is the direction that our nation needs to go in.
I had to spend a night in Dubai on the way back and I am ashamed to say that I checked into the airport hotel and stayed there. In my defence it is the height of summer and apparently it was 40° and humid outside the building. One of my fellow passengers warned me about this and also remarked that it was very uncomfortable. The hotel was very adequate and a good night’s sleep was much appreciated. They even had a small, but well equipped gym, with a power plate, an astonishing piece of equipment that, I believe, almost does the exercise for you. I would be very happy to travel on Emirates again, perhaps that will be my route from Canada to South Africa in the years ahead.
At the end of the month I drove up to Swaziland for a Waterford Governing Council meeting. It’s a long drive, and so I left ahead of schedule to drive halfway back and stayed overnight at Mkuze. There will be more on Waterford and event in the next posting since that is where I am going in a few weeks for the ‘decade’ reunion to mark the 50th anniversary of the school. There are some new photos in the gallery.
Films
Alceste A Bicyclette, a delightful French film about a TV star going to Ile de Ré to persuade a friend who has become reclusive, to star in his new production of Molière’s infamous comedy of manners ‘The Misanthrope’. The place does not get very good press, it seems to rain there more than one would expect. The way the characters are portrayed is excellent and most of the story is dialogue-driven and about character development.
The Sapphires is an Australian film based on the true story of four aboriginal women who get together to form a group to entertain the American and Australian troops in Vietnam. They have to overcome racial prejudice and function in a war zone. The way these people were treated in Australia is quite shocking. At the end there were pictures of the women as they are now, I found that extremely moving.
Jack Reacher is a straightforward film about the character created by Lee Child. Reacher is a former military policeman who is now a drifting investigator. Five people are shot in a seemingly random manner by a sniper. The police take a ministry veteran into custody, he is beaten up in jail and spends the period of the film in a coma but requests that Jack Reacher be called in before this happens. Reacher then investigates and discovers that one of those killed was being targeted. This is a thriller and great for watching on airplanes. There is unusually no love interest at all!
Admissions is a feel good comedy. A Princeton admissions officer risks and loses her job getting a young man admitted to the university. She does this because she is led to believe that he may be her son, given up for adoption some 20 years before. The film does capture some of the conflicts faced with unwanted pregnancies and families. Her mother is portrayed as a feminist who was quite unbending. Again this is a good film for traveling.
Felix is on a similar theme. The story is about Felix Xaba, a 14-year-old black boy living in a township outside Cape Town who is admitted to a private school. His mother is a domestic worker. Felix dreams of becoming a saxophonist – like his late father. This is a South African feel good film but quite interesting to think this may be the experience of some of the children we admit to Waterford. I really enjoyed it and would recommend it of all the films I saw as it is well made and thought provoking.
Leaving Durban
It is now absolutely official and irrevocable. I will be leaving HEARD, the University of KwaZulu-Natal and Durban at the end of the year. My post as the Director of the Health Economics and HIV and AIDS Research Division was advertised in the Mail and Guardian on Friday 28 June. I hope we will get strong candidates and anyone reading this posting who knows people who might want to apply, please encourage them.
I am going to Canada where I have been appointed as the Center for International Governance and Innovation (CIGI) Chair in Global Health Policy at Wilfrid Laurier University in Waterloo. It is quite a complicated appointment. I will be located in the Balsillie School for International Affairs (BSIA) and am also part of CIGI which is a think tank. Waterloo is a small university town located about an hour south west of Toronto’s Pearson Airport. It looks like a very interesting place with the two universities (the other one is Waterloo University); the BSIA and the Perimeter Institute for Theoretical Physics, all close together. It is worth looking at the websites, if only to see the wonderful buildings. CIGI is in the renovated Seagram’s Distillery while BSIA has its own new building next door.
The process of going has been a protracted one. I was offered the position and accepted last year. I informed the University of KwaZulu-Natal and the HEARD Board of my intention to depart and began the process of negotiating the transition. It has taken a long time to get the advertisement put together, longer than anyone would have liked.
I will be transitioning in a measured manner, I am already fractionally appointed in Waterloo, will increase this with effect from September 2013 and will then be 100% there from 1 January 2014. I am aware that this is in the depths of the Canadian winter. So cross country skiing will be on my agenda.
Last year was a time of endings. At the end of the Washington AIDS conference I completed 12 years as a Governing Council member for the International AIDS Society. At the end of December 2012 I finished a three and a half year term as a British Department of International Development (DFID) Senior Research Fellow. This was a factional appointment. It was a huge learning experience and a pleasure to do. I so enjoyed working with the DFID team – although I am totally opposed to open plan offices as a result of this experience. I don’t know how people managed to get so much done.
I began thinking about leaving HEARD some time ago for a number of reasons. The predominant one was the desire to have a legacy. A prerequisite for a legacy is one has to leave! I firmly believe founders have ‘sell by’ and ‘use by’ dates and hope I did not pass mine. HEARD is an established organisation with excellent staff, reasonably secure funding, and great track record. I won’t blow our trumpet, the information is all on the website but I must however mention the remarkable number of peer-reviewed publications being produced by our team: 34 last year alone.
I felt it important for the organisation to have new leadership. There are so many issues in the health field that need attention in southern Africa and my focus is somewhat constrained. A new Director will bring a fresh vision and take the group in some interesting new directions. Things that they can think about include the rise in Non-Communicable Diseases and the environmental changes we are seeing.
Finding a position to go to was rapid. I went for a number of interviews in South Africa and beyond. I was told about the post in Waterloo by a friend of 40 years; looked at it; put in an application; and went for an interview and visit. The rest, as they say, is history.
The post is really attractive. The organisation is new and developing. It gives me the opportunity to work with major issues in a different environment. There will be considerably less administration and more time to write and think. I will, for the first time in many years, have the opportunity to teach and work with graduate students. In addition I will be able to talk to people and go to meetings in New York, Washington, Toronto and Ottawa without having to worry about time zones and long journeys and jet lag. It is very exciting.
Back in Durban the HEARD team have been extremely busy. We have just had the 6th SA AIDS Conference here. Important new data were released. Ahead of this there was a meeting organised by the South African Medical Research Council and the National Institutes of Health on Research frontiers in HIV, HIV related malignancies and TB. It was a summit on shared research priorities and was mainly bio-medical. The dinner was held on the top floor of the Blue Waters Hotel at the north end of the beachfront. The night was clear and the view across the city and the new stadium, as far as Umhlanga, magnificent.
On the Tuesday of the conference opening we co-hosted a meeting with UNAIDS at the HEARD offices. This was on Investments into Critical Enablers for the KZN AIDS Response: Where are the Gaps? The guest of honour was the provincial Minister of Health Dr Sibongiseni Dhlomo. There was much excitement about this as we had to deal with protocol and bodyguards. He was supposed to arrive just before 10am but at 9:20am I got a message to say they were in the car park. I dashed down and he told me he was going to sit there and work and would come up at about 9.55am, and I should stop fussing. He is such a nice man. When this was over I dashed down to the International Convention Centre to attend the opening of the Conference.
The title of a plenary speech by the CEO of the Human Sciences Research Council, Dr Olive Shisana, HIV/AIDS in South Africa: A last the glass is half full, summed up the complex and extremely challenging situation. The estimated number of people in South Africa living with HIV has risen to 6.4 million people (up from the previous estimate of 5.6 million). The estimated prevalence of HIV increased from 10.6% in 2008 to 12.3% in 2012. It is highest in KwaZulu-Natal at 27.6% of those aged 15 – 49, falling to 9.2% in the Western Cape.
While that was bleak, the research and policy input coming from HEARD is influential and important. There were panels organised by HEARD’s Disability and HIV Project and a reception held at Kingsmead cricket ground in the director’s box. We organised a meeting on HIV resource tracking and costing in east and southern Africa which was http://www.gmai;held on Howard College campus in a wonderful new building next to the science block.
On the personal level Douglas has finished high school and, while waiting for the results, is looking at next steps, including coming to Canada. Ailsa is dealing with the bureaucracy of the move, endless forms and complexities! Rowan is busy with two jobs, one at the Writers Centre Norwich. It is worth mentioning that Norwich is England’s first UNESCO City of Literature. She will be starting an MA in creative writing in 2014. So, in summary, all is well and exciting.
Book
C.J Sansom, Dissolution
This was first published in 2003 by Viking. I got one of the 2011 World Book Night copies. The WBN is ‘a celebration of reading and books which sees tens of thousands of passionate volunteers gift specially chosen and printed books in their communities to share their love of reading’. In 2013 it was celebrated in the UK, Ireland and the USA. This is a crime novel set in the 16th century during the dissolution of the monasteries. It is as good as the Hilary Mantel books, and is complimentary since it takes a different view, a hunchback lawyer in the employ of Thomas Cromwell investigates crimes in monasteries. It is an excellent read. What makes it particularly relevant is that I am also reading Steven Pinker’s Better Angels of our Nature: Why Violence has Declined. I will review that in the next posting – but for now he argues that the world is a more peaceable rational place, the 16th Century was routinely violent.
Film
‘Save your legs’ released in 2013, an independent Australian film
This is the story of a not very good Australian cricket team called the Abbotsford Anglers who go on tour in India, with all the trials and tribulations that is involved from rotten pitches to food poisoning. Not all the characters are developed or believable but it is a nice human observational film.
Some Random Thoughts for the Next Posting
I had an insight into the way that I write articles. Recently I needed to write a paper to be presented at a conference in Cape Town. It became apparent my best modus operandi is to begin on Monday; write furiously for three days, each day starting by reading what I have already written; and then on Thursday and Friday I go back and edit. So the lesson is not to try to start an article in midweek but to save up and get on with it on a Monday. What I have not yet learnt is the best way to do the reading other than at the gym.
At the end of May I went to the conference mentioned where the paper was to be presented. The conference was organised by the Center for International Governance Innovation, my new employer in Canada, and the American Political Science Association. It was on the future of South Africa and what Nelson Mandela’s legacy might look like.
I traveled from Durban a day before the meeting. I went up to Greyton, about two hours drive from Cape Town, in the Overberg mountains. I spent a night with Tim Quinlan, who worked for many years at HEARD as my deputy. Greyton is really beautiful and I much enjoyed the calm small town feel of the place. I’ve posted a couple of pictures of my stay with this blog. The question is, could I and would I want to live there and while it is great to visit I honestly do not think it would work in the longer term as it does feel very isolated.
The conference itself was fascinating, and I came away uncertain as to what the future of South Africa looks like. There were a number of criticisms of Mandela. Three stuck in my mind. The first was allowing Winnie to get away without answering for the murder of Stompie Moeketsie in 1991. She was convicted of kidnapping and being an accessory to assault, and sentenced to six years in jail, but this was reduced to a fine and a two-year suspended sentence on appeal. Second, was taking money for elections which allowed a culture of corruption to take root. Thirdly and of course, closest to my heart, not picking up on the threat that HIV posed to South Africa. We worked hard though. The meeting began with a dinner on Friday, on Saturday and Sunday we met from 9 am to 6 am and then had working dinners. Yet another weekend gone! I now need to complete my chapter.
Back in the UK there were a few small wins. We went to the beach, and although it was far too cold to venture into the water the dog had a good run. On the way back to Norwich we stopped at a garden centre and bought some pond weed and water plants. The pond was cleaned a month ago and looked very bare. There will be many happy frogs.
I mowed the lawn and it took nearly two hours. The first challenge is getting the lawn mower to start; it should never be taken for granted that it will indeed fire up with the pull of the cord. It was extremely satisfying when, on this occasion, it started first time. The grass was not too thick, but I still filled nearly half of the garden waste bin. This activity was instead of going to the gym and it was probably nearly as good the work out as I would have had there. I put in my Zen Player, wore a headband to keep it on and listened to the BBC news.
The dog came out to help, which means her biting at the wheels and waiting for me to throw tennis balls for her. I was also joined by a friendly robin that perched on a nearby branch and talked to me, and a thrush that followed the mower to see what edible goodies I might be turning up. It was actually a rather pleasant and productive way to spend a couple of hours.
Just over six weeks ago we (HEARD) were asked to undertake a study for the Global Fund for AIDS, TB and malaria. The question posed was: how should resources be divided between the three diseases before being allocated to countries? This was asked by the Board. An earlier question: Should resources be divided between the three diseases before being allocated?, was not on the table. We were asked to work to a tight timeline to develop a formula to try address this question. I put together a team of five staff members led by Catherine Sampson who has joined us for a year and who is a Peace Corps volunteer.
We were sent a series of dates on which various things had to be delivered and we succeeded in doing the work. There were three groups invited to be involved in the work the others being from the USA and UK respectively. I was delighted to learn we had been the only group that had succeeded in making the technology of video conferencing work for all the meetings, and we were also the only ones to stick to the deadlines we were given. It was a real learning experience for us all and I was delighted by the way people stepped up to the mark.
Books
Ben Goldacre, Bad Pharma: How Drug Companies Miss Doctors and Harm Patients, Fourth estate, London 2012, 430 pages
Ben Goldacre hates sloppy and misleading science, ‘Bad Science’ was the title of his first book. It took a bit of time for me to get into this book, but once I did I really enjoyed it and was almost sorry it came to an end. Although I have to say that it peters out rather than ending with a bang. This may be because he is writing for primarily a British audience and finishes by setting out various things that patients, doctors and the community can do to respond to the mis-selling of drugs. It is an excellent book which describes how deals? go wrong in the development and selling of drugs. There is a detailed explanation of how trials are carried out and why they so often don’t tell us what we need to know.
What is missing from this is an understanding of the difficulty of publishing null results. This goes beyond science broader research and public community. It then takes us into human psychology and an understanding of what makes us tick. We want news that is interesting and grabs our attention. When it comes to medicine we want to know what will work. The problem is healthcare is a form of market failure. When people are sick, they want to get better right now. Healthcare professionals need to be gatekeepers. It also means that they need to be more honest about what medicine can and can’t do.
We, as a society, need to be accepting of the concept of a ‘good death’, and that will take some psychological leaps. This is a book that should be read by every scientist and social scientist as well as the public who want to be informed about drugs and drug companies. My biggest criticisms are his lack of understanding of economics and an unwillingness to engage with this, but perhaps that is the subject of another bigger book; secondly one has to ask who ultimately benefits from the pharma industry and why they do it. Given that most pharmaceutical companies are publicly listed it seems that we mislead ourselves willingly.
Stephen Grosz, The Examined Life: How We Lose and Find Ourselves, Chatto and Windus, London 2013, 225 pages.
This is the story of the experiences and learning of a psychoanalyst. Grosz was born in the USA but practices in London (how he got there would, in itself be an interesting tale). The book is divided into six parts: beginning; telling lies; loving; changing; and leaving. This style of the book for case studies of patients to be presented to illustrate points. Each is extraordinarily well written and extremely readable. There are some deeply interesting people, a professor who at age 72 realises he is gay and wants to negotiate his relationship with his wife and family.
The book does not tell us the outcome for all patients out there on many lessons in it. The back cover says ‘this book is about our desire to talk, to understand and be understood. It is also about listening to each other, not just words but the gaps in between. What I am describing here isn’t a magical process. It’s something that is part of our everyday lives-we, we listen’.
This is a book for every therapist and everyone who goes for therapy. It is also a book for anyone who wants to have a better understanding of themselves and others and how we interact, or so often fail to. It is not very long but I was really sorry to come to the end of it, it could be twice the length and just as readable. There are no solutions in it: that is the point we have to look within ourselves. What I did find rather interesting is that we learn how each of the patients was affected and in many cases damaged by their parent’s and upbringing. It would be interesting to have had parents psycho analysed, did they know what effect they were having on their children? Even more important is, do we understand what we are doing to our kids at the moment. That is something I battle with all the time. An answer is to have two funds for our children: one for college and the other for analysis.
Andro Linklater, Measuring America: How the United States was Shaped by the Greatest Land Sale in History, Harper Collins, London 2003, 312 pages
Perhaps one of the most striking differences in flying across large parts of the United States or Canada or Europe is the way the landscapes are regulated. In Europe human habitation tends to follow the contours, rivers and other natural features. In the USA the grid dominates. This book is about how the land was surveyed.
I picked up a copy at a secondhand bookstore and have to say I found it deeply fascinating. The significance of the measuring was that it allowed private property to dominate, unlike the feudal system of Europe and the United Kingdom. This in turn shapes the North American psyche. Clearly they went hand in hand but one that could not have happened without the other.
The author describes the measurement systems, not just for length but also wakes and liquids. At the core of the distances was the chain, a length of linked metal bonds devised by one Edmund Gunter, a clergyman who issued instructions on how to do this in 1623. He had first used the chain in about 1607 to measure the estates of the Earl of Bridgewater. I can remember ‘chaining’ the sports field at Waterford school as part of a geography lesson. A chain is 22 yards long which is the length of a cricket pitch. This last fact has no significance in the USA. Measuring has to do with politics, commerce and fairness. Politics determine what distances and measures are used, commerce demands certainty and consistency.
Gyms and Elephants
I am at the end of a long period in Durban. Most of the time was spent in the city although there were a few short trips. The first was up to Nairobi for an AIDSpan board meeting. I flew up on the last Thursday of March and returned on the Saturday. It was an interesting meeting with a great deal of progress in the organisation. It has a new executive director, last year one of the things the board did was to select the person. She is settled in and everything seems to be running smoothly. Although I was born in Nairobi I am not a great fan of the city as it is today. It has grown rapidly and the infrastructure simply does not cope. The theme of many of these successful African capital cities seems to be severe traffic congestion. Nairobi has a particular problem in that the city has roundabouts and the psyche of the drivers does not include giving way.
In front of the White House during the Economic Reference Group Meeting April 2013
A couple of weeks later I went up to Lusaka for the Swedish Sida strategy meeting. This too was a short trip, going up on the Sunday and coming back on the Wednesday. Again it was a productive meeting with like minded people, who are committed to making a difference. It is evident though that the terrain of donors and recipients is changing.
In both locations I had excellent meals in nearby restaurants. In Nairobi we walked across the street to an Indian restaurant where the food was as good as anything I have eaten anywhere in the world. The Lusaka restaurant was also within a few hundred metres of the hotel. It is noteworthy that we now feel comfortable walking in these cities, albeit in a group. Things have changed. I am not sure that I would be happy sending people off on foot in parts of Durban. While one might be safe from assault in Lusaka the lack of streetlights made the walk quite hazardous. In both cities what passes for a pavement would keep Western lawyers happy with litigation four months.
The hotels were adequate: comfortable beds, clean bath rooms, reasonable restaurants, fresh bedding and not too noisy. Horror stories from fellow travelers include pubic hairs in ostensibly clean beds and walking back into the room to find the cleaner using the guest’s toothbrush in the toilet! For me a decent gym is really important and I am happy to say that both the Jacaranda in Nairobi and the Intercontinental in Lusaka have these facilities.
Increasingly I look at what equipment is provided as both sons of the founder of my gym in Durban Fitness Company are involved with the importation of machines for the South African market. My most recent trip ended in Waterloo, Ontario where I got a great offer at a gym – 14 days for $15, pity I was only there for six days. Much of their equipment is the same as that in Durban. Interestingly rowing machines are not popular in Canada – perhaps because it is hard to watch the TV when the focal length keeps changing.
The international airports in Lusaka and Nairobi both urgently need an upgrade. They are small, crowded and rather dirty. I was extremely unimpressed when I asked a security guard a question in Lusaka. Before he answered me he inserted one grubby finger up his nostril as far as the first knuckle. He kept it there while talking to me. Disgusting! He was a singularly scruffy individual – but dressed in the uniform.
I waited at our wonderful airport in Durban on my return from Lusaka as my sister Gill was flying in an hour later. She had been in Cape Town visiting my brother and came up to spend five nights with me. We did various things around Durban, and she reconnected with a school friend that she had not seen for close to 35 years. It was a significant birthday for her and one of her presents was the trip to Durban.
I took her up to the Zululand game parks. It is only about a three-hour drive from Durban on a really good road. We went in through the Umfolozi gate at the south of the park and drove through to Hilltop Camp where we spent a night. We did not see a great deal as the grass was thick; it is the end of the rainy season. We did however get close to a rhino and calf, giraffes and an elephant. Usually on visits to the game parks I see something that I have never seen before. On this occasion, we came around the corner to see a large Monitor lizard, locally called a leguaan, licking its lips looking very pleased with itself. The reason for this soon became apparent, a dung beetle had been busy creating the ball of dung it would roll to a suitable location and lay its eggs in. The ball was there, but there was no dung beetle in sight. I guess it was in fact inside the lizard.
Despite the lack of game the countryside was really spectacular. From the game park we gently made our way back to Durban. There was the obligatory stop beside the road at the craft market where Gill bought handicrafts and I got fruit, including fantastic avocados. I dropped her (and the hire car) at the airport and caught a taxi to my office.
I am feeling very much under the whip at work. There is a huge amount going on and so I am very busy. The problem is that much of it depends on input from others, which means that I have to wait. Tim Quinlan, HEARD’s former research director, came up to plan various projects and articles. We sat together on Saturday and worked through one we are co-authoring on the potential role of China in the AIDS response in Africa. What a pleasure to be academic.
I was supposed to travel to the USA via Swaziland where there was a big celebration at Waterford. For various reasons I decided that this was simply asking too much of myself and so did not make it. It is a pity because there was some wonderful press coverage on BBC and in the British and South African Guardian . We have to make the most of this opportunity to secure funding for the next 10 years at least.
I want to get this posting up on the website so will stop there. The next will cover my travel to the US and Canada and the big news about my plans.
Babies on Board, Sport and Sunshine
I am at the beginning of a period of travel. This posting is a series of observations about places, planes and people.
The first, short, trip was to Johannesburg, to a conference venue and hotel near the airport. The place, which will not be named, is in Boksburg. It is under the flight path of the aircraft coming into or leaving OR Tambo airport. I don’t mind this – my liking for aircraft is well documented, however when the first scheduled flight of the day leaves at 05.45 it is a bit trying. The centre is best described as ‘having got fat on government money’. It is a sprawling slightly shabby complex: visitors are ferried round on golf carts. The guests comprise those there for meetings (and on per diems) and those whose flights have been cancelled and whom the airline is accommodating.
I really don’t like the place. This view was confirmed when it took three attempts, going on the golf cart from the reception area, to get someone to unlock the door to the only bar. Apparently access is controlled because ‘ladies’ hang out in the bar, drug the male guests, go back to the rooms and rob them. That did not happen to me – but then I guess when I asked for two bottles of water it was apparent I was not a likely target. I was stayed for one night and that was enough.
On my return to Durban I had a day in the office then had to get up at 04.30 to catch the 06.30 plane to Joburg and connect to Nairobi. The racial mix of the cabin staff has changed from mainly white to mainly black, they have however, retained one of the phrases that always amused me. The Afrikaans crew would come round before serving the meal (OK I must put my hand up and acknowledge that this only happens in business class) and offer the passengers “Hot owl sir”. It is, of course, a hot towel, and it is still being offered.
On the flight from Durban two amusing little instances occurred when we were boarding. First a mother got on clutching a baby of eight or nine months. She was festooned with a back pack, bags, changing mats and all the paraphernalia that goes with travelling with a small person. So much did she have, that she could not fit through the aisle to her seat – 28 – right at the back of the plane. Calmly she handed the child to the gentleman in row 1.
“I will be back in a minute”, she said, “Do you mind holding the baby?”.
Well he did it. Both the infant and the passenger looked a bit bemused. Sure enough she came back and collected the child a few minutes later.
The last passenger to board was a flustered looking blond woman. At a guess she was in her late 20s. As she walked past me a young man was hurrying up towards the door.
“Why didn’t you wait for me?” she said angrily.
“I thought you had gone ahead”, he replied.
It was clear that there would be a further exchange of words when they got to their seats. Not a good way to start your honeymoon.
It has been a busy time. The team at HEARD continue to work well. In pure academic article productivity terms, 2012 was a record year. The details are on the website. I managed to produce a good few articles and book chapters, and will take credit for creating the environment where others can achieve their potential.
At the beginning of 2013 we managed to recruit more staff with interns coming on board; our first ever Peace Corps volunteer; and a number of Post-Doctoral Students scheduled to join us. The Post Docs are funded through a new initiative from the South African National Research Foundation, and while it is not a fortune they are given a significant amount of money and a chance to write. We have also recruited our 10 Doctoral Candidates (six at the University of KwaZulu-Natal and the balance around the country).
The big question I ponder is where to take my own academic interest over the next 10 years. More on this is due course. There is so much that is really interesting to research. To some extent I am spoilt for choice, and I don’t need to prove anything.
I have been in Durban for over two months with very limited travel. Apart from work, this has been a chance to spend time at the gym, go running, and do a fair bit of yoga. There is no doubt that I am much more flexible as a result of the yoga, but will be the first to acknowledge that I am not very good at it. The most interesting class has been the Bikram or ‘hot’ yoga. This is done in the normal studio, but with the wall heaters turned on. In Durban! In summer! The sweat just pours off me. At the end my yoga mat has sodden, slimy patches and is banished to the veranda.
The yoga studio offered a three session course on meditation. There were ten people on it. When the teacher went round the group and asked why people were there, they all said it was because of stress and their need to manage it. That was not why I was there, I just wanted to learn something new, so I felt a bit of a fraud. Yoga is breathing and stretching, meditation is breathing without the stretching – although I am prepared to admit that I may not have entirely got it!
My trainer at the Berea Gym, Wade, decided I needed to relax more so loaned me eight DVDs. They are all, unsurprisingly, action films, and I am slowly working my way through them. The advantage of a DVD is it can be stopped. It took three sittings to get through the ‘The Perfect Storm’, which was actually an excellent film, with George Clooney and the rest of the caste I did not know. It does not have a happy ending (spoiler alert): the boat goes down with all hands.
Running is done in the morning, ideally just as the sun rises. It is great, because the course I run, which is between six and nine kilometres, depending on how much time I have, has many hills and winds its way through the leafy suburbs. As we have reached the equinox the sun rise is at about 5.40 am. This run is a really good way to prepare for the day ahead. The alternative might be to go down to the beach with the body board, which I have only done once. However I did manage to catch a wave, the most amazing feeling but unfortunately rare event.
There have been a number of events I have attended. St Clements is a little coffee shop on – Musgrave Road with excellent music every few months. They have taken to holding salons or soirees on a Monday. Some are excellent, others simply indulgent. But it is all grist to the mill, and nice that it is happening. The recent book launches have been extremely poorly attended, which is unfortunate. The Centre for Jazz and Popular Music at the University has been full at the Wednesday performances.
My flat has been having its own set of experiences (without me). Durban and the surrounding areas have a problem with a pest called wood borer. These insects eat wood and paper and it has been known for chairs to crumble when one sits on them. The sign of wood borer are little piles of dusty droppings called ‘frass’. I got a pest control person in to deal with them. He claimed to offer an eco-friendly service. In my view that would involve enticing the little beast out and relocating them. As I write that I realize that would be a ‘humane’ service not an eco-friendly one. What he actually has is a pesticide that only kills insects, the geckos, mice and rats survive. Of course they then starve to death over a period of time. Wood supplied now is treated and does not have this problem.
There has been some fierce weather, thunderstorms and strong winds. I got back to the flat one evening to find the door to the linen cupboard in the hall had been ripped off its hinges. Clearly there had been a gale howling through the flat from the bathroom to the kitchen!
So that is the news from Durban for now. My next posting will, I think have some big news, and I will also send out my once a year mass email.
Alan Whiteside 