There are sparrows living in the terminal building at National Airport in Washington. Clearly they have found an ecological niche and are making the most of it. I don’t know if they spend all their time in there or if they manage to get in and out. This is the sort of question that I would ‘Google’, but I was unable to connect with the internet. I was too tired to do battle with the technology, especially since I had just 40 minutes before boarding my flight to Toronto. Instead I sat in the boarding area and contemplated. There was an elderly gentleman sitting in there playing snatches of music on a French horn. This was designed to keep the waiting passengers amused I think. Unfortunately he was not very good and did not play any piece for long enough. One of the gate staff walked over, plonked himself in an empty wheelchair next to me, and gently rolled himself back and forth in time to the music while texting furiously. These are the vignettes of the departure gate.
Since its recognition in 1981, the HIV and AIDS epidemic has been a defining factor in the financing of health across Africa. The reasons are simple: AIDS is exceptional. It primarily infects adults; it is incurable; if untreated, death results; and while treatment is available, it is complex and expensive.
There are many places in Ontario named after English towns. Not far from Waterloo, there is a Norwich and down the road, the small town of Stratford hosts, perhaps predictably, an excellent Shakespeare festival. The other day I told a colleague I needed to leave the meeting we were at: I was travelling to London.
“Oh”, she responded, “So am I”.
The difference was she had to drive for an hour while my journey was to Pearson Airport, Amsterdam, and a connection to Heathrow.
The HEARD team are home from the XIX International AIDS Conference in Washington and hopefully are reflecting on what we did and learnt. I am currently in the UK, and was in DC the longest (from Wednesday 18th to Saturday 28th July). This was my last official meeting as Treasurer and Governing Council Member of the International AIDS Society (IAS). On Saturday 21st July we had a breakfast Finance Sub-committee meeting at the absurd hour of seven thirty am, followed by the Executive and Council Meetings (until three pm). The IAS members’ meeting was the following week. I completed my duties as Treasurer by presenting the 2011 Financial Report.
I have learnt a number of lessons attending conferences over the years. The paramount order of business is to get a suitable room at the hotel. The one I spent the first night in faced a busy street and was very noisy, with buses stopping outside from about four o’clock. I spoke to the receptionist and spent an hour the next day looking at rooms before identifying the one that I would call home for the next nine nights. I do not for example; want a room with two king-size beds, I only use one at a time. I walked around the hotel with the concierge, a thick set Liberian gentleman called Shakespeare. He let me into rooms until we identified the best option. I did not in fact make him carry the luggage but he did not seem to appreciate this. I ended up on the seventh floor. It was fortunate that we were at the conference all day because the hotel was being renovated. The work was going on immediately above me, drills and jackhammers from nine o’clock to five o’clock, sleeping during the day would have been impossible.
A second lesson is that airlines do not look after your luggage! When I last went to South Africa, the handle of my case was destroyed. I only remembered that I needed a new one towards the end of my stay in Durban. I dashed to the luggage shop and chose what I thought would be a sturdy case. Arriving back in Norwich I discovered it was missing a wheel and I had a fairly bad tempered exchange with Linda, one of the grounds staff in Norwich. The bag has since been collected and company will decide whether to replace it or repair it. Packing for the Washington trip was not a problem because we have plenty of cases in the house in Norwich. However the return connection from Washington via Amsterdam to Norwich was tight and we were further delayed due to thunderstorms. My bag was not on the carousel at the airport, but I kind of expected this. The person on duty was, unfortunately, Linda.
I walked over to her and said, “So, if you don’t destroy my bags you lose them.”
She responded, “I will get the forms, Mr Whiteside.”
It is rather alarming that I had made enough of a (bad) impression on her that she knew my name, although not my title! As I had anticipated the bag came in on the next flight and was delivered to the house.
I attended bits of two pre-conferences. The first on Social and Political Sciences, where I presented Thinking Politically …With a Focus on the Politics of AIDS Exceptionalism vs. Taking AIDS out of Isolation: Reflections from South Africa, it was surprisingly painful to put this talk together as it brought back the dark days of denialism. The second was the International AIDS Economics Network (IAEN) pre-conference. HEARD was one of the co-sponsors and organisers of this meeting. It is always a pleasure to be surrounded by other economists as it makes one feel ‘normal’. Another spiritual event was the special AIDS service at the Washington National Cathedral, a magnificent mock gothic building. Every faith, sexual orientation and gender was represented (except I think for the scientologists).
There were numerous presentations and meetings at the International AIDS Conference. Of particular interest was a ‘round table’ event organised by the International AIDS Alliance at the British Embassy on the importance of human rights approaches to HIV and AIDS. My conference highlight was facilitating Swazi special interest meetings, held in the IAS offices. We had no idea how many people would turn up: it was billed as an opportunity to hear what was going on in Swaziland for people who work in, do research on, or simply care about the country. To our surprise and delight the room was full for both meetings. It saw the birth of the Swaziland AIDS Research Network (SARN). Unfortunately I was not able to attend the second meeting because I was chairing the rapporteur session (which I did in Vienna in 2010). This is the last formal assembly of the conference before the closing ceremonies. A key attribute required of the Chair is they be able to keep people to time. I can and did. I even made a few jokes. It was fun.
At the Conference, HEARD organised two side presentations at the IAS office. Mine Step Forward the Economists: the changing dynamics of AIDS Funding – was attended by just five people! Kay’s (HEARD’s Research Director) turnout was slightly better (seven). Media events included doing interviews for the Centre for Strategic and International Studies and for a film Positively Beautiful. The second interview was under lights. Given my lack of hair and the heat I needed make-up to reduce the glare! This worked so well I made sure I powdered my head for the Rapporteur Session, sadly I doubt anyone noticed. I have now got a reputation for rushing about and asking who has make-up available! All HEARD’s outputs presented at the Conference are on http://www.heard.org.za/heard-resources/aids-conference-2012
As I was also present at the meeting as a DFID Senior Research Fellow I had the opportunity to work with my colleagues from London and South Africa. This was a real learning experience as they produced both a ‘Telegram’ and an excellent ‘Back to Office’ Report. I am lifting from my contribution to the report for my reflections on the meeting.
There were two major tensions. First biomedical science now rules. There was little discussion of behaviour change. Second participants heard much about the cost of response and what the funding gap is, but there was no reality check on how the gap might be filled and what to do if it is not. The central theme was moving to ‘an AIDS free generation’. I understand this to mean everyone who needs it is on treatment (thus people living with AIDS, but not dying from the disease) and there be zero new infections. One quick and obvious win will be to eliminate mother to child transmission. Mead Over of the Centre for Global Development has consistently pointed to the concept of an ‘AIDS Transition’ where the number of new infections falls below the number of AIDS deaths. Until this happens the number of people living with HIV and AIDS will increase (as will the need for resources).
Funding was a hot topic. There was an excellent debate at the World Bank offices on the motion: Continued AIDS investments by donors and governments is a sound investment, even in a resource-constrained environment on Monday (which I missed as I was at the British Embassy). It was well attended and put many of the issues out in the open. Here is the podcast. One argument was money is not a constraint! We live in a rich world. Others responded that low and middle income countries do not have access to this money, sadly, true. Interestingly capacity constraints were not mentioned. Bernhard Schwartlander of UNAIDS noted: “The lives of more than 80% of the people who receive AIDS treatment in Africa, depend every morning on whether or not a donor writes another check.”
Much has been written about the Conference. I can especially recommend the blog of Laurie Garrett of the Council for Foreign Relations in New York.
In summary it was worthwhile and fun. The fact that the IAS has been able to bring the conference back to the US (due to the lifting of the travel ban for HIV positive people) was mentioned frequently, and is significant. This was the conference where economists should have stepped forward but did not. Hopefully they will be present, vocal and listened to in Melbourne the site of the XXIAC in 2014. My prediction is that Melbourne is the conference where behavioural science should be prominent and probably won’t. Despite this I do have a sense that we are beginning to win the battle against the epidemic. The challenges will be, as always, to prevent new infections; treat people already infected; and provide for those who are impacted, the orphans, the elderly, and address the needs of the health care services.
At the end of the conference there is always a party for the IAS staff, volunteers and Governing Council Members. It started at about eight o’clock and finished at one o’clock the next morning. Generally these are great fun and this was no exception although I was a little taken aback when my neck was nuzzled by an unshaven male. Clearly I was sending a wrong message.
This posting would not be complete without mention of the Olympic Games which are going on in London. It very much reminds me of the mood we experienced in South Africa at the time of the Soccer World Cup. A major sporting event, it is an opportunity to have a party, and unite in supporting one’s own teams, while making all the visitors feel comfortable and welcome. Britain had not done all that well in terms of winning medals at the time of writing but there is time. On Wednesday I saw two women win the first British gold medal for rowing. Cyclist Bradley Wiggens (who had just won the Tour de France) took gold in the final trials, an amazing achievement. The speed at which they ride is a dangerous 50kph. All the venues are great, and because they are spread out across London and the South East there is a sense that it is more than just one city hosting the games. The train from Norwich to London goes past the Olympic site and I have watched with interest as the building began and was completed. I do hope that this provides a sporting legacy for the country.
Peter Piot, No time to lose: a life in pursuit of deadly viruses, WW Norton & Company, New York 2012, 387 pages.
This autobiography tracks the progress of the HIV epidemic since its earliest days. Peter was the head of UNAIDS from its inception to 2008 – a total of 12 years. This is his story, from the early adventures in Zaire where he was part of the team engaged in the identification of Ebola virus, through to his stepping down from the executive directorship of UNAIDS. It is a fascinating book and an easy read. I took it to my gym and found myself losing track of time. Any book that does this for me has to be excellent. It is particularly engaging since I both know the history and was a part of it. Having finished the book and reflected on it I feel that it is a factual account of what went on and Peter could have put more of his personal story into it. There are gaps, for example the Commission on HIV/AIDS and Governance in Africa, set up by Kofi Annan is not mentioned. I was a member of this, which may be why I wanted to see it cited. The last 50 pages appear to have been written in a rush. Nonetheless this book is an important chronicle of the time of AIDS and deserves to be widely read. One thing that is clear is that we were all ‘making it up as we went along’, there is no way we could have done anything but this. Peter’s comments on the origin of the denialism in South Africa show how bizarre this period was. “Mbeki was an intelligent, indeed coldly rational man; and yet here he was impervious to my reason. What could be the origin of this denialism? I had thought maybe it was economic – the cost of treatment – but after that evening I was convinced that this could not be the case. Psychological, then. …”. Page 280.
Andrea Camilleri, The Track of Sand, Picador, London, 2011, 279 pages.
This is one of a series of books featuring Inspector Montalbano, a Sicilian detective. As always when reading a book that has been translated from a different language I wonder how important the original style of writing was and how important the translation is. The Scandinavian crime writers are a good example of this as they are extremely popular and include Swedish, Norwegian, Danish, and even Icelandic genres. This Montalbano series of books is great fun. It gives a sense of the complex society of Sicily and the characters are kindly portrayed. There is an awful lot of food and a little bit of love in the stories. This particular mystery centres on the body of a horse which appears in front of the inspector’s apartment. It is whisked away while he is trying to get his men to come and assist with the investigation. The story takes off from there and, pardon the pun, gallops to a thrilling end. I recommend these as something more than a light read.
The Best Exotic Marigold Hotel a 2012 British film directed by John Madden. It has a starring cast of older actors Judi Dench, Bill Nighy, Maggie Smith and Tom Wilkinson are the ones I recognised. It is about British pensioners moving to a retirement hotel in India, run by an eager young Indian entrepreneur. He sells the Best Exotic Marigold Hotel, in Jaipur as a hotel “for the elderly and beautiful”. There are a series of stories: an impoverished widow; a gay High Court judge who grew up in India, and who is seeking his first love; a working class racist, retired housekeeper who needs a hip replacement operation (quicker and cheaper in India); and a couple of love stories. The acting was outstanding, the story plausible, and I really enjoyed the fact that I have spent time in Jaipur and so recognised the setting.
Salmon Fishing in the Yemen a 2011 British romantic comedy-drama film. This is the story of a sheikh who decides to introduce salmon into the Yemen as part of a ‘civilising’ and economic development process. His consultant asks the British government for help and the press secretary decides that this is a good news story and a time of really bad news from Afghanistan. The main character is the Scottish expert in salmon fishing who also has mild Asperger’s syndrome: “You can’t insult me because I don’t understand it.” It is also a love story and there are probably many metaphors in it. It has the potential to become a cult film. I am pleased to note that it has been a box office success. The Internet chat between the press secretary and the Prime Minister is beautifully captured on the screen and in the story.
The Girl with the Dragon Tattoo a 2011 American made thriller.
This is the first of what, I hope, will be a trilogy of films since there were three books. It is based on the Swedish novel by Stieg Larsson and stars Daniel Craig and Rooney Mara. It is the story of journalist Mikael Blomqvist’s (Craig) commission for a wealthy Swede to find out what happened to his niece who disappeared 40 years earlier. The film builds and then introduces computer hacker Lisbeth Salander (Mara), who is the ‘Research Assistant’ and while being extremely capable on computers is gauche and uncomfortable with people. There are some violent and distasteful scenes, and it does not end happily for all the characters. I had been hoping to watch it for some time. The flight from Washington to Amsterdam is about seven hours and this film is nearly three hours long. Given that I was in economy class (well premium economy) I decided this was the chance I had been waiting for, although, frustratingly it took over an hour for my seat’s entertainment system to start working, it was reset about three times. An excellent series of books and the first film in series is fantastic; I will look forward to the rest.
I flew from the United Kingdom to Durban on Monday, 11 June. It was the long daylight flight from Amsterdam so as well as working I saw the film Warhorse. After an overnight stay at the Intercontinental Hotel in Johannesburg and I flew to Durban on Tuesday. I went straight to the office and got a lift home at the end of the day. The next morning was an early start, I went back to Johannesburg, met up with colleagues from the British Department for International Development’s (DFID) office in Pretoria. We drove down to Swaziland where we spend 24 hours in meetings talking about a possible regional HIV and AIDS program. This included a dinner with members of Swazi civil society.
I had less than a week in Durban and then headed for Florence for a UNICEF meeting. On the Wednesday I flew out on the Air France A380, the biggest plane in the world (and it is quite fantastic), to Paris and changed for the flight to Italy. I was rather exhausted when I got in and so slept for part of the day before going out and wandering around the city. The weather was perfect, and it is without doubt one of the most spectacular cities I know. The two day meeting on child well-being was deeply interesting. We finished at about three o’clock on Saturday and I headed for the airport to get back to Paris, Johannesburg and Durban. The EUFA cup game between France and Italy was being broadcast in the lounge. I was the only one who cheered when Italy scored – and they won. I had one night in Durban and then flew to Cape Town to visit the Children’s Institute.
In Cape Town I managed to both deliver a birthday present to my niece in Hout Bay and meet up with my uncle, aunt, cousins and second cousins for dinner. Uncle Fred was one of those people who was an absolute role model for me. He and June live in a retirement home in Pinelands just outside Cape Town. They originally bought two units expecting to be allocated ones adjacent to each other so they could create a decent living space. The elderly lady who owned the one changed her mind about moving. They spent at least a year living in two separate apartments on two floors. When the lady died they were finally able to consolidate. I knew the whole story and happened to be visiting on the day that they got the news of the woman’s death. I am afraid that my reaction was:
“Oh good now you can settle in properly”, which is exactly what they have done.
The University of Cape Town put me up in a nearby guest house. After checking in and having a shower I went back to the reception and took a manager to my room to point out all the things that were wrong with it. These ranged from the steps into the room without a guard railing, actually quite dangerous; through to blankets on the bed – good establishments have duvets which can be washed between every guest, that doesn’t happen with blankets; a faulty shower and a number of other minor issues that were annoying. It was a rather twee establishment and they had a blackboard in the reception area with a quote on it, something like “happiness is a state of mind” and as I walked past it with the manager I pointed out that happiness only has only one ‘p’. Afterwards I thought ‘and so does pedantic’.
I then had less than two weeks in Durban before heading back to the United Kingdom and on to Washington for the international AIDS conference. It was very busy. The buzz in the office, as people prepare for the conference: writing papers, making posters, planning the stand, sending material and generally getting ready, is exciting and rewarding. HEARD will have a significant contingent and it will be great to see how they do. Probably the best part of my job is seeing people grow and develop.
I was invited to the United States Consulate General’s home, along with several hundred other people to mark the 4th July. He, sensibly, arranged parking at a primary school down the hill and had a shuttle bus taking people to the house. There was a significant police presence as the guests included the provincial premier, various members of his cabinet, the American ambassador, King Zwelithini and other dignitaries. I decided to walk back to my car. Two Metro Police driving past saw me strolling down the hill. They knew where I had been, and asked if I wanted a lift. I have not yet been in the back of a police car and did not feel this was an appropriate time to start so thanked them very much and walked on. I slightly regret this now.
I was planning to return to Norwich on Tuesday. Our university decided to migrate our e-mail system to Microsoft outlook over the weekend. On Monday and Tuesday there were to be teams going around our campus ensuring that the changeover went smoothly. It did not! My PA spent most of Monday at the walk-in center with my laptop trying to get it set up to work on the new system. On Tuesday I went down with her and we kidnapped one of the technical people and brought him back up to the offices to try and sort things out. It took nearly all day. The level of stress was considerable and I correctly made a call that it would be better to delay travel by a day and ensure that I had all the technology that I would need for the next month. It does seem to be working now.
Coming through Amsterdam I had a really pleasant surprise. I used the business class lounge shower, and emerged wearing nice fresh clothes and feeling clean to bump into Father Michael Kelly, a Jesuit priest from Lusaka. He was a really critical part of our AIDS and education work 12 years ago. Apart from being a fantastically nice and thoughtful person he is an individual who I admire and who has mentored me over the years. He is now 83 so these encounters are extremely valuable and need to be savored. We had about 45 minutes to talk before he went off to catch his plane. He is one of the unsung heroes of the fight against AIDS, a most compassionate sensible man.
The next posting will be after the Washington conference. There will be a great deal of activity on the HEARD website though – www.heard.org.za so you can follow events there.
Films and books
Warhorse. The story of a horse Joey, requisitioned at the beginning of the First World War from a farm in Devon. The son of the farm, Albert, joins up. Towards the end of the war Joey, after being captured and ‘serving’ the German forces, gets caught up in the wire in no-man’s land. He is released by a German and British soldier in moment of armistice. He is to be put down but is reunited with Albert. The children’s book is by Michael Morpurgo was first published in 1982. The film was directed by Steven Spielberg. It is a moving story and is beautifully made. It is also complex and sometimes there seemed too many subplots for me to entirely follow. The message is war is hell!
A Thousand Words. This was billed as a comedy drama starring Eddy Murphy. It is a simple tale of an literary agent who is cursed by words. It was badly reviewed, and deservedly so. However on the 23.20 flight from Johannesburg it was watchable and I saw the last 30 minutes over breakfast so did not feel it was wasted time. There are other films on the KLM flights I am looking forward to seeing.
Random Violence by Jassy MacKenzie, Umuzi, Houghton, 2008 238 pages. This is a novel set in and around Johannesburg that has been on my selves for some time. I found it, initially, very difficult to get into. However I persisted and was pleased I did. I hope that she writes more. She has the potential to develop into another good South African crime writer. The end is a bit too much ‘and with one bound he was free’ but in general it was believable, well observed and well plotted. It is set in the period leading up to the World Cup and MacKenzie catches the nation’s mood very well. The heroine is a private detective named Jade de Jong, the daughter of murdered white senior policeman, who returns to SA after 10 years away and gets caught up in a complex plot involving property development and crime.
It’s been a few months of intense traveling and presenting research for HEARD staff. I participated in various conferences commemorating the 30th anniversary since HIV and AIDS was first discovered. Below are some of the event highlights and information on forthcoming conferences I will be attending.
2011 Caribbean HIV Conference
The 2011 Caribbean HIV Conference was held in the Bahamas from 18 – 21 November. The focus this year was given to sharpening the focus on HIV in the Caribbean, the region with the world’s second highest adult HIV prevalence. As a panelist at event, I presented What is Realistic ‘Sustainability’ within the Context of a Multi-country Regional HIV Response?: A Perspective from southern Africa. This conference presentation was prepared with the support of HEARD research intern Natashya Pillay and was well received. The key points were that the Caribbean has succeeded in controlling their epidemic and should be commended for this, the price of success is continued vigilance. There is diversity between the countries. One key lesson both ways is to build on regional organisations.
Focal points of the presentation:
- An epidemiological comparison of hyper-epidemic countries in the Caribbean and sub-Saharan Africa.
- Sustainability; regional versus multi-country efforts; prevention, treatment and impact mitigation.
- Results/Good Practices
- In particular, lessons can be learnt from Swaziland, the sub-Saharan country with the highest adult HIV prevalence rate.
- Efforts need to be concretized and regional integration is a way to achieve this. It will allow HIV and AIDS efforts to be mainstreamed.
Economic Reference Group Meeting (ERG) in Washington
HEARD organised the World Bank and UNAIDS ERG in Washington on 29 and 30 November. This meeting was attended by HEARD researcher Ilaria Regondi and Professor Whiteside. The meeting looked at financing of the AIDS response and the results of the RethinkHIV project.
Guest of the School of Public Health at the University of Alberta
In late November I travelled to Edmonto and was hosted by David Zakus, who is a Professor and the Director of Global Health in the Division of Community and Occupational Medicine Engagement of the Department of Medicine at the University of Alberta.I gave four presentations consisting of two lectures presented to a class of students: Aid for AIDS and Making Hard Choices: Prevention in the Global Crisis; and two public lectures Economics and HIV in Africa: Costs and Consequences and A Safe Sex/No Sex Month: Could it work? Innovative Responses for Preventing HIV Transmission.
AIDS @30 Symposium at the Harvard School of Medical Health- 1 and 2 December
I was also invited as a participant together with other international health leaders, elected officials, scientists, artists and activists. The meeting was convened to reflect on what we have learned from AIDS and how to apply those lessons towards ending the epidemic. There were presentations from among others, Julio Frenk the former Mexican Minister of Health and currently Dean of the Harvard School of Public Health and Anthony Fauci who is the Director of the US National Institute of Allergy and Infectious Diseases. Durban academics were well represented at the event.
Health Systems Workshop at the Wellcome Trust London
This workshop will take place on the 13 and 14 December 2011. This is the UK health funders workshop on health systems research in low and middle income countries.
Swaziland has been high on my agenda for the past few weeks. I travelled there in late July before returning to Durban. There were two main reasons for my Swaziland visit. First was to meet up with my colleagues at theNational Emergency Response Council on HIV and AIDS (NERCHA), a body formed by the government in order to respond to the epidemic. I have been working with them since they were established. The second was to go to Waterford Kamhlaba School for a number of events including our mid-year Governing Council meeting.
I flew into Matsapha airport, and as usual, picked up a car. Driving through the industrial estate, I found myself behind a mini bus with five large colour photographs in the back window. Moving from left to right they were of: Che Guevara, Osama Bin Laden, Muammer Gaddafi, Robert Mugabe and Julius Malema. The last may need some introduction; he is the young firebrand leader of the African National Congress Youth League who makes frequent intemperate and irresponsible speeches. Most recently he and his comrades called for the overthrow of the Botswana government as it is “led by capitalist lackeys”. This did not go down very well in South Africa, and of course was even less appreciated in Botswana! I wonder why the driver put up those particular photographs, and in that order. It was clearly a message but it went over my head.
The visit to NERCHA was, as always, inspiring. The staff are an excellent bunch and I am proud to be associated with them. The country is facing a crisis which is the subject of two separate postings on this website. The first is a briefing that I am putting up on this website separate from my usual monthly blog and the other was co-authored with Jacqui Hadingham for the Royal African Society.
When I was in Mbabane (and this is reflected in the postings) the talk was of imminent government bankruptcy. Swaziland had asked the South African government for a E1.2 billion loan as the International Monetary Fund and the African Development Bank had turned them down. On my return to Durban the news came that the King secured an E2.4 billion loan from South Africa on quite favourable terms. He was hailed in the (government owned) media as the saviour of the nation. The Swazi opposition and some of South African unions are outraged. Quite what will happen next is not clear: it is not time to give up.
I was invited to open the student’s annual art exhibition at Waterford. It was a flattering invitation. I took it seriously and carefully prepared my brief opening remarks. There was, I hope, one key message: hard work and practice are necessary for good art. I hung the message on the example of Lucian Freud who died the previous week. His obituaries described how long it took for him to complete his portraits. The second example I gave was that some years ago I exhibited a piece of work as part of the annual ‘Member’s Exhibition’ at the KwaZulu-Natal Society Gallery. This convinced me that, as an economist, I do not have an artistic bone in my body but also good art requires good craftsmanship. I was told that my remarks were well received and appreciated.
The Governing Council meeting was long but productive. For the first time in a long time there were no major issues or crises to deal with. The school is running well. It looks as though there is more demand and then there are places and the calibre of the applicants remains high. Big issues we had to consider were at what level to put the fee and salary increases at for next year. This is always the task of the July GC meeting. There was a discussion of the economic crisis and the effect it will have on Swazi parents. The best way forward may be the creation of a ‘hardship fund’ of some description. We already give a significant number of bursaries, cannot set differentiated fees, and need to be pro active and imaginative.
Films and books
Lincoln Lawyer (2011) based on a book by Michael Connelly, this is the story of a lawyer, Mickey Haller, who works from his car in Los Angeles County. He is employed to defend a wealthy Beverly Hills playboy, Louis Roulet, accused of beating up a prostitute. Initially the lawyer believes his client was in the wrong place at the wrong time. He then sees similarities to an old case where he persuaded the client to plead guilty. Haller decides Roulet was guilty of this killing but cannot divulge this because of attorney-client confidentiality rules. He gets Roulet off on the case he is retained on, but manages to get him arrested on the earlier charge. The book is good and this film is an excellent courtroom drama that I found gripping. 8/10.
Green Hornet (2011) is what we would have called a ‘skiet and donner’ movie. Literally a ‘shoot and beat up’ film. It was not my first choice on the plane. Even given the heightened emotions of travelling, it turned out to be fun and quite thought provoking. It begins with the relationship between a boy and his wealthy father who publishes an influential paper. The son inherits the paper and, with a former employee of his father (a kung fu expert) the two join forces to fight crime. . The son Britt Reid creates a superhero persona for himself, ‘The Green Hornet’. At one level this is a simple film packed with action. On another, it looks at father son relationships; the relationship between the two young men (platonic); how one can be spoiled by having too many resources; and the role of the press. Of course the classic study of this topic is Edmund Gosse’s Father and Son, published in 1907, which was one of our set books at school. 6/10
Eat, Pray, Love (2010). Based on the runaway best seller by Elizabeth Gilbert this is the story of discontentment. Julia Roberts plays Gilbert, a young married woman with everything a modern woman could want – a husband, a house and successful career, yet, she finds herself lost, confused and searching for what she really wanted in life. She gets a divorce and travels for over a year to three destinations spending four months in each: Italy (eat), India (pray); and Bali (love). It is the story of a journey of self-discovery. I read the book some years ago and found it interesting but indulgent. The sequel Committed is more interesting but
In May 2011 I was asked by the Royal African Society (RAS)2 to prepare a short commentary on the current political situation in Swaziland. There had been an increase in attention towards the country with news of protests and economic decline. The analysis was intended to stimulate discussion on whether political reform was likely.
At the end of July, I spent a few days in the Kingdom. The primary reason was to attend a Governing Council Meeting at Waterford Kamhlaba School but I also took the opportunity to meet with a number of people outside this community. I spent time with the National Emergency Response Council on HIV/AIDS (NERCHA) and presented an update on recent events, including the IAS Pathogenesis Conference.
We were briefed on the Swazi economy; the political situation; and the rule of law. On the basis of all of these meetings, and other observations, I am reporting on the situation. It does not make happy reading. If I were in the prediction business then I would say in the next six months the crisis will reach its peak.
The economy is in dire straits and the country is bankrupt. Earlier this year, the International Monetary Fund suggested the government declare a ‘fiscal state of emergency’ and offered support subject to Swaziland following a road map of measures. This would have included laying off staff and reducing government expenditure. The government declined to do this. There was a view that the country would not meet its July 2011 salary bill but it has in fact done so. The civil service and security forces are now under pressure to take cuts in pay.
The country has seen a 60% fall in revenue, primarily because the South African Customs Union (SACU) payments have dropped (SACU members are Botswana, Lesotho, Namibia, South Africa and Swaziland). This was not a surprise. The government, international agencies, donor community and Swaziland watchers have been aware of this expected fall for many years. See for example our brief and longer article on our website. Brief at: www.heard.org.za/downloads/health-expenditure-implications-of-sacus-revenue-volatility-in-blns-countries-issue-brief.pdf.
In early August the King went to South Africa, cap in hand, asking for emergency funding. The country has received R2.4 billion. South Africa has put conditions in place for better fiscal governance (but there are few on democratization, this has caused great unhappiness among South African unions and others). This loan is a stopgap. Until such time as there is good economic governance there will no new investment in the country. At best the economy will slowly contract, with debt rising steadily.
Swaziland is the last absolute monarchy in Africa. King Mswati III seems oblivious to pressures to reform; the suffering of his people; and does not understand basic economics. Quite how the country operates politically is unclear, even to informed Swazis. It is a nepotistic, autocratic, kleptocracy where the ruling elite treat the national treasury as their own personal bank. The election system of tinkundla is Byzantine and impenetrable. Although there were constitutional reforms in 2006, political opposition remains banned. Nonetheless there are a growing number of protests and the trade unions – possibly with help from across the border – are flexing their muscles.
The Legal Situation
There is a crisis of law and the independence of the judiciary is under threat. Chief Justice Michael Ramodibedi was appointed as Chief Justice by King Mswati. He is from Lesotho and also sits on the appeal court in Botswana. He issued an order preventing anyone from “directly or indirectly” suing the King. He then suspended High Court Judge Thomas Masuku. In a case filed recently with the Judicial Service Commission, the Law Society accused Ramodibedi of sexual harassment. The Judicial Services Commission banned Swazi press from publishing details of the complaint.
There is an excellent source on Swaziland at: http://swazilandcommentary.blogspot.com.
What Does this Mean for HIV/AIDS?
Swaziland has the world’s highest HIV prevalence. In the last ante-natal clinic survey 42% of women tested were HIV-positive. The 2006 Demographic and Health Survey (DHS) found that 26% of all Swazis between 15 and 49 years were infected; among men prevalence was 20% and among women 31%. Overall HIV population prevalence was 18.8% across the nation meaning about 200 000 Swazis are infected. The response, coordinated by NERCHA, ironically is one of the country’s few success stories.
NERCHA was created through an Act of Parliament, in 2001 under the Prime Minister’s office. It is charged with coordinating and facilitating the HIV/AIDS response and implementation of the national strategic plan. Its main sources of funding are government and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, and it acts as a conduit. The second major source of funding in the country is the US government. PEPFAR provided $38 million in the 2011 financial year.
The exceptional measurable progress is that approximately 70% of those who should be on anti-retroviral therapy are receiving the drugs. This is 65 000 of 84 000 people and therapy is administered at the 350 or lower CD4 cell count level which is extremely impressive. There has been great success in the area of prevention of mother to child transmission. Approximately 97% of women visit the ante-natal clinics, and 85% of those who need drugs are started on therapy. Prevention has been slow to show results. There is a major programme of medical male circumcision with over 30 000 men circumcised in the last three years. Various other initiatives are also in place.
The lack of government money means that NERCHA’s funding is under threat. They asked for E63 million3 for the April 2011 to March 2012 financial year. They were allocated E47 million (about E4 million per month). For the four-month period ending 31 July 2011 they have only received E4 million of the E16 million allocated. There is no indication as to when, or indeed if they will get the next subvention.
Swaziland was unsuccessful in its last Global Fund bid. Globally there are concerns about US funding. The US House of Representatives Appropriations Subcommittee Bill would cut 9% from current global health funding levels and 18% from President Obama’s FY2012 budget request. It is not clear how this will operationalise in Swaziland.
The Ministry of Health is charged with implementation but government is creaking and it is unclear as to how sustainable the response will be.
As early as 1993 we were warning of the potential social and economic consequences of this epidemic for Swaziland. While it has taken longer than anticipated, the AIDS epidemic in combination with the failure of governance and economic contraction means Swaziland faces a bleak future. Ironically the glimmer of hope is in the response to HIV and AIDS where civil society is powerful and the receipt and disbursement of outside funding is efficient and honest.
1Alan Whiteside grew up in Swaziland and maintains close links with the country. He has written extensively about Swaziland, and is working on a book The Political Economy of Swaziland intended for publication in early 2012
2The RAS undertakes research, analysis and host lectures and meetings of African interest. Its website with commentary is African Arguments
3The Swazi Currency the Emalangeni (sing. Lilangeni) is on a par with the Rand, and Swaziland is in a Common Monetary area with South Africa.
Since the beginning of 2010 I have made three trips to Swaziland, twice flying in and once driving up. The reason is, primarily, that I am desperate to write my book The Political Economy of Swaziland. Although I know the country well, am a regular visitor, and try to stay in touch I need to collect data, do research and check facts.
There is also the Waterford connection as one of the trips coincided with the School Governing Council meeting. We have a new development officer in post and have great expectations going forward. Do visit the website at www.waterford.sz.
Swaziland is such a beautiful country, at the end of this summer it seems to be exceptionally green and lush. I drove from the airport to Mbabane in the late evening on my last trip. There had been rain and the sky was overcast and quite ominous. We had dodged thunderstorms en route from Johannesburg to Matsapha. There was a band of cloud halfway up the Mdimba mountains on the side of the Ezulwini valley. The contrast between the black glistening rock, the green of the grass and vegetation and the pure white of the cloud was remarkable. I wished I had a camera because words can not begin to capture the scene.
The story of Swaziland is being written slowly. I have divided the book into four key periods. The first the history up to independence in 1968; second the reign of King Sobhuza over the independent nation from 1968 to his death in 1983; then the time up to 1994, a defining moment when South Africa gained independence and Swaziland began to slip off the international radar screens; and finally the story to 2010. This last part is dominated by two themes, the change in South Africa and the inability of Swaziland to adapt to it; and the HIV/AIDS epidemic. As with many activities this book is so clear in my head, but then I sit down to write and it slips away like water between my fingers.
There are also distractions that mean I literally loose the plot. The big diversions have been the HEARD board and donor meetings and international travel. We gathered with our key donors in Durban on the 17th March and on the 18th we held the first board meeting of 2010. The good news is that the organization will continue to be funded; it seems that we will have support for the next four years. This means we can plan serious work, and I can continue to put time and resources into Swaziland, one of the themes of this letter. These meetings need a great deal of work, thought, preparation and co-ordination and are ‘core business’.
The most recent international travel involved going to British Department of International Development organized ‘High Level Meeting on HIV/AIDS’ which was held in the House of Lords. My word it was interesting, the setting alone was amazing. The Houses of Parliament must be among the most majestic gilded buildings of any national assembly anywhere in the world. The meeting was held in a committee room called ‘The Moses Room’ because of the huge painting on the back wall. This is of Moses bringing tablets of stone (the commandments) down from the mountain to the people of Israel. I suppose one could make a link between these tablets and anti-retroviral therapy – but it would be a stretch!
The purpose of the meeting was to assess how we, the global community, are doing in achieving the targets for 2010. It was attended by the core international leaders of the HIV response and I was invited to give the opening remarks and set the scene. Of course the power point presentation I had prepared was not on the projector and so I had to start without the pictures. Despite this it was a good presentation and a great meeting.
I flew from London to New York for the International AIDS Vaccine Initiative’s Policy Advisory Committee meeting and was there from Wednesday to Saturday when I was scheduled to fly back to Durban. The hotel in New York was at the end of the Island of Manhattan just off Wall Street. The weather was uniformly windy and miserably wet, so walking back to the hotel I ducked into a stationary office supply shop that had a most unlikely selection of secondhand books. One of these was called “How we die” and the details are at the end of this letter.
The highlights of New York were having dinner with Stephen Lewis and Paula Donavan of AIDS Free World (www.aidsfreeworld.org), this was really fun; and sitting at JFK Airport with no flights taking off or landing because of strong wind which was not fun. A key theme of the dinner was what is going on in Swaziland. Among Stephen’s many activities has been mobilizing grandmothers primarily in Canada to work with their African counterparts. The details of this remarkable initiative can be found on the Stephen Lewis Foundation website at http://www.stephenlewisfoundation.org . There will be a “Grandmother’s Gathering” in Swaziland in early May. One of the big questions is how to reach the political leadership in Swaziland and, specifically, the King. There is so much misuse of money that it becomes hard to argue for continued support without real changes at the top. This, importantly, does not mean change of leadership, but rather change of heart and style.
I expected to leave New York at six o’clock on Saturday and be back in Durban early on Monday having slept overnight in Johannesburg. It was a filthy day so I took the taxi to the airport well ahead of time, checked in and went to the lounge. The wind was incredibly strong, gusting across the airport, making the building shake and the luggage containers dance. There was no activity at all out on the apron. The boarding time came and went. We were informed that the airport was closed, flights were being diverted or cancelled and we just had to be patient. I know I had missed my connection and that there was nothing I could do so I just chilled out.
At ten pm that evening the flight was boarded and the captain came on the public address system and said something like: “Welcome aboard ladies and gentlemen, you all understand the reason for the delay. We have been told a lull in the wind is forecast, so we will taxi down to the end of the runway, and if it is safe we will take off. But don’t worry if it is not safe we won’t. I am afraid the wind was so strong that there has been no baggage or food loaded onto the plane. However we did bring cookies on through the front door”.
We duly taxied to the end of the runway. I could see from the windsock that the wind was blowing straight down the runway (which was good), and the lights of two other planes landing. I was reasonably confident that we would be able to leave. The crew put on full power and, after the shortest take off run, I have ever experienced we were in the air and on our way.
There was a small degree of chaos in Amsterdam, but eventually I got to the front of the queue to see what my options were. The ground staff had already booked me on a flight from Amsterdam to Cape Town the next morning, which was a rather a long way round so we looked at other routes. In the end the best option was to fly to Paris then go overnight on the Air France flight to Johannesburg. I only looked at my boarding card when I was in Paris – and then saw that I was in seat 68F. After a moment of bafflement I realized that this was the new airbus, the biggest plane in the world. I walked to the gate to look at it and it is amazingly huge! It does not feel that different inside. As I boarded I asked the steward where my seat was.
“Hang on”, he said with a delightful French accent, “I will have a look at the map”.
They are having teething problems, in the case of this flight the entertainment system did not work. Oh well what can you say. At least I got back to Durban and having been there a couple of days had the donor meeting then drove up to Swaziland with a colleagues from the SIDA team in Lusaka. Then back to Durban to welcome Rowan my daughter and her boyfriend for their ‘South African holiday’. They arrived and went to a party this evening so I headed for the cinema. The film that was on when I got there was called “It’s complicated”. With Steve Martin, Meryl Streep and Jack Baldwin. I found it both touching and though provoking.
I will in my next posting, describe going on a canopy tour , which basically meant being terrified, the pictures are on the website. They say: “The canopy tour involves traversing from one platform to another along a steel cable suspended up to 30m above the forest floor. The tour comprises seven platforms and eight slides that zig-zag down a pristine forested valley”. Nothing about the fear and horror and getting stuck!
Thirteen Moons; by William Frazier Random House 2007 432 pages
About 12 or so years ago William Frazier published his first novel called “Cold Mountain” set in the American Civil War. He has not published anything since. A couple of weeks ago I was passing though the airport in Durban and Exclusive Books had a sale on. In among the piles of books I spotted “Thirteen Moons”. It is an excellent and thought provoking book. It tells of an indentured boy who is sent to manage a trading post in the Cherokee nation. The main characters are the boy, Will Cooper; his adoptive father Bear, a Cherokee Chief; Claire with whom he has a complicated sporadic relationship, but who the wife to an aristocratic Indian called Featherstone. The love story is between Claire and Will, but there is also a deep relationship between him, Bear and in complex ways, with Featherstone.
The Cherokee Nation and indeed all the Indians in the East of the United States were forced to move to ‘beyond the Mississippi’, something I did not know and which resonates with South Africa. Will and Bear fight to keep land for the Cherokee Nation and succeed in doing so. Will ends up re-meeting with Claire at a Spa towards the end of the book and the end of his life. According to Wikapedia again the book is loosely based on the life of William Holden Thomas who was the principal chief of the eastern band of Cherokee Indians and served in the Confederate Army during the Civil War who lived from 1805 to 1893. Charles Frazier was given an advance payment of over 8 million dollars for the proposal and of its initial print run of 750 000 only half were sold so the publisher may lost money on the advance. It deserves to do better. I learnt a huge amount from the book about the United States, the removals of the Indians and was surprised to learn that it was set in North Carolina. It is clear that this part of the world had a bloody history of which I know only a small part. I find myself wondering why we are so slow to learn from experience.
Perhaps the most poignant is the way in which the book is written as an older man sitting and reliving his life. He is perceptive but desperately alone, and I have to say I found it to be most moving especially as I have aged (although I am certainly not in my 90’s, I sometimes just feel it). I wonder if this is sort of thing that my father and others went through as they moved through their lives. I hope it is more widely read, it certainly is a classic and is deeply moving.
“How We Die: Reflections of Life’s Final Chapter” by Sherwin B. Nuland (Vintage 1995, 304 pages).
Nuland examines what death means to the doctor, patient, nurse, and family. It was thought provoking and humane. He draws on his own experiences with various people close to him: the deaths of his aunt, his older brother, and a longtime patient. Disease, not death, is the real enemy. However there is not much comfort as he warns most deaths are unpleasant, and painful. It is an excellent book and certainly one we should all read. I found myself thinking of it as the South African Deputy Health Minister Sefularo died in a car accident last week. I had met him some months ago and was so impressed, what an excellent man and what a loss
I was quoted in a recent article which appeared in the Observer and published on guardian.co.uk However, the news article bears little resemblance to the headline, which I find sensational and does not reflect my views as I emphasised that AIDS spending is crucial “for those already on or requiring treatment”.