Yesterday came the news: South Africa’s Beet Lady is dead.
I’ve often been surprised but have rarely been shocked; the Beet Lady managed to do it.
About five years ago in South Africa where I was attending a press conference held by Ms. Manto Tshabalala-Msimang, then Minister of Health. Glowing with confidence and assurance she told us that retroviral drugs had nothing to do with treating HIV-Aids. What people needed were good nutrition and African folk remedies. Beets, garlic, olive oil and African potatoes were among her suggestions.
One of the stunned journalists asked her whether there was any scientific evidence for the benefits of African potatoes. Minister Tshabalala-Msimang replied by saying that African folk remedies should be tested according to protocols developed by African scientists for African products, rather than by standard dreary European scientific protocols. If that happened, she confidently told us, there would be plenty of evidence for the benefits of this marvelous plant.
Now I myself have never eaten the African potato (hypoxis hemerocallidea) and have no idea what its properties may be. Herbalists speak highly of what is said to be a bitter root that is used in a number of traditional African cures. I am sure that the minister meant well and there was a germ of truth in her talk: in poor countries like South Africa, poor nutrition does have a serious effect on HIV positive people. But even then, South Africa was headed into a massive HIV epidemic; this level of ignorance and denial from its Minister of Health was, well, staggering.
It is hard for anyone, even a cabinet minister, to be 100% wrong about something, and Tshabalala-Msimang and her president Thabo Mbeki did have a substantial point to make. At the time, the various donors, government officials and activists who constitute the international anti-AIDS movement were fixed on the idea that countries like South Africa needed to focus on treating infected people with retroviral drugs in the ‘cocktails’ that had recently been found to be effective against the virus. It’s a great idea and one that is currently responsible for prolonging millions of lives in Africa alone, but it seriously complicates the work of developing public health systems in developing countries where there is essentially no medical infrastructure that can serve most of the population. Where there are no midwives, no clinics for diseases like TB, no widely available facilities to dispense basic antibiotics or treat common diseases like malaria, parasite infections and the childhood diarrhea that annually carries off uncounted numbers of children under five, it is not clear that concentrating limited resources on HIV victims is the way to save the most lives or help the most people. Resentment against well-intentioned but wrongheaded and imperious meddling from rich white people living abroad is one of the most potent political and cultural forces in today’s world; the Beet Lady was not all wrong about the shortcomings of her critics.
Moreover, the worst mistakes South Africa made in the fight against AIDS were not made by the Beet Lady; they were made by the much more urbane and sophisticated president of the country, Thabo Mbeki. Over the years I ran across President Mbeki at meetings large and small; he never failed to mention his doubts that the HIV virus was the cause of all the trouble. As time went by, he learned to phrase his concerns more cagily, but during the years in which millions of South Africans were infected with HIV, the country’s president was basically in denial. Currently something like 5.8 million South Africans are infected with HIV; the costs of treating them are a serious drag on the country’s tight budget, and even with treatment millions will die. Children will grow up as orphans; the country will lose the talents and services of some of its brightest and best educated people.
A focused effort at prevention could have nipped the South African epidemic in the bud. Countries that are poorer and on the whole worse governed than South Africa have done this; there is no reason that Mbeki’s government couldn’t have led a national effort to educate and prevent that would have saved millions of lives at a very low cost.
The world press loved the Beet Lady; she was so ignorant, so wrongheaded, but so assertive and determined that she was always good for a story. Mbeki was a more slippery but ultimately a much more destructive figure. A dignified and deeply serious man, and the chosen successor of Nelson Mandela, Mbeki was the author of the greatest human catastrophe his country has ever suffered. Many more black South Africans will die as a result of his policy choices than died in the jails of the apartheid regime. By the time it is over, the South African AIDS epidemic will rival apartheid itself as the greatest disaster ever to befall that beautiful place.
The Beet Lady wasn’t the last shock I had on that trip to South Africa. I was there for the tenth anniversary of the end of white rule, and the Foreign Minister hosted a large reception for foreign journalists and visitors on a glorious estate in the South African wine country. As I made my way through the large grounds leading up to the mansion, I almost fell over in shock and surprise: to the side of the path where the guests walked was a band of musicians in blackface playing African-American songs from the early 20th century. “Uh, what kind of band is this,” I asked the South African who was shepherding me through the event.
“Oh,” he said happily, “that’s a coon band.”
It turns out that ‘coon bands’ as they are known developed among Capetown residents of mixed race after they saw minstrel shows from the US going back into the nineteenth century. This particular coon band was performing at the reception as part of South Africa’s multicultural program of highlighting the cultural achievements of all the many racial and tribal communities who live there.
In South Africa, honoring coon bands is part of what it takes to be PC.
So culture is local; science is not. South Africa has its own protocols for determining what is culturally appropriate; a coon band would not be appropriate at one of Hillary Clinton’s garden parties, but in South Africa people would be offended if the coon bands were left out.
On the other hand, when it comes to testing AIDS remedies, South African scientists and US scientists should use the same methods.
Manto Tshabalala-Msimang died two years after receiving a liver transplant. I am glad she got such good treatment; somehow I suspect that she consulted doctors trained in those boring old European protocols when it came to her own health.