by Amanda Alexander
“You do realize there’s no plan. The government has no plan for us,” one Treatment Action Campaign activist told others who marched with him towards Pietermaritzburg parliament last Thursday. How quickly the tedium of delivering a memorandum gives way to devastation when there is doubt whether the official standing before you, or even the people she works for, has the information you need.
As part of TAC’s “Right to Know” campaign, 1200 activists marched through Pietermaritzburg’s sweltering heat, demanding a timetable and targets for the government’s promised ARV rollout. TAC was battling the Minister of Health in Pretoria High Court once again, and crowds across the nation – in Cape Town, Bisho, Nelspruit and Polokwane – echoed with rage and frustration. Momentum has been building around their demands since February when TAC first asked the government to release information that could potentially prolong millions of lives.
In Pietermaritzburg, where colorful umbrellas blocked out the sun and placards became shields against the sky, the afternoon’s action was in every way a march about survival. As Gugu Mpungose read out the memo to the chairperson of the Health Portfolio Committee, Lydia Johnson, people searched for shade and water.
As Mpungose explained, TAC has been demanding for months that the government release a document called Annexure A, a detailed schedule for ARV treatment delivery. TAC has been in and out of court, bearing rising legal costs, only to discover two months ago that Annexure A was only a draft document, never adopted by Cabinet or the team tasked with drafting the operational plan. TAC activists and healthcare practitioners now doubt whether an operational plan with timetables exists at all.
Faced with the state of healthcare here in KwaZulu-Natal, it is not difficult to understand why many people consider the government to have given up on them. 88 percent of the province’s population relies on state health, and clinic queues are interminably long, with one public sector doctor per 4362 people. With the highest HIV rate in the country at 37.5 percent, the situation is disastrous. ARV delivery only highlights and intensifies existing problems with the dispensing of chronic medicines (diabetes patients, for example, have long suffered difficulties in trying to access their medicines month in, month out).
It is estimated that only 900 people are on ARV treatment in KZN, drastically below the original target of getting treatment to 25000 people in the province by March 2004. After it failed to meet its first benchmark last year, the only way that the government has managed not to break its promises is by not making any.
When it comes to the healthcare system and drug delivery, says one KZN health practitioner affiliated with TAC, the drain is clogged somewhere. The pipes are groaning, already bursting out at the seams, and TAC wants to know the government’s proposed strategy for making medicines flow. However, the restless energy of last week’s march suggests that – should the government not deliver a plan, followed very shortly thereafter by ARVs for all who need them – people in urgent need of drugs will not hesitate to unclog the system through sheer pressure.
With threads of uncertainty running through the Pietermaritzburg crowd, it felt ridiculously well-mannered and crushingly optimistic to place so much faith in the Health Minister to respect the “right to know”. When the ANC government’s foot-dragging around the ARV rollout is placed within the context of water cut-offs and university mergers, evictions and the dismal failure of land reform, it’s clear that it has little respect for the lives of the poor, black majority. Now that over 1.5 million South Africans have died from AIDS-related illnesses with government complicity, including 33-year-old Zandile Mazwane who died on 4 October and in whose honor TAC activists marched that day, the government would seem to have very little authority on the matter of respect.
One of the march’s organizers observed that it was not just the heat that caused restless energy to shoot out in all directions. Last year’s civil disobedience campaign was perhaps more in stride with the needs and desires of KZN activists. At that moment, the campaign had embodied the crisis point that HIV/AIDS has reached in millions of South African households. The crisis hasn’t gone away, and some activists are ready to make their increasingly privatized crises a very public concern. At least for the treatment access struggle in KZN, TAC – should it choose not to rise to the challenge – may become the least of the government’s worries. People who march through sweltering heat to demand their right to lifesaving information, if denied that information, may not bat an eye at taking over some official’s air-conditioned office or a clinic waiting room and refusing to leave without initiating ARV treatment.
When the march came full circle to Market Square, no one was ready to climb into the buses and head back to Durban. In scattered shade, we danced, sang, for over an hour we passed the loud speaker around, leading vigorous chants, trying our voices at giggling solo numbers, giving shout-outs to those who put all of themselves into making the action what it was, to those who came from the furthest away, and to comrades lost in recent months who had marched, organized, spoken, sang, strategized, reflected, toyi toyied, nursed, raised resources, lobbied, listened – who had done everything they could but wait for the government’s treatment plan.
For many TAC activists, particularly women I’ve spoken with, being part of the campaign has changed the way they live. It seems only natural that such vitality will lead to new, uncontainable heights of struggle. Until the knots in the healthcare system are worked out – by the government’s design or ours – hundreds of people will continue to die each day in KwaZulu-Natal alone. Let Thursday’s march reveal that KZN activists are quickly gaining the most influential form of knowledge there is: that of their own power.
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