Manto 1 de Lille 0

I thought that the South African Minister of Health, Dr, Mrs Manto 'Whatsername' Tshabalala-Msimang won her tussle with the leader of the Independent Democrats on radio this past week. She vigorously defended her 'vegetable' stand at the world AIDS congress held recently in Toronto. Mrs de Lille was a usefully deferential foil for revealing an aggressive human who simply fills the airwaves with vituperation and makes any probing of her position an exercise in attrition. I think de Lille took the radio equivalent of a good Zindane headbutt every so often for daring to be out of place. I also don't think the Minister can be fired for allegedly not doing her job properly, as Minister of Health, because the impression I got from her most assertive and simultaneously evasive handling of herself in that tussle was that she was implicitly following orders.

What are these orders? Who gives the orders?

Firstly the winning Party that appointed her as Minister 'gives orders' - The Minister's Party won the last election with more than 70 % of the votes and they are doing what their mandate demands-making a better life for all, except apparently for recidivists who have contracted AIDS. In practical terms the Party applies the 'Vision thing' and she follows the broad guidelines set by the party, as implemented by her boss the President. We are regularly told this by sundry party apparatchik spokespersons who also lecture us as frequently on the role of collective responsibility as an instrument to ensure that no-body ever gets blamed for things.

This inconvenient disease [HIVAIDS] was not planned for in the Struggle manifesto and it seems it must be conveniently ignored through persuasive acts of denial, and even welcomed if it helps the Party achieve its long-term goal of making a better life for [nearly] all its followers. It is possible that this is happening but that the news is being buried in a pile of rhetoric and the government's own growing credibility problem.

In the old days before the transformation we had some 3.6 % population growth annually [in SA]: the population actually doubled over the twenty-year period '74 to '94 [which says something we shan't dwell on about the nutritional standards of the day]. At the same time the economic 'real' growth rate was less than 1 % per annum over that time [excluding allowing for inflation]. This meant that over time each citizen was becoming significantly poorer. According to fairly regular reports to this effect in the daily business press the average income earner is not as well off today as an income earner at their same level was in 1981 [in SA specifically although there are many other examples of places that have regressed economically while going allegedly going forward].

However: a STATS fellow on Perlman's morning radio show remarked recently that the population growth rate was now 1,7% [I recollect no reference to declining rates or comment he simply gave the number that jumped out of the airwaves into my awareness]. Now [assuming the STATS fellow was right] if we have a 1,7 % population growth rate and currently a 4,9 % economic growth rate [quarterly non-adjusted rate reported this week] then the whole country is getting [three percent or so] better off each year that this equation persists and the Party is effectively fulfilling its mandate, appearances notwithstanding.

In other words we are slowly clawing our way from the Poo notwithstanding the devastation caused by this disease.

3.6 to 1.7 over about fifteen years is pretty good going and usually is an indicator of an improved standard of living on a considerable enough scale to have a dramatic effect It seems that there is a trend towards fewer children per family but not enough perhaps to account for such a dramatic short-term decline in population growth.

According to ongoing press reports some two million people in SA have already died [prematurely the Treatment Action Campaign: TAC, activists argue] of AIDS related causes. One suspects that these figures are as ephemeral as the population ones and the Sowetan is publishing fewer pages of dead people every Friday. Arguably, the mounting death rate seems to reinforce the usefulness of such a dramatic decline notwithstanding the repulsive nature of its implications.

When one recollects that the philosophical underpinnings of our ruling Party's mission: to create a better life for all in our society, are rooted in the Leninist doctrine that the 'ends justify the means' then implicitly permitting a mass elimination of what may be [unfairly] called society's more superfluous citizens, is proving to be an effective growth strategy. In other words the policy seems implicitly to be 'if you can't afford your own ARV's then you should die quickly please'. Part of the disease pathology is that people die slowly though and not pleasantly.

Logically our President can't actually come out and say that that 'Thins' sickness is self- inflicted, for the most part, through negative sexual behaviour and practices. The Pres cannot actually say [can he] that if you can't afford the medicine you should practice large-scale masturbation: or suffer the consequences of your intemperate actions and die soon.

There are far too many examples of collateral damage anyway in respect of unsuspecting housewives with wandering HIV laced husbands; and blood transfusion recipients of bad contaminated blood, not to mention huge numbers of rape victims and children born afflicted. Nonetheless broadly speaking if you don't want AIDS do not have unprotected sex! Especially with multiple partners; and what is the point of having a democracy if you cant get to fuck who you want when you want how you want-Being free means having the right to foul up if you want to.

That's the problem for the Pres with being in the 'nice guy' party. To say something like what I've just suggested rather seriously dents the whole human rights culture that motivated the ruling party's thrust to power in the first place. This conflict between what is said and what is done [over a range of policy issues] is in no small part the reason why South Africa is attracting a subtly more critical global audience than it has been used to over the past decade. The President's realism is leading him into a brutal territory and creates discomfort in a world which seeks to be ever 'nicer' to everyone in general-on the basis that one never knows when the tolling bell 'tolls for thee' to mangle Hemingway.

We know from our past history that dictatorial trends always follow attempts to rationalise the irrational and the government's position on HIV/ AIDS is fundamentally irrational

However, the President is dammed if he does and dammed if he doesn't and is therefore in an invidious position. Basically an afflicted HIV positive person is doomed to die. Anti-retrovirals simply prolong the time scale to the inevitable; and so he is under intense pressure to supply them. Apparently too, the anti-retrovirals [ARV's] that are widely available are designed to treat the HIV sub-type B strain [which is where the most lucrative end of the market is] and most of Sub-Saharan Africa [including us] experiences sub type C HIV apparently; and so ARV drugs that start out problematic will become even more problematic as drug resistant strains of the virus mutate into existence, something the government apparently regards as inevitable, given our prior experience with other drugs to treat our worsening incidence of Malaria and Tuberculosis; and because part of the problem with this HIV virus is its rapid and constant mutation rate.

Simultaneously the government is deliberately failing to fund research into a medical solution, presumably because they don't want to. I have heard people argue that a change of attitude on the part of the SA Govt to treating this disease could fuel an intense inflow of foreign investment by drug companies eager to exploit our comparative advantage developed over two decades into HIV research. And we do apparently have a serious comparative advantage where it counts- developing therapeutics to prevent HIV access to the body in the first place. But such research needs money and with Government unwilling to even acknowledge that the problem really exists it is inevitable that the private sector prefers to fund other things.

Ironically, a place that was always a colonial outpost from the POV of everything from comics to football rules suddenly finds itself at the 'centre of empire' and our old habits of simply appropriating research from the colonial parent is no longer appropriate to an age where we have become the epicentre of the change. Where the change to be fought is ours alone. So in the same way that we have obfuscated building new power stations, new roads, transportation nodes, introducing competition to the telecoms sector and, and, and: we are choosing to do nothing about this pandemic but hold endless meetings to discuss more meetings about meetings yet to come. And when we do act we set up vegetable stands to demonstrate our opposition to the virus, where our sophisticated audience expects some serious power play. We are being perceived as a nation of talkers with increasingly dramatic execution issues.

Thus it would seem that the good Manto is a smokescreen. For those happy people who do not know who this intriguing person is or why her bizarre behaviour is under an 'inscrutable scroot' [a form of scrutiny-Goon Show circa 1950's] This medical doctor, Dr Manto cum brutally styled Mashonisa* type thuggish politician has a strange predilection for non-scientific medicine for someone allegedly trained as a scientist-for what is a medical doctor if not a scientist extraordinaire. [* Mashonisa: a 'heavy' used for carrying out unpleasant tasks like for instance collecting money.]

Dr Manto is accused this week in the wake of her Toronto 'veggie' exposé, of promoting vegetables and 'magic' muti as her government's palliatives to the global HIV/AIDS pandemic which is having a particularly damaging effect on her jurisdiction. Her response to Mrs de Lille's attack demonstrated a conviction that veggies and traditional muti were as good as anything yet contrived given that there is no real cure for this disease coming from anywhere at the moment, and she asserted that her roll out program for ARV's was the envy of the world.

We can deduce from the verbal exchange that Dr Manto has a three point strategy for dealing with the pandemic. Better nutrition [garlic is good for you], sangoma's [traditional doctors] expenses should be claimable on medical aid now, and anti-retrovirals are approved of and form part of the strategy for combating the effects of the so-called 'Syndrome' [HIV/aids]. There is some alleged foot-dragging over the ARV's. It was hard to see what the fuss was all about-the stand never made it to the visual media apparently, well not around here anyway, and there is seemingly a huge fuss from almost the entire planet about her veggies.

Perhaps the real truth is that this disease is currently incurable and the medicines those suffering from it demand are too expensive to take without government help. One senses that rational democrats can see a barrage of precedent based demands that could flood the health services with demands for treatments for cancer, diabetes [a pandemic in the making we heard on another Perlman debate] and others from A to Z: once the precedent of supplying drugs to combat the unwanted effects of sexual behaviour becomes de rigueur.

So the Health Minister has been set to play Lear's Fool, distracting attention from the real horror, by presenting us with a committed employee who follows orders to the point of buffoonery and who brazenly prevaricates on the subject of anti-retroviral treatment because she has to-and loudly promotes a weird combination of vegetable nutrients and traditional remedies in the forlorn hope that improving basic diet will help to alleviate the vulnerability that contributes so effectively to the disease's continued growth.

And out of all this the country is prospering, change is taking place at a remarkable rate notwithstanding a great deal of whining to the contrary-Unfortunately though, there is a potential flaw in the plan-not all those who are leaving so prematurely are superfluous persons; this is becoming particularly noticeable amongst the sub-continent's agricultural workforce, and accounts for many nurses doctors and teachers, and as many are discovering you cannot train replacements for key people fast enough to compensate for the cost of them dying-Eventually this cost has to catch up with the growth figures somehow-hopefully it will be in that 'long run' when Mr Keynes predicts that we'll all be dead anyway.

The Health Minister is an ironic eye in a tragic storm.