Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Read online

  “Thousands flocked to the clinics from all over the southeast,” writes the historian Terence Ranger, “until the movement of people took on some of the dimensions of a mass pilgrimage.” People spoke of “these wonderful injections” that within four days could have the desperately ill “literally dancing with joy.”

  IT IS ONE thing to troll the history books for talk of white doctors and needles, and quite another to put episodes in their requisite contexts. In November 1918, when the Spanish Influenza was felling the young and the healthy, and people spoke of the long needle of the white man coming to inject more harm, Pondoland had just commemorated the twenty-fourth anniversary of its formal annexation. Its people were under few illusions that their relationship with colonial power could amount to much more than mutual plunder. There is thus not much mystery in the fact that a little-known white technology was greeted with extreme caution.

  The fear of Hermann Reuter’s needle came eighty-five years later. He was employed by a nongovernmental organization that had entered a formal partnership with a freshly elected democratic government, one which the people of Pondoland had voted for and identified with en masse. The context could hardly have been more different.

  These questions beg: If South Africa’s government had felt unequivocal about ARV treatment and had rallied behind it, what would Sizwe have thought of Hermann’s needle? Would people have asked in quiet tones whether their government was killing them? Or would Mpondos have pointed out that elements of Western technology have always been benign, that ever since their first encounters with the West, they have picked and chosen among tools ranging from the plow to paracetamol? Would Hermann have been viewed as the agent of a benign, and black, adoption of a helpful technology?

  It is unlikely that things would have worked quite so simply. The fears kindled by an epidemic as great as this one cannot be made to vanish entirely by the talk of political leaders. When the young are being decimated, no technology can be stripped of all meaning and made simply benign.

  But as things stood, Hermann and his needle came to Pondoland at a time when President Thabo Mbeki had left an air of besiegement across South Africa’s body politic. Whether because he could not stomach the notion that he had inherited a country that was sick, or because he believed that those defining the terms and causes of the epidemic were hostile to Africans, Mbeki read calls for universal AIDS treatment as an attack on South Africa’s sovereignty and as harmful to its people. While he himself always spoke opaquely about AIDS and antiretroviral medicine, the more vocal of his supporters in provincial ANC centers such as Eastern Cape cloaked ARVs in an ambience of antipatriotic mischief; they had been brought to our shores by people bent on hurting and profiteering from Africans.

  In the same week Sizwe and I visited Nomvalo, I had dinner with a local government councilor in Lusikisiki. He was an elderly man, a local ANC veteran, and a fierce Mbeki supporter. It was a warm evening, and we stood in his garden barbecuing steaks, sausages, and mealies, and then ate under the starlight.

  We spoke about my work in Lusikisiki.

  “I don’t trust these ARVs because they are not ours,” the old man declared authoritatively toward the end of our meal. He picked up a mealie cob that had been lying on the plate in front of him. “This is ours. If a clever African scientist made an AIDS remedy out of this, I would trust it.”

  “But mealies are no more African than antiretrovirals,” I replied. “Five generations ago, your forebears farmed sorghum. Foreigners brought mealies. You started to use them because they were more productive than sorghum and required less labor to farm. You borrowed something foreign because it was useful, and soon it became yours. It should be the same with ARVs.”

  “You are just trying to be clever,” he snapped, waving the mealie cob dismissively. “What I am saying is that one must be very careful before accepting the offerings of others.”

  Perhaps I was trying to be clever, but I was momentarily offended by the belligerent nativism of a man who otherwise seemed wise and reasonable. And I was pretty certain that he would not have waved a mealie cob at me if Mbeki had not read the AIDS epidemic as an attack on him and his country’s independence. Mbeki did not fabricate the old man’s paranoia, but he did draw it to the surface of South Africa’s political culture.

  About the fear of AIDS needles in Nomvalo and Ithanga I am less certain. The councilor who fed me barbecued mealies was literate, middle class, and immersed in the politics of the provincial elite. Ithanga is only obliquely connected to this world. Without television or newspapers, the village receives its politics third or fourth hand, through this individual and that public service announcement. By the time national debates arrive in such places, they have been translated into a thoroughly local register.

  Ithanga’s and Nomvalo’s forebears had, episodically at any rate, feared the needles of white doctors for at least four generations. That is an inheritance bequeathed to today’s villagers. Whether that inheritance was teased back to life by the political choices of an incumbent president I cannot say for sure.

  LATE IN MY research, Hermann finally offered me his perspective on the fear of his needle. Scheduled to leave Lusikisiki in a few months, he was slowly working the place out of his system, his thoughts and his emotional investments as much in the future as in the present. His sixteen-hour days had long passed. It was July 2006, World Cup soccer time, and on some evenings he would join his housemates in front of the TV. He had recently discovered the pleasures of roasting fresh Ethiopian coffee beans in a pan on his stove; the beans snapped one after the other like popcorn while he told me his story.

  As was his custom, he began by circling my question. He spoke of an episode he had witnessed on an evening some thirteen years earlier. At the time he was working in an emergency room in a large township on Johannesburg’s East Rand, a region in Greater Johannesburg that is home to more than two million people. The year was 1993. The ANC had been unbanned three years earlier, negotiations to end apartheid were at a fragile, short-tempered moment, and few South Africans were confident that the protagonists would reach a settlement. On the East Rand, a conflict akin to civil war was in progress. Zulu-speaking residents of the East Rand’s migrant worker hostels, aligned to the Zulu nationalist Inkatha Freedom Party, had fought a series of violent battles against ANC-aligned residents in the surrounding townships. Many had lost their lives. The entire country sensed that if the transition to democracy were indeed to fall apart, the unraveling would begin in the East Rand.

  At the height of the war, Hermann attended an ANC-aligned meeting in a packed community hall at the very heart of the conflict. Two issues dominated the agenda: the question of armed self-defense, and an ongoing consumer boycott of white-owned businesses.

  On the first matter, the meeting was agreed that arms must be distributed to members of civic associations and trade unions so that communities could be defended from attack. The discussion was cogent and sober. It was argued that if weapons were to circulate, they must be put in the hands of workers, who are disciplined and responsible, rather than youth, who are liable to drink and get out of control.

  The discussion turned to the consumer boycott. Across the country at that time, consumer boycotts of white-owned businesses in the town centers were enforced by the young. Youths would assemble at township taxi ranks waiting for the taxis that brought commuters home from central business districts and white suburbs. They would search the parcels of each commuter for groceries. Among the more unsettling stories that began to spread at the time were those of young men forcing middle-aged women to drink the cooking oil they had bought in town.

  At the meeting Hermann attended, a question was raised about how to dispose of the groceries the youths confiscated.

  “One person suggested that the food be given to an old-age home in KwaThema,” Hermann told me. “Others said no, it is not safe to do that because the whites may inject this food with poison in order to kill our old people.
r />   “That was for me such a weird logic. If whites can inject this food with poison, why wouldn’t they give it to the young people? Why only now during this special crisis, and only for the old people? All the people in that hall who had had such a good discussion about armed self-defense were buying the idea that it was not safe. They used to buy that food at white shops every day and eat it. But now because there is a consumer boycott and they are taking groceries away from people, the enemy will do something malicious to this food to kill the poor old people who will eat it. It was a weird, weird logic for me.

  “A few years later, a story circulated in South Africa. You know those oranges that look like they have blood inside, the ones with the red juice? I think they are called blood oranges. The story went round that those oranges have had HIV injected into them and that if you eat them you will get HIV.

  “Again, there is a half-truth. It is always when stories mix that they become much more credible. During the time of the international boycott of South African goods in the 1980s, those Outspan oranges were exported to Europe and antiapartheid activists used to pour blood over them in the shops so that people would not buy them. I’m sure that there’s a connection between the two stories. Back in the ’80s, those oranges were seen as the epitome of apartheid: you had to fight the oranges to fight the regime. And now, a decade later, the story had turned around: these oranges were being used by white people to fight back…You know all these things have racial undertones always. It was just amazing for me, these stories.

  “So this business when it started happening in Lusikisiki with me was no surprise for me, no surprise at all.

  “You must also think of it medically. When I am investigating a patient, for me as a doctor, I know exactly the sequence and what it means to me. I ask questions to gain information. Then I examine the patient, make a diagnosis, and give treatment. That is how I have been trained, that is what I have known my whole life.

  “The patient doesn’t understand that. For the patient the talking is important. It is not about how to understand the problem. It is counseling. The touching is not examining, it is massaging. For most patients, touch is, you know, from small, when you cough, your mother rubs you. They perceive touching as treating.

  “A woman will come to me with an STI [sexually transmitted infection], and I do an internal vaginal examination, and she comes back two weeks later.

  “I ask, ‘Is the discharge better?’

  “And she says, ‘Yes doctor, since you cleaned it.’

  “I say, ‘When did I clean it?’

  “She says, ‘When you wiped it with your fingers. You wiped it and made it better.’

  “So me making the diagnosis, I think the patient is interpreting it in the same way. Actually, the patient is interpreting it in an entirely different way.

  “It is the same with an injection. An injection is considered treatment. You prick something. Pricking is introducing, it is not taking out. This idea of taking blood out to test it, it is not easily understood.

  “These are difficult concepts. It doesn’t surprise me that people see HIV…Hermann comes to Lusikisiki. Nobody has HIV. He tells the nurses to prick and suddenly everybody has HIV. Where does the HIV come from? It comes from the pricking. It doesn’t surprise me.”

  “Especially if you are white and no black leaders here are talking about it,” I said.

  “That probably contributes. I cannot explain to people what I do. I cannot defend myself. And they know I’m doing something against government. There are obviously a lot of questions.”

  “When did you stop hearing about the HIV in your needle?” I asked.

  “It was isolated pockets. Bodweni, some other clinics. It can spread anywhere. Other doctors have been accused.”

  “I have heard about it all over Lusikisiki.”

  “It is the story that spreads. It’s not happening everywhere. I wasn’t challenged about it everywhere.”

  “What was your response when you were challenged?”

  “In Bodweni I showed how the HIV test worked. I pricked myself. I showed them. I tried to explain to them. I gave quite a scientific explanation. I treated the people who tested positive, and people saw I have skills that need to be respected; people who were so sick they had nothing to lose except…what is that Marxist word?” He giggles dryly. “Their chains. They were saying, I am going to die anyway: let’s trust this doctor.”

  IN THE END, it was during a conversation with Sizwe that I learned my most memorable lesson about white doctors and black bodies. The conversation was neither about needles nor AIDS; it was about his grandfather’s skull.

  Driving into Ithanga one morning with Sizwe, I took my eyes off the road for a moment to get a CD out of its case. When I looked up, we were heading for the roadside; I veered straight again.

  “Sorry,” I said.

  “You are going to kill us,” he replied calmly. “Maybe the evil spirits are with us. Even this morning in town, there was a taxi that nearly hit us.”

  “It’s just that I was concentrating on the CD,” I said.

  He cocked his head and peered out at me from between two thick dreadlocks.

  “You don’t believe in evil spirits.”

  “No.”

  “So when we are talking about these spirits, you believe we might be stupid or something?”

  The tone of his question was disarmingly earnest; it was as if he had asked me whether I thought it might rain.

  “No,” I said. “I believe that there is anger and envy, and that they cause people to do terrible things to each other. But I don’t think you can use magic to do it. What you say is magic, I say is envy. It is powerful and destructive. It can cause enormous damage. But I don’t think you can make someone go mad just because you want them to.

  “Do you think I am stupid for not believing in magic?” I asked.

  “No,” he replied. “I don’t think you are stupid. Because it is not in your culture. I have never heard of people going to a white person far away to get the right medicines. We know that the Indians are good with medicines. And the Bushmen can use the medicines very well. We know about foreigners from other parts of Africa: they can use medicines. But not the whites.”

  “Do you not think, then,” I asked, “that there is a problem in white culture?”

  “No. There is no problem. It is just different.”

  He said nothing for some time; he appeared to be giving thought to a difficult formulation.

  “The problem,” he said finally, “is that sometimes we forget that we are different. We do many of your things now, and we are forgetting about a lot of our own things. We believe in the things that are being done by you. We are losing our culture.

  “You can see why. My father wanted to keep me at home when I was young because that is how it was in the Mpondo culture. For him, education was not about going to school: it was about teaching the children the culture. But my mom and others saw that our culture was making us poor. She wanted us to learn to read and write. You follow the one who is educated because you see that he is doing so well. And that is good. But maybe you follow too much, or in the wrong way. You follow, you follow, and then you remain with nothing.

  “Not so long ago, our ancestors spoke to the sangomas. They warned the family if there was trouble coming; they said you must do this and this to avoid trouble. Today, the sangomas still tell you to do this and this, but the ancestors have not spoken to them.”

  “The ancestors no longer come because people are losing touch with their culture?”

  “Yes. I am thinking of the funeral services, and the things that have changed. In olden times, if a person dies today, tomorrow you go out and tell the relatives from far away. On the second day, the relatives travel to your place. And then on the third day, the person is buried.

  “Now, we take the person to the mortuary. He lies there for two weeks, even three weeks. They keep him on ice. He comes back to be buried without his brain or
his intestines. They have taken those parts out at the mortuary to stop him from going rotten.”

  “They take out your brain at the mortuary?” I asked incredulously.

  “You don’t know this?” He laughed uncomfortably. “We have a belief that if you go there, you come back without your brain, without your intestine, because these things make you rotten, even if you are on ice. In the stomach, for instance, is food, and it takes a long time for the cold of the ice to reach the stomach and make it stiff. So they take them out, and the brain as well.”

  “What are the implications?”

  “We believe the spirit does not come back now. The spirit is left there, with the brain and the intestine.”

  “They will never become your ancestors?”

  “Yes. There are no ancestors now because their spirits are lost.”

  “And that is because of Western influence?”

  “There were no coffins in the old days. In the old days, a rich man was buried in the skin of a cow. He chose the cow himself before he died. He instructed his children to slaughter it and to bury him in the skin. A poor person was buried in a blanket.”

  During the time I had spent with the Magadlas, they had spoken a great deal about Sizwe’s paternal grandfather, Vuyani. I thought of him immediately.

  “When your grandfather died,” I asked, “did he go to the mortuary?”

  “Yes.”

  “Do you think his spirit is not here?”

  “He might be here because he once came to see me. And there are many people who have said he came to them and talked to them.”

  “When did he come to you?”

  “It was quite a few years ago. I had a girlfriend in a village a far distance from Ithanga. I have a cousin in that village. My girlfriend and I always arranged to meet at my cousin’s place. I arrived, and she was not there. I was told she had another boyfriend, and she was with him. I waited and waited, and I started getting so furious. I stayed at that place right through the next day, and she came the next night. I was so angry with her. I slept there with her, but it was horrible. We were not talking: the one sleeping facing this way, the other one the other way.