Tag Archives: South Africa

Ageing Mandela reminds us of importance of palliative care in Africa

This article was originally published in The South African.

Whilst wishing Mandela a full recovery we can, and indeed must, use this opportunity to talk about the importance of palliative care – a taboo across much of the world including most of Africa.

Left: A 1961 photo of Nelson Mandela (AP); Centre: Mr Mandela and his then-wife on his release from prison in 1990 (AFP); Right: Mr Mandela pictured in 2007 (AP)

In 1999 Nelson Mandela famously said, “A society that does not value its older people denies its roots and endangers its future. Let us strive to enhance their capacity to support themselves for as long as possible and, when they cannot do so anymore, to care for them.”

Ever self-effacing, Mandela would have said these words to offer support to other South Africans and indeed other Africans who needed this care. Now however, approaching his 95th birthday, it is clear that Mandela needs this support for himself.

People from across the world have come together to wish Mandela a recovery from his latest lung infection – a legacy of the tuberculosis he suffered from when he was imprisoned on Robben Island. Prayers have been said and fingers have been crossed as anxious individuals wait for next bulletin of news to come from Pretoria’s Mediclinic Heart Hospital.

As difficult as it is to say, it would appear that Nelson Mandela is moving closer to the inevitability of death that faces us all at some point.

Writing in the Independent, Jeremy Lawrence comments on Mandela’s ill health saying, “The dilemma his doctors face – when to stop “striving officiously” as the Hippocratic oath has it, and switch focus from curing to caring – is all too familiar to palliative care specialists. Recognising that the end is approaching and broaching the subject with the patient and their family demands strength and delicacy – and is often avoided.”

Whilst wishing Mandela a full recovery we can, and indeed must, use this opportunity to talk about the importance of palliative care – a taboo across much of the world including most of Africa.

Mandela’s support and care that he is receiving at Pretoria Mediclinic Heart Hospital sets him out as unusual. The vast majority of African’s do not have access to basic palliative care provision. The African Palliative Care Association summarizes the scale of the challenges when they say:

“A survey of hospice and palliative care services on the continent found that 45 per cent of African countries had no identified hospice or palliative care activity, and only nine per cent could be classified as having services approaching some measure of integration with mainstream health provision.”

The WHO estimates that about 1% of the Africa’s population requires palliative care – this is approximately 9.67 million people across the continent – approximately half a million of whom live in South Africa.

Death is never an easy thing to contemplate. This is especially true when we are talking about someone we love and above all an anti-apartheid hero such as Nelson Mandela. When the inevitable comes closer however, it is not only the patient who can benefit from effective palliative care, but also the family, friends, and loved ones.

In the case of Mandela, it is not just his friends, family and loved ones who suffer the pain of uncertainty but his nation, his continent and, it is not over-stating it to say, most of the world. As Mandela faces the challenges of illness and hospitalisation, the support he receives will not only ease his pain, but also the pain that others around the world feel.

Mandela is in hospital for the fourth time this year already. We stand united wishing him the quickest and fullest recovery possible. We know that his medical team will look out for any indication of suffering that may be physical, social, spiritual or psychological and deal with it.

It is important that palliative care providers in Africa follow this example, and integrate the needs of the aged and the ageing.

Mandela is a man who has inspired a generation. In his later years, hopefully the quality palliative care that he receives will continue to inspire people from across Africa.

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The World Cup – can it unite a divided nation?

Racial divisions within South Africa blight the country’s history.  Today however, racial apartheid is no longer the major divide within the country, its economic division.  A recent OECD report has stated that SA is on path to become one of the most unequal societies in the world. There is a section of the black population that is becoming increasingly wealthy, exaggerating the inequality statistics. 

While inequality between different ethnicities may be falling (slowly), the “intra-race” inequality within the black community is actually growing.  This, the report states, “is preventing the aggregate [inequality] measures from declining”. 

With the fall of racial apartheid in 1994, the ANC introduced a Black Economic Empowerment programme aimed at reversing the economic hierarchy.  This policy has had many critics.  White (especially working class white people) has found it very hard to get a job in a country that currently has an unemployment rate of about 25 %! Equally, it is widely acknowledged not to have benefited the majority of black South Africans. It is clear that a small minority of blacks have disproportionately benefited from the BEE policy.  It has not succeeded in its aim of re-balancing inequality. 

Although, inequality, in racial terms still underpins many of the official statistics; it is economic inequality that now blights the rainbow nation. 

The World Cup 2010 to be held across SA, is being widely held up as a unifying force for a divided nation.  The CEO of the South Africa World Cup, Danny Jordaan, has said that this tournament will represent the “most unifying moment in the country’s history” (a big claim).  Football is a universal language that does indeed bring together people from all backgrounds.  But do these claims about the “unifying” potential of the World Cup hold up to examination?

Firstly, in relation to race; it has to be noted that Football is still predominantly a black past time in SA.  Will the 5 million whites in South Africa (or the millions of other ethnicities) embrace the world cup, or will they see it as predominantly black affair? If they do embrace it, will they relate it to race relations or as a completely separate event?

Secondly, will the world cup help to reduce economic inequality? It has created a number of programmes aimed at bringing football, health and education to the wider population.  The majority of money however has been spent on new football stadiums, glitzy VIP boxes and improved infrastructure.  What percentage has been spent on the health, social development and education that were promised in the country’s bid?

SA’s only famous White Football player, Mathew Booth, warns not to put too much emphasis on sport’s ability to heal divisions.  This, he said can be only done through tackling economic inequality.

I think the World Cup will bring SA together.  Rich and poor, black and white will find great pride in their Nations successful staging of the World Cup.  Will the unity however, last longer than 90 minuets? Will the World Cup help to tackle the underlying causes of inequality within SA? I doubt it.

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Filed under Economics, Football, Politics

The African Cup of Nations in Angola and the World Cup in South Africa – there’s no comparison

I have recently read a whole series of sensationalist articles suggesting that due to the unrest and violence that has occurred during the African Cup of Nations (held in Angola), the safety of the football World Cup being held in South Africa should be questioned.  This is idiotic at best.

Angola is about 2,000km away from South Africa.  A similar distance can be found between Spain and Mali, or Greece and Iraq. Angola only gained independence from Portugal in 1975.  From there it slipped into an intense civil between the MPLA and UNITA (1975-2002).  In this time about 500,000 people were killed.  It was one of the ‘conflict theatres’ of the cold-war that lasted the longest.  This war provided one of the few significant links between South Africa and Angola; apartheid South Africa supported (along with the US) the anti-communist UNITA. 

The civil war spawned a terrible humanitarian crisis, internally displacing about a third of Angola’s population (about 4.2 million).  In 2003 the UN estimated that 80% of the population did not have access to basic medical care and 60% did not have access to safe drinking water.  The life expectancy in Angola is less than 40.

Are we completely surprised then, when the world gives a country (or terrorist movement) a media hook like the Cup of Nations that violence should ensue? The Togo football team defied organizers demands to only fly in and took a bus from neighbouring Congo.  The following attack left at least 3 people dead.  Adebayor, the ex-Arsenal Striker was left holding one of his best friends as he passed away in his hands.  This sort of attack, with its high profile football stars, filled the Western Press (see http://www.timesonline.co.uk/tol/news/world/africa/article6982463.ece).

There is no doubt, that this Cup of Nations has shown some outstanding football, but this has been over-shadowed by the politics and violence that surrounds it.  Commentators have suggested that this has set a precedent for coming competitions, including the South Africa World Cup in the summer.

This is ridiculous!  Firstly, it suggests that this is a new idea (to attack a large sporting event to gain publicity – remember the Israeli athletes at 1972 Olympics?).  In this sense South Africa is no more under threat than it was before the latest violence in Angola.  I strongly suspect, this is another example of the media exploiting Europeans ignorance of geography and politics to paint these two “southern African” nations to be similar.  They have both been through turbulent recent histories, but to suggest that they share much more than this is wrong.

South Africa became an independent republic in 1961, and the government decided to continue to legislate based on apartheid until the early 90’s.  Since then, the country’s politics have been dominated by the ANC, fist with the figurehead of Mandela, then Mbeki and now Zuma.  There is still a high rate of crime across South Africa, especially for murder and rape.  One in three women questioned in a recent survey said that they had been raped in the past year (http://news.bbc.co.uk/2/hi/africa/258446.stm).  There are clearly problems facing South Africa, especially in relation to the security issues in the run up to the World Cup; but do you:

A) Think that FIFA have not discussed this with them and are satisfied with their plans and

B) This has any connection to the violence in Angola?

What does this mean for the average footy fan?  It means you should be vigilant when travelling in South Africa.  Have a read up on the risks before you go, take sensible precautions.  Just like with every world cup, there will be a small surge in crime, especially petty.  Should you be afraid of a violent terrorist attack, I really doubt it – you are much more likely to get your wallet stolen.

This African Cup of Nations and the coming World Cup will hopefully illustrate an awkward juxtaposition between the extravagant wealth of modern football and the relative hardship faced in South Africa (and the extreme hardship faced in Angola).  Let the football be enjoyed, but let’s not forget the politics.

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Filed under Football, Human rights, Sport