When I’m not reading, I am a disease ecologist. I study disease transmission across landscapes transformed by human activities, and have learned that diseases emerge and spread quickly where people overuse resources and modify natural systems. Tropical ecosystems are very fragile and when resource demands result in deforestation and other large-scale changes in landscapes, microbes begin to flourish. Sadly, the areas that are most impacted by these intense demands on natural resources are also the regions where many impoverished people live in high densities without access to sanitation. The result is a high incidence of disease among people with little or no access to quality medical care. The most frustrating part of this story is that it is driven by the material “wants” of the wealthy. People living in these ecosystems often do not “own” the land or have any say about resource extraction. The nutritional demands of large populations leads to overgrazing on small, marginalized parcels of land. Without excessive resource extraction driven by the wants of the wealthy, tropical ecosystems could provide the necessary resources for the people living there. Intact ecosystems also mitigate the impacts of diseases that currently emerge at disastrous rates. So in a sense, consumption by the wealthy dictates the economic and health outcomes of the poor (if you will allow my possible oversimplification). So even if you disagree with my generalization, perhaps I can persuade you that consumers could reverse the trend of degraded ecosystems by buying less or at least buying used?
I’ve been teaching these types of lessons for quite a while now. When I read Cry The Beloved Country by Alan Paton, I understood this on a much larger scale. Of course, this book is not about disease transmission, but it is a book about the unintended consequences of consumption (greed). It is a book about South Africa before apartheid, but after the devastating consequences of colonization and forced slavery.
Paton starts the book with a description of rural South Africa:
“There is a lovely road that runs from Ixopo into the hills. These hills are grass covered and rolling, and they are lovely beyond any singing of it. … Where you stand, the grass is rich and matted, you cannot see the soil.”
It sounds lovely, but the land that is intact is not for the Africans, it is the land farmed by the Europeans. The Africans were marginalized into smaller parcels…described by Paton:
“But the rich green hills break down. They fall to the valley below, and falling change their nature. For they grow red and bare; they cannot hold the rain and mist, and the streams are dry in the kloofs. Too many cattle feed upon the grass, and too many fires have burned it.”
South Africa has a long and complex history that is characterized by violence and marginalization of the very diverse indigenous people groups of the region. Following the Dutch colonization in 1652, the British arrived and took over the Cape in 1795. Gold was discovered in 1866, and African Independence was lost in the 1880s, and the British and the Boers (Dutch Farmers) began to impose taxes on the Africans. The taxes had the result of forcing Africans to the mines. There were hunt taxes (just to hunt and additional taxation of all animals killed), poll taxes, and labor taxes (this was waived if Africans could prove that they worked for 3-months/year). Work at the mines provided the income to pay taxes, and this also solved the problem of cheap labor in the mines1. Every mine had an associated hostel where men lived in very cramped conditions (up to 16/room)2. These conditions were perfect to facilitate the spread of tuberculosis (Mycobacterium tuberculosis). Mines had poor ventilation and silica dust, which increases susceptibility to TB because it damages the miners’ lungs, and the very cramped conditions in the hostels resulted in very rapid transmission among the miners. Finally, when the miners returned home they took TB with them back to their villages3. The legacy of TB remains. South African miners have an incidence of TB at 3000-7000 cases / 100,000 people (non-miners have an incidence of 981/100,000 and the global incidence of TB is 128/100,000)4.
The legacy of TB is intricately tied to the story of HIV in South Africa. In fact, TB and HIV are a co-epidemic, and the result of both diseases together is much worse than either disease alone4. The Labor migration system (hostels at mines, and subsequent return of miners to their villages) has facilitated the rapid spread of HIV. The sex trade flourished at the mines and workers were infected, on average, within 18 months2. Miners returned home with both HIV and TB.
When a person has both HIV and TB they are at risk of a faster progression of TB disease and a faster progression towards AIDS5. When a person inhales the bacilli of M. tuberculosis, their immune response sends macrophages (white blood cells) to fight the bacilli collecting in the alveoli (sacs in the lungs where oxygen is exchanged). If the person is HIV+, their macrophages are defective5 – thus the response isn’t as effective as it would be in a healthy individual and this person is at risk of a fast progression of TB disease because the infection isn’t effectively contained. In fact, the risk of TB disease is 20-30x higher for an HIV+ person5. Likewise, people with TB disease are much more vulnerable to a rapid progression of HIV because the immune response to TB weakens the part of the immune system that would be attacked by HIV5.
Paton’s Cry, The Beloved Country describes the unintended consequences of Dutch and English colonization, land grabs and resource extraction – but this may not be what most people take away from the book. As I read the book, the story of HIV and TB in South Africa was all I could think of. I’m sure that this isn’t what Paton had in mind. He tells the story of two men and their sons – lives that come together in a tragic way (the death of one son at the hands of the other). The guilt of the murderer is not disputed – but you come away from the book wondering how the social and political atmosphere brought these 4 men to this tragic end. The man who was murdered was an activist for change in South Africa… as I read “his words”, I was taken right into the mines and the story of HIV/TB:
“What we did when we came to South Africa was permissible. It was permissible to develop our great resources with the aid of what labour we could find. It was permissible to use unskilled men for unskilled work. But it is not permissible to keep men unskilled for the sake of unskilled work.”
It is especially tragic that keeping unskilled men unskilled for the sake of inexpensive labor has led to so many deaths from HIV and TB! In the story, when the father reads these words written by his recently slain son, it is as if they meet for the first time. His response is to build relationships – relationships with the Africans living on his land, including the father of the man who murdered his son. Reconciliation through personal relationships becomes an impetus to work towards restoration of the land – neighbors loving neighbors through caring for the land that they share.
References:
1: http://www.sahistory.org.za/archive/all-glitters-glitter-gold-emilia-potenza
2: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524552/
3: http://www.aidsmap.com/South-African-gold-mines-a-TB-factory-activist-claims/page/1439030/
4: http://www.ifrc.org/en/what-we-do/health/diseases/tuberculosis/the-link-between-tuberculosis-and-hiv/
5: http://hivinsite.ucsf.edu/InSite?page=kb-05-01-06#S4X
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