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- A Stuijt
- Retired South African medical journalist, ex-Sunday Times of Johannesburg.
One of South Africa's most celebrated Afrikaner writers has issued a damning attack on the South African political order for failing the country's citizens. Breyten Breytenbach, the poet, writer and anti-apartheid activist, has written a scathing article titled Mandela's Smile: notes on South Africa's failed revolution, in the latest edition of the US magazine, Harpers.http://www.harpers.org/archive/2008/12/0082308
Breytenbach now divides his time between New York, where he teaches creative writing at New York University, and the Goree Institute in Senegal.A reviewer of the article said that Breytenbach cites "the relentless, mindless violence, nepotism and corruption that prevail here as sources both of South Africa's shame and of Breytenbach's incendiary call to quit the country".
Breytenbach was born in Bonnievale, about 180km outside of Cape Town, and his work includes the book, The True Confessions of an Albino Terrorist, in which he describes aspects of his imprisonment by the apartheid state. Even though his brother Jan Breytenbach, headed up the country's anti-terrorism unit before 1994, Afrikaners are not overly fond of the poet - many view him as a sellout of his nation.
More houses were built for the poor under apartheid than now...
In a subsequent radio interview, listen here Real Audio Stream: Breytenbach charged:
- "Critical institutions have practically imploded under our national health system, to some extent our educational system, certainly our security system. It is claimed that even under apartheid more houses were built for the poor than has been built by the new government ... a lot of it must be brought to the door of responsibility of those in power within the ANC. There's been a very rapid promotion and enrichment, quite obscenely so, of a small number of senior cadres."
He said the transition to democracy could be rightly described as a "boardroom revolution", to the exclusion of the poor he told Democracy Now.
"Rural areas are war zones..."
Breytenbach was appalled by South Africa's crime rate. "The situation is that we have an average of 55 murders a day. We probably have something like 150 women being raped. We have, in vast parts of the country in urban areas, what are in effect being considered as war zones. With organised hijacking, with police repression."
My bitter advice would be to go...
The Harper's article is accessible to subscribers only, but news reports on the internet quote Breytenbach suggesting:
- "If a young South African were to ask me whether he or she should stay or leave, my bitter advice would be to go. For the foreseeable future now, if you want to live your life to the full, and with some satisfaction and usefulness, and you can stand the loss - then go!"
This article was originally published on page 5 of The Cape Argus on December 17, 2008
Breyten Breytenbach, South African poet, writer, painter and outspoken activist against injustice. He divides his time between New York University, where he teaches creative writing, and the Goree Institute in Senegal, West Africa.
Transcript of radio interview Dec 16 2008
AMY GOODMAN: Breyten Breytenbach is the exiled South African poet, writer, painter, outspoken activist for justice. Born to an Afrikaner or a white South African family in 1939, he moved to Paris in the early ’60s, became deeply involved with the anti-apartheid movement. He married a French woman of Vietnamese descent and faced the prospect of being arrested if he returned to South Africa because of laws banning interracial marriage.
After a brief visit in 1973, Breyten Breytenbach founded an anti-apartheid group with other exiled white South Africans. In 1975, he returned secretly to South Africa under a false passport. He was arrested, charged with terrorism, imprisoned for more than seven years. One of his most famous books was based on his experience in prison, called The True Confessions of an Albino Terrorist.
Today, Breyten Breytenbach divides his time between the Goree Institute in Senegal and New York University, where he teaches creative writing. He’s the author of dozens of books of poetry, essays, and has won numerous prizes and worldwide recognition for his writing and painting. His latest book is called All One Horse, and his most recent essay is published in the December issue of Harper’s Magazine. It’s an open letter to Nelson Mandela called “Mandela’s Smile.”
Breyten Breytenbach joins us here for the rest of the hour. Welcome to Democracy Now!BREYTEN BREYTENBACH: Thank you. AMY GOODMAN: It’s good to have you with us. BREYTEN BREYTENBACH: It’s good to be here with you. You have got a great program.
AMY GOODMAN: Thank you. Going back in time to 1975, you weren’t just caught. Your group was infiltrated, right? They knew, when were in France. The minute you got that visa—
BREYTEN BREYTENBACH: That’s right.AMY GOODMAN: —they followed you.
BREYTEN BREYTENBACH: That’s right. We were probably infiltrated. We were also working, as many other organizations in those years, from abroad in connection with a large underground supporting organization, which was probably also infiltrated, based in France called Solidarité. So, you know, we were in contact with people from Brazil, from Mozambique, from Angola, from the Middle East, from many parts of the world where there were liberation struggles going on. And I suppose counterintelligence or intelligence agencies from all of these various countries had an interest in trying to understand what we were trying to do. So it was no surprise that we were infiltrated. I was caught after about two weeks in the country, yes.
AMY GOODMAN: And that’s when they jailed you on charges of…?
BREYTEN BREYTENBACH: Well, that’s when they—as happens under those circumstances, there was a preliminary period, quite extended, about six months, of interrogation, and then taken to trial. And then, quite a few other people were arrested with me. These were essentially people from the National Union of South African Students, people that I had been working with and we had been working with before, another few close friends of mine. We were about twenty-one people who were arrested at the time. I was the only one who ultimately was charged and sentenced to nine years for terrorism.
AMY GOODMAN: Your brother, at the same time, Jan—
BREYTEN BREYTENBACH: That’s right.
AMY GOODMAN: —was head of the South African Special Forces?
BREYTEN BREYTENBACH: Mm-hmm. Yes, he was the founder of a well-known infamous battalion called 32 Battalion, also known as the Buffalos, made up of remnants of various Angolan opposition movements and who worked with UNITA for the South African forces behind the lines, behind the lines of contact in Angola, later on in Namibia and in various other parts of southern Africa. He was also the commander of the Special Forces, called the Recces in South Africa, and one paratroop battalion. So, yes, he has a very long and, I suppose, illustrious career as the most decorated soldier in the history of South African armed forces, wounded seventeen times.
And this may be a surprise, but we are very close. In fact, I invited him last year to Goree, where we had quite a wonderful workshop last year, August, looking back at fifty years of African independence and twenty years since the South African changes took place. The concept was the notion of ethics in governance in Africa. And as a military expert, as a man of experience, together with people from other parts of the continent, he contributed, and I was very, very interested, listening to what he had to say.
AMY GOODMAN: So, here you were in jail, in the apartheid jail.BREYTEN BREYTENBACH: Mm-hmm.
AMY GOODMAN: He is the apartheid enforcer.BREYTEN BREYTENBACH: Mm-hmm.AMY GOODMAN: Did you communicate during that time?
BREYTEN BREYTENBACH: No, no, not at all. He came to visit me once when I was in prison. We’ve always had—he’s my oldest brother. We’ve always had a close family relationship despite our political differences. And he jokingly said to me, “Do you want me to take you out of here? I can have you sprung from jail immediately.”
He was the only member of my family who ever had the possibility—it was only that one time—to actually have a contact visit with me. In other words, we were in the same room, the way we are now. It was never allowed, neither for my parents nor for my wife or any other family member.
I think that probably—I’m not sure that he ever at any point intervened on my behalf. I think he lived by his own code of conduct, by his own commitment and his own ethic. But I do think that the fact of him being such a respected person in those circles probably had the effect of protecting me to a certain degree. I know that probably some of the interrogation officers didn’t go as far as actually physically waterboarding me or doing any one of these extraordinary interrogation techniques that are now being practiced in so many parts of the world.
AMY GOODMAN: Were you beaten?
BREYTEN BREYTENBACH: No, I was never beaten. I had a lot of psychological torture, I suppose one would call it. I was in isolation. I was, in fact, for the first two years of my incarceration after being sentenced, I was kept in very strict isolation. AMY GOODMAN: How do you survive isolation? What do you do?
BREYTEN BREYTENBACH: Well, you know, I was not that young when I went in, and I was lucky. I had had a very active internal life, as well, as a writer and as a painter. I think one talks to oneself, and one imagines a lot of things to yourself. I’ve written about this. I think, after a while, the shadows on the wall become as intriguing as a painting by Rembrandt or Breugel. The bird sounds that one hears maybe from time to time nearly could be read or could be heard as sonnets. I think that had a lot to do with it.
I do think that one loses sense of oneself. It’s a kind of a prolonged process of questioning and reevaluating the sense of oneself, the I, the person, and perhaps recognizing that it is futile to hang on to a certain number of concepts one had about oneself and to let go. In other words, one is trying to build some kind of a freedom that cannot be attained by those who keep you in prison. But it is not something that I would encourage. I think if you’re going to do that, rather go into a monastery.
AMY GOODMAN: What was it like for you? I mean, you were released when then? From ’75, ’82?
BREYTEN BREYTENBACH: Mm-hmm.
AMY GOODMAN: Mandela, still in prison at Robben Island. When he was released, where were you? And how you came to know him?
BREYTEN BREYTENBACH: Actually—well, of course, I knew of Mandela, you know, as all of us. We were very much involved in campaigns to try and have him freed all those years. When I went back in 1973, for instance, one of the missions I had was to meet with his wife, with Winnie Mandela, who was then under house arrest. It was one of those bad, bad movie scenes where you meet on a street corner and she’s disguised as somebody working as a servant in a house, and I can’t remember what I was disguised as. I had to—I transmitted some money to her from abroad. So I felt an affinity and a closeness to the Mandela clan and to the Mandela family and, of course, as a fellow prisoner.
In fact, the first time I had contact, although it was not direct, was I was working in the general stores in a prison called Pollsmoor in Cape Town, and he was brought back from the island on his way to another prison inland, and he had to be issued with new clothes. I was involved in doing that. I had to prepare his clothes for him. And I remember how furious the warders were at any notion that he may be getting privileged treatment. You know, as they were saying, he’s a—using a very pejorative term, racist term, “He’s a black like everybody else. Why should he be treated differently?” And when he came, when he actually arrived the day in that particular prison complex—
AMY GOODMAN: In Pollsmoor? BREYTEN BREYTENBACH: In Pollsmoor—the security officer, a man called Rouge, also very red-faced, walked into my cell, threw his cap on my bed and said, very angry, “I suppose you’re happy now.” I said, “Why?” He said, “Well, your boss is here.” So I knew that he had arrived in prison.
When he was released, we were actually in the country, and it was such a moment of absolute elation, such a moment of, you know, profound—it’s not easy, I think, to describe to people that, after all those many years, when that particular man, Nelson Mandela, came to incarnate, embody the dream of freedom and the dream of justice and to see that man walking out—he was an old man already—and walking out holding his fist in the air with dignity and with courage and already, as he walked out, in control of not only himself in his immediate environment, but of the situation. He was taken to Cape Town, and he made a speech from the balcony of the city hall, which was—which, of course, was again another powerful movement. AMY GOODMAN: So he was held for twenty-seven years. In 1973, when they caught him—
BREYTEN BREYTENBACH: Yes.
AMY GOODMAN: —wasn’t the information given of his whereabouts by the US CIA, handed over to the South African authorities?
BREYTEN BREYTENBACH: There’s always been very, very close collaboration between the United States intelligence agencies and, of course, diplomatic services and the apartheid regime. I remember in the—would have been at the end of the 1980s, when I was here in this country for the first time for a PEN international conference, meeting with a man called Elliott Abrams in the offices of The New Republic at that time, and we had a flaming argument about South African policies. At that time, they were promoting something called constructive engagement, I think. And, of course, my brother’s own adventures in Angola, he’d be able to tell you the extent of CIA and American support they had. Whether Mandela was actually shocked by CIA information, I’m not sure.
AMY GOODMAN: So he comes out of prison on February 11th, 1990, a moment all in South Africa and around the world will never forget. And what then—how is the plan laid out for a new South Africa? The election, the multiracial, multiparty election doesn’t take place for another four years.
BREYTEN BREYTENBACH: Yes, yes. AMY GOODMAN: We talked to Desmond Tutu. Desmond Tutu came in the other day, the South African archbishop. He voted for the first time in 1994 at the age of sixty-three.
BREYTEN BREYTENBACH: It was also the first time I voted, in a South African election, at least. In the meantime, I had obtained French citizenship, so I had voted in France, but it was the first time I voted in my country of origin.
I think part of the problems that we see at the moment in South Africa probably can be traced back to that period and to that process. Mandela had probably been—well, not probably. We know that he had been not negotiating, but he had been having talks with South African authorities for quite a while. The contact between Mandela and the people with him in prison, his closest comrades, people like Walter Sisulu and Govan Mbeki and others and the outside wing of the ANC and the outside underground of the ANC, was a very difficult thing. So one had the coming about of a de facto three components of the African National Congress, what we call the “insiles”, or the prison people, the leaders, the historic leaders, the internal underground that was grouped under an umbrella organization called the United Democratic Front, led by people like Desmond Tutu and Boesak and others, and, of course, the exile organization, which was the official African National Congress, led by Oliver Tambo.
And I think that although there probably was certainly a—we all believed in the same objectives, the way of going about it and perhaps even to some extent the ultimate goals of what this struggle was for was not necessarily shared by everybody. I think Mandela and the people around him, and certainly with the agreement of all the senior people in the ANC, decided that the situation could only be negotiated to work towards a national government or a government of national coalition, which is how we had for the first few years even de Klerk and some of his national party ministers, who were the architects and the defenders of apartheid in the new liberation government. When de Klerk and the others then left, and Mandela was, after a while—when he resigned as—or at least when he came to the end of his first mandate and Thabo Mbeki took over, I think there was a new turn in the history of South Africa.
I think the breakup we see at the moment within the ANC, for instance, is partly—can partly be understood in terms of, I would say, nearly to some extent, competing traditions. The internal wing was really the people who were responsible for bringing the party to an end. The outside ANC was far more of an ideological organization and probably far more attuned to international affairs and to international alliances. The fact of the demise of the Soviet Union around about the time, at the beginning of the ’80s, when the ANC came to power, probably accounts to some extent for a strategic choice that was made that we’re getting to rue now. The strategic choice was to some extent the abandonment of the Freedom Charter, which was essentially a socialist document, and opting for a free market economic system, so as to be able to secure the interests, the financial interests, and the investments of the South African governing class, economic class and, of course, of the outside community. I remember the South African ambassador in Washington telling me that when our people came up in his first period, the State Department and the Treasury people would insist that they wear ties and they don’t talk to—they don’t address one another as “comrade.” This is no longer allowed.
AMY GOODMAN: Breyten Breytenbach, we have to break. When we come back, I want to talk about this very critical letter you have written to Nelson Mandela, his piece called “Mandela’s Smile,” and then a piece you’re working on now talking about Mandela and Obama. Breyten Breytenbach is our guest for the rest of the hour. Stay with us.
AMY GOODMAN: Our guest for the hour, Breyten Breytenbach, the South African poet, writer, anti-apartheid activist, dividing his time between here in New York at New York University, where he teaches creative writing, and at Goree Institute in Senegal.
You mention in your article in Harper’s former South African president and anti-apartheid leader, Nelson Mandela, turning ninety this July. More than 50,000 people attended a star-studded concert in late June to honor Nelson Mandela.
NELSON MANDELA: Even as we celebrate, let us remind ourselves that our work is far from complete. Where there is poverty and sickness, including AIDS, where human beings are being oppressed, there is more work to be done. Our work is for freedom for all.
AMY GOODMAN: Nelson Mandela at the ninetieth anniversary birthday—ninetieth birthday party. Breyten Breytenbach, he says our work is far from done. Your piece in Harper’s magazine called "Mandela’s Smile: Notes on South Africa’s Failed Revolution,” a letter to Mandela in his ninetieth year.
BREYTEN BREYTENBACH: Well, it’s perhaps a harsh way of saying the same thing. The traditional wisdom has always been, within the liberation movement, that there’s probably a two-face process that needs to happen. One is national liberation, in other words, doing away with apartheid and moving towards a dispensation where the majority of the people can participate in all of the processes that impact on their lives, political, social, cultural, economic.
And the second one, the second phase that would perhaps—one could describe to a more hardcore inner circle within the African National Congress was that we would have to move towards a socialist—revolution is perhaps too provocative a word. People tend to get goose bumps when you use the word “revolution.” But what I mean by that is a profound restructuring of the power and of the economic system in a country. You know that at the moment the gap between rich and poor is bigger; it’s larger than it was under apartheid.
AMY GOODMAN: In South Africa.
BREYTEN BREYTENBACH: In South Africa. In South Africa, critical institutions have practically imploded: our national health system, to some extent our educational system, certainly our security system. It is claimed that even under apartheid more houses were built for the poor than has been built by the new government.
Now, a lot of that—a lot of that one can explain and one can take—one can contextualize because of the very difficult national conditions that they came to power in, the international situation. But a lot of it is also, I think—must be brought to the door of responsibility of those in power within ANC. There’s been a very rapid promotion and enrichment, quite obscenely so, of a very small number of senior cadres. It’s sometimes called a boardroom revolution. It’s a very intelligent and, I suppose, natural way for the for the very rich international enterprises in South Africa—and the national ones, of course, too—to obtain credibility by incorporating, by co-opting black faces or brown faces or Indian faces at a boardroom level and paying them extraordinary amounts of money to do so. The fact that we’ve opted for, as I said earlier on, at a time of coming to power in ’92, from ’92, ’94, for going for the free market system and subjecting ourselves to all of that, which is of course—was under external pressure. Even now, the recent South African ambassador to Washington, Barbara Masekela, will tell you that the American Treasury has a right to walk in whenever they want to into South Africa and tell people what they should be doing in terms of economic policy. So, of course, they work in—
AMY GOODMAN: Was that said critically, or…?
BREYTEN BREYTENBACH: It was critically, yes. It’s critically. But my criticism would be directed at my own people, at our own people. I don’t think we should have expected any different.
South Africa is a very rich country. It’s also a country which has a very crude capitalist system. It’s been very profitable to many people, both nationally or minority nationally and to, of course, the international community, as well. We knew that this was going to be the case. We know what the policies, international policies, in Africa are, more or less. It’s quite crude. It has to do with security, and it has to do with access to natural resources.
And, by the way, I don’t think, unfortunately, the new American administration is going to be any different. I don’t see any signs of that coming out at all.AMY GOODMAN: What do you mean?
AMERICA IN AFRICA IS NOT ABOUT VALUES...
BREYTEN BREYTENBACH: I mean that America in Africa is not about values. It’s about American interests as they’re interpreted by—in a very narrow way by people in power here. It has to do with imagining that unless Africa is being left to the untender mercies of those in power, the dictators in power, you will have a resurgent or you’ll have a coming about of Islamist extremism. As somebody said, as I read in a document, everything that is not defined or everything that’s open is potentially dangerous. An empty space on a map, which Africa is largely, particularly to the north, is potentially dangerous, it is thought by people in this country. And I think that the security concern is going to be a priority and, of course, access to oil and access to diamonds and access to precious wood and everything that comes out of the Congo. And South Africa fits within this pattern, so I don’t think we should have expected any different.
Where we can and we know—historically, ethically, morally, politically—we could have expected different is the power, is the courage of our leaders within the African National Congress, and the other political parties, as well, to cover, to root for ourselves, within a context. We were powerful enough to do so. We had the legitimacy. We had the history. After all, we’re talking of the ANC, which was founded more than a hundred years ago, and it’s gone through decades of intense and powerful struggle, where it was the vehicle for creating a new national identity with a new ethic underpinning.
And then, when we come to the moment when we actually get to that power, I can quite understand why we needed to have a transitory period of preventing civil war from happening, of neutralizing the South African armed forces, of having something like the Truth and Reconciliation Commission that would serve as a kind of a mechanism to pacify the people and to avoid extremes from taking place, extreme action. But that we should have strategically fallen into lockstep with the North, or with the Western world, when it comes to economic policies and, to some extent, when it comes to political policies, as well, I find that utterly unacceptable.
I’m not holding Mandela responsible for that. I don’t think that was—I don’t think at the time when he came to power he had the leeway or perhaps even internally the power to make it different. I think that, strangely enough, Mandela, perhaps because he’s such an adulated figure and because he had become such an emblematic symbol, the real political power, in terms of his own party and in terms probably of the country, was leached from him. And I’m somewhat concerned that maybe something similar may be happening to Obama, that—of course, we’re talking of vastly different moments in history, but it seems to me very interesting and very intriguing parallels between these two men. I sometimes—
AMY GOODMAN: That there’s tremendous opportunity actually for change, but they’re not going that road.
BREYTEN BREYTENBACH: These are two people, first of all, in their personal histories, who have obviously had to work very deeply upon themselves. Mandela says that his major political work was done upon himself while he was in prison all those years. How to move from, say a nationalist leader to a national leader, how to move from a historical revenge to reconciliation, to nation-building, these were not easy things. And I think, in some ways, it has to do with constructing one’s own identity. It has to do with constructing one’s own ethical guidelines. And I think this is what Mandela did, and I think this is what Obama has done also.
But they come to power carried on a huge wave of popular expectation. You know, what I find painful at the moment, it seems to me, but, of course, one doesn’t know, because these things are very—it’s a very early stage—it’s that it seems to be a kind of a discarding of what this national mandate actually means that brought Obama to power here. When one sees the way the new administration is being constructed, it seems like Washington is just continuing the way it always has and that he will be locked in or spun in a particular web of people who probably may even be very, very concerned, may even be very honest and very serious, but do have vastly different interests from the people who put him in power, who voted for him.
And I think this happened to some extent with Mandela, as well. It is nearly as if having achieved that kind of historical, emblematic capacity of being able to bring such vastly different components of a society together then somehow seems to incapacitate you to be able to carry further that which really historically needs to be done.AMY GOODMAN: You describe very graphically the violence in South Africa today.BREYTEN BREYTENBACH: Yes.
55 murders a day, 150 rapes a day...
AMY GOODMAN: We live in a very insulated world in the United States, even as the most powerful country on earth. Can you tell us what you see on the streets? What is the situation?
BREYTEN BREYTENBACH: Well, the situation is that we having, on average, fifty-five murders a day, and we probably have something like 150 women being raped. We have, in vast parts of the country, in urban areas, what can in effect be considered as war zones, with organized hijacking, with police repression.
You know, we’ve done away with capital punishment, which is, I think, something that everybody in South Africa is extremely proud of, although if it were to be put to the national vote, I’m sure the majority of people would want it to come back, as probably all over the world. I do think it was an act of political courage, as happened in France also in 1981, by the way, when Mitterrand came to power. And I’m very glad that we did so. But it’s being replaced by people being executed on the street.
And in the failed revolution, via the bitter frustration of thwarted expectations of the vast majority of the people of the country, when they are as poor as they were before, or even poorer, adding to that a huge influx of people from other parts of the continent, the so-called “amakwerekwere,” which is a horrible word—it means those who speak like birds, languages we don’t understand. And you probably have seen over the last year the ethnic — the internal ethnic violence within the African communities, foreign Africans being chased and being beaten up and their properties being burned, etc.
We have a state of lawlessness. We have an implosion of the security services. We do not have political leadership coming from the minister of security or from the African National Congress, not really so.
AMY GOODMAN: Breyten Breytenbach, we have to wrap up here. But I want to ask if we could have you back next week, before you leave, to finish this conversation.
BREYTEN BREYTENBACH: OK.
AMY GOODMAN: I think it’s a very important one. Breyten Breytenbach, South African poet, writer, painter, outspoken anti-apartheid activist and activist for justice in this country.
XDR-TB Spread the Story. Stop the Disease. -
Dec 17 2008 - Like other forms of TB, XDR-TB is spread through the air. When a person with infectious TB coughs, sneezes, talks or spits, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected. And the world-wide infection rate now has reached the highest level of extremely-drug-resistant TB in the entire modern history of medicine. The world's health services believed they had brought TV under control with the magic combination of antibiotics and a 100-year-old vaccine - however TB is rearing its ugly head again, in a much more lethal form which is resistant to a huge range of drugs which were always effective in the past. In South Africa the combination of AIDS with extremely-drug-resistant Tuberculosis was first identified in 2002, and has since then caused the deaths of at least 4-million people. Western countries have however not yet awakened to the fact that their populations are equally endangered. http://www.telegraaf.nl/binnenland/2815245/__Meer_tbc-patienten_dan_gedacht__.html
Mankind is clearly losing its fight against XDR-TB. And most of these millions of patients live in South East Asia and South Africa. Moreover, the vaccine which has always been so effective in preventing mass-TB epidemics over the past 100 years, has now become totally ineffective against it. New vaccines are urgently needed - and a much faster way must be found urgently to diagnose it in time, before the patients die of it. Without treatment, infected people die of it within four weeks. This was said in the latest issue of The Lancet by top Indian TB experts Dr Mandeep Jassal and Prof William R Bishai (email email@example.com )
WHAT IS XDR-TB? Video - Voice of America:http://www.youtube.com/watch?v=INdBNgOc5ls
"Extensively drug-resistant (XDR) tuberculosis has now soared to the highest number of cases ever recorded worldwide,' the two TB-experts wrote in The Lancet on December 16, 2008.
Definition: "Extremely-drug resistant tuberculosis," they write, ' is a disease caused by Mycobacterium tuberculosis with resistance to the drugs isoniazid and rifampicin, any fluoroquinolone, and at least one of three injectable second-line drugs (amikacin, capreomycin, or kanamycin). This definition is important when diagnosing TB-patients, as 'it would 'allow more uniform surveillance," they said.
Ten years ago, it still looked as if mankind was finally beginning to win its centuries-old war against tuberculosis with the help of a powerful range of antibiotics and an excellent vaccine. Worldwide many specialist-TB hospitals even closed their doors because the number of patients had dropped so dramatically, including in South Africa before 1994.
Highest XDR-TB rate ever recorded
However, Dr Jassal and Prof Bishai warned in The Lancet this week, "recent surveillance data have indicated that the prevalence of tuberculosis drug resistance has risen to the highest rate ever recorded."
So what has gone wrong in mankind's fight against TB?
The most dangerous aspect about XDR-TB - besides its airborne ability to infect people rapidly - is the fact that it takes so long to diagnose. By the time XDR-TB is diagnosed several weeks have passed. If this patient is not isolated during that time, they can and do infect many others around them.
"The gold standard for drug-susceptibility testing has been the agar-proportion method; however, this technique requires several weeks for results to be determined,' they warned.
That's why it's so very difficult to combat the epidemic everywhere -- and the most urgent need felt by the medical community is to develop more sensitive and specific diagnostic tests, but these are still unavailable in poorer countries.
However, XDR-TB is a fast killer everywhere, not only in poorer countries with poor health-care systems, they warned:
- "Clinical manifestations, although variable in different settings and among different strains, have in general shown that XDR tuberculosis is associated with greater morbidity and mortality than non-XDR tuberculosis."
The financial burden on any community with a large number of XDR-TB patients also is very heavy: it requires from 18 to 24 weeks in isolated wards, which also is a tremendous hardship for both the patients and their families. And many health-care workers also rebel against having to work with XDR-TB patients, also because the disease, especially when combined with HIV-infection, often causes a high level of mental instability in its sufferers.
- Moreover, the very countries where XDR-TB is endemic (such as southern Africa) also have serious weaknesses in their national health-care models, they write.
So how does this cold, clinical summary in The Lancet translate itself into real life - especially for the health-care workers and families who have to deal with this dangerously-infectious disease combination every day in South Africa -- which has the largest infection rate in the world? They even have their own name for it there: Turbo-Aids, because HIV+ patients often die within two weeks of contracting XDR-TB.
According to the medical aid agency Medisins Sans Frontieres, South Africa has an estimated 8-million people carrying the AIDS-virus- and 67 % of them (5,4-million) are also co-infected with extremely-drug resistant TB They base this assessment on their own findings from their work at the country's only combined TB+AIDS clinicat Khayelitsha, Western Cape.
SUPER-TB KILLER-TIME BOMB: BUT IS ANYBODY LISTENING? ask desperate SA health workers...
Picture: Treatment Action Campaign On august 5, 2008, South African health workers raised an alarm about the growing XDR-TB crisis at a seminar, announcing that the two combined epidemics of XDR-TB and AIDS epidemic are posing a growing threat to workers -- and infecting them rapidly.
This combined super-TB+AIDS epidemic is now soaring out of control throughout the Southern African region, which due to its unstable governance, also has very high migration patterns in and out of South Africa. This is the way XDR-TB is now spreading very rapidly throughout southern Africa.
Even the once so efficient South African health-care system - which still remains the best in the entire sub-Saharan region -- is now cracking under the strain. Many health-care workers warn that they are becoming far too terrified to work with the increasingly aggressive Turbo-TB-patients - who even deliberately cough on health workers to infect them, out of pure spite and anger.
In South Africa, XDR-TB has become an airborne killer-epidemic which is at large in all the main-stream communities of South Africa, rich and poor -- not just inside hospitals and clinics. It now has also started killing healthy people within just a month -- in the country where, by the way, the FIFA world football cup 2010 tournaments are going to be held, which will bring some 350,000 visitors to the country from across the world.
Yet most of the international health-care and aid-agencies still deal with the AIDS epidemic and the XDR-TB epidemic in South Africa as two stand-alone diseases except for Doctors without Borders, which runs a combined TB-AIDS clinic in the giant township of Khayelitsha near Cape Town. In South Africa, these doctors warn, AIDS has created a mutated form of XDR-Tuberculosis which kills within a month - many patients already have died by the time laboratories can diagnose it as XDR-TB.
There's no vaccine against this form of TB - contrary to what travellers to South Africa are being told. It is nearly untreatable with present-day drugs. And because it takes so long to diagnose, the patients often get the wrong TB-drugs until they die. Video - Voice of America:http://www.youtube.com/watch?v=INdBNgOc5ls
WILL THE WC2010 SPREAD TURBO-TB ALL OVER THE WORLD?
How much longer can the world 's tourism- and sports-bodies still go on ignoring this growing international health threat - with hundreds of thousands of international soccer fans expected to travel there for the FIFA World Cup in 2010 in South Africa?
Journalist Anso Thom reported in the Cape Times in July 2008 that 'an explosive situation is developing at all of South Africa's hospitals and health clinics'.
The hospitals' doctors, nurses, kitchen employees, drivers and laundry-workers dealing with this rapidly-growing army of (increasingly angry) patients are also rapidly being infected with super-tuberculosis, they warned at the seminar in August. Many colleagues are dying -- within just a month of infection with extremely-drug-resistant tuberculosis from their patients -- mainly because the health authorities are completely ignoring the need for countrywide infection control.
Due to the present political turmoil which has left the country 's leadership in limbo and indecisive, at least two provincial health departments - the Eastern Cape and North West provinces -already are so badly managed that they are nearly defunct - leaving thousands of underequipped, underfunded health workers out in the cold, combating a rapidly-spreading killer-epidemic all on their own. A full 40% of the country's public-health jobs are open.
140 TB patients all trying to deliberately cough on you at the same time...
One counsellor working in the Eastern Cape described the situation at the TB hospitals as 'out of control.'
- "We see patients deliberately trying to infect health workers when they become angry at being locked up to prevent them from spreading the infection," she said. "And when things get out of hand and you sit with them to hear their grievances, you have 140 patients all deliberately coughing their bacillae all over you at the same time."
A bus driver transporting patients was infected with TB, a chief nurse died of MDR-TB, five staffers treating 16,000 prisoners were infected, 100 staffers at one KZN hospital got TB;
These were only some of the frightening tales told by delegates at a 'skills' session presented by the SA HIV Clinicians Society at the national TB conference in Durban . Worried nurses, bus drivers, and laundry and kitchen staff said that they were becoming very frightened of dealing with these patients, as their colleagues and family members were being killed at a huge rate by the killer-lung-infection contracted through their jobs.
- In South Africa, most of the XDR-TB deaths occur among people with the AIDS-virus. However many people also are dying from it who are HIV-negative.
- Natalie Beylis of the National Health Laboratory Services, said that two of the 54 people who died when extensively drug-resistant (XDR) TB was first identified at Tugela Ferry, KwaZulu-Natal in October 2006 were health workers.
Chief nurse died of Super-TB: but staff get no masks...
A health worker employed at an HIV clinic at one of Johannesburg's large hospitals said it had taken her two months to get the hospital managers to buy a box of masks after the chief nurse (who was HIV-NEGATIVE) was infected with MDR TB and died very quickly.
16.000 prison inmates gave five staffers MDR-TB
A doctor from Chris Hani Baragwanath Hospital said five staff members treating more than 16,000 inmates at a nearby prison had become infected over the past two years, two now suffer multiple-drug-resistant Tuberculosis, which can be treated with only two available drugs.
'TB-vaccine is useless'
- XDR-TB has no cure nor an effective vaccine at all -- and even people who have been vaccinated with the only available TB vaccine, die from super-TB. This once so effective vaccine - which brought Tuberculosis under control all over the world, now is becoming practically useless.
100 staffers infected in KwaZulu-Natal
Another doctor from a hospital in rural KwaZulu-Natal said 100 staff members, including nurses, laundry workers, kitchen workers and cleaners, had contracted TB since 2000.
'Super-TB patients sit in the rear of the bus - that's the only infection control...'
Another doctor from this hospital said 200 MDR TB patients were sent every month to the King George Hospital in Durban on an overnight bus. "They are transported in the same bus as patients going to see other specialists at the tertiary hospitals, including HIV-positive patients," the doctor said.
- "The best infection control we could put in place was to put the MDR patients at the back of the bus."We are really sitting on a time bomb. We know about it, but we need to ask whether anyone is listening out there.
"We need to put infection control more firmly on the agenda. We are the ones getting infected, but I remind myself every day not to think about it too much or I wouldn't be able to continue with my job."
Health nurses are often HIV-positive already...
A nurse working at an MDR centre in the Eastern Cape said it was becoming increasingly difficult to recruit staff. "Health workers are often HIV-positive and there is no way you can expose them to the risk," she said.
- Police often have to be called in to protect doctors assessing whether Super-TB patients could go home, the counsellor said.
All the health workers complain that countrywide, infection control measures 'poor or totally absent'. Often, where ventilation systems or UV lights had been installed, these were out of order or inadequate.
TB is just ignored:
"I find it laughable that when we have one meningococcal meningitis case then there is an uproar," a doctor said. The patient is placed in a side room and prophylaxis is given to everyone who comes into contact with the patient, but TB is just ignored." Delegates have called for the conference to take a strong stand on the urgent need for infection controls. Also read:
- Health- Is South Africa riding its health-care train to total collapse?
- Environment- Polluted SA waterways cause socio-economic collapse
- Health: SA kids get high on free AIDS-drugs-
- Health- South Africans dying much younger, getting much sicker since 1994
- Cholera- SA cholera does not come from Zimbabwe
SA doctor cleared for showing AIDS as cause of death on death-certificate
April 8 2008 - Dr Wagner, former chief pathologist of the Free State and Solidarity trade union member, was cleared of any wrongdoing by the South African Health Professions Council (SAHPC) for showing AIDS as a cause of death on a death-certificate, for which he had been arrested.
World Health Organisation XDR-TB info: http://www.who.int/tb/challenges/xdr/en/index.html
Overworked doctors can't contain Super-TB in Humansdorp -- health officials warn Humansdorp district hospital manager Johan Wiggill warns that 'things were becoming totally untenable for the hospital, there are only three doctors left who have to work an average 120-hour week. The mobile TB-clinic treating hundreds of rural patients hasn't been out in the field to distribute medication since June 2008 as some 50% of the nursing posts were vacant. And the East-Cape health department which arranges new appointments hasn't answered its telephones for weeks.
Medicines Sans Frontieres Khayelitsha:
Recent report by Fergus Walsh of BBC-TV: http://news.bbc.co.uk/player/nol/newsid_7260000/newsid_7268200/7268204.stm?bw=nb&mp=wm&news=1&nol_storyid=7268204&bbcws=1
Super-TB in SA - could it become a worldwide health threat? News summaries: