On the questions of African belief, science, and medicine in contemporary South Africa, see Adam Ashforth, Witchcraft, Violence and Democracy in the New South Africa (Chicago: University of Chicago Press, 2005); Ashforth, “An Epidemic of Witchcraft? The Implications of AIDS for the Post-Apartheid State,” African Studies 61, no. 1 (2002): 121–43. See also Isak Niehaus, “Witchcraft and the New South Africa: From colonial superstition to postcolonial reality?” in Henrietta Moore and Todd Sanders, eds., Magical Interpretations, Material Realities: Modernity, Witchcraft and the Occult in Postcolonial Africa (London: Routledge, 2001). On traditional medicine and AIDS, a special edition of the journal Social Dynamics, 32, no. 2 (2005), edited by Nicoli Nattrass, is devoted to the subject.
Two extraordinary studies of Zulu traditional medicine are Harriet Ngubane, Body and Mind in Zulu Medicine (London: Academic Press, 1977); and Axel-Ivar Berglund, Zulu Thought-Patterns and Symbolism (London: Hurst, 1976). On the status and the use of traditional medicine in a postcolonial context I learned much from Murray Last’s essay, “The Importance of Knowing About Not Knowing: Observations from Hausaland,” in Steven Feierman and John M. Janzen, eds., The Social Basis of Health and Healing in Africa (Berkeley: University of California Press, 1992), pp. 393–406.
On Christian Zionism and its conceptions of health and healing, mentioned so often in this book but never adequately explored, see Bengt Sundkler’s classic study, Bantu Prophets in South Africa (London: Lutterworth, 1948).
This book is set in Lusikisiki, once the capital of Eastern Pondoland, the last of the Eastern Cape’s independent African polities to surrender to the British. Pondoland’s best historian is William Beinart. See his book The Political Economy of Pondoland 1860–1930 (Cambridge, U.K.: Cambridge University Press, 1982). Beinart has also written a thought-provoking essay on youth socialization in Pondoland: “The Origins of the Indlavini: Male Associations and Migrant Labour in the Transkei,” in Andrew Spiegel and Patrick McAllister, eds., Tradition and Transition in South Africa: Festschrift for Philip and Iona Mayer (Johannesburg: Witwatersrand University Press, 1991), pp. 103–28. For some of Beinart’s other work on Pondoland, see Beinart, “Pig Killings, Contagion and Purification in South Africa,” paper prepared for Conference on Culture and Consciousness in Southern and Central Africa, Manchester, U.K., 1986; Beinart, “Worker consciousness, ethnic particularism and nationalism: The experiences of a South African migrant, 1930–1960,” in Shula Marks and Stanley Trapido, The Politics of Race, Class and Nationalism in Twentieth Century South Africa (London: Longman, 1987), pp. 286–309; Beinart, “Transkeian Smallholders and Agrarian Reform,” Journal of Southern African Studies 11, no. 2 (1992): 178–99; Beinart, “Environmental Origins of the Pondoland Revolt,” in Stephen Dovers, Ruth Edgecombe, and Bill Guest, eds., South Africa’s Environmental History: Cases and Comparisons (Cape Town: David Philip, 2002), pp. 76–89.
For a brilliant ethnography of Pondoland in the early 1930s, see Monica Hunter, Reaction to Conquest: Effects of Contact with Europeans on the Pondo of South Africa (London: Oxford University Press, 1961), first published in 1936. Hunter also wrote two seminal essays on Pondoland, the first on women, the second on witchcraft. See Hunter, “The Effects of Contact with Europeans on the Status of Pondo Women,” Africa 6 (1933): 259–76; and Monica Hunter Wilson, “Witch-Beliefs and Social Structure,” in Max Marwick, ed., Witchcraft and Sorcery, 2nd edition (Harmondsworth: Penguin, 1982), pp. 276–85.
Dunbar T. Moodie’s book, Going for Gold: Men, Mines and Migration (Berkeley: University of California Press; Johannesburg: Witwatersrand University Press, 1994), contains a magisterial account of the masculine identities of Mpondo men that formed in the nexus between the gold mines and rural homestead economies of Pondoland; the book is something of an elegy to Buyisile’s generation.
For a remarkable study of Mpondo engagement with the politics and power of Western technology in the 1920s, see the chapter on Pondoland in Helen Bradford, A Taste of Freedom: The ICU in Rural South Africa, 1924–1930 (Johannesburg: Ravan Press, 1987).
For a study of livelihood strategies in two Lusikisiki villages very similar to Ithanga, see Flora Hadju, “Relying on Jobs instead of the Environment? Patterns of Local Securities in the Rural Eastern Cape, South Africa,” Social Dynamics 31, no. 1 (2005): 235–60. See also Hadju’s doctoral thesis, “Local Worlds: Rural Livelihood Strategies in Eastern Cape, South Africa,” University of Linköping, 2006.
For Médecins Sans Frontières’s own accounts of its Lusikisiki project, see Médecins Sans Frontières, “Achieving and Sustaining Universal Access to Antiretrovirals in Rural Areas: The primary healthcare approach to HIV services,” October 2006, at http://www.msf.be/fr/pdf/lusikisiki_final_report.pdf; and “Siyaphila La Programme—Lusikisiki, Eastern Cape: Implementing HIV/AIDS services including ART on a rural resource-poor setting, Activity Report 2003-2004,” at www.epi.uct.ac.za/ideufiles/Lusikisiki2004.pdf.
For a journalist’s early assessment of the project, see Belinda Beresford, “Pioneering Treatment Access in a Rural Area of South Africa,” Development Update 5, no. 3 (2005): 277–91.
I fear that I have written far too superficially and too coldly in this book about nurses. For an incisive account of nursing in South Africa before 1990, see Shula Marks, Divided Sisterhood: Race, Class and Gender in the South African Nursing Profession (New York: St. Martin’s Press, 1994). Marks and others have also written of the pioneering, midcentury project of preventative social medicine established by Sidney and Emily Kark in the old province of Natal. The Karks’ work was something of a spiritual precursor to MSF’s Lusikisiki project and stands as testimony to the health-care system that South Africa might have built in the second half of the twentieth century. See Shula Marks and Neil Andersson, “Industrialization, Rural Health and the 1944 National Health Services Commission in South Africa,” in Feierman and Janzen, eds., The Social Basis of Health and Healing in Africa, pp. 131–61. See also Sidney and Emily Kark, Promoting Community Health: From Pholela to Jerusalem (Johannesburg: Witwatersrand University Press, 1999).
Acknowledgments
First thanks go to the health-care workers, activists, and administrators in Lusikisiki who gave generously of their time to share their perspectives on antiretroviral treatment with me. Former Médecins Sans Frontières staffers: Mfundo Fogobile, Nomzi Khonkwane, Nomini Mabena, Zikhona Majavu, Doli Mapungu, Lwazi Mfecane, Siphokazi Somhlahla and Bavuyise Vimbani. From the Treatment Action Campaign: Akona Ntsaluba. From Saint Elizabeth’s Hospital: Drs. Thomas, Okito, and Hussein. From the Qaukeni LSA: Mrs. Nombulelo Mofokeng and Mrs. Tandiwe Sapepa. From the Eastern Cape Department of Health in Bisho: Nomalanga Makwedini and Thomas Dlamini. Many thanks too to the staff at Bodweni Clinic, Gateway Clinic, Goso Forest Clinic, Magwa Clinic, Malangeni Clinic, Qaukeni Clinic, Village Clinic, and the mobile clinic at Good Hope, who accommodated me in their working environment and answered my questions.
To the HIV doctors who took time out to help me understand something of their work: Hoffie Conradie, Richard Cooke, Eve Mendel, François Venter, Sabine Verkuijl, and, of course, Hermann Reuter, to whom I owe a special debt of gratitude, not least for having the foolish courage to allow a layperson to write about his work.
For invaluable discussions and exchanges on the material and ideas in this book: William Beinart and his graduate students at the African Studies Centre at Oxford University, Dhianaraj Chetty, Nomboniso Gasa, who helped me to understand Sizwe’s relationship with his father a little better, Lungisile Ntsebeza, Deborah Posel, and Helen Schneider.
I am especially grateful to Hillary and Tony Hamburger and to Susan Levy, who, over many, many hours, gave me an education in the psychology of shame. Our discussions profoundly shaped the last two chapters of this book.
Many thanks to those who read and commented on drafts of the manuscript: Antony Altbeker, Edwin Cameron, Ben Carton, David Jammy, Nicoli Nattrass, Helen Schneider, Carol Steinberg, and Ivan Vladislavic, a masterful reade
r, from whose experience and perspicacity I have now benefited three times in a row.
I needn’t have to add, but will nonetheless, that all errors of fact and foolishness of perspective are mine alone.
Mark Gevisser, my colleague, peer, and friend, gave more time and wisdom to this project than I could possibly measure. I am, as ever, deeply grateful.
Thanks to my agent, Isobel Dixon, and to my editor at Simon & Schuster, Dedi Felman, who has taught me a great deal about storytelling. At Jonathan Ball Publishers, thank you to Jeremy Boraine, Francine Blum, Tanya White, and to Jonathan Ball himself, whose warmth and loveliness are beyond any telling.
This book was funded by the Ford Foundation through the Institute for Security Studies in Pretoria. Anton du Plessis, former program manager at the institute, offered to facilitate the funding of the project before I had even begun to badger him. Many thanks for that. Anton’s successor at the institute, Boyane Tshehla, has accommodated my work in warm and generous spirit. Busi Nyume handled the budgetary administration of the project without complaint. Many thanks.
Finally, to Lomin Saayman, who has not complained, either, despite having now seen two books through from beginning to end.
About the Author
Jonny Steinberg was born and bred in South Africa. His previous two books, Midlands (2002) and The Number (2004) both won South Africa’s premier nonfiction literary award, the Sunday Times Alan Paton Prize. Steinberg was educated at Wits University in Johannesburg and at Oxford University, where he was a Rhodes Scholar. He has worked as a journalist at a national daily, written scripts for television dramas, and has consulted extensively with the South African government on criminal justice policy. He is currently writing a book about immigrants in New York.
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