Left to her own devices, B-list is long on optimism, short on analysis. I like to blame Paul Farmer.
Eleven years ago, I heard A-list All Star Paul Farmer debate Mead Over, then of the World Health Organization. This issue was whether AIDS drugs could be provided to poor people in developing countries, and the match-up, for someone like me, was a little bit like watching Batman debate the Joker. Mead Over called women who trade sex for money “epidemiological pumps” and Paul Farmer dropped this Wendell Berry quote: “Rats and roaches live by competition under the laws of supply and demand; it is the privilege of human beings to live under the laws of justice and mercy.”
Oh Paul. I’m sure you didn’t mean for me to abandon economic arguments and concerns about governance. I should have finished more of your books, I know. But for 11 years, I’ve waved a banner blazoned with “justice and mercy.” Fits on a flag; sounds like a song.
But a few things have happened over the past decade. I’ve gotten older. We’ve all gotten older. And by “we” I also mean the presidents of African nations, including Uganda, where the phrase “one-party democracy” is something the president still says with a straight face.
These days, the B-list banner isn’t big enough to block out the signs that said laws cannot be applied in countries where the rights of citizens to protest are not respected or exercised or both. Over the past several months, new African countries including Uganda and Malawi have joined the familiar ranks of Zimbabwe and Cote d’Ivoire in the despicable practice of firing live ammunition at protesters, arresting warrants for civilians expressing opposition, and issuing Big Man statements about how resistance is futile.
These bullets pierce right through the banner and get B-list to a place that many activists arrived at long ago: It’s governance, stupid.
Last weekend, though, B-list darned up her flag and waved it in a one-woman salute to the activists behind a lawsuit against Uganda’s government which claims that the country’s appalling maternal mortality figures violate women’s right to health. On the last Sunday in July, this lawsuit was highlighted in a front page article by Celia Dugger in the Sunday New York Times.
The article tells horrible stories of women who died of preventable complications during pregnancy. It suggests that many more will die before Ugandan fixes the problems in health professionals, supplies and basic infrastructure that lead to these deaths. If there was time for sentimentality, this would break your heart.
But eternal optimism of the B-lister leads me to focus less, for the moment, on the terrible truths of preventable maternal death and more on the story-behind-the-story of the activist coalition that is, as I write, doing things like making sure that courtroom dates for the hearings will be packed; sharing resources for families who have lost mothers, daughters, wives, so that there are plenty of testimonials for journalists like Dugger and others who are starting to pay attention; and–miracle of miracles–organizing a meeting of the executive directors of coalition members to look at where budget gaps are emerging for joint activities.
Pooling funds? Moving away from a rigid, donor-driven “advocacy” agenda? Volunteering time and energy? Yes, yes, yes. Also this: having brave, cautious conversations about when to seek permission for lawful assemblies and when to say–though few Ugandans would ever say it in quite this way–Fuck the police.
The first step to good governance is a mobilized civil society that isn’t afraid of speaking truth to power and doesn’t sit on its ass unless a per diem envelope is available for transport to and from an activist meeting. Sadly, these envelopes–which contain cash that’s referred to in Uganda as “facilitation”–have become a pre-requisite forgetting people to sit down together to discuss many issues, while very valid fears of political repercussions and/or cutting off the steady drip of government funds to so-called independent civil society, have kept people from taking anything but the most anodyne political stances.
Dugger’s story should be required reading for anyone seeking to understand the shell game that developing country governments have played since funding for AIDS treatment exploded about 7 years ago. (No money for health, no money for hospitals, no money for primary care, please give us more money… Oh wait — under this shell, there’s half a billion dollars for a fighter jet and a presidential inauguration that will take place the same week that protesters get tear-gassed in Centenary Square.)
The fact that the law-suit is starting to get international press and that the court has realized that it can’t dodge the issue by simply saying, as it did on the first court date, that it didnt have quorum, is a sign of the power of this coalition, which includes groups that are working on a wide variety of other things, all of which are arguably as important and as tragic as this issue, and who have decided for the time being not to pit one issue against another.
Is this related to the “walk to work” protests and the utterly unprecedented public statements of despair from public health officials that I talked about a few posts ago? Absolutely. Something is brewing. It isn’t the Arab Spring and it isn’t going to happen over night. But as uber A-lister, Kenyan corruption fighter John Githongo wrote a week or so ago,there’s a mounting frustration with the status quo of sub-Saharan African governments that feed the rich and squash the middle class.
Unlike the issues raised by protesters in the Arab spring–countries with small or unreported AIDS epidemics who have never been on the donor list for AIDS largesse–civil society in Uganda, Malawi and elsewhere in sub-Saharan Africa, knows exactly how full the coffers have gotten in the name of this plague and so may likely hinge their protests on more rational health spending in a way that their northern counterparts did not.
The past seven or so years have seen an absolutely unprecedented amount of disease- and epidemic-specific money flow into developing countries, including Uganda. This money, earmarked to fight AIDS, tuberculosis and malaria, was desperately needed and has done amazing things. It needs to be sustained and even expanded, but that is an issue for another post.
The Ugandan civil society lawsuit on maternal mortality is the best possible thing that could happen to its slightly moribund AIDS activist scene. A substantial proportion of ill-gotten, rich-get-richer money in Uganda has certainly been diverted from health and, more specifically, from AIDS. Tug the string of maternal mortality and the whole rotten story of money diverted from the Uganda’s Global Fund grants to Health Minister’s houses and MP junkets into their home districts during campaign season will eventually unravel. Spent correctly, money for AIDS should be raising the quality of overall health care. The fact that it isn’t is an indictment that, coming at this time of unprecedented public ire in Uganda and its neighbors, could actually become part of the popular uprisings that are by no means over.
And–here, B-list reaches, in her eternal optimism, for a point that is not yet, yet, supported by events: Any demand that money be spent better has to take into account the tremendously practical ways that are emerging to treat and prevent AIDS better than ever before.
Which is why the lawsuit, which has nothing to do with AIDS on its surface–and in fact is a powerful argument against disease-specific funding–is one of the most exciting and hopeful things that’s happened there since the free AIDS drugs first came to town.
As of a couple of weeks ago, at the International AIDS Society meeting in Rome, I was convinced that this could be a year when the epidemic turned around. The science certainly says that this is a reasonable hope. But every scientific finding needs to prove its worth in the real world. For me the crucible is always going to be that landlocked, equator-straddling, president-for-life-having state. Thanks to the civil society coalition working on the maternal mortality lawsuit I have, for just this moment, something lovely to believe in.
But. Oh Uganda.You never quit, do you?
This morning as I sat down to write this little silver-lining seeking love song to your nascent civil society, I find out that the newly-appointed Health Minister, about whom I heard great things, had just given an interview in which she said that AIDS could be cured via prayer. As in,“I am sure and I have evidence that someone who was positive turned negative after prayers.” She’s a Born-Again minister, that woman is, which is less of a surprise for a Museveni minister of health than the fact that she’s actually got relevant health experience. She’s actually run a hospital … that was the good news, until today.
Prayer doesn’t cure AIDS. I wish it did. It don’t. But for as long as I have been sitting in AIDS clinics in Uganda, I have been meeting people who sidled up to me and asked (because all white women must be doctors) whether God would ever cure them. Everyone wants this to be true. At a point in Uganda’s AIDS treatment effort when people are being turned away from clinics because they are not sick enough to qualify for drugs, the false hope of a cure-through-prayer will lead these same people to die at home without ever returning to the clinic again. She should retract, and quickly, before there is too much blood on her hands.
As an HIV positive Ugandan doctor and health professional posted today, “I believe in miracles but must confess I have not yet seen a PLHIV who has turned HIV negative. I myself take ARVs as if my life depended on them but also pray as if my life depended on prayer.”
We have to be careful what we believe in, for our health and so that we have the strength to carry on. The fact is that the post I just quoted was made on the same listserv that is organizing the maternal mortality suit. People aren’t working on one issue at a time. There’s enough outrage for them all. That, for today, is what I’m going to believe in.