Edited Transcript of Zackie Achmat's Speech at the Opening of the People's Health Summit (Session chaired by Linda Mafu who is referred to a number of times in the speech) Peoples Health Summit 2 July 2004 Last year, our government promised us treatment. Today, fewer than 10000 people have been put on treatment by this government. We know that there are enormous difficulties to do it, we know that. But, there is no leadership from national government. Our national Dept of Health Comrade Nono Similela has left the department. The National Department doesn't have a TB director, the National Department does not have a deputy director for AIDS programmes, the National Department does not have a director general because Comrade Ayanda Ntsaluba couldn't work with our National Minister. Today, there is no national leadership from the National Department. Provinces are left on their own to run their antiretroviral program. And that is fine for provinces like the Western Cape. But it is extremely difficult for provinces like the Eastern Cape, Limpopo, Mpumalanga, and the other poorer provinces of the country. So, it's a tragedy, that no one of National Government is here. The premier of the province sends her apologies. She's at an ANC NEC. But she said she'll send Dr. Goqwana to be here the whole weekend. Regrettably he sees fit only to come on Sunday. We hope, that he will come with a message of hope, instead of fighting with us on Sunday. But if he's coming for a fight, he will get one. This Peoples' Health Summit has to give us some of the tools for people living with HIV/AIDS. Our health care workers, our families, our friends, our communities. Those tools are knowledge, unity, and leadership. Knowledge of our own health is critical as some of the comrades who've spoken before me have said. Understanding medicines, through treatment literacy. No one can be a TAC activist, if you're not a treatment literacy activist now. We also must have knowledge of our rights as citizens. But in order to make the antiretroviral program reach millions of people, we're going to need knowledge of our health care services. So knowledge is one of the weapons that we have to take away from this conference. The second one is unity. Unity between health care workers and people living with HIV and unity on the principle that everyone has the right to life and everyone has the right to health care access. If we can achieve that unity in our TAC branches, in the Eastern Cape Provincial Council of Churches and throughout the country,we will build an antiretroviral program. But unity is not enough; leadership is also required. Now we know that nationally, we cannot rely on this Health Care Minister for leadership. So where is that leadership going to come from? It has to come from us, from civil society. It has to come from the individuals here. But our leadership has to be built first and foremost on a pro-poor message. That we address the needs of the poorest first. And that is why we have tonight, people from Lusikisiki here. Because, in the Transkei, in the former homelands, it suffered most under apartheid. Like many of the other rural areas. We must not be scared to be pro-feminist, to be pro a woman's right to chose when to give birth or not to give birth. That is the type of leadership that we need to give. We must not be scared to be pro-human rights in the leadership we exercise. Health care and illness are a mirror that reflects poverty and inequality including poor working conditions, poor housing, lack of access to nutrition, lack of access to water sewage and other social security. All these contribute to why we have ill health in our country. The success of the antiretroviral rollout will only be achieved if we can build a peoples health movement that understands the history of our country and the history our struggle for freedom Our struggle for health is deeply rooted in our struggle to transform South Africa to eliminate inequality and injustice. South Africa was formed under colonialism and apartheid and from our struggle against it. Let us consider some of the old figures which we mustn't forget. In order to live decently, our workers need a decent income. Under apartheid, workers wages was based on colour. The average white person's annual income in 1979 was more than R7,600, an Indian worker R3,200, a coloured worker R2,400, and an African worker R1,180. A white nurse started work at R310 a month and an African nurse at R197 a month. How did our struggle for health begin? Comrades will remember from school, there was a missionary called Kemp. And he visited the old Transkei, and he said 'the country is remarkably healthy'.' And he pointed out that there was no TB and no syphilis. Although people died, sometimes of famine and of illnesses like malaria, mostly people were health with few abnormalities. What then happened in our country? In 1899 our gold mining industry had 12,000 white workers and 100,000 African workers. By 1970, that was 40,000 white workers and 400,000 African workers. Why am I boring you with those statistics? A very simple fact: that with migrant labour came illness. (And I want to add the voice of TAC nationally to the voice of TAC Lusikisiki, to say that that empty clinic of Anglo Gold, that stands empty only sees a few people a day, in Lusikisiki, should become a part of the public health service. Anglo Gold needs to repay our communities.) I have in front of me the record of a report written in 1946 which explains how diseases such as TB, rheumatoid arthritis and sexually transmitted infections spread on the mines and there were taken back to the rural areas. Women were particularly affected by men returning from the mines. The private sector, in particularly the mining industry, has a lot to answer for. (And we have to support the National Union of Mine Workers, to make sure that Anglo American, does not only treat their workers, but their partners too. We also have to ask why are workers dropping out of the antiretroviral program so fast, why is there only one mine worker who is prepared to reveal his status? ) In 1914 the first World War broke out. It started in Europe and spread across the world. And at the end the war, South Africa didn't have a National Health Department. But what came back with the soldiers was a flu epidemic, a viral infection that killed 20,000 white people and 130,000 African people. Out of that epidemic, we got the first National Public Health Department. By the time of the 2nd World War, millions of men were now working not only on the mines, but also in factories that made cars, shoes, clothes and all sorts of products. From 1942 to 1944 a national commission investigated the creation of a National Health Service in South Africa. So when we talk about a Peoples' Health Service, we must know that our struggle goes back many years. In 1944, the National Commission for a National Health Service reported that we must implement a plan where we have 400 publicly funded community health care centres across the country. And it shouldn't only be in the poor areas, it should be in the rich areas as well. And it shouldn't be hospital centred, it should promote health rather than only look after people where they are sick.' They promised 400 but only established 50, and only 5 worked. They demanded that there should be a single health authority. That all the provincial and local departments should be combined under a single health authority. As we know, this never materialised. The Commission said that health should be a fundamental right, that we should eradicate the practice where health services are purchased as a commodity. And most importantly, it said that health care should be funded from a single health tax, not public, not private, not people paying to medical aids that serves service only the well-off. They recommended a single funding base for health care for everyone in the country. What was government's response? They made the doctor who headed the commission Minister of Health. And when he became Minister of Health, he gave up two things immediately: the single tax base for funding the entire health service and the community health centres! Then the Nationalist Party came to power. Some comrades here might be too young to remember them, but many comrades will. Linda Mafu (chairperson of the opening ceremony of the People's Health Summit) mentioned already, that struggles like the Defiance Campaign, the Anti-Pass Campaigns of both the ANC and PAC, and the struggle of the South African Congress of Trade Unions for a pound a day for all - a national minimum wage. Those struggles led to the Freedom Charter adopted at Kliptown in 1955. The Freedom Charter promised us that a preventative health scheme shall be run by the state, free medical care and hospitalisation should be provided for all and special care for mothers and young children. We're still very far from that vision, even though we have that right in our Constitution now. By 1980, for every 1000 live births, 12 white children died, 36 Indian children died, 110 coloured children died and 120 African children died. For under every 100,000 under 5s in 1940, 563 white children would die, 1,091 Indian children would die, 4,001 coloured children would die and 3,845 African children would die. TB, comrades will remember, is an old epidemic. We mentioned it earlier, all of us speak of TB, many of us are TB dot supporters and many community health care workers work to eradicate TB. By 1979, there 169 cases per 100,000 people throughout our country: 18 white people per 100,000, 27 Indian people per 100,000, 266 coloured people per 100,000, 93 African people per 100,000. But on the mines the figure was more than a 1,000 per 100,000. In the homelands, there was no proper accounting which is possibly why the statistics show fewer African people with TB. By 1981 it was estimated that between 15 and 30 thousand children die every year from malnutrition. And that is what gave rise to the struggle of the trade unions, to the struggle of the UDF and the civics. The Apartheid system created the Natal Medical School for black people only, that is coloureds, Indians, but particularly African people. And out of that medical school we had came some of the best political activists. People like Comrades Zweli Mkhize, Ayanda Ntsaluba, Steve Biko who died, and Mamphela Ramphela. We should remember their good work. Comrades will remember Dr. Mamphele Ramphela, she was one of Steve Biko's associates. She was banned to a small town in what was then the Northern Transvaal. And there she started a community health program. Today of course she's with the World Bank, which makes rural life a misery, but she did a good job then. Comrades will remember Dr. Neil Aggett who worked for the Food and Canning Workers Union , now FAWU. He was killed by the apartheid government, but he helped develop worker health programmes. Many unions looked after the interests of their health workers. Niel Aggett's partner, Dr. Liz Floyd, who is now the head of the Gauteng AIDS program, set up a clinic in Alexandria. Dr. Ivan Thoms, who is now the head of Cape Town Municipality health, set up a clinic in Crossroads. Jack Lewis and Deena Bosch from TAC, but who could not be here tonight, set up the Belville Community Health Project, where Ivan Thoms and Dr. Asraf Grimwood worked. Now why am I telling you those things? Because our struggle for our health involved many things over the years. It involved door to door work finding out who was sick. It involved educating our communities about TB and malnutrition. But, we had a government that didn't listen. In 1990 the ANC was unbanned and Comrade Linda Mafu (the chairperson of the opening ceremony) mentioned the Constitutional right to health and the ANC's Health Plan for South Africa. That plan is one of the best visions for health care South Africa has had. It was adopted also by the ANC at its conference in Mafikeng. But what is left of that vision? That vision said that doctors and nurses in the public sector, should be paid as much as possible to keep them there, so that we could reverse the drain that the private sector puts on us. That vision told us that we would have a functioning district health care system. It also told us that all clinics would have essential drug lists. That vision told us that a National Health Service would be created in our country. And that over years, the public health system must become the best health care service in the country. Yet, where are we now? We have frozen posts so no new nurses are hired. We have closed down our nursing training colleges. Where are our nurses? In England? They didn't go there because they wanted to. They go there because we chased them away. We didn't pay them enough, we froze their posts and we cut down the nursing training colleges. That is why we have a health care shortage in the country now. And , Emilca Cabral, an African revolutionary, said, 'don't tell lies, don't claim easy victories.' Comrade Manto fights with America and England for stealing our nurses and doctors. But she doesn't say what we did to chase them away. We have to admit that we haven't treated our health care workers properly and because of that we have the health care shortage. The ANC health plan promised a comprehensive, equitable, and integrated health care service with free and equal access for all. We don't have that. Instead we have a health care system that is haemorrhaging, both under the HIV epidemic, and because of the economic policies followed by the government in the first 10 years. Now, we hope that is changing, but some of the damage, or substantial damage has already been done. So what do we say? We have to stand with nurses and with doctors to fight for better conditions of service in the public sector. We have to support NEHAWU, DENOSA, SADNU and HOSPERSA. But there are too many nursing trade unions and they should unite to ensure that the public health service delivers. Now why am I saying this? I'll tell you why. Comrades heard about Lusikisiki. Lusikisiki has more people on antiretroviral treatment than the Northern Cape province. Lusikisiki has more people on ARV treatment than Limpopo province and more than the rest of the Eastern Cape in the public sector. But they had 55 vacancies for health-care workers and by June only three of these vacancies were filled. Five people had applied, two went away because they waited too long and so only 3 vacancies were filled. But in that time 10 nurses had resigned. And why, because the nurses in Lusikisiki live in squatter housing, shanty townships outside St. Elisabeth's hospital. The student nurses live in offices of the Department of Health training college, and they've been served eviction notices by public services. So we ask, why do nurses want to go to rural areas? They do not get proper accommodation, proper money or proper support. And if we don't get nurses there, the antiretroviral programme will not function. In the week I was in Lusikisiki, two clinics were closed and two nurses with many, many patients decided to take their holiday. And they need that holiday; we mustn't hold it against them. But there was no co-ordination at district management level to ensure those nurses could be replaced while they were on leave. So the knowledge we need here in TAC is that we need to go back to the streets to demand that our district health care systems work.. We need to go back to the streets to say, employ more nurses and pay them better, we need to say that if this does not happen the antiretroviral programme will not work. We need to treat people faster. In Chris Hani Baragwanath Hospital in Gauteng, they're limited to putting 20 patients a week on antiretroviral therapy. But they have the capacity to put hundreds of patients a week on treatment if they wanted to. So we must say that the slow rollouts in areas where there is capacity, is criminal. In areas where we need treatment the rollout must start and it must go together with a proper increase of nurses wages and doctors salaries. This is a message that we have to take to the international movement. We need doctors and nurses to come here while we train more and we get ready to place our own doctors and nurses here. We need volunteers from other countries, rich ones not poor ones. We must not steal Uganda, Ghana and Nigeria's doctors, because they desperately need them. We must take doctors from Europe and North America, until we have our own doctors and nurses trained in large numbers for the public health care service. So comrades, what I'm saying is that, the leadership that we're going to be required to give, means taking every opportunity over the next few days, to learn why a decent peoples health service, is necessary for the implementation of a national antiretroviral program. We cannot save the lives of millions of people if we don't deal with the health care service simultaneously. That, I want to emphasise again means, that, where we can, we must start, even if there aren't pharmacists, doctors and nurses we must ask the private sector to give us pharmacists, doctors and nurses. But I want to say that all the work that we have done has been because we have volunteers that are prepared to suffer and sacrifice. TAC, cannot be like the government, we don't have the resources of the government. What we can give each and every one of our members, is knowledge, to be able to lead. And I want to appeal to everyone, that that is what we must do at this People's Health Summit. I went to a conference in Bloemfontein a few days ago. The discussion amongst the sociologists was so terrible. They didn't understand HIV and they didn't understand medicines. Even in the poorest areas of TAC, there are comrades in our branches who can speak of HIV better than the professors can. I got very cross with them- I lost my temper I'm sorry to say. But one of them said to me, you've told us about ARV's, but you didn't tell us about the side effects that you yourself had. Comrades, if it wasn't for ARV's, I'd be sick now, I'd not have my life back. The same is true for many other comrades here. And we have to fight for those comrades who don't yet have treatment, because the treatment has given our life back to us. It's given my life back to me. It's given me more energy and more concentration. So I want to say to RUDASA, I want to say to SADNU, I want to say to ECPCC, and I want to say to MSF; we want you to join us and to lead a movement to create a peoples' health service for everyone in South Africa. Amandla.