Thursday, March 11, 2010

The Power Of Choice

Sometimes, when reading about the AIDS Denialism that was (is?) our government’s approach to HIV and AIDS, I get a lightbulb moment and understand what Mbeki was saying. Some of it anyway.

I just had such a moment.

I once was in an argument with someone about medicine, true health care, and medically resolving a problem. If the patient is not comfortable, even extremely uncomfortable, with the treatment, is he then treated & the problem truly resolved?

The situation presented to me was of a poor black South African man who was having headaches and battling to see. He went to a western science doctor and to a traditional healer.

The western doc gave him glasses. The headaches ended but the man never liked or trusted the glasses and rather never wore them. He ended up choosing headaches over the western medical “solution”.

The traditional healer gave him a muti that did not take the headaches away either. And it didn’t give him better sight.

My opponent argued that this man was stupid. Because the solution was clear, and the poorly-sighted man was refusing it for muti that was doing nothing.

My argument was that neither solution had won or helped this man. And that this man was not stupid for not being comfortable with a western medical solution. There are countless ideas or approaches that each person rejects in life because we do not trust them or are not comfortable with them.

The man must be comfortable & embrace a solution for it to be a successful solution. Western medicine does not have all the answer and does not solve all the problems. Despite what its disciples argue to others.

I have even more examples, including a person who chose death over chemotherapy. Medical science did not solve her problem, even though it claimed to. Another person I knew well chose death through heartbreak over life and antidepressants.

Western medical science can create a pill or a pair of glasses. This does not mean it has solved the medical problem. I am not discounting the incredible achievements of medical science. But that a problem needs to be solved holistically, sustainably, and this goes beyond chemicals or tactile inventions.

Mbeki argued that ARVs are that pill, that tactile invention. But they will not necessarily resolve the root of a HIV-positive person’s medical concern, and they definitely will not solely resolve the HIV pandemic in his country.

Which is why our government continues to promote Prevention campaigns as much as it addresses treatment issues. Nutrition and a healthy life style can do incredible things and do play a role in an HIV-positive person fighting the disease within their body. Poverty has played a key role in the macro-level transmission of HIV. When you cut away the hysteria & simplicity, Mbeki had some valid points. If taken into account in the nationwide fight against HIV, these points work towards a holistic solution.

The difference between Mbeki rejecting ARVs for South Africa’s Public Health system and the elderly man rejecting a pair of glasses is, Mbeki never gave any of the other of millions of South Africans the choice.


po said...

Yeah I get the pill thing. But I got the impression Mbeki's attitude was "don't trust the white scientists who want to kill all black people with this poisonous pill and is AIDS even real anyway."

Which is understandable considering what went before, but a huge error of judgement nevertheless. You gotta pick your battles.

Cam said...


Champagne Heathen said...

@Po - As far as I am aware, it was never as "racially conspiracy theory" as this is white peope trying to kill black people.

Mbeki was in the process of trying to kickstart the African Renaissance, which has the motto "African solutions to African problems". Which is a sentiment that I agree with. Not in the way that we throw all Western solutions out the window or that we "look to the past" pre-Colonialism. But that our structures, problems, successes, thinking, our very geology & geography & infrastructure is all unique. We can try to superimpose Western solutions onto our challenges, but they will fail long-term, because Western solutions were designed to solve western problems, through western settings. I see this all the time in the aid & internat. development world.

But I babble.

He didn't deny the existence of AIDS. He denied the connection of HIV & AIDS. That HIV is a virus. And AIDS is a collection of opportunistic infections, which is why some people say they have never met someone who has died from AIDS - because the person dies from an opportunistic infection.... (which is able to take over the person's body because of AIDS, which is now widely acknowledged to be the final stage of the HI virus in a person's body). He started cautionary... and went extreme.

Why did he go extreme is always my question. Why did he refuse any western solutions...because they could have been offered in African ways, and adapted to African means.

In terms of picking your battles, I guess he saw this as the perfect practical opportunity to push his "African problems need African solutions". To get the message through to the world, he needed a big example. This might have been that example. But it failed & backfired in the worst way. Not only because of the death of so many people, but because now the rest of the world & Africans will take a step back when they have the "African solutions for African problems" pushed at them.

Why did he deny HIV-positive people the choice of ARVs while pushing his African Renaissance agenda? I would need to read all those biographies to know better but from heresay has said, is cause he was a "distant father" style of leader. That attitude of "I know what works best, don't need to explain it to you (the children), you must just obey me & my intelligence". The thing is though, he was not meant to be the country's father, he was meant to a democratic country's top leader.

(I hope this makes sense... I am loaded up on flu & flu meds. Not thinking to straight!)

@Cam - :) Always preferable!

SonnyVsDan said...

I can't really see where you are coming from here. Not knowing exactly what Mbeki has been sprouting.

But that man's choice not to wear glasses is his failing, not that of western medicine. That he came to that choice through his culture, education and whatever else is a shame. But having worked in a developing country - at an eye hospital no less - glasses are the most economical solution to blindness or visual acuity loss. His doctor could have prescribed painful, scary, expensive and not always effective surgery. But he provided the best available solution.

If there was a viable "african" solution, then so be it. But it has to work for your argument to do the same.

So tying that in to AIDS, ARV have had a massive impact in other countries, why argue against the science?

Champagne Heathen said...

I will always disagree with Mbeki for full-out rejecting ARVs for all South Africans, in favour of AIDS dissidence. One reason being AIDS dissidents argue from a western scientific paradigm, which means they must accept the basic tools of western science, eg rationality, validity tests & peer review. Another is because he then took away choice from citizens.

My argument is not arguing the science, it is arguing the solution.

For me, the solution is much bigger than the scientific aspect.

My argument is that you have to take your mind out of the hospital when prescribing the solution, & put your mind into that person’s life.

Countless South Africans were not raised on western health care & medical science (doctors & hospital visits when sick), & there is a lot of power in how you were raised to see a health problem & how to solve a health problem.

Generally, western doctors often see only the immediate problem, prescribe a solution, & consider it solved, unless you return to them. This mindset does seem to be changing though, possibly through encounters with other cultures’ ways of thinking about health.

I do agree with Mbeki that more consideration needed to also be put into other 'solutions' in terms of the South African HIV pandemic.

With the creation of ARVs, along came questions in South Africa of "how can a person who has no regular access to food be expected to regularly take ARVs?", "how do we ensure that people adhere to their treatment regimes when they do not have regular access to health facilities", "how does a developing country with a shattered public health system afford to distribute ARVs", “what are going to be the reactions of the traditional healing system & its followers (the majority of South Africans) to this western solution”.

ARVs come in pill-form. That’s the medical side. But they open up massive economic, cultural, logistical and social challenges.

One challenge being many South Africans’ distrust or lack of knowledge around Western medicine.

One challenge being the apprehension people have towards pills & taking pills. My partner is a scientist, yet even he refuses to take medicine, because he believes that there are unrecognised side-effects to many medicines. He grew up in a culture that taught him from a young age that western medicine & pill-taking was the way to solve a health problem. Now imagine the reaction to pills of the many people who grew up being taught other ways to solve their health problems; such as through a visit to a “traditional” healer.

If a pill cures you of one problem but creates another problem, was it a solution?
This was one of Mbeki's initial arguments in terms of ARVs, that there had not been enough research behind the side-effects of ARVs.

A cancer patient can take chemotherapy & this might rid his/her body of cancer, it might kill off some of the cancer for awhile, or it might not do anything. It is a solution. But does this mean that when the decision comes down to chemotherapy or possible death, you are wrong because you choose no chemotherapy? Chemotherapy is a solution, but it is not the only solution available to you. And it might not be a satisfactory solution, thereby nullifying it as a possible solution.

Champagne Heathen said...

In terms of the man with poor eye sight; You can prescribe a pair of glasses, give it to the person then & there, but how are they going to access you & the next pair of glasses when their eyes weaken further? In a rural setting this is extremely problematic.

I wear glasses & can’t even say how many times my prescription has changed in 12 years. 1 optometrist refused to believe I had an eye problem even, because his tools didn’t pick it up, yet I could not see the classroom chalkboard. Another doc said I must accept that I’ll never have 20/20 vision & only so much can be done to solve my eye sight problems. Only one doc has ever recommended eye exercises, the rest have all just handed me a prescription for glasses that haven’t completely worked. And I have been through countless types of contact lenses before my eyes stopped itching. I hate glasses because they get dirty so easily & scratches, could break & then sorry for me. And I come from a “western medical healthcare” mindset & am privileged enough to have access to many 2nd opinions.

Now imagine this in terms of a man who was raised by being told that when you have a health problem you visit a traditional healer & accept their diagnoses & solution.
He does not have the resources for countless visits to countless people and countless attempts at solutions.
He has 1 visit to a new form of health care (western doc) & is deemed stupid because he doesn’t accept the doc’s solution. But did the doctor examine how this solution will fit into this man’s life, whether this man was comfortable with the solution, and what else could be examined in this man’s life other than his eye strength that could be part of the solution.

The 2 solutions you offer are both medical. You were raised being told when you are sick or have a health problem, you go to a doctor, who is a clever man & studied hard, & knows what is best for you, you accept his diagnosis, take his solution, and your problem is resolved. Sometimes it needs tweaking. But what about looking at what caused your health problem & making lifestyle changes?

Also think how many people you know who have visited “Chinese medicine” practitioners once, enjoyed the solution as an “alternative health” trend, & then rejected this solution. The Chinese medicine practitioner would argue that they solved the health problem & that this western person was “stupid” for not sticking with the solution.

Western medicine is one means to view a health problem

It does not create a once-off magical solution that you can just distribute & the problem is resolved. But it often makes this claim. It is often arrogant in saying it will always come up with a 100% solution, even when it only solves some of the problem. And often it only solves the visible problem, not underlying issues or causes.

Western science does not value personal choice. It offers a solution & if a person does not accept this solution, the person is seen as "stupid" or "ignorant".

What Mbeki might not have done is give enough credit to citizens coming up with their own solutions. We will only start to see this now as ARVs become more widely available in SA.

I am not saying that western medicine does not have solutions and has not made incredible achievements. But it has an arrogance about it seems to shout “You’re either with me or wholly against me”, which is ridiculous & outdated.

Why can an individual not have the power of choice & critical analysis when presented with a western solution?