EMORY : in the world

South Africa’s Greatest Challenge
By Rebecca Baggett & Robin Tricoles

In the Zulu language, “Nozizwe” means “mother of all nations.” And in many ways, Nozizwe Madlala-Routledge is a founding mother of today’s Republic of South Africa. Madlala-Routledge was actively involved in her country’s struggle to end apartheid through her numerous roles in the African National Congress. After apartheid ended and the majority-led government of President Nelson Mandela was established in 1994, Madlala-Routledge transitioned from her role in the resistance movement to an important leader in her country’s young government. She is currently a Member of Parliament and served as Deputy Minister of Defense and Deputy Minister of Health under President Thabo Mbeki. Madlala-Routledge garnered international media attention and public support in 2007 when she publically disagreed with President Mbeki’s rejection of the scientific consensus on the causes of and treatments for HIV/AIDS. Mbeki dismissed Madlala-Routlege from her Deputy Minister of Health post after she voiced her opinion and took an unauthorized trip to an AIDS Vaccine Conference in Spain.

In April 2008, Madlala-Routledge spent a week on the Emory campus as the Emory Global Health Institute’s first Distinguished Visiting Fellow. During her visit, Rebecca Baggett and Robin Tricoles discussed with Madlala-Routledge her views on South Africa’s most pressing health challenges and the role she thinks American universities can and should play in low and middle-resource countries. An excerpt of this interview is below.

What do you think are South Africa’s greatest health challenges?
We have a very huge problem with HIV/AIDS and related illnesses like TB and pneumonia. We also have a great problem with diseases like high blood pressure and heart disease which emanate from an unhealthy lifestyle, so we have a very big disease burden. But I think our system is beginning to respond to all of these challenges because in relation to HIV/AIDS, we now have a national strategic plan designed to deal with issues of prevention and treatment.

How do you think the country should address these challenges?
I will start with the issue of having a plan. Because I think that while we have all of these challenges, including infrastructure challenges for health, it would be very important to start with a plan because then we would establish what our priorities are and where we should start. The issue of the budget is very important because we can’t do anything without adequate finances. But in relation to that, there is also an important role to work out regarding whether we’ve got the health workforce, the people who are going to deliver quality health care, so there are different elements, but they all need to be worked out in a plan that is very clearly outlined for approaching the health problems. We have a policy already in South Africa which emphasizes primary health care, which is quite an important policy because it deals with issues of prevention, making people aware of what causes illness, and how to prevent it. But we also have strong secondary and tertiary care elements, and this involves research and dealing with high technology and related issues. I also think it’s important to have an integrated approach to health care because health goes beyond simply illness and wellness. There are a number of other related issues. Issues, for example, related to education, making sure literacy levels rise in your community because as you raise awareness and raise education, people are better able to take care of their own health.

Do you think organizations like Emory can assist South Africa and other low and middle-resource countries in addressing their health challenges?
I think partnerships are very important between those in the developed world and those in the developing world. Particularly, if you look at the burden of disease you’ll see that the heaviest burden is in the developing world. And in a number of cases the diseases that people in the developing world die of are diseases that have been eliminated in the developed world. So I think there should be sharing of information to say in terms of this particular illness; this approach was used in the developed world and it worked. I also think there should be consideration to the issues of trade because there are problems that hinder the developing world from accessing health care simply because it is beyond the means of many people. I think in relation to this, we must consider issues of payment and how medicines can be made to be more affordable. But I also think the exchange I have seen here at Emory is absolutely critical, where young people from South Africa or other developing countries come to the institutions that are established here to work and develop their own capacity and knowledge. So I think what is happening [at Emory] is very, very important and will strengthen that which we are starting to do.

What existing and potential partnerships between Emory and South African institutions do you think hold the most promise?
Well, we’ve talked a lot about drug discovery and areas around legislation, the types of contracts that need to be put in place, and the agreements between government and the private sector [in situations] where the research would be happening at the government level in the institutions that are created by government and then how that then translates into commercialization of that information. I’m also interested in looking at issues such as the healthcare workforce because I have found that in the U.S. and in South Africa we have the same problem of a shortage of health workers, but also the issue of some of our health workers leaving South Africa for the U.S. or other countries in the developed world. And here I think the partnership is very important in how to develop the workforce together because if one country has the capacity to train health professionals and the other one needs health professionals, then I think there should be a partnership there to say this is how we can assist one another.

If you would like to listen to the full interview with Nozizwe Madlala-Routledge, please visit www.globalhealth.emory.edu.

Rebecca Baggett is the communications manager at the Emory Global Health Institute, and Robin Tricoles is a writer in Emory’s Health Sciences Communications Department.