What I did on my summer vacation

The other day as I was trying to get every ounce out of what remained of summer, riding my bike up the Hudson River, I became really aware of the changing light and the presence of Columbia University just over the hill of Riverside Park. Summer was over. But it was also, compared to last year, a really good one. Last year I was still recovering from a really stressful job and trying to find my way in the new post-work identity. This summer, I took every opportunity that would get me closer to my goals and turned down others that would be less productive. The end result? Here's what I did with my summer vacation:

1. Hosted a birthday picnic for my 30th in Central Park with close friends
2. Ran lots of races with New York Road Runners
3. Hiked Bryce Canyon and Zion with my mom
4. Took a course in global public health in Geneva
5. Took another course in Amsterdam on post-conflict development
6. Traveled by myself for the first time in years
7. Took myself out to a lovely dinner on the river in Geneva
8. Ran a half-marathon through the street of New York City!
9. Went on a billion interviews and met some great people and organizations
10. Learned how to negotiate better for what I deserve
11. Swam in the ocean
12. Had many a lovely Thursday night out with my girlfriends
13. Started knitting again and made a dress for my friend's baby
14. Cleaned my closets and organized all my work and school stuff
15. Grew tomatoes, herbs, and flowers

I'm sure there's more, but with classes starting and some interviews just a few hours away they are escaping me. But it was a really good summer.

Letter to the Editor

Well, if the NYT won't publish my letter on the Afghanistan/Narco-State article then I'll do it myself! :)

Dear Sir:

Thomas Schweich's assertion that eradication must at all counts be pursued is flawed (Is Afghanistan a Narco-State?, July 27, 2008). There is a middle way to the poppy problem: pay farmers to grow the crop and turn the harvest into much-needed pain medication.

When more than 80% of the world's cancer patients and more than half of those with HIV/AIDS suffer severe pain but can not access drugs to ease their pain, to destroy crops with medicinal value is an enormous missed opportunity. By directing a portion of the funds now directed to eradication, the U.S. and its allies could help the Afghan government channel the crop into legitimate uses and be seen as a force for development instead of livelihood destruction.

This isn't a new idea. Turkey's government also refused eradication requests made by the U.S. in the 1970's and the two countries brokered an agreement that permitted the cultivation of poppy crops for medicine. The result? Millions of dollars each year to Turkish poppy farmers and 80% of the U.S. supply of poppy for medicine. Afghanistan's poppy problem requires creative solutions based in human rights and development, not military enforcement.

Alicia Meulensteen, New York, NY

Pain Relief for the Poor

Are we content to allow more than half of the world's cancer patients die in severe pain? Current global policy on opiate access says that we are. I was never aware of the global shortage of opiates for pain management for terminally and chronically ill patients until a very moving series published in the NYT last fall brought it to my attention. In this paper I explore the barriers to increased access and call for a review of existing restrictions on production and access to opiates, as well as an overhaul of regulations in developing countries that constrain the use of these powerful drugs for people in pain.

Pain Relief for the Poor:
Increasing opiate access in developing countries
Before death, agony. The World Health Organization estimates that 80 percent of the six million people who die from cancer each year suffer severe pain, as do 50 percent of those dying from AIDS.1 As development progresses and the world's population lives longer, people in developing countries now have the perverse “opportunity” to suffer and die from the diseases of the developed world—cancer, diabetes, and heart disease being the most common—while lacking the diagnostic and treatment tools that could help manage their illnesses and accompanying pain. Lack of diagnosis and unavailability of or inability to pay for treatment make palliative care and access to potent painkillers more than just an issue of proper medical pain management, but also an issue of inequality and social justice. This paper presents compelling health, political, and human rights arguments for making increased opiate access a priority in global health policy. It then proposes possible measures to greater access that have benefits for stakeholders in both the developed and developing world.

Palliative Care and Health Policy
Palliative care covers symptom management of acute and chronic illness as well as end-of-life care.2 When it is no longer possible to prevent a patient from dying, palliative care aims to alleviate suffering, make the final days as good as possible for both patient and family, and to help the patient die peacefully.3 Palliative care offers the dying patient and their family a support system to live as actively as possible until death occurs. Pain-relief medication such as morphine by no means constitutes the entirety of a comprehensive palliative care program, however, it does play a key role in advanced pain management. Other palliative care treatments include discussing anxieties, spiritual guidance, support of family and friends, physical comfort, and other measures.4 At its essence, palliative care is about enhancing quality of life. Palliative care is an essential part of public health, but one that is often overlooked. The World Health Organization writes:

“Assessing cancer palliative care needs is in many ways equivalent to assessing an urgent humanitarian need to reduce unnecessary suffering of patients and their families. It is important to bear in mind that although – in the medium to long term – effective prevention, early detection and treatment will reduce palliative care needs, palliative care needs will never be eliminated, because some types of cancer will inevitably remain fatal for some patients.”5

The World Health Organization defines essential medicines as “those that satisfy the priority health care needs of the population.”6 Opiates are on the WHO list of essential medicines for all countries, but access to opiates is obstructed by lack of availability of drugs, regulatory and policy barriers, and lack of education about the drugs.7 Recognizing that misperceptions persist around pain management and treatment, the World Health Organization created a three-tier ladder for pain treatment for cancer patients. This logic has been replicated and applied to pain relief and palliative care in other treatment settings as well, such as HIV/AIDS. The first “rung” on the ladder of pain treatment is non-opioids, such as aspirin and paracetamol. Then, as pain intensifies to what the WHO classifies as “mild to moderate” levels, and the first rung of treatment options are no longer effective, mild opioids such as codeine are administered. When the patient is in what they would consider moderate to severe pain, opioids are added to treatment options.8

Misperceptions about addiction—by the patient, their family, and even the medical community—present barriers to medicinal pain relief. The American Cancer Society acknowledges that fear of addiction is a major reason people with access to opiates opt not to take them, even though there is a difference between continued medicinal use of opiates and addiction, and that “when opioids—the strongest pain relievers available—are taken for pain, they rarely cause addiction.”9 Developing countries have additional barriers to comprehensive pain management. Poor health care system infrastructure development, staffing shortages, and limited funds for public health all conspire to prevent palliative care from becoming a priority in national health policies. The WHO reports that “there is a close correlation between the proportion of the population needing palliative care and the proportion of adults living with HIV/AIDS. The highest proportions are found in Botswana and Zimbabwe.”10 Given the lack of access to anti-retroviral drugs for HIV/AIDS and the fact that the majority of cancer cases in Africa are incurable by the time they are diagnosed, palliative care needs to be incorporated into national health priorities.11 The emphasis on national plans that address HIV/AIDS by countries and funders have also directed efforts away from creating national public health plans that deal with the emerging challenges of chronic disease. The World Health Organization found that Ethiopia, for example, inadequately addressed cancer in its national health plan.12

Political Barriers to Opiate Access
Morphine and other opiates appear on the list of essential medicines published by the WHO for inclusion in all national health programs. There is no doubt that opiates are powerful drugs with potential for abuse and that their use must be carefully monitored in the course of treatment. All opiates derive from the same source, the opium poppy, and include heroin, morphine, oxycodone, methadone, codeine, fentanyl, buprenorphine, tradmadol, and others.13 All opiates create a sense of euphoria for the user, but they can also kill by suppressing breathing. Long term use can create dependence, and with use over time greater and greater doses are needed to achieve the same high relief. However, opiates can be used for shorter-term management of severe pain without addiction.

Opiates also have the distinction of being listed as both essential medicines and class 1 narcotics. Two of the best-known derivatives of the opium poppy, morphine and heroin, are both included on the list of Class 1 narcotics, as are several other products of the opium poppy.14 Opium production is tightly controlled by regulations in the 1961 Convention; five articles govern the cultivation and distribution of opium poppy, while only two dictate control and cultivation of coca leaves and cocaine. Yet because of the relatively low cost of production and high resale value of the crop, the end result of these numerous articles and qualifications is restrictions on poppy cultivation and export that limits legitimate medical use while at the same time fueling a lucrative market for illicit drug use.

Legalizing opium poppy production in developing nations is one possible answer to the medical shortage of opiates, and this is not the first paper to propose such measures. The International Narcotics Control Board's 2007 Annual Report acknowledges such advocacy in a recent annual report, though it falls back on its earlier stances and regulations instead of opening the door to further discussion of creative alternative policies.15 Yet the current restrictions on the cultivation and transformation of opium poppy ignore the realities on the ground of the trade in opiates. Article 23 of the 1961 Convention calls for the creation of a national oversight office to closely regulate the cultivation of poppy crops, determine which land and farmer can grow the crop, collect the harvest, and have the exclusive right of import, export, and trade of the crop.16 All of which, upon initial inspection, do not seem overly onerous until one thinks of the top opium poppy producer, Afghanistan, and its government whose rule of law extends not much farther than the city limits of Kabul. Afghanistan produces over 90% of the world's opiates, with 30% of its population engaged in poppy cultivation and production.17 With help from Western military and contractors, the Karzai government continues to routinely destroy poppy crops in an attempt to decrease the supply of raw poppy for the heroin market.

This approach is problematic for a number of reasons, not the least of which is the destruction of a crop whose medicinal use is much needed for poor patients around the world. Destroying crops without compensating farmers creates hostility towards Western forces and countries, including those engaged in peacekeeping and relief efforts. Such actions also deprive farmers in Afghanistan, a country with a GDP per capita of $1,000,18 of the means to support their families, which may lead the men or boys to join rebel movements, become even further indebted to creditors, and ultimately face the decision to give up a daughter as payment or emigrate to Pakistan.19 None of these scenarios are beneficial to the development of Afghanistan.

Human Rights and Access to Opiates
The UN High Commissioner for Human Rights states that the right to health is a fundamental human right, upheld in the Universal Declaration of Human Rights, where it is included as part of an adequate standard of living, as well as in the International Covenant on Economic, Social, and Cultural Rights. According to the High Commissioner, “every State has ratified at least one international human rights treaty recognizing the right to health.”20 What is included in that right, however, is often truncated in the conversation on this human right.

By now, the medical and NGO community is well-acquainted with the rhetoric surrounding the debate on access to essential medicines. Arguments on access to essential medicines usually start and end with access to anti-retroviral medicines or malaria and TB treatments. This narrow focus on treatments for only contagious diseases overlooks the growing problem of treatment for chronic illnesses in developing countries. Disease prevention should of course be a priority in all nations, prevention being cross the board a more cost-effective approach than treatment. Yet the right to health seems to be increasingly construed to the right to a long life, without as much emphasis on a productive life.

Worldwide, most cancer patients are in advanced stages of illness when diagnosed. For them, the only realistic option is pain relief and palliative care. Treatment is no longer an option, if indeed it ever was due to availability of chemotherapy, radiation, and other treatments. In the absence of early and effective treatment, having all the resources available for proper pain management becomes even more necessary to a country's health policy. The vast majority of the world's legally produced opiates—more than 85%—are consumed by just 20 developed nations.21 Pain medication should not be the luxury of those who die in hospitals or hospice only in the developed world.

The economic benefits of pain management are also an important consideration in advancing access to opiates. Coping with chronic illness and disease can drive families living on limited resources even deeper into poverty. Proper pain management allows poor patients to remain active and productive members of their communities. It may even allow them to return to work, which in even a limited capacity can help earn income to feed their families and continue to send children to school.

Solutions: Pay the Farmer, Place Reasonable Restrictions
Patients in the developing world need access to pain medication. Nations developing and developed all want a decrease in illegal drug use and trade for their own security and the health of their citizens. Afghanistan's development must improve for state security and regional and global stability. To address these goals, a two-fold solution is needed: increased access to raw materials for medicinal opiates and rational restrictions on its trade and use.

Destroying poppy crops is not the answer to any of the objectives above. Achieving increased access to medicinal poppy requires that there be adequate crops. Farmers sell the product because there exists a demand. A World Bank study on market prices for Afghan opium poppy shows that prices have varied widely over the past few years, ranging from a low of $30 to a high of $600. Prices over the past few years have stabilized somewhat, to around $150/kg, likely due to bumper crops in the opinion of the Bank.22 According to the Bank, “Just as the de-facto legal status of the opium trade under the Taliban regime may have helped keep prices low, increasing criminalization and law enforcement efforts subsequently have tended to induce higher prices through higher risk premia, even if success in reducing opium production has been limited.”23 This creates a perverse incentive for farmers to gamble on producing poppy: if their field is the one not destroyed, their returns can be quite great. Legalizing poppy production for medicine would instead provide farmers with predictable, steady income. While some may still decide to gamble in the illicit market, the majority likely will not, preferring instead to be able to feed their families and earn a steady income. Further, making opium poppy a mainstream crop and legal would generate tax revenue to help build up weak government institutions in Afghanistan, while also freeing up hundreds of millions of dollars that could be used for development.

This is not uncharted territory. Since becoming independent, India has legalized poppy production, bringing $40 million in revenue for that nation and its farmers.24 In the 1970's, the United States and Turkey developed a legal poppy production agreement to divert that nation's crop to medicinal uses after total eradication of the crop was rejected by Turkey. Today, the United States gets 80% of its medicinal poppy from Turkey, which in turn earns that nation $60 million a year in export revenue.25 Given that Turkey and India's poppy production still do not meet the global demand for opiates in palliative care, adding Afghanistan to the list of legal providers would create competition, but not an insurmountable amount, for both these countries whose economies are increasingly dependent on other industries for economic growth. Afghanistan will need serious assistance in developing proper controls to regulate its poppy crops but these efforts, supporting farmers and their livelihoods, would likely be received with more enthusiasm by the Afghan people.

Availability due to limited crops is one obstacle, but national and state laws restricting the administration, prescription, and handling of the finished products of opium poppy are perhaps easier to alleviate in the short term. In some cases, countries may have legitimate concerns about expanding access to such powerful drugs, particularly if they are operating in a post-conflict environment where drugs may have fueled wars, either by providing funds for different groups or by manipulating child soldiers, such as in Sierra Leone or Liberia. It is here that the World Health Organization needs to provide more guidance and assistance on implementing reasonable restrictions on these powerful drugs. In a recent survey of sub-Saharan countries and their palliative care policies, the WHO found significant deficiencies in pain management policies, including misperceptions of opiates, lack of workers trained in palliative care, non-existent policies on opiates, and overly-strict regulations on prescription of opiate drugs.26 In India, states issue their own policies on opiate access and regulation, creating a complex web of bureaucracy to navigate when looking to transport opiates across state borders.27 Simplified, national guidelines and licensing schemes would significantly ease the burden facing pharmacies and hospitals seeking opiates and other strong painkillers for their patients.

Increasing access to opiates for those in severe pain will require the participation of several stakeholders. Developed countries and donor institutions have a role to play by easing restrictions on the funds they provide for national health in developing nations and looking beyond infectious diseases when deciding on funding priorities. Global health and regulatory institutions need to help developing countries create reasonable restrictions on opiates that take into account each country's particular development challenges, especially those in post-conflict environments. States need to take assessments of their own internal policies on opiate production and use. Finally, the global community needs to reassess the benefits of opium poppy eradication when considering the effects of such a policy on global access to painkillers, the development of poppy-producing countries and their economies, and the use of funds which could otherwise be spent on regulation and development. Patients suffering around the world deserve better than the status quo currently on offer.

1 McNeil, Donald (September 10, 2007) “Drugs banned, many of the world's poor suffer in pain.” The New York Times. Retrieved on June 3, 2008 from http://www.nytimes.com/2007/09/10/health/10pain.html
2 World Health Organization (2004) Palliative Care: Symptom Management and End-of-Life Care. pp.2 Retrieved on June 20, 2008 from http://ftp.who.int/htm/IMAI/Modules/IMAI_palliative.pdf
3World Health Organization (year unavailable) Care for the Dying Patient and the Family. pp.205 Retrieved on June 7, 2008 from www.wpro.who.int/internet/files/pub/85/205-210.pdf
4Ibid, pp.208-209
5World Health Organization (2007) Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes, Palliative Care. pp.15 Retrieved on June 15, 2008 from www.who.int/cancer/modules/en/index.html
6World Heath Organization. (2008) “Selection and Rational Use of Medicines.” Retrieved on July 8, 2008 from http://www.who.int/medicines/areas/rational_use/en/index.html
7World Health Organization (2000) Narcotic and Psychotropic Drugs: Achieving Balance in National Opioids Control Policy, Guidelines for Assessment. pp.7 Retrieved on June 9, 2008 from http://whqlibdoc.who.int/hq/2000/WHO_EDM_QSM_2000.4.pdf
8World Health Organization (2008) WHO's pain ladder. Retrieved on July 17, 2008 from http://www.who.int/cancer/palliative/painladder/en/
9American Cancer Society (2007) Pain Control: A guide for patients with cancer and their families. Retrieved on July 11, 2008 from http://www.cancer.org/docroot/MIT/content/MIT_7_2x_Pain_Control_A_Guide_for_People_with_Cancer_and_Their_Families.asp
10World Health Organization (2007) A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Sub-Saharan Africa. pp.5 Retrieved on June 8, 2008 from http://www.who.int/cancer/media/FINAL-Palliative%20Care%20Module.pdf
11Ibid, pp.6
12 Ibid, pp.21
13International Narcotics Control Board (1997) INCB Report 1997: Drugs of Abuse. pp.1 Retrieved on June 22, 2008 from http://www.incb.org/pdf/e/press/1997/e_bn_09.pdf
14United Nations. (1961) “List of Drugs Included in Schedule 1.” Single Convention on Narcotic Drugs, 1961. pp.41 Retrieved on June 5, 2008 from http://www.incb.org/pdf/e/conv/convention_1961_en.pdf
15Ibid, pp.49
16Ibid, pp.26
17World Bank (2006). South Asia-Afghanistan: Drug Industry and Counter-Narcotics Policy. Retrieved on July 15, 2008 from http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:21133060~pagePK:146736~piPK:146830~theSitePK:223547,00.html
18CIA World Factbook. (2008) Afghanistan. Retrieved on July 11, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/af.html#Econ
19Vanda Felbab-Brown (March 23, 2006) Hasty Poppy Eradication in Afghanistan Can Sow More Problems. Christian Science Monitor. Retrieved on July 11, 2008 from http://www.csmonitor.com/2006/0323/p09s01-coop.html
20United Nations Commissioner for Human Rights, World Health Organization (2008) The Right to Health: Fact Sheet No.31, pp.5. Retrieved on July 19, 2008 from http://www.ohchr.org/Documents/Publications/Factsheet31.pdf
21 David E. Joranson, MSSW (1994) Global Opioid consumption: trends, barriers, and diversion. IASP Newsletter. 4-5. Retrieved on June 21, 2008 from http://www.painpolicy.wisc.edu/publicat/94iaspg.htm
22World Bank (2006). South Asia-Afghanistan: Drug Industry and Counter-Narcotics Policy. Chapter 5: Prices and Market Interactions in the Opium Economy. Retrieved on July 15, 2008 from http://siteresources.worldbank.org/SOUTHASIAEXT/Resources/Publications/448813-1164651372704/UNDC_Ch5.pdf, pp.3
23Ibid, pp.5
24Romesh Bhattacharji (2007) India's experience in licensing poppy cultivation for the production of essential medicines: Lessons for Afghanistan. Retrieved on July 11, 2008 from http://www.selinascouncil.net/documents/india_case_study
25Jorrit Jamminga (2006) The Political History of Turkey's Opium Licensing System for the Production of Medicines: Lessons for Afghanistan, pp.6. Retrieved on July 15, 2008 from http://www.senliscouncil.net/documents/Political_History_Poppy_Licensing_Turkey_May_2006.
26World Health Organization (2008) A Community Health Approach to Palliative Care for HIV/AIDS and Cancer Patients in Sub-Saharan Africa. pp.21 Retrieved on June 13, 2008 from http://www.who.int/hiv/pub/prev_care/palliativecare/en/
27M.R. Rajagopal, David Joranson, Aaron Gilson (2001) Medical use, misuse, and diversion of opioids in India. The Lancet. Vol. 358, pp.140.

Books not Bombs

Great Op-Ed in today's NYT on the efficacy of putting money spent on military actions into education and human development instead. Click here to read the full piece.

It reminds me a bit of my current research on increasing access to medicinal opiates in developing countries. What if we took the money currently being used to try to destroy Afghan poppy crops and instead bought the harvest from farmers, turning the materials around into subsidized pain medication for people dying in developing countries who currently do not have access? I'll be posting that paper next week, once it is finished.

I have many interviews this week and lots to catch up on, in addition to still trying to shake off my epic jet lag. More posts later when I have a moment to spare!

WHO, WIPO, and Wagner

So here I am in Geneva, taking a class through NYU on Global Public Health. And we're acting like such UN groupies. We spent Monday at the ICRC, Tuesday at the WHO, and this morning at WIPO (world intellectual property organization--who knew?).

Geneva is, of course, lovely. It is a cozy, relatively multi-cultural city, and one that seems to blend both the lovely old Europe style with a very diverse population of ex-pats from the UN and migrant workers from everywhere else. It's rare that an European city does it well--I'm jaded on the subject from so much time over here--and from what I've seen on the admitted surface of Geneva it seems to get along better than other cities.

The ICRC was, unfortunately, a big disappointment, mostly due to our speaker. I really wanted to press someone on the issue of neutrality. What was the ICRC's position on Rwandan refugee camps, when other groups pulled out because they realized they were aiding people who had committed genocide? How far can one take the topic of neutrality--and is there such a thing in so many of today's modern conflicts? Sadly, topics I will have to explore on my own, so it seems.

WHO was much better. We spent a lot of time on malaria and also on non-communicable diseases. We don't think about them too much in the context of developing countries, but cancer, diabetes, hypertension, and other things you can't catch are a growing problem in the developing world, largely because the treatment we get in the developed world just aren't afforable to people elsewhere.

Which actually ties into the topic of my research here: the lack of opiods for palliative care in the developing world. Between late-stage AIDS, rising cancer rates, and an utter lack of diagnostic or surgical care in many developing countries, palliative care is needed yet terribly lacking. Something like 3 countries in the developed world consume 85% of the world's opioids, even though they are grown in India and--hello--Afghanistan. Morphine is listed by the WHO as an esstential medicine, but burdensome regulations and misinformation in the medical community prevent their use in many places where people suffer from stages of cancer and AIDS that the developed world doesn't see too much of anymore. People die in agony. More of this happy topic later once I post my paper, but here is a link to the article that woke me up to this issue.

At WIPO today we heard from someone working on the issue of patents and IP issues of folklore, local medicine, culture, and biological material. That was a highlight. One of the big issues in health care equity and ethics is what to do when developing countries provide the raw material for influenza vaccines but developed countries develop the actual "flu shots." Shouldn't the countries that provided the virus receive a supply of the vaccine that otherwise they couldn't afford? How can developed countries and their pharma companies place patents on medicines from plants in the developing world that have been used by communities for generations? We often only think of patent issues when it comes to AIDS medications but it goes far deeper than that.

Tomorrow we go to UNHCR, which I am ridicuously exicted about, having spent several years working for a refugee organization. More on that later. Right now it's back to the EuroCup, which everyone around here is utterly transfixed by, and rooting for underdog Turkey.

Off to summer courses

This is just a quick post to say that it's been really busy since the end of classes and tomorrow I leave for Geneva and Amsterdam for yet more school fun so no chance of getting a post of any depth until I come back! I'll be taking a course on global public health policy in Geneva (and researching palliative care and opioids policy in the developing world) and post-conflict development (researching the role of women and youth in reconstruction) in Amsterdam.

I've been really preoccupied with my job search and the interviews and finally starting to roll in. Here's hoping there are some more meeting requests when I get home.

Until July...

Xenophobia in South Africa

For my Politics of International Development course this semester, I had to follow one country through various themes and research them for two papers. The first paper was posted in March, on South African state-building and reincorporation of the "homelands" post-apartheid. My last topic, the sorry state of South Africa's refugee processing, dealt a lot with rising xenophobia in the country and the shameful scape-goating of immigrants from the rest of the African continent. Sadly, more and more articles on this issue cropped up every day that I wrote the massive paper. Over the weekend it seems the kettle boiled over.

The NYT reports that over 200 people were arrested in and around Johannesburg over the weekend in one of the country's largest waves of anti-immigrant violence. Twelve people were killed, beaten by sticks, shots, or burned alive.

It would be easy to dismiss this as repressed anger unleased in the face of high unemployment, HIV/AIDS edipemics, massive poverty unresolved after apartheid's fall, etc. But it's not just ordinary people who scapegoat immigrants and refugees from Zimbabwe and other nations--government officals have done their share of blaming, as have government ministries and the police force, which has at times encouraged citizens to assist them in outing illegal immigrants. As a result, people are targeted if they appear "foreign" and a lot of apartheid's racial classifications are rearing their heads again as people judge whether someone looks "too black" to be South African.

I wasn't planning on posting my paper because it was, after all, 20 pages long, but I'm going to post a few excerpts below today for some background:

The Rainbow Nation ends at the fence
The end of apartheid was a literal and figurative end to South Africa's “fortified boundaries.”1 Under apartheid, the electric fence along South Africa's border was set to “lethal” and claimed close to 100 lives of those seeking clandestine entrance into or out of the country.2 Under the new government, the electric fence has been in non-lethal mode, but South Africa's borders are not considered any less threatened by many in its government, media, security forces, and indeed even by some in the South African population.

South Africa has long wrestled with its identity. For a nation where race had determined citizenship, redefining what it meant to be South African was an enormous undertaking. To forge a new national identity, South Africa's leadership referred to its peoples past, invoking their common, if divisive, history.3 Experience of this “divided but shared history is used to identify true 'South Africans'...those who are deemed to stand outside this shared history are excluded from its unifying implications.”4 South Africa also tied its new identity to its national borders. Peberdy writes that “the reinvented nationalism and national identity of the 'new South Africa' is 'derivative' in that it continues to identify with the territorial boundaries and national models of the apartheid state.”5 While simplistic, using recognized borders to define the nation allowed the new government to side-step demands for independent territories by both black and white groups within the country during the handover from the old regime to the ANC.

South Africa has created an image of itself as separate from the rest of Africa. The nation historically felt a certain superiority when compared to its neighbors, not uncommon amongst immigrant-receiving countries, who tend to view the desire of other people to move to their country as stronger than it may be in reality, while viewing their own borders as vulnerable to this onslaught of people fleeing poverty and conflict.6 Some South African websites describe migration to South Africa in almost religious terms: “For many, post-apartheid South Africa has become both an imagined Mecca of economic opportunity, or a haven from war-torn or troubled homelands.”7 Under apartheid black South Africans were denied educational and economic opportunities; nonetheless, the apartheid government played up statistics of black migration to South Africa as proof of apartheid's success and the country's position in comparison to other African nations, promoting a view internally that without tight restrictions on black immigration South Africa would be flooded by the rest of the continent.8 This idea supported the racist views of many of South Africa's white citizens. In also created a xenophobia amongst South Africans at large. The nation is struggling with its promises to deliver greater opportunity and equality for its citizens, and this xenophobia is now proving problematic in the country's dealings with refugees and migrants who are viewed as competing for scarce resources and causing violent crime, economic downturns, and rising HIV infection rates.9

Creating “illegal people”
Regardless of how they enter the nation, South Africa's laws for refugees and migrants, and the practices of their security forces and government institutions charged with processing asylum claims, create a system where attainment of the rights on paper is incredibly difficult. It has been argued that the cause of South Africa's hostility to refugees and migrants is not the sheer number of asylum seekers but is instead that South Africa's ministries tasked with handling asylum applications are simply overwhelmed due to chronic under-staffing and poor training.1 Departments lacking translators and other key staff are overwhelmed with any increase in volume of asylum applications, and may be more apt to deny asylum in order to clear cases off the docket. Indeed, part of UNHCR's recent campaign in South Africa was to train more officials to facilitate the processing of additional asylum claims, but many of those trained soon found work in other, more lucrative, areas.2

South Africa's strict refugee laws have been likened to that of Spain, a European nation on the receiving end of migration from developing countries. Other researchers have argued that Spain's laws “are written in a way to marginalize third world immigrants, to regularize the notion of the 'irregulars.'” Barriers to normal status are constructed through long waits for permits and other restrictions.3 South Africa creates similar hurdles. Its government states that asylum claims can be filed at any of its refugee reception offices.4 However, these offices are all located in the country's major cities, not at its border crossing, and are notorious for long lines that are sometimes patrolled by security forces picking up undocumented migrants.5 These centers also make migrant and refugee populations highly visible and vulnerable to abuse from the community.

Several different departments have interactions with refugees and migrants; the majority of them involve security issues. The South African National Defense Force, the Department of Home Affairs, the South African Police Service (SAPS), and the SAPS Border Policing component all have a role in enforcing South Africa's Alien Control Act.6 South Africa's laws similarly not only construct the migrant and refugee as “illegal” by their very nature of being in the country without authorization, but South Africa goes one step further by creating a category of “prohibited persons” who, by their nature, are “without legal standing as persons.”7 This language dehumanizes migrants and effectively categories them as criminals, making abused by police, security, and local populations seemingly more justifiable.

Apart from Africa
South Africa's neighbors are some of the world's poorest countries, and with large income disparities between neighbors often comes a flow of documented and undocumented migrants. The cases of the countries on South Africa's borders also test the largely artificial distinction between “refugee” and “economic refugee.” Zimbabwe is one such case. In the past decade, the inflation rate in Zimbabwe has escalated from 32 percent to over 100,000.8 Today, Zimbabweans face not only hyperinflation but unemployment rates of 80%, food shortages, and an increasingly oppressive government.9 Human rights groups within South Africa have warned that Zimbabwe is near collapse.10 Initial asylum claims from people crossing over the South African border were dismissed by the South African authorities, who stated that “Zimbabwe is not at war” and so any claims were invalid.11 At the time of writing, results from Zimbabwe's March 29 election had just been released, with results pointing to a run-off, and reports of violence and persecution against opposition-party members and sympathizers on the rise. A shipment of arms destined for Zimbabwe came under international pressure to return to China, but violence against the political opponents and suspects opponents of President Mugabe has been increasing. According to the BBC: “The defense minister in neighboring Botswana said Zimbabweans were fleeing the violence, with almost 100 people arriving in the past three days. He said in the past, Zimbabweans had been economic migrants but now they were seeking political asylum. There have been similar reports from Mozambique.”12 If one looks to Kunz's theory that refugee migrations are signaled by the early migrations of a few, and then examines the situation in Zimbabwe, it makes little sense to categorize those fleeing Zimbabwe now as legitimate refugees but not those who left earlier in the unraveling of the state.

Numerous human rights abuses have been documented in the arrest and detention of undocumented migrants, refugees, and those suspected of being non-citizens by security forces in South Africa.13 Several human rights NGOs have also highlighted growing abuse of asylum seekers.14 These abuses include frightening parallels to apartheid's police state. Police have used “irrational standards to determine whether individuals are 'illegal immigrants,' including skin color and location of vaccination marks.”15 People report being stopped and interrogated based on perceptions of their race or nationality due to “texture of hair and breadth of nose.”16 This has led to persecutions of naturalized South Africans by police forces who have determined them to fit one of their arbitrary conditions, a troubling allusion to apartheid's pass laws when black South Africans could be stopped and forced to produce their papers.17 Such actions now violate South Africa's Bill of Rights and the right to privacy of all its citizens.18

Host governments of refugee populations often argue that refugees “present serious economic, environmental, and security threats, and that they can no longer keep their borders open.”19 Over 50% of South Africans still live in poverty,20 and despite an end to formal segregation and discrimination, the majority of the country's wealth still resides with its non-black population. These economic disparities contribute to the scape-goating of migrants and refugees. Maharaj writes that “xenophobia is rife in the townships, where migrants are referred to as kwerekwere (disparaging word for African immigrant). It has been argued that xenophobia thrives where economic deprivation and hardships are acute.”21 Regarding its treatment of Mozambican refugees, even UNHCR criticized South African xenophobia.22 In recognition of the problem in South Africa, national ministries, working with UNHCR, launched a campaign against xenophobia in the country in 2000.23 Even as of last month, South Africa's government offices were still taking steps to address the issue.24 It is a sign of progress that the government seems acutely, and uncomfortably, aware of negative perceptions of its treatment of asylum seekers.25 How the government chooses to continue to address the problem will be illustrative.

1Jeff Handmaker. (2001) No Easy Walk: Advancing Refugee Protection in South Africa . Africa Today, Vol. 48, No.3, pp.98
2UNHCR. (2005) UNHCR Global Reports: South Africa. Retrieved on May 3, 2008 from http://www.unhcr.org/publ/PUBL/4492678e0.pdf
3Jonathan Klaaren; Jaya Ramji. (2001) Inside Illegality: Migration Policing in South Africa after Apartheid. Africa Today, Vol. 48, No.3, pp.39
4South Africa Department of Home Affairs. Directorate: Home Affairs. Retrieved on May 5, 2008 from http://www.home-affairs.gov.za/refugee_affairs.asp#3
5Refugees International. (2004) Zimbabweans in South Africa: denied access to political asylum. Retrieved on May 6, 2008 from http://www.refugeesinternational.org/content/article/detail/3012
6Jonathan Klaaren; Jaya Ramji, pp.40
7Ibid.
8CIA World Factbook. (2007) Zimbabwe. Retrieved on May 1, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/zi.html
9J. Anthony Holmes; Sasha Polakow-Suransky. (April 17, 2008) The Silence of Mbeki. The International Herald Tribune. Retrieved on April 21, 2008 from www.cfr.org/publication/16059/silence_of_mbeki.html
10Zimbabwe Standard (November 26, 2007) Zimbabwe: AU Probes Abuses of Refugees. Retrieved on February 6, 2008 from http://allafrica.com/stories/200711261669.html
11Human Rights Watch (2006) Uprooted Migrants: Zimbabweans in South Africa's Limpopo Province. Retrieved on February 7, 2008 from http://www.hrw.org/reports/2006/southafrica0806/
12BBC News. (May 2, 2008) Zimbabwe announces poll results. Retrived on May 2, 2008 from http://news.bbc.co.uk/2/hi/africa/7382319.stm
13Klaaren; Ramij, pp.35
14U.S. Committee for Refugees and Migrants (2007) World Refugee Survey. Retrieved on May 6, 2008 from http://refugees.org/countryreports.aspx?subm=&ssm=&cid=2020
15Klaaren; Ramij, pp.43
16Maharaj, pp.52 See also Peberdy, pp.21
17Peberdy, pp. 21
18Southern Africa Migration Project. (2001) The South African White Paper on International Migration: an analysis and critique. Migration & Policy Brief No.1, pp.10. Retrieved on April 14, 2001 from http://www.queensu.ca/samp/sampresources/samppublications.
19Karen Jacobsen (2002). Can Refugees Benefit the State? Refugee resources and African statebuilding. The Journal of Modern African Studies, Vol. 40, No.4, pp.579
20CIA World Factbook (2007) South Africa. Retrieved on May 1, 2008 from https://www.cia.gov/library/publications/the-world-factbook/geos/sf.html#Econ
21Maharaj, pp.51
22Klotz, pp.833
23Humanitarian Practice Network (2008) “We are not treated like people: the roll-back xenophobia campaign in South Africa.” Retrieved on May 5, 2008 from http://www.odihpn.org/report.asp?id=2208
24South Africa Department of Home Affairs (2008) Deputy Minister to hold a discussion with youth immigrants/Refugees and stakeholders in Pretoria. Retrieved on May 6, 2008 from http://www.home-affairs.gov.za/media_releases.asp?id=467
25South Africa Department of Home Affairs (2008) Press release, Refugee Day remarks by President Mbeki. Retrieved on May 6, 2008 from http://www.home-affairs.gov.za/documents/refugee_article.pdf

Diary of an Overachiever?

It occurs to me that I don't write about myself...well, ever, really...and given that it is going to be a lazy, reflective kind of Sunday around here it seems a good enough time.

The past few weeks have been really busy. Wrapping up final projects--20 page paper in 2 weeks? Statistical analysis and two exams to boot?--oh, and client budget reprojections due the same day at Stats final, and really, why not sign up for that 6.2 mile race while you're at it? But the day before the race make sure you are the only volunteer who agrees to stand out in the pouring rain and wind at the animal adoption event trying to get folks off the street to come in and meet the cats, cook dinner with your 4 girlfriends, and go to a board advisory council meeting for a small non-profit in the city. All of which has been crammed into the last 2 weeks alone. I just *do* all this stuff, and it doesn't feel like "overachieving" because I honestly love doing all of it.

A friend of mine often calls me an overachiever, joking in part because he's somewhat the same way himself, and to be honest I've never quite known what to make of that. I always think of overachievers as people who wear their accomplishments on their sleeves and won't ever shut up about their Harvard GPA, work in Guatemala, or whatever. And I don't think I've ever really been like that. I always wonder if those boasting people do what they do just so they can brag about it or because they really enjoy it.

I think some people get energy from the things they do, and others lose energy from it, and we all handle it our own way. Which is not to say that I don't need copious amounts of quiet time to recharge or that I don't run myself into the ground sometimes, but in the process it's a great time. I am ambitious and I do have very high standards for myself. Maybe I cram it all in because I want to advance faster, or maybe it's just because the more things on my plate the more I seem to thrive on it. I'm not sure, but regardless I don't like the overachiever badge very much.

The next three weeks are a little more on the downtime scale for me: hiking out west first week of June, then my birthday, then off to Geneva and Amsterdam for summer courses and then it's July. I'm in the full job-search mode at the moment, and I hope when I come back from hiking there will be some promising interviews waiting. In the meantime, I'll keep running and volunteering and have a million other little projects going because, in the end, I'm creating my life the way I want to, and there's a certain joy to that.

Commentary

My Op-Ed on reducing maternal mortality and achieving the heart of the MDGs is published today on RH Reality Check. Check it out here.

I spend a lot of time at the Union Square Farmer's Market, and I recently started serving on the advisory council of a group called Just Food that helps connect farmers with community supported agriculture programs, supplies farm-fresh produce to food banks, and advocates for better food policy. So I've definitely noticed that the global food crisis impacts the prices farmers have to charge for their bread; it hits them, too.

My paying an extra dollar for bread is a hassle but not a hardship. Most of the world lives on less than $2 a day. We all know this by now, right? So an increase in commodities hits them hard. Families have to decide between one meal or two, or maybe even who doesn't eat a meal altogether. And when someone has to go hungry, most often it is a woman or girl in the family.

The NYT piece on food security and overall security in Afghanistan got me worried today. Here is a nation that really doesn't need any more instability or another event to shake up an already fragile state. This is also the perfect environment for breeding warlordism: if the government shows it can not provide food, someone else will step in who can, even if they have to use force. Which is really how Afghanistan's warlord problem started in the first place.

It is hard to imagine a lasting stability in Afghanistan, or anywhere, if the country does not have the means to feed itself, whether growing its own crops or paying for food imports. Afghanistan relies heavily on international aid; the donor community needs to do better to address this pressing need.

Countdown

One final behind me, two more to go. Well, three. I have a big ol' paper due tonight, an exam tomorrow morning, and a project due in a week. All of which I feel, strangely, are under control. I've been somewhat laser-focused on getting all these things reined in after a few moments of panic two weeks ago and it seems to be working.

I have been mentally compiling a list of all things I plan to do once the finals are behind me, and I figured I'd actually take a minute to write it down.

1. First, buy some trashy magazines with no information on the following: finance, statistics, international development, foreign policy, humanitarianism, or aid
2. Pick up the sweater I started knitting a year ago and attempt to make some progress on it
3. Go out with my friends
4. Take a long aimless walk around the city

That's the fun stuff. The rest is just a list of things to do, like buy clothing for an upcoming hiking trip and finish up some work projects before said hiking trip.

Send good karma for the remaining finals...

Getting to the root of the MDGs

Reducing maternal mortality will require tackling the politics of reproductive health
Promoting women's health holds the key to development. Two years ago, Kofi Annan, then Secretary General of the United Nations, stated: “The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And this means stronger efforts to promote women's rights and greater investment in education and health, including reproductive health and family planning.”

Millennium Development Goal #5, reducing maternal mortality by three-quarters by 2015, has been called the heart of the MDGs. High levels of maternal mortality are linked to a chain of negative consequences, including decreases in infant survival and education and increases in poverty. With attainment of many of the MDGs already in jeopardy, reducing maternal mortality has become all the more urgent. Reducing maternal mortality needs not only the provision of more and better pre-and ante-natal care but also comprehensive reproductive health services—including safe abortion. Unless the politics of reproductive health and abortion are confronted head-on, MDG#5 and its accompanying targets may remain only a goal, and not reality, for millions of women in the developing world.

Maternal mortality is a phenomena largely confined to the developing world, with 99% of maternal deaths—over half a million women per year—concentrated in low income countries. While hemorrhage, eclampsia, sepsis, and obstructed labor account for many maternal deaths, the most easily prevented of the top maternal death culprits, unsafe abortion, remains a political, rather than health, issue in most of the world. The World Health Organization estimates that almost 13% of all maternal deaths are caused by complications from unsafe abortions.
Reducing maternal deaths from unsafe abortion is one of the most straight-forward public health problems to remedy. It requires increases in access to safe abortion and contraceptives. It is well-documented that countries with the lowest rates of abortion are those with the greatest access to legal abortion services and contraceptives. According to the Guttmacher Institute, a reproductive rights research center, Belgium, where abortion is legal and accessible, has an abortion rate of 7 per 100,000 women. Contrast this to Peru, where the procedure is illegal, and the rate skyrockets to 56 per 100,000. Despite the evidence, reproductive health targets were not initially included in the MDGs. These targets came late to the process in 2006--almost half way to the end date of the campaign—and were added under the goal of reducing maternal mortality only after significant pressure from UN member states, including members of the EU and several developing nations such as Cambodia, Cuba, Madagascar, and Nigeria.

MDG subgoal 5B sets out to have universal access to reproductive health by 2015. Unlike other MDG's, reducing maternal mortality and achieving universal access to reproductive heath care will take more than technical expertise and material resources. Reducing maternal mortality, unsafe abortion, and increasing access to reproductive health care requires that governments, societies, and donors confront not only the issue of abortion but also medically-accurate sex education for women and girls and access to contraceptives. These measures alone would decrease by 90% incidents of unsafe abortion—and go a long way to reducing maternal mortality.

Abortion is a reality of many women's reproductive lives. The underlying political gap is standing in the way of women's access to comprehensive reproductive health care. Without added pressure from donor governments, local women's health advocates in the developing world can only do so much to stop deaths from unsafe abortions in their countries. Donors who place restrictions on reproductive health funding, such as the United States which prohibits any organization accepting these funds from offering abortion as part of their comprehensive reproductive health care programs, do so at the peril of women's lives. Other developed nations, such as Great Britain and EU members, have made a commitment to unrestricting their reproductive health funding.

Reducing maternal deaths is a laudable goal, and one that must be achieved if the rest of the millennium development goals are to be realized. But reductions in maternal mortality can never be fully realized unless the global community of donors, governments, and public health starts including abortion in realistic approaches to protecting women's health. If the world wants to promote development, it needs to start promoting comprehensive reproductive health care.

Female condoms and foreign aid

From the Lancet Global Health Network:

Female condoms and foreign aid
Few people would disagree that there is a huge need for interventions that allow women to initiate protection against HIV infection. But while the research community is not having much luck in the development of a microbicide is another, already existing intervention-the female condom-being overlooked? Yes, according to the Center for Health and Gender Equity (CHANGE). In a report just released, CHANGE argues that the female condom is an effective tool for HIV prevention that is getting little attention from international donors and governments, who are instead ploughing millions of dollars into microbicide and vaccine development. Ineffective programming and lack of political will continue to deny women access to female condoms, say the report authors.

Now, I *know* I just read another report that talked about the success of getting female condoms to work in Thailand among female sex workers. The women were able to get customers to use them by touting them as sex toys, even talking about how much better it made sex for them. Clever!! The result was more sex workers using female condoms and even some clients requesting to use them when visiting a sex worker.

You always run into the argument about unequal power relationships and condom use. I thought the study on female sex workers and getting clients to use them was a refreshing change. I'll have to dig that up, but probably won't until finals are over!

The Right to Health

Not a lot of time to write today, but wanted to share this piece from the Lancet's Global Health Network. Great site, great features and podcasts, and this piece on what it means to have a universal right to health is very interesting:

http://www.thelancetglobalhealthnetwork.com/archives/269#more-269

And some more links to the UN special Rapporteur's reports on the right to health:
http://www2.essex.ac.uk/human_rights_centre/rth/reports.shtm

Food crisis, women, and agriculture

Check out my latest post in my other blog, Our Planet, Ourselves, on the current price spike in commodities and the impact on agriculture and women:

http://www.zimbio.com/Our+Planet%2C+Ourselves/articles/12/Food+crisis+women+agriculture

Like a coffee van, but with cats

Thursday was ASPCA day which, due to impending finals and class that evening, I was unable to partake in this year. I was, however, able to work my first mobile adoption event for the ASPCA yesterday and it was so much fun. I'm definitely hooked on public outreach!

In the afternoon we loaded up a selection of cats into what is possible the world's greatest vehicle. The ASPCA's mobile adoptions van not only has a plexi-glass side that is exposed when you roll up the metal side so people can see all the gorgeous kitties, it has a big ol' dog face above the windshield. It is fantastic. Someone on the street called their friend and described the van as follows: "You know how the coffee and bagel vans lift up the side and then the coffee stand is there? Well, it's like that but instead of coffee it's cats." Brilliant.

We adopted out a third of the 9 cats we brought on board. They were largely not impressed with the van ride, nor being moved from their boxes to the display windows (one was so worked up he peed on me), but they all warmed up to the new digs after we had been parked for a little while.

It was a lot of fun to be the defacto "hawker"--standing outside the van, handing out leaflets, answering questions talking to people who were interested in the cats, and encouraging them to go inside and take a look and fill out an adoptions application. It was really nice to see people's faces as they went home with cats right then and there.

Tomorrow I am running a race in Central Park for the TGL foundation again--their annual race for lung cancer research funding. 9am--a little on the early side for a Sunday, but I'm really looking forward for the chance to see Central Park in Spring--all the flowers should be out by now. Here's hoping for good weather!

Rise in food prices hurts developing countries most

Paul Krugman has a great editorial that quite neatly summarizes why we've seen a rather sudden increase in the price of commodities. Climate change, increased demand for meat in middle income countries, and subsidized corn to produce ethanol (not the green fuel it is made out to be) have been driving up the price of wheat and other grains. Add to that a fall in production in Australia and you have a shortage that had caused the World Food Program to appeal for funds.

You can read the full piece here.

There is also a piece up on reliefweb that gives the humanitarian perspective in more depth.

Microfinance for profit?

I may be a little late to this debate, but I attended a conference last week where the keynote speaker, president of ACCION International, was asked about the growing trend of microfinance NGOs morphing into microfinance banks with a for-profit goal.

Micro-finance began with the goal of increasing access to credit for some the world's poorest people who otherwise would never have the means to get a loan with a non-exploitative interest rate. It's not that the poor had no access to loans in the past, it's that when they did, the terms and interest rates were so excessive it only drove them further into poverty.

Micro-finance, which gaves loans at reasonable rates, used a more community-based model that held people accountable to a small group of other investors if they defaulted on their loan. The result was near zero default rates, community empowerment, and the chance for many to finally embark on sending a child to school, starting a business, seeking medical care, etc.

The success of micro-finance has propelled some to take it to a for-profit model, typically by starting micro-finance or micro-credit banking institutions. As I understand it, there is not a lot of regulation in this area yet. Further, one has to wonder about the goals of such an institution with two bottom lines: decrease poverty but make money for the bank owners.

The NYT had two recent articles on this very topic:
http://query.nytimes.com/gst/fullpage.html?res=9C0CE4DD113DF930A3575AC0A966958260&sec=&spon=&pagewanted=1

http://www.nytimes.com/2008/04/05/business/worldbusiness/05micro.html?em&ex=1207713600&en=a2d7c7eef5743078&ei=5087%0A

Midterms are over!

Well, almost. The light at the end of the tunnel is getting brighter. I have one more paper to pound out today and then I am done. Today, after a 2 hour panel on expanding women's roles in Afghan society through civil society organizations, my schedule is to get said paper finished and, depending on what time is left over, catch up on a million other things I need to get done. But, to be truthful, things like calling the insurance company and checking retirement accounts will probably wait until next week when I am *on break.* Except I still have to work. But, whatever, it's still break because I'll only be getting home past 9 if I want to :)

I know I'm getting to the end of my rope when the podcast listening increases and the long-forgotten pile of knitting starts looking really appealing. There was a NYT article recently on taking a digital day off each week. No blackberry, no blogging, just taking downtime. Wow, it's been a while since I managed that. But in the spirit of trying to calm down, I have planned a digital day off for tomorrow. No emails, no blackberry buzzing, no work. No one said it would be easy. I'm going to take a long run in the morning, work on my plants outside, read something non-academic, get a massage, and hopefully end the day with dinner and a movie out (not Netflix! It's great and all, but a girl has to get treated to going out once in a while). True, that paper may not be done, but I can make notes on paper and finish Sunday if need be. I think my addled brain needs the time off more than the paper needs to get done right now.

Off to start my busy day today...

State-building in South Africa

Reconstructing the Veld: Challenges of state-building in post-apartheid South Africa

“South Africa belongs to all who live in it, united in our diversity”
--Preamble to the Constitution of the Republic of South Africa, 1996

South Africa's past and present is one of state building and reconstruction. The new South Africa would not be a state forged by modern wars, but by hundreds of years of accumulated conflicts. Post-apartheid, South Africa needed to change more than just hearts and minds to become a new nation. Apartheid rule had tried to carve out South Africa as a country reserved for whites only. The “rainbow nation” would strive to be different. Black, white, or colored, the qualification to be South African was now to have shared in South Africa's success and its suffering. South Africa, the new Constitution stated, “belongs to all who live in it.”1

Post-1994 South Africa's goal and challenge was to build “a new inclusive identity based on citizenship and national territorial integrity.”2 Territorial integrity and representation would prove to be key. Apartheid had yoked citizenship with elaborately gerrymandered borders and boundaries. Years of forced relocation of blacks to government-designed “homelands” outside the major urban areas and economies had created majority black areas plagued by under-development, lack of basic social services, and malnutrition and rates of child mortality common in sub-Saharan Africa. Black South Africa, though the vast majority of the country's population, was squeezed onto a mere 13% of its land.3 Most of South Africa's rural land still remains under state ownership, with those living on it for generations having little to no say in the fate of its use or redistribution.4

Debates of land reform and redistribution raised questions of claims to the land and who should oversee its administration: the state, local authorities, or individuals? As Lungisile Ntsebeza writes: “One of the key problems contributing to the constitutional obligation to establish law guaranteeing tenure security for all South Africans...is the unresolved issue of the roles, powers and functions of traditional authorities in land matters and, indeed, in the new democracy.”5

Bantustans and borders
Even before the term “apartheid” was coined in 1948, the white leadership of South Africa was creating a legal structure that would fundamentally challenge the notion of what it meant to be South African living in South Africa. A series of laws, starting in 1913, began removing blacks' claim to land as well as their physical presence on it. Over subsequent decades, dozens of laws and acts were passed with the goal of creating a white South Africa. The Native Affairs Act of 1923, the Slum Act of 1934, the 1951 Bantu Authorities Act, and finally from 1976-1980 the “independence” of a series of “homelands,” also known as bantulands, removed black South Africans, often forcefully, from their places of residence to distant sections of South Africa that had been decreed by the government to be their “true” homelands. Resettlement to the homelands was the final stage in the campaign to redefine South African citizenship as the exclusive domain of whites.6 Each homeland was “legally” outside the boundaries of South Africa as a state. Initially blacks resettled to the homelands were granted “dual citizenship” in their homeland and South Africa, but as homelands were “granted” their “independence,” those residing in them found they were no longer South African citizens. It is illustrative of the white perception of the homelands that some apartheid-era academics went so far as to classify them as “less developed countries” and used the language of development studies to explain the challenges and reforms needed to improve social conditions in these overcrowded, poverty-ridden areas.7

The homeland areas did not reflect traditional landholdings of different tribes but were instead drawn to remove black populations from important white landholdings, gold or coal rich areas, and urban areas of economic importance.8 Homeland economies were largely dependent upon “migrant” labor to South Africa's cities and suburbs.9 Despite claims of homeland independence and self-governance, the Bantustan Administrations were dependent upon the South African government for financing two-thirds to three-quarters of their meager budgets.10

Too Many Institutions
Ironically, post-apartheid South Africa suffered from a surplus of institutions, but few of them functioning. In an effort to build legitimacy for the homelands, the apartheid government had invested in the establishment of homeland bureaucracies. Homelands such as QwaQwa, an arid land surrounded by mountains, by the late 1980's had not only their own self-administered police force, jails, president, cabinets, parliament and civil service but also their own rigged elections, patronage networks, and repression.11 The ANC's official position on bantustan structures was favoring their eradication.12 When the party was banned, the UDF picked up the struggle, and in standing for a united South Africa advocated for not only the abolition of homelands but also homeland governments and the role of chiefs.13

Institutions alone would not have been enough to keep up the appearance of homeland self-governance. The apartheid government “made extensive use of headmen and traditional authorities as a way to extend the rule of the state into the rural areas of the country, and the appointment of tribal authorities and headmen generally reflected the power dynamics of the apartheid state.”14 During apartheid, chiefs were instrumental in implementing and maintaining homeland rule. Widely derided as puppets of the state, chiefs were either appointed from existing traditional structures or simply created by the state to fill a governance position in the homelands. The 1951 Bantu Authorities Act gave power to a hierarchy of chiefs, but compliance with the ruling government was essential. Uncooperative chiefs would find themselves displaced by a government-sanctioned successor.15

When the opportunity of a reunified South Africa arose, not all homeland governments welcomed the idea. Despite the early approval by the prominent homelands of Transkei and Ciskei, other homeland chiefs balked at the prospect of losing the rights and power they had accumulated under homeland rule.16 After all, some of the chiefdoms were creations of apartheid, with no historical claim to their positions.17 Part of the challenge in rethinking South Africa's local administrations is that both those who promote the retention of chieftaincies and those who call for their end can point to South Africa's history to bolster their argument. The country does not have a good track record of the central state looking out for the best interests of the majority of its population. In contemporary South Africa, the ruling ANC has also neglected the needs of many South Africans through a strong urban bias in its early reconstruction plans.

There were fundamental problems with adopting chieftaincy into the new South African government structure. For a country striving to base its laws on human rights and inclusion, how could an institution based on heredity—and one that often relegated women to second-class status—have any legitimacy? While chieftaincy did allow some measure of popular concern to be voiced during apartheid, it remained a largely apartheid power construction.18 Linked to the trouble with local chiefs is the challenge of reconstructing South Africa's civil service for provincial and local governments. Provinces were rebuilt from fragments of the old provincial and homeland systems. New local-government structures will also have to be “built up from an inheritance of racially segregated and duplicative institutions.”19 In a nation with limited resources, homelands created redundant institutions that sapped funding that could be spent on other programs:

“One major headache for the government of the Northern Province was the incorporation of three former bantustans: Venda, Ganzankulu (destined for the South African TsongaIShangaan; the majority of the Shangaan live on the other side of the border in Mozambique) and Lebowa (Northern BaSotho). The government inherited the costly legacy of Grand Apartheid. The bureaucracies of the former bantustans, reputed to be inefficient and corrupt, had to be absorbed in the new provincial administration. Traditional leaders, until recently maligned as the faithful servants of the apartheid government and the bantustan despots, had to be incorporated in provincial and local government and in the ANC's ambitious five-year development plan, the Reconstruction and Development Programme (RDP).”20

Conclusions
South Africa's inequality is still quite heavily drawn along racial lines, but perpetuation of apartheid-era governance structures further divides the population, this time splitting black South Africans into those who “have” and those who “have-not.” As Pickles and Woods foresaw in the late 1980's:

“...the artificiality of homeland governments and their corrupt bureaucracies threaten
those not part of the patronage system...and second, that the ongoing restructuring of social relations in the homelands is creating concrete social structures and ideologies, and entrenching the mythology of ethnic difference within the political discourse of South African society.”21
South Africa today is increasingly accepting and proud of its multi-racial identity. The latest edition of the Economist reported on a survey showing that most South Africans belief race relations are improving, while “an emerging black middle class is slowly blurring racial and social lines.”22

Overcoming the social class divide will not be accomplished by retaining institutions like chieftaincies that perpetuate class divisions. The ANC states its commitment not to “perpetuate the separation of our society into a First World and a Third World—another disguised way of preserving apartheid,” but rather to “meet the basic needs of people,” particularly in the rural areas.23 Along with promoting rural people's land tenure should be a commitment to fostering community organizations and boards where ordinary citizens, for a fixed term of service, have a direct role in land reform and local administration. This is a challenge in any society with high levels of illiteracy, such as South Africa, but it would be a step towards incorporating historically marginalized people directly into the governance process, making them key stakeholders in the new rainbow nation in more than just rhetoric.

1Sally Peberdy. (2001) Imagining Immigration: Inclusive Identities and Exclusive Policies in Post-1994 South Africa. Africa Today, 48(3), pp.16
2Ibid.
3Lungisile Ntsebeza (2003) Land Rights and Democratisation: rural tenure reform in South Africa's former bantustans. Transformation: Critical Perspectives on Southern Africa (52). pp.77
4Ibid, pp.71
5Ibid, pp.78
6Joseph Lelyveld. (1985) Move Your Shadow: South Africa, Black and White. New York: Penguin Books. pp.124
7Ibid, pp. 79
8Nial MacDermot. (1984) Self-Determination and the “Independent Bantustans.” United Nations Centre Against Apartheid. pp.9
9Ibid.
10Ibid, pp.13
11John Pickles; Jeff Woods (1992) South Africa's Homelands in the Age of Reform: the case of QwaQwa. Annals of the Association of American Geographers, Volume 82, No. 4. pp.637
12Ineke van Kessel; Barbara Oomen (1997) “One Chief, One Vote”: The revival of traditional authorities in post-apartheid South Africa. African Affairs, Volume 96, No. 385. pp.567
13Ibid, pp.568
14Noah Zerbe (2006) Democracy Compromised: Chiefs and the politics of the land in South Africa. African Studies Review, Volume 49, No.3. pp.144
15Kessel; Oomen. pp.581
16Pickle; Woods. pp. 647.
17Kessel; Oomen. pp.581
18Ibid, pp.585
19Charles Simkins. (1996) Problems of Reconstruction. Journal of Democracy.7.1 pp.85
20Kessel; Oomen. pp. 578-579
21Pickle; Woods. pp. 658
22The Economist. “South Africa: Skin Deep.” March 8-14, 2008. pp.55
23Fred Judson (2006) The Dynamics of Transition Governance in South Africa: Voices from Mpumalanga Province. Africa Today. 60. pp.7