New global map reveals reforestation sweet spots
But, like any other vital organ it needs to be in the right place.
Reforesting the wrong areas can hurt communities and even entire ecosystems.
READ | Discussion | Extreme weather and climate change
Now, Wits has mapped out the best spots for reforestation on the entire planet.
Its Future Ecosystems for Africa programme undertook the groundbreaking research. Programme lead, Professor Sally Archibald unpacked this on eNCA.
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Mail & Guardian
4 days ago
- Mail & Guardian
Rhinos go nuclear: Scientists use cutting edge deterrent to foil traffickers
A white rhino is being monitored while it is sedated and awaiting the insertion of a dosage of radioisotopes into its horn by members of the Rhisotope Project. What if Led by The conservation initiative is the brainchild of researchers from 'We have demonstrated, beyond scientific doubt, that the process is completely safe for the animal and effective in making the horn detectable through international customs nuclear security systems,' said Larkin, the project's chief scientific officer and the director of the radiation and health physics unit at Wits. Six months ago, radioisotopes were embedded into the horns of 20 rhinos in the Unesco-listed Waterberg Biosphere in the pilot phase. Blood tests and veterinary monitoring showed no adverse effects on the animals from the isotopes levels used. Using a technique known as biological dosimetry, researchers cultured blood samples and examined the formation of micronuclei in white blood cells — a proven indicator of cellular damage. No such damage was found. 'This is just one example of how Wits University's researchers work and think innovatively, stepping out of the clinical environments of their laboratories to bring bold, creative solutions to some of the world's toughest challenges — often going above and beyond in their commitment to make a real difference,' Wits vice-chancellor and principal Zeblon Vilakazi said in a statement. Detection tests using 3D-printed rhino horns — designed to mimic real keratin — were run through carry-on luggage, air cargo and even inside full shipping containers. In each case, even a single horn with significantly lower levels of radioactivity than what would be used in practice, successfully triggered alarms in radiation detectors, Larkin said. The Rhisotope Project was launched to counter the high levels of the poaching of South Africa's rhinos, with more than 10 000 of the animals lost to the crime in the past decade. Although the focus is on rhinos, especially the critically endangered black rhino and near-threatened white rhino, Larkin sees broader potential. There will be a number of different ways in which the poacher will learn not to come onto a property to poach rhinos, the project team said. 'There will be strategic signage posted at regular intervals on the perimeter fencing, there will be an extensive local education effort to inform residents in the area that these animals have been treated, and more generally a social media campaign. 'The marking of those animals that have been treated on a reserve will be in a manner agreed upon by the rhino owner or the reserve management team. The research team will be looking into the pros and cons of an obvious mark placed on the animal, post treatment.' Larkin said the methodology could be adapted to protect other endangered species such as pangolins and elephants. 'We're already in discussions about applying this to elephant ivory … I hope this significantly curtails wildlife smuggling of these megaherbivores.' These radioisotopes will provide an 'affordable, safe and easily applicable method' to create long-lasting and detectable horn markers that cause zero harm to the animals and environment. Collaboration with customs agencies and international security bodies is under way, while the researchers are also in discussions with airlines, because much of the illicit trade travels as commercial luggage and freight. 'We'll keep watching what fantastic organisations like Traffic [the wildlife trade monitoring network] are doing in terms of 'We recognise that we're in an arms race, so the research stuff has not stopped. Me and my colleagues at Necsa [Nuclear Energy Corporation of South Africa] are having regular meetings … to look at other ways we can use nuclear science to devalue rhino horn.' On whether the end user will be harmed by ingesting some of the radiation, the project team notes that a person would have to consume a whole rhino horn to cause any harm to themselves. 'The intention is not actually to harm the end user but to use their natural fear of radioactive materials to dissuade them from wishing to purchase or otherwise acquire radioactive horn. They might get sick if they consume enough of the horn.' With the Rhisotope Project now a registered nonprofit and fully operational from this month, the team is urging private rhino owners, conservation NGOs and national authorities to come forward. 'We've got to work with forward-thinking, early-adopter rhino owners in South Africa and in Southern Africa and wherever else there are rhinos in significant numbers,' Larkin said. 'Once they show it works, the others will come along by necessity, dare I say. Eventually, I hope we can bring big players like SANParks on board and then we can really give these poachers a proper kicking in some ways.' Rafael Mariano Grossi, the director general of the IAEA, said this project exemplifies how nuclear science can be applied in novel ways to address global problems. 'By leveraging existing nuclear security infrastructure, we can help protect one of the world's most iconic and endangered species.' The IAEA said tagging rhino horns with radioactive material makes the horns detectable by radiation portal monitors (RPMs), which are already deployed at borders, ports and airports worldwide. 'These RPMs, commonly used to detect nuclear and other radioactive material, can now be harnessed against wildlife crime. 'With millions of vehicles and people crossing borders every day, the use of an estimated 10 000 RPMs worldwide has become a critical tool for detecting unauthorised transboundary movements of nuclear and other radioactive material.' Rhisotope Project chief executive Jessica Babich put it simply: 'Our goal is to deploy the Rhisotope technology at scale to help protect one of Africa's most iconic and threatened species. By doing so, we safeguard not just rhinos but a vital part of our natural heritage.' The project team said the final testing phase had been made possible through the collaboration of the IAEA, Wits, Necsa, the Limpopo Rhino Orphanage and the Unesco Waterberg Biosphere.
Daily Maverick
6 days ago
- Daily Maverick
Hout Bay mussels contaminated with hidden toxins and sewage
A new study has found that waterways in Hout Bay, Cape Town, are severely contaminated with sewage, packed with invisible pharmaceutical chemicals and bacteria that even make their way into the seafood we eat. Hout Bay, a coastal suburb of Cape Town, is facing a growing pollution crisis in its waterways, with increasing levels of pharmaceuticals and other toxins detected in mussels, according to a new study. The study, by scientists from UCT, Wits, the University of the Western Cape and Stellenbosch University, investigated contamination in the coastal and riverine environments of Hout Bay by assessing pharmaceutical and personal care products in mussels and microbial indicators in water samples. The researchers set out to determine the extent of the pollution's impact zone. Their analysis of samples taken between 2020 and 2021 found contamination from the Hout Bay marine outfall, inadequate riverine sanitation and other sources indicated an urgent need for upgraded wastewater treatment and infrastructure to protect public and environmental health. The findings underscored the 'significant impact' of untreated sewage on the environment, the researchers said. The numbers are stark Acetaminophen, a common painkiller, was detected at concentrations ranging from 32.74 to 43.02 nanograms per gram of dry mussel tissue (ng/g dw) Bezafibrate, a drug to lower cholesterol, was by far the most common contaminant, reaching concentrations as high as 384.96 ng/g dw. Triclosan, an antibacterial found in many personal care products, was also high, at 338.56 ng/g dw. The results show that marine organisms are consistently being contaminated by medicines and personal care products. The increasing concentrations over time are likely because of more people moving to the area and the growing use of these kinds of products. The microbial analysis conducted as part of the study detected exceptionally high levels of E. coli in the Hout Bay River, specifically in areas receiving stormwater from the Imizamo Yethu settlement, with counts reaching more than 8.3 million colony-forming units per 100ml (cfu/100 mL). What it means for residents Because of the high levels of contamination, regularly eating the mussels and other seafood could lead to chronic exposure to these harmful chemicals, which may cause chronic illness and organ damage, the study says. However, the effects are far more prominent in marine organisms and marine environments. According to the study, Hout Bay's contamination levels are comparable to those in other highly urbanised and industrialised regions of the world. Leslie Petrik, a professor of chemistry at UWC and one of the study's authors, advised residents and beachgoers to 'stay away – the risk is consistently present'. Petrik said trends indicate that the quality of the water is deteriorating, increasing the risks for recreational users as well as commercial and tourism activities. 'Each of us has a duty for environmental stewardship. The toxicity of these persistent compounds is well documented and should preferably be substituted,' she said. The city's response City of Cape Town Deputy Mayor and mayoral committee member for spatial planning and environment, Eddie Andrews, told Daily Maverick that the challenge of the removal of pharmaceutical and product chemicals from wastewater was by no means unique to Hout Bay or Cape Town. 'Wastewater treatment works globally do not generally effectively remove contaminants of emerging concern from sewage, irrespective of the level of treatment,' said Andrews. Advanced techniques can remove some contaminants, but Andrews said these were costly, energy intensive and impractical at scale for municipal systems. The city has been investigating long-term options to replace marine outfall pipelines with new wastewater treatment works, but no decisions have been made on the timing of these replacements. Andrews said that Cape Town faced many competing priorities, with underserved areas requiring basic sanitation upgrades and that the 'prioritisation of limited funding' needed to be weighed up in this context. An environmental monitoring programme was under way and the sampling of both water and tissue at sites near the marine outfall was providing insight into this issue, he said. Extensive impact zone The researchers found that chemicals in pharmaceuticals, including those in antibiotics, antidepressants and hormones, as well as those found in personal care products, are not being adequately diluted or dispersed. Instead, they pass through wastewater systems largely untreated. As a result, they accumulate and persist in marine environments and organisms, such as the mussels studied, even at significant distances from where the waste enters the waterways. The main source of contamination is the Hout Bay marine outfall, which releases about 5.7 million litres of screened sewage into the ocean every day, 2.1km from shore at a depth of 39m. Contamination is also from the polluted inflows from the Disa River and other tributaries, which are heavily affected by the ineffective sanitation infrastructure, especially in informal settlements such as Imizamo Yethu. The study found that the impact zone around the outfall and river mouth was extensive. These zones are 'too pervasive for truly safe, consistent recreational use', said Petrik. The researchers warn that the current sewage treatment is not enough to curb the pollution, and that the marine outfall 'was not designed to handle the ever-increasing volumes of chemical constituents'. Growing informal housing built over sewer lines means these systems are often blocked or broken, leading to raw sewage routinely flowing down streets and into stormwater drains, which feed directly into the river. Another key factor identified is Hout Bay's unique geography as a 'bay within a bay', which limits water exchange and circulation. Instead, it acts as a trap, causing pollutants to recirculate back to the shoreline rather than being flushed out to sea. Improving wastewater systems Zahid Badroodien, the city's mayoral committee member for water and sanitation, said that Cape Town was committed to continually improving its wastewater systems: 'While the Hout Bay marine outfall currently operates within its design parameters and complies with national discharge regulations, we recognise that CECs [contaminants of emerging concern], including pharmaceutical and personal care products, pose new challenges globally.' Research on the treatment of these contaminants was ongoing across the world, she said, and the city was 'evaluating multiple long-term options that may address this in the future' at all of its wastewater treatment works. Petrik said that the study aimed to focus attention on the peculiar way that the city measured impact zones, using a single snapshot model of enterococci levels, which are used to detect faecal contamination. But, she said, the marine outfall and the Disa River released untreated raw sewage continuously, '24/7/365'. Petrik said that the city should rather trace the chemical fingerprint of sewage to properly understand the impact zones. 'The city keeps claiming that the marine outfall dispersal works according to its design criteria, but the measure of dispersal they use is vastly inadequate. 'Enterococci die off after a while, whereas the persistent contaminants give a far clearer, longer-lasting and traceable measure of the dispersal and thus the impact zones around these point sources of sewage discharge,' said Petrik. River pollution The city acknowledged that the Hout Bay River, also known as the Disa River, was in a very poor state due to periodic and ongoing pollution from a number of sources. 'It receives flows from a catchment of approximately 37 square kilometres, which includes natural upper slopes in the Table Mountain National Park, formal residential areas and smallholdings on both sides of the Hout Bay River, formal housing with backyard dwellers in Imizamo Yethu and Hangberg areas, and informal dwellings in Imizamo Yethu, which includes a fairly large informal settlement with limited services,' said Andrews. City's plan to improve sanitation services in Hout Bay, particularly in informal settlements like Imizamo Yethu Immediate actions: Increased, proactive cleaning, rapid response to spills, door-to-door inspections to enforce by-laws, and public education campaigns. Medium-term plans: Exploration of temporary solutions like diverting flows at the Victoria Road pump station and investigating the feasibility of in-line water treatment. Long-term strategy: A feasibility study in 2028/2029, which will focus on a major upgrade of the Disa River sewer pipe to increase its capacity and resilience. Badroodien said these efforts were part of a broader R1.25-billion city-wide investment in sanitation infrastructure for the current financial year, with R355-million allocated for sewer pipe replacements and R241-million to upgrade pump stations across Cape Town. Andrews said that they agreed with the authors of the study that further research into the bioaccumulation of pharmaceutical compounds by bivalves, such as mussels, in a marine protected area was needed. He said measures of when these contaminants should be considered to be at a level that was harmful both to people and the environment were not yet established, but that the city remained 'engaged in this emerging science as it develops globally'. DM
TimesLIVE
01-07-2025
- TimesLIVE
Professor screw it, let's do it
An inaugural lecture is a formal event thrown by a university to commemorate the lecturer's appointment to full professorship. They are usually gravid, pinnacle-of-career moments. Francois Venter's inaugural lecture, held at the University of the Witwatersrand in 2023, was not typical. He began by describing how, for years, he had successfully dodged requests to deliver the lecture by blaming the university's email system. He confessed he missed a trick during the Covid-19 pandemic, 'when I could have done this online', and while he dutifully name-checked his professional role models and heroes, he also gave shout-outs to his tennis and rock climbing coaches, in between anecdotes about drinking tequila with Dexter Holland of The Offspring rock band (who earned his PhD in molecular biology in 2017), and being called by Standard Bank, twice ('I swear I turned this off …'). Venter's allergy to formalism, and to being in the spotlight, remains untreated. 'I hate, hate, hate talking about myself,' he warns. We are sitting in the immaculate boardroom of Ezintsha, the Wits-based medical research centre that Venter leads. Ezintsha came to international attention in 2019 after the results of a clinical trial called ADVANCE were published in the New England Journal of Medicine, showing the effectiveness of new HIV therapies and perhaps more importantly, demonstrating why it is important that clinical trials be conducted in the contexts in which the drugs are mainly consumed. The therapies worked but, as Venter puts it, 'with complications peculiar to local populations, far from the sanitised world of curated pharmaceutical studies done on healthy white men'. Venter, by this time, was already well known for his work in HIV, not only for his scientific outputs but for taking up cudgels on behalf of people living with HIV. In a series of recent op-eds, for example, Venter has excoriated both the president and the health minister for providing scant leadership in the face of the US's defunding of the HIV response in South Africa, comparing their inaction to the infamous Aids denialism of Thabo Mbeki and his health minister, Manto Tshabalala-Msimang. Venter's response to being singled out is predictable: 'There are so many people in the HIV world who did much more, and more bravely.' It is the refrain of many treatment activists and no deterrent to my questions about his childhood in the lowveld town of Phalaborwa. The picture builds in fragments. 'The town has a paint colour named after it — Phalaborwa Dust — a sort of dull grey, which says everything, really,' says Venter, who was born in 1969, the first of seven children. Venter's Afrikaans-speaking father worked as an accountant for the Palabora Mining Company, while his English mother ran a creche. 'You couldn't have a family that size today,' he says. 'They managed because the company subsidised everything from education to golf club memberships.' In a time of grand apartheid, Venter's world was particularly white and insular. 'Growing up I never met a black person who wasn't a servant,' he admits. On Fridays, he and his fellow students were made to march in quasi-military uniforms. Sadistic corporal punishment and other forms of bullying had become 'entrenched to an unthinking level'. PHALABORWA IN COLOUR Image: Supplied 'I worked like crazy at school, knowing that was my ticket out of there,' says Venter, who worried his lowveld credentials would make him the odd man out at Wits medical school. 'Instead I walked into this amazing diversity of people. For a boy who grew up on Springbok Radio, it was more than I had dreamed of,' he says, though admittedly the scene was intense and traumatising. 'All the hospitals were segregated, our training was segregated, even blood was segregated — white patients would only be given blood from black donors in extreme cases. It was just insane,' he says. Cancel language Venter is tall, powerfully built. The sharp edges of a forearm tattoo peek out of the sleeve of a black puffer jacket. His disposition is nervous, though, his speech often self-effacing, though mention one of his many bugbears and a quiet fury brims. Venter is known for speaking without any regard to self-preservation, using what a lecturer friend calls 'borderline cancel language'. Like a good journalist, he calls it as he sees it. The comparison pleases Venter, who was editor of the campus newspaper, Wits Student, in 1991. The publication had been overtly political since depicting prime minister John Vorster in a butcher's outfit in 1973, and by the late 80s was the biggest of all the student papers in the country, having lost none of its satirical venom. 'I enjoyed the cut and thrust of the media, and understanding its place in political life,' says Venter, who credits journalism with making him a better HIV researcher and political organiser ('I was able to chair meetings and construct agendas. It helped me to write grants and manuscripts.') He describes his involvement in student politics as an almost involuntary act, akin to staying afloat in a turbulent river. 'The late 80s were some of the worst for apartheid repression. Fellow students were being detained and tortured, their families maimed and disappeared. There were these extreme ideologies on campus — the United Democratic Front was very active — but at the same time there were people in my class saying the activists had it coming. That dissonance was difficult, but as far as I was concerned, there was nowhere for a white person to hide, and joining the fight [against apartheid] was the only moral choice.' Medicine, in those first years, was at the edge of Venter's concerns. He maintains he was a 'mediocre student, at odds with many of my classmates', though he pulled his socks up in his fifth year. 'I found I was enjoying clinical medicine and realised I needed to really knuckle down to stay in it.' Dying in Baragwanath Healthcare provided Venter with a clear view of the twistedness of apartheid policy. 'You go into the black hospitals and it's like, jeez, the things that are happening there. Meanwhile, white people are receiving world-class care,' says Venter, who did his 'house job' (residency) at Hillbrow Hospital, which is where he first encountered HIV as a student. 'It was the beginning of that incredible surge in numbers that occurred between 1993 and 1997. The first cases I saw were returning political exiles,' says Venter, who experienced an internal snap after an incident in a Yeoville restaurant. 'It was 1995, and I was nearing the end of a year at Helen Joseph Hospital. In those days Rocky Street was still quite eclectic and happening, and I was hanging out in a restaurant run by this Caribbean guy I knew. He had booted out a young drug addict, who went across the street and bought a knife, came back and stabbed him in the heart. It was 10am. I tried to resuscitate him, but I had nothing. The waiters continued to serve the customers and stuff, stepping over his body. It was just such a savage thing. He bled to death in front of me, and I was like, f*ck South Africa and its trauma and violence.' Venter boarded a plane for the UK, , and a hospital job he found 'terminally boring'. By 1997, he was back in Johannesburg, specialising in internal medicine. The HIV epidemic was at its zenith and hospitals across the country were overwhelmed. 'In some of the hospitals, like Bara [Baragwanath Hospital] you just left patients in casualty, and they would die there and go out the door. In Joburg Gen [Johannesburg General Hospital, today Charlotte Maxeke Johannesburg Academic Hospital ] you put them on the floor in the corridors, and they died there waiting for a bed. It was brutal,' says Venter, who cautions against apportioning blame for this wave of death. 'The numbers had surged with a suddenness and severity that we still don't really understand. Nelson Mandela was trying to prevent a race war. There really wasn't much that he, or anybody else, could have done. I didn't understand the transmission enough, and we didn't have the tools to prevent it.' What Venter struggles to forgive, however, is the callousness of some senior administrators. 'As a junior doctor working in a Gauteng hospital I remember phoning the heads of health in the province and saying, 'We're full, can you redirect the ambulances?' As far as I could see there were people lying on the floor, largely dying of Aids, but also with strokes, heart attacks. They were dying of pneumonia and TB. 'Who is from other provinces?' the administrator asked me. 'Send them back.' And I was like, 'Well, the problem sir is I've taken the history from this person from Mpumalanga, who has been sent from hospital to hospital and clinic to clinic, and they didn't get help, you know, and that's why they're here.' And he said, 'I don't care, send them back, they're not supposed to be in Gauteng.' 'And looking back, that was the first sign of the absolute arrogance of some of the health people in government. And you see it now in the way foreigners and poor people are treated in the public sector. It is one thing to have no idea how to deal with a problem, but to lack the ability to do any reflection, have any empathy and to self-correct is so upsetting.' Toxic — and incredibly effective On completion of his specialist time Venter was burnt out, and unsure of what to do with his life. He was interested in HIV, sparked by his experience of looking after a haemophiliac in 1997. 'The patient was one of a group that had HIV after receiving infected blood imported from the US by the state in the 1980s. The apartheid government took a decision to pay for their treatment with what was then extremely expensive antiretroviral therapy [ART], and the ANC government continued this,' says Venter, who was amazed at the effect of the drugs on his patient. 'I saw this patient in ICU just come off a ventilator, which just did not happen in those days.' Venter was offered a job with the Wits-based Clinical HIV Research Unit by world-renowned HIV expert Ian Sanne, who, says Venter, 'taught me how to do clinical trials, how to play with these toxic, incredibly effective drugs, and it was really the first time I was able to start seeing myself as someone who was going to get involved in HIV. The drugs have evolved since then, now more effective with almost no side effects.' 'We were working from a hopelessly overcrowded outpatient clinic in the then Johannesburg [now Charlotte Maxeke Johannesburg] Academic Hospital in which gay doctors had looked after gay men until the epidemic became more prevalent, and they all left. I was working under this amazing endocrinologist called Jeffrey Wing, and a dedicated Jewish GP called Clive Evian. At the time it probably was the biggest HIV clinic on the continent, with queues out the door every day. That's where I learnt about HIV outpatient medicine,' says Venter. It was also where Venter started interacting with the NGOs and activists then taking the fight for affordable ARTs to the government. 'We needed each other,' says Venter. 'We needed access to the drugs, and the Treatment Action Campaign had started smuggling them into the country. They needed proof that the drugs were effective in this context, and to treat their members and as many people as possible, and we had just started publishing findings from our cohort. 'It was devastating, though, watching them fighting our government to even acknowledge HIV existed, while their members died needing those drugs. The hypocrisy of senior political figures, many of whom had family members on ARVs I was treating, yet didn't call out Mbeki, is unforgivable.' He then joined Prof Helen Rees's Wits Reproductive Health and HIV Initiative and began working out of Esselen Street Clinic, an old Hillbrow facility home to the first South African HIV testing site, and from where he ran a huge US-government funded HIV support programme for the next decade across several provinces, gaining experience in expanding primary care approaches in chronic diseases. Sponsored by They were heady times, in which Venter was left disappointed again and again by much of the medical community. 'Other than the rural doctors, who have always fought for their patients, and the HIV Clinicians Society, the healthcare worker organisations were nowhere to be seen. The lawyers were there, civil society and the journalists, too, all fighting tooth and nail for access to therapy, but the professional organisations were too busy fighting for the interests of the profession,' says Venter, lamenting that little has changed. 'ThroughCovid-19, and now with the defunding of HIV and scientific research, it is the same people raising their voices, and the same organisations sitting on their hands. Worryingly, a lot of the people we are fighting are the same ones who stood in the way of access during the Mbeki era.' Since those heady Esselen days, many important clinical trials, HIV programmes, research papers and court cases have gone under the bridge, and Venter has become part of the moral conscience of South Africa. Ezintsha, for years based in a Yeoville house, and Hillbrow back rooms, around which sewage spills split and foamed, now occupies two floors of a large office block in Parktown, an environment of biometric access controls and curvilinear glass, employing 150 people. On the upper floor is the Sleep Clinic, where patients with suspected sleep disorders lie back on R50,000 mattresses sponsored by the company. QUID PRO QUO The Sleep Clinic at Ezintsha in Parktown treats people with suspected sleep disorders, with beds sponsored by a mattress company. It's also now the home of a new obesity clinic with new drugs which, says Venter, are 'every bit as fiddly as antiretrovirals were in 2000'. Image: Delywn Verasamy 'The quid pro quo is that they be allowed to advertise,' says a faintly apologetic Venter, as we cross through an incongruous six-bed showroom. The Sleep Clinic also houses a new obesity clinic, where Venter sees patients with South Africa's new pandemic. 'The new drugs for obesity are every bit as revolutionary as the HIV drugs,' he says, 'but every bit as fiddly as antiretrovirals were in 2000.' New studies, using these wonder drugs in people with both HIV and obesity, are being hatched here. Ezintsha's health staff are looking at using HIV lessons to try to improve primary care for diabetes, hypertension and other common diseases in South Africa. The race to the bottom We are a long way from Phalaborwa, a long way from the house in Yeoville, too, and while it is probably unfair to include Ezintsha in this observation, the transit away from the streets into cushy offices is one that many organisations working on HIV have made in recent years. 'It is nice not to have to worry about staff being pistol-whipped while at work,' remarks Venter, but he doesn't dodge the inference, which is that donor funding, while key to the fight against HIV in South Africa, has also distanced organisations from communities, and created a dependency which, following the collapse of the US government's Aids Fund, Pepfar, and the United States International Agency for International Development, USAID, threatens catastrophe. 'What happened still feels quite unthinkable. On the one hand it feels like 2004, when Mbeki's denial of HIV became national policy and everything felt like it was going backwards. On the other hand it is extremely frustrating that our systems have not been made sustainable, and are now on the brink of collapse as a result of Pepfar having been interwoven with the national HIV programme to such an extent everything unravels when it is stopped.' Venter sketches a scenario, in which South Africa's HIV response — 'the one effective programme we have' — is misleadingly characterised as 'too expensive', and dragged down to the lowest common denominator, 'leading to the same terrible outcomes you find in crap programmes, like diabetes'. Patients in neighbouring countries like Lesotho, where the country's HIV programme relied almost entirely on US funding, start crossing into South Africa en masse in search of treatment, where they are conveniently scapegoated by South African authorities for collapsing the health system. MR FIX IT Venter says getting 'everyone from the president and the minister of health down' to use the public healthcare system using their medical aid will mean 'they will have an immediate investment in assisting those fixing it'. Image: Supplied 'A race to the bottom, in other words,' says Venter. 'We have poor indicators for almost every health metric outside HIV, TB and vaccines and even those are now slipping, due to the health department dropping the ball. Both our public and private health services are an expensive mess, for very different reasons. The health minister has been in charge for most of the last 17 years, we have endless excellent white papers and policy documents that gather dust, and little to show for the continent's most expensive health system.' Will this grim scenario prevail, or will South African healthcare be shepherded through the labyrinth of budget cuts and misfiring systems? Venter doesn't see why not. 'It wasn't so long ago that we seemed to be in the grip of load-shedding without end, yet Eskom was turned around in 18 months. Our problems are systemic, and we have enough resources and brains to fix them. What is needed is strong leadership, which is something we currently lack,' says Venter, pausing to mull the judiciousness of his next point. It isn't a long pause. 'I'll tell you what you do. You take the top people from the medical aids and tell them: you can't be head of Discovery or the Government Employee Medical Scheme, Gems, any more, lead with the best people from academia, from government, the private sector, donors, civil society, form a focused group with teeth, and run the health system.' 'We all declare our interests, put an end to corruption and everyone from the president and the minister of health down in government must use the public healthcare system when using their medical aid. If they experience the system first hand, they will have an immediate investment in assisting those fixing it. Stop blaming the private sector and a lack of money for the problem. 'Start using the innovations South Africans are world leaders in, including data systems. If we do that, I am telling you we will fix the system in five years.'
