Disparities

South Africa has an incredibly progressive constitution- with it come rights such as the right to dignity, equality before the law, universal rights to basic education, the right to basic provisions such as housing and the right to healthcare for all. One of TAC’s (Treatment Action Campaign) missions is to ensure and advocate that the government provides equal and fair healthcare access for every one across the country. Unfortunately, although this is explicitly stated in the constitution, in reality this is not occurring in South Africa.

Discrimination can be seen everywhere. The horrors of what apartheid created – a society of inequalities – is still ever present in the current South Africa. Although all are told they have the dignity of being humans, if one is not treated as human, do they truly have this promised dignity? One way that one could easily lose the sense of dignity is through illness and sickness. The healthcare system should treat you with respect. The terrifying truth however, is that a huge percentage of people are not treated as humans when receiving treatment or being attended to at hospitals and clinics. Some people are able to receive state of the art care – as tour guides love informing us, South Africa is home to the first successful heart transplant. However, other people will not even make it to the clinics because of a variety of complicated reasons. Frustration with the health care system, tiredness of being treated as unequal because of a disease, fear of the stigma that people receive, even in a hospital, all deter people from receiving treatment. The difference in the level of the healthcare that people receive in South Africa is absurd.

I distinctly remember a conversation I had with an anti-apartheid activist, Jane, who invited our group into her and her husband’s home. In addition to talking to us about integrating a church in District 6, and what it was like to live during Apartheid, she discussed modern day South Africa. She talked about visiting a friend at a hospital in Cape Town that she had never been to before. She came back shaken by the visit, stating that there were bullet holes through the building, the infrastructure was failing, the sanitary conditions were appalling and that there were not even enough doctors attending to the patients. She kept repeating that this was happening near other hospitals that are fully functioning and doing extremely well. I was really moved by hearing her speak about the discrepancies she observed in different hospitals and it got me thinking even more deeply about health disparities around the world.

Not only is there discrimination based on socio-economic lines, there is discrimination based on gender. This is especially prominent in certain illnesses such as HIV and HPV. The lack of attention that it is receiving is shocking. The ratio of the risk of developing cervical cancer is 1:39 for women in South Africa. The already gendered HIV endemic (were twice as many women as men are living with HIV/AIDS than men) has another complicated layer to it for women– HPV and cervical cancer. The second most common cancer in South Africa is both preventable and easily detectable. Why are so many women dying from this? Why is HPV not talked about as frequently as HIV and TB in South Africa? Why is there such a backlash against the vaccination against the most common types of HPV, which would protect one from getting a life threatening and devastating cancer? Why aren’t more women getting tested for HPV?

One of the reasons that this is despicable is because there are simple HPV tests, such as PAP smears, which detect cervical cancer, and a vaccination against some HPV strains, which cause cervical cancer. Unfortunately, there are several problems with these two simple solutions. First of all, PAP smear test results take up to 6 weeks in the clinic, while in the private sector they take a maximum of 4 days. Furthermore, women are afraid of doing PAP smears because many of them do not know what they are and how they work, and they are not always treated well at these clinics. The HPV vaccine is also problematic. The vaccine is administered at schools, since it targets both boys and girl starting at 9 years old. Parents and educators are pushing back against this, because they are afraid the vaccine then makes their children more likely to have sex. In addition, this vaccine is available only to the students who attend school. This means that many children who live in rural areas who struggle to get to a school are unable to receive the vaccine. Given that this vaccine has been proven to prevent cervical cancer, that the PAP smear is an easy and painless test, and that there are new inventions, such as David Walmer’s cerviscope which detects cervical cancer, the number of women who die from cervical cancer should be dramatically lower that it is in South Africa.

HPV and cervical cancer can be prevented, treated and cured if detected at an early stage. This must be given time and attention in the health care system in South Africa. Women need to have access to information about this disease, as well as prevention and treatment options. Increasing health awareness, improving the healthcare system, and making sure that people with any type of illness are treated equally and with dignity are essential steps to reducing health care disparities in South Africa.

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