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The Rat Race Against The silent Killer

Tuberculosis is a silent killer; now there is a greater chance of people dying from it. A strengthening superbug is defying drugs and sending African hospitals into the red. Doctors are calling it a ticking time bomb and all that stands in its way are new pills, new technology and a rat pack.

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Seven months ago, Daniel, not his real name, was so tired he couldn’t walk and at night he would wake up sweating. He was so thin people thought he was on tik (crystal meth). He hadn’t worked for two years.

At the time, Daniel thought he had a bad cold, so he went to his clinic in Bonteheuwel, a township in Cape Town, to get medicine. To his horror the nurses told Daniel he was suffering from what they call extensively drug resistant tuberculosis (XDR-TB) – a virulent strain of multidrug resistant tuberculosis (MDR-TB). A mere four years ago, this would have been a death sentence.

In Africa, tuberculosis (TB) is called the poor man’s disease – it strikes in overcrowded homes and overcrowded taxis.

Professor Andreas Diacon

“I didn’t know anything about TB. I didn’t know anything about MDR or XDR. I didn’t realize TB was a disease that could kill you… [Death] hung at the back of my mind. I wouldn’t sit next to people who had it… I was scared of them. Now, it’s the opposite. I was the one who had it,” says Daniel.

It hit home hard over Christmas. Daniel was allowed out of hospital, but his family refused to sit with him. Many others are ostracized by their own people largely because of the relationship between HIV/Aids and TB; half of South Africa’s TB patients also have HIV.

“In my community people believe TB can change to HIV. But that’s not true. TB stays TB and those who have HIV can get TB. They told me to sit outside and drink by myself, alone,” says Daniel.

Daniel is one of millions in a worldwide TB epidemic. It’s been called the world’s number one infectious killer disease, taking more lives than HIV and malaria in 2015, according the World Health Organization (WHO). In that year alone, 1.8 million people died from TB. That is a third of the people living in Cape Town and more than a small country like Gabon.

The problem is, over the last 40 years, TB has sharpened its teeth, yet hospitals haven’t. In 2015, an estimated 480,000 people developed MDR-TB alone, according to the WHO.

This is because MDR-TB has become a superbug.

For those who do survive, it means up to two years of expensive treatment; in which you swallow almost 15,000 pills and in which you take daily injections that can make you deaf.

Thanks to a revolutionary drug called bedaquiline, Daniel’s death sentence has been stayed.

It was discovered in 2005 by Belgian veterinarian Koen Andries, a pharmacist at Janssen pharmaceutical company. This was the first TB drug to be registered in 40 years in 2012.

It proved so promising that a mere month later it was being handed out in South Africa at the behest of the country’s Minister of Health, Aaron Motsoaledi.

Just 15 kilometers from where Daniel still lies in hospital, Motsoaledi sits in the oak-furnished offices of Parliament, in Cape Town. Motsoaledi is keen to push his point for the war against TB – he is a qualified doctor who has seen its effect firsthand.

Bedaquiline is helping to save the lives of 4,385 people living in South Africa, like Daniel. To this day 60% of all the people taking bedaquiline are treated in South Africa, according to Motsoaledi.

The effectiveness of TB treatment is measured by a patients’ sputum culture – infections in the respiratory system – converting from positive to negative. The South African government says the number of people with MDR-TB cured is 79.7% for those on bedaquiline; up from 39%.

“[TB] is a silent killer that does so in an undramatic way, so nobody notices. In 2009, 80 members of the National Union of Mineworkers died in rock falls, everybody knew about it. But in that same year 1,500 of their members died of TB. They are all deaths, it’s a loss. But the 80 made the most noise. The 1,500 died a silent death in a bed,” says Motsoaledi.

Motsoaledi is trying to convince the world as board chair of the Stop TB Partnership, a United Nations project. He is exasperated that TB has not been debated in a general assembly of the United Nations, based in New York. Even though it is part of the Millennial and Sustainable Development Goals, which hopes to eradicate TB by 2030, it was only recently amended to be on the agenda for 2018.

 

“TB is not bringing a lot of fear to people. But look at the figures, when Ebola broke out it killed 11,000 people during its time of existence. But almost every human being on the planet heard about Ebola and got worried. But during the same period TB killed 1.5 million. I am not trying to say Ebola was not a big scare, but these 1.5 million hardly made a blip on the radar screen,” he says.

In the yellow hallways of the Brooklyn Chest Hospital, in Cape Town, is the grim proof of the statement. Here, Doctor Paul Spiller is one of the people standing against the tide. He looks laidback, in an open neck shirt, but his job is far from so. He has been Manager of Medical Services at Brooklyn Chest Hospital for six years and says the new drug has transformed treatment.

“Before these new drugs became available, [Brooklyn] was a very depressing place. XDR-TB survival was less than 10%, we had a 90% mortality rate. It was like trying to fight a war with a peashooter,” says Spiller.

The downside is XDR-TB could also bankrupt a country.

“The difference in costs are oceans apart. To treat a person with normal TB you spend between R300 ($20) to R400 ($30) for treatment. Once you get MDR-TB its goes to R400,000 ($30,000) per patient. Once you get XDR-TB its R800,000 ($60,000) per patient. It’s a 1,000 times more expensive to treat someone who has MDR-TB than a person with ordinary TB,” says Motsoaledi.

The expensive battle continues.

 

An Idea Born Of A Sheet Of  Paper And A Fist Full Of Bucks

What makes Daniel’s story even more remarkable is that it all started with a flimsy piece of paper, R200 ($15) and a doctor-turned-entrepreneur with a truckload of perseverance.

The proving ground was a company called TASK Applied Science, headquartered in Bellville, Cape Town. It was the brainchild of the full-of-life Professor Andreas Diacon, a Swiss-born lung doctor – pulmonologist – who came to Africa looking for a job. He is every inch the eccentric nutty professor with a joke on his lips and hope in the eyes. He is also a man on a mission.

“If you read in the newspaper that bedaquiline is reducing the mortality by many many percent. Then we know, without [TASK], all these people would have died,” says Diacon.

Diacon deals firsthand with South Africa’s overburdened public health system. He is a consultant in pulmonology who works in the Internal Medicine and ICU units at Tygerberg Hospital, in Cape Town. It was here that Diacon came across the Afrikaans saying ‘a farmer makes a plan’ – it became his mantra in taking down TB.

“As opposed to being a doctor in Switzerland, being a doctor here in an intensive unit, in a public hospital, people die. This is a job that drains you… There is too much disease for too little resources. The system is just not big enough.”

APOPO laboratory

The idea to start TASK came by chance in a fast crowd. Diacon came across retiring Professor Peter Donald, a renowned TB researcher also living in Cape Town, at a lecture in 2002.

“I had seen all his work. I was fascinated by it. I, in Europe, in my medical training, had read about it. He is the leading researcher of TB for the last 30 years. Suddenly this man is here and he is giving a lecture in front of five people, and I was one of them.”

On the day, Diacon asked who would continue Donald’s research. Donald’s reply was straight forward and bleak: there was little future for research in a disease where there was no money; no revolutionary new drugs and no interest.

“Two weeks later, Donald gets a phone call from a drug company called Tibotec (now known as Janssen). They said they had this new drug called bedaquiline, at the time it was called TMC207. It was a completely experimental compound. They were desperately looking for someone to test it in people. Donald had just cleaned up his office, so… he called me,” says Diacon.

It was the sort of challenge Diacon had been looking for. Donald handed Diacon a pamphlet with trial protocols; the rest was up to him.

“[South African hospitals] needed new TB drugs, why should I ever say no? From my point of view it’s imperative that every drug that people have, that might work, must be tested. It’s the only way we can get control of the problem.”

It wasn’t easy. Diacon struggled to find the beds; hospitals turned him down saying they had no space and they didn’t want TB to spread. After months of looking, Diacon found the sympathetic ear of Professor Frans Maritz, who was head of the Karl Bremer Hospital, also in Cape Town.

“It didn’t take longer than five minutes. He said to me ‘Andreas, this is the most important research I’ve ever heard of in my career. You can have my private ward here,'” says Diacon.

Then there was the matter of finding the budget. Diacon secured upfront funding and with R200 ($15) – enough to put petrol in your car – opened a bank account to pay his four employees.

“Then we got this drug. It was the first time I did anything like this. And somehow we did [the trials] well. And then the drug worked. And we could show that the drug works. It was the first new TB drug that showed some signs that it could do something. It was not as strong as people had hoped, but it was there,” says Diacon.

TASK’s bedaquiline trials started with 180 patients, on a two-week course in 2010. It took seven years, five months and five days to go from discovery to FDA approval – Diacon counted. What is significant is that drugs can take up to 15 years to develop, but in this case bedaquiline was fast-tracked, because of its necessity. Without Diacon’s research, the drug could have taken a lot longer to make it to FDA approval by 2012.

“For a drug manufacturer, getting FDA approval is like being knighted. If you are a chemist, that leads to marketing approval of a drug. It gives them patent protection for 10 years,” says Diacon.

“But for TB drugs it’s a bit of the opposite because nobody has any money to buy it. The development cost will never be covered. So in return the FDA offer a voucher system, whereby if [a drug company] develop a drug under these circumstances, then the FDA agrees to fast-track another drug they develop.”

“With only data from 180 patients, there I was presenting the story to the FDA… it wasn’t a strong case. [The FDA] agreed to a special situation where people with really drug resistant TB would be allowed to be registered, under the condition that it was researched further.”

TASK began tests with more patients over longer periods with bedaquiline.

“Suddenly we became the hub where everyone went to with their new TB drugs,” says Diacon.

Still, hospitals were reluctant to trial the drug. Diacon managed to eke out eight beds in an empty building at the Brooklyn Chest Hospital, in Milnerton.

“We renovated [the building] ourselves. We even went to an old bed store in Brooklyn and welded the beds together out of broken parts. We didn’t have the money to buy beds… Then one morning the groundsman came and took four of our beds saying the head nurse needed them elsewhere in the hospital.”

As the drug showed signs of working, he needed more patients to test over longer periods of times. So he walked the hallways of the hospital looking for candidates that met the trial’s rigid requirements.

TASK’s current MDR facility is on site at Brooklyn, and can accommodate up to 10 patients overnight.  Daniel is one of hundreds to have undergone trials and on the road to being cured.

The company has grown from four employees to more than 150, and so have the facilities. Among them, Diacon converted an abandoned mosque into a trial center in Bellville. TASK also opened sites in Delft and Mfuleni, and is building one in Scottsdene, which are extremely rural townships on the fringes of Cape Town. You could say that he is building up his own clinical empire in TB.

“TB is curable. It’s a bacterium that can be killed. If the shortest time it can be killed is six months, then there will always be people not sticking to treatment. We need to get a once-off injection, or a two-week course of antibiotics. It needs to be affordable and we need to be able to make sure people are swallowing the drugs and not infecting anybody else,” says Diacon.

Diacon’s company has emerged as the leading clinical trial company to do research into this overlooked killer. Thanks to R200, a pamphlet and making a plan like a farmer.

 

The Ticking Time Bomb That Kills

The fight against TB in Africa has only just begun and it will be rats and machines on the frontline.

New research on TB resistance was published in the New England Journal of  Medicine by a team led by Dr Sarita Shah, of United States-based Centers for Disease Control and Prevention (CDC). The study was done in KwaZulu-Natal, a province with many cases of XDR-TB. Findings suggested at least 69% of XDR-TB patients caught it in an overcrowded house or an overcrowded taxi.

The research contradicts previous opinion where it was believed patients acquired XDR-TB though failing to take their pills. The research also shows why South Africans, like Daniel, are suffering from a tenfold increase in XDR-TB cases since 2002, says the CDC. Key statistics have led researchers to call XDR-TB a ticking time bomb.

Early detection is key to diffusing this bomb. According to the WHO, more than a third (4.3 million) of people with TB go undiagnosed or unreported, some receive no care at all and for others, access to care is questionable.

Dr Florian von Groote-Bidlingmaier

“After one week, [patients] would disappear forever. Then the person who is diagnosed with TB wouldn’t come back and is spreading it. You try to track the person down but by the time you have tracked them down, they have infected many more people,” says Motsoaledi.

To combat the spread, scientists have racked their brains to find ways of detecting the disease faster. One of them is the diagnostic machine, the GeneXpert, deployed by the South African government since 2011. This can test for TB in just two hours, instead of weeks in a laboratory.

“Our figures of TB are very high. In terms of what we had five or seven years ago, the numbers are going down. We used to be the number one country in the world with TB. Now, we are sixth. In 2008, we had 70,000 dying of TB, now the number is below 40,000. Obviously, that is very significant. In 2008 the cure rate was 67% [for normal TB]. It is now 85%,” says Motsoaledi.

“Because of the GeneXpert, we are picking up more people and it is helping to pick up the people who would not have been diagnosed before.”

By 2016, just over 10 million specimens have been processed, says the South African National Health Laboratory Service.

The GeneXpert is expensive. The most common model is the GX4 which costs $17,000 per unit. This machine can test four cartridges in two hours; the subsidized cost for each cartridge is around $10.

“In terms of rand for rand, the GeneXpert is more expensive. But it’s faster and more efficient. Also, for microscope testing, you have got to be a qualified medical technician, or microbiologist. [With] the GeneXpert, you can be trained in 15 minutes. The machine does the work for you,” says Motsoaledi.

Motsoaledi says the results of combining this early warning system with advanced trial treatment of bedaquiline has been a game changer.

If cost is the problem, TB detection can border on the bizarre. African scientists at APOPO, an NGO in Tanzania, have found the African giant pouched rat to be very good at sniffing it out.

“By using rats alongside conventional methods we have raised partner clinic detection rates by 40%. One rat can take 20 minutes to test up to 100 samples, this would take a clinic technician, using conventional microscopy, up to five days,” says James Pursey, Head of Communications at APOPO, from their TB research and training facilities in Morogoro, Tanzania.

Since 2005, APOPO has trained over 80 rats to sniff out TB in the sputum of patients. Each one costs $6,500 and takes nine months to train. Once trained, they can screen as much as 1,500 sputum samples a month.

The rats are trained on a click-reward system. They learn to associate the smell of TB with a click in its ear and are given a bite of a banana as a reward. The rats are given samples and when TB is detected they hover or scratch over the sample for three seconds. The sputum is then verified at APOPO’s laboratory within 24 hours for the patients to given their results – much faster than standard microscopic testing.

“A clinic technician usually gets through 10 to 20 samples a day. The difference is that conventional microscopy is 20 to 60% accurate so around 50% of TB patients in sub-Saharan Africa go home misdiagnosed, where they can infect up to 15 other people in a year. The rats are an addition to the current method and they are effective because they are so fast at screening the samples that the clinic already tested. This gives doctors time to then check a much reduced sample base using better methods (concentrated smear LED microscopy) which the clinics can’t afford in time or cost,” says Pursey.

March saw the opening of a new TB-detection program in Addis Ababa, Ethiopia, funded by the Skoll Foundation. It aims to increase the number of identified TB patients by at least 35% in the short term, in the heart of the city, with 30 rats in training.

In addition to Morogoro, APOPO operates out of Dar es Salaam, Tanzania, and Maputo, Mozambique. To date the rats have found over 11,000 TB-positive patients missed by clinics.

It’s not all good news – the rats do have their limitations. Pursey says they can’t tell the difference between types of TB. Using rats is also a new science, there are many questions surrounding how or what the rats are smelling and whether they are able to detect the TB.

“The smell is a bouquet of volatile organic compounds and we are currently carrying out research to find out exactly what the rats are targeting,” says Pursey.

Their scientists have also been left bemused when their research showed that a number of rats were picking up a bunch of seemingly false positives in samples of many patients who went on to develop TB.

“It turned out the rats might be able to detect the TB up to six months in advance. [Our scientists’] working theory is the rats may be more sensitive to the volatile organic compounds released by the TB,” says Pursey.

African solutions to world problems – an expensive machine in South Africa that can tell you have TB in a matter of hours and rats in Dar es Salaam that can sniff out in a trice. Where else but in Africa?

Focus

Climate Explained: How Much Of Climate Change Is Natural? How Much Is Man-made?

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How much climate change is natural? How much is man made?

As someone who has been working on climate change detection and its causes for over 20 years I was both surprised and not surprised that I was asked to write on this topic by The Conversation. For nearly all climate scientists, the case is proven that humans are the overwhelming cause of the long-term changes in the climate that we are observing. And that this case should be closed.

Despite this, climate denialists continue to receive prominence in some media which can lead people into thinking that man-made climate change is still in question. So it’s worth going back over the science to remind ourselves just how much has already been established.

Successive reports by the Intergovernmental Panel on Climate Change – mandated by the United Nations to assess scientific evidence on climate change – have evaluated the causes of climate change. The most recent special report on global warming of 1.5 degrees confirms that the observed changes in global and regional climate over the last 50 or so years are almost entirely due to human influence on the climate system and not due to natural causes.

What is climate change?

First we should perhaps ask what we mean by climate change. The Intergovernmental Panel on Climate Change defines climate change as:

a change in the state of the climate that can be identified by changes in the mean and/or the variability of its properties and that persists for an extended period, typically decades or longer.

The causes of climate change can be any combination of:

  • Internal variability in the climate system, when various components of the climate system – like the atmosphere and ocean – vary on their own to cause fluctuations in climatic conditions, such as temperature or rainfall. These internally-driven changes generally happen over decades or longer; shorter variations such as those related to El Niño fall in the bracket of climate variability, not climate change.
  • Natural external causes such as increases or decreases in volcanic activity or solar radiation. For example, every 11 years or so, the Sun’s magnetic field completely flips and this can cause small fluctuations in global temperature, up to about 0.2 degrees. On longer time scales – tens to hundreds of millions of years – geological processes can drive changes in the climate, due to shifting continents and mountain building.
  • Human influence through greenhouse gases (gases that trap heat in the atmosphere such as carbon dioxide and methane), other particles released into the air (which absorb or reflect sunlight such as soot and aerosols) and land-use change (which affects how much sunlight is absorbed on land surfaces and also how much carbon dioxide and methane is absorbed and released by vegetation and soils).

What changes have been detected?

The Intergovernmental Panel on Climate Change’s recent report showed that, on average, the global surface air temperature has risen by 1°C since the beginning of significant industrialisation (which roughly started in the 1850s). And it is increasing at ever faster rates, currently 0.2°C per decade, because the concentrations of greenhouse gases in the atmosphere have themselves been increasing ever faster.

The oceans are warming as well. In fact, about 90% of the extra heat trapped in the atmosphere by greenhouse gases is being absorbed by the oceans.

A warmer atmosphere and oceans are causing dramatic changes, including steep decreases in Arctic summer sea ice which is profoundly impacting arctic marine ecosystems, increasing sea level rise which is inundating low lying coastal areas such as Pacific island atolls, and an increasing frequency of many climate extremes such as drought and heavy rain, as well as disasters where climate is an important driver, such as wildfire, flooding and landslides.

Multiple lines of evidence, using different methods, show that human influence is the only plausible explanation for the patterns and magnitude of changes that have been detected.

This human influence is largely due to our activities that release greenhouse gases, such as carbon dioxide and methane, as well sunlight absorbing soot. The main sources of these warming gases and particles are fossil fuel burning, cement production, land cover change (especially deforestation) and agriculture.

Weather attribution

Most of us will struggle to pick up slow changes in the climate. We feel climate change largely through how it affects weather from day-to-day, season-to-season and year-to-year.

The weather we experience arises from dynamic processes in the atmosphere, and interactions between the atmosphere, the oceans and the land surface. Human influence on the broader climate system acts on these processes so that the weather today is different in many ways from how it would have been.

One way we can more clearly see climate change is by looking at severe weather events. A branch of climate science, called extreme event or weather attribution, looks at memorable weather events and estimates the extent of human influence on the severity of these events. It uses weather models run with and without measured greenhouse gases to estimate how individual weather events would have been different in a world without climate change.

As of early 2019, nearly 70% of weather events that have been assessed in this way were shown to have had their likelihood and/or magnitude increased by human influence on climate. In a world without global warming, these events would have been less severe. Some 10% of the studies showed a reduction in likelihood, while for the remaining 20% global warming has not had a discernible effect. For example, one study showed that human influence on climate had increased the likelihood of the 2015-2018 drought that afflicted Cape Town in South Africa by a factor of three.

Adapting to a changing climate

Weather extremes underlie many of the hazards that damage society and the natural environment we depend upon. As global warming has progressed, so have the frequency and intensity of these hazards, and the damage they cause.

Minimising the impacts of these hazards, and having mechanisms in place to recover quickly from the impacts, is the aim of climate adaptation, as recently reported by the Global Commission on Adaptation.

As the Commission explains, investing in adaptation makes sense from economic, social and ethical perspectives. And as we know that climate change is caused by humans, society cannot use “lack of evidence” on its cause as an excuse for inaction any more.

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Current Affairs

The Rage And Tears That Tore A Nation

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Snapshots of the outrage against foreign nationals and protests against sexual offenders in South Africa in recent weeks, captured by FORBES AFRICA photojournalist Motlabana Monnakgotla.


As the continent’s second-biggest economy, South Africa attracts migrants from the rest of Africa. But mired in its own problems of unemployment and political instability, September saw a serious outbreak of attacks by South Africans on foreign nationals and foreign-owned businesses. And they have been ugly.    

The spark that fueled the raging fire was in Pretoria, the country’s capital, when a taxi driver was shot dead by a foreign national who was selling drugs to a youngster in the central business district (CBD).

The altercation caused a riot and the taxi industry brought the CBD to a standstill, blocking intersections. It did not stop there; a week later, about 60 kilometers from the capital in Malvern, a suburb east of the Johannesburg CBD, a hijacked building caught fire, leaving three dead. As emergency services were putting out the fire, the residents took advantage and looted foreign-owned shops and burned car dealerships overnight on Jules Street.

The lootings extended to the CBD and other parts of Johannesburg.

To capture this embarrassing moment in South African history, I visited Katlehong, a township 35 kilometers east of Johannesburg, where the residents blocked roads leading to Sontonga Mall on a mission to loot the mall and the foreign-owned shops therein overnight.

Shop-owners and workers were shocked to wake up to no business.

Mfundo Maljingolo, a worker at Fish And Chips, was among the distressed.

“This thing started last night, people started looting and broke into the mall and did what they wanted to do. I couldn’t go to work today because there’s nothing to do; now, we are not going to get paid. The shop will be losing close to R10,000 ($677) today. It’s messed up,” said Maljingolo.

But South African businesses were affected too.

Among the shops at the mall is Webbers, a clothing and footwear store. Looters could not enter the shop and it was one of the few that escaped the vandalism.

Dineo Nyembe, the store’s manager, said she was in disbelief when she saw people could not enter the mall.

“We got here this morning and the ceiling was wrecked but there was no sign that the shop was entered, everything was just as we left it. Now, we are packing stock back to the warehouse, because we don’t know if they are coming back tonight,” lamented Nyembe, unsure if they would make their daily target or if they would be trading again.

 Across the now-wrecked mall are small businesses that were not as fortunate as Webbers, and it was not only the shop-owners that were affected. 

Emmanuel Nhlane’s home was robbed even as attackers were looting the shop outside.

“They broke into my house, I was threatened with a petrol bomb and I had to stand outside to give them a chance; they took my fridge, bed, cash and my VHS,” said Nhlane.

Nhlane had rented out his yard to foreign nationals to operate a shop. He does not comprehend why his belongings were taken because he doesn’t own a shop. Now, it means that the unemployed Nhlane will not be getting his monthly rental fee of R3,700 ($250).

Far away, the coastal KwaZulu-Natal province of South Africa, was also affected as trucks burned and a driver was killed because of his nationality. This was part of a logistics and transport industry national strike.

Back in Johannesburg, I visited the car dealerships that were a part of the burning spree on Jules Street.

The streets were still ashy and the air still smoky, two days after the unfortunate turn of events.

Muhamed Haffejee, one of the distraught businessmen there, said: “Currently, we are still not trading.” 

Cape Town, in the Western Cape province of South Africa, which hosted the World Economic Forum (WEF) on Africa from September 4 to 6, was also witness to protests by women and girls from all walks of life outside the Cape Town International Convention Centre, demanding that the leadership take action to end the spate of gender-based violence (GBV) in the country.

There were protests also outside Parliament. What set off the nationwide outcry was the shocking rape and murder of Uyinene Mrwetyana, a 19-year-old film and media student at the University of Cape Town, inside a post office by a 42-year-old employee at the post office.

There was anger against the ghastly crimes and wave of GBV in the country that continues unabated. According to Stats SA, there has been a drastic increase of women-based violence in South Africa; sexual offences are up by 4.6%, from 50,108 in 2018 to 52,420 in 2019.

A week later, on a Friday, Sandton, Africa’s richest square mile and one of the biggest economic hubs, was shut down by hundreds of angry women and members of advocacy groups from across Johannesburg. They congregated by the Johannesburg Stock Exchange (JSE), the cynosure of business, singing and chanting, to demand “a 2% levy on profits of all listed entities to help fund the fight against GBV and femicide”.   

Among the protesters was Cebi Ngqinanbi, holding a placard that read: “I’m not your punching bag.”

“We came here to disrupt Sandton as the heart of Johannesburg’s economic hub. We want to make everyone aware that women and children are being killed every day in South Africa and they [Sandton] continue with business as usual, sitting in their offices with air-conditioners and the stock exchange whilst people on the ground making them rich are dying. That is why we are here, to speak to those that have economic power,” said Ngqinanbi.

She added that if women can be given economic power, they will be able to fend for themselves and won’t fall prey to abusive men, since most women stay in abusive relationships because men are more financially stable.

Amid the chanting and singing of struggle songs, Nobuhle Ajiti addressed the crowd and shared her own haunting experience as a migrant in South Africa and survivor of GBV. She spoke in isiZulu, a South African language.

“I survived a gang rape; I was thrown out of a moving car and stabbed several times. I survived it, but am I going to survive xenophobia that is looming around in South Africa? Will I able to share my xenophobia story like I can share my GBV story?” questioned Ajiti.

She said as migrants, they did not wake up in the morning and decide to come to South Africa, but because of the hardships faced in their home countries, they were forced to come to what they perceived as the city of opportunities. And as a foreign national, she had to deal with both xenophobia and GBV.

“We experience institutionalized xenophobia in hospitals; we are forced to pay huge amounts for consultation. I am raped and I need medical attention and I am told I need to pay R5,000 ($250).

“As a mere migrant, where am I going to get R5,000? I get abused at home and the police officer would ask me where I’m from because of my accent, I sound Zimbabwean. What does my nationality have to do with my husband beating me at home or with the man that just raped me?” she asked.

Women stop traffic while they hold up placards stating their grievences against GBV. Picture: Motlabana Monnakgotla

Addressing the resolute women outside was the JSE CEO Nicky Newton-King who received the memorandum demanding business take their plight seriously, from a civil society group representing over 70 civil society organizations and individuals.

The list of demands include that at all JSE-listed companies contribute to a fund to resource the National Strategy Plan on GBV and femicide, to be launched in November; transport for employees who work night shifts or work after hours; establish workplace mechanisms to provide support to GBV survivors as part of employee wellness, and prevention programs that help make workplaces safe spaces for all women.

Newton-King assured the protestors she would address their demands in seven days. But a lot can happen in seven days. Will there be more crimes in the meantime? How many more will be raped and killed in South Africa by then?

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Current Affairs

Quality Higher Education Means More Than Learning How To Work

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When people talk about quality education, they’re often referring to the kind of education that gives students the knowledge and skills they need for the job market. But there’s a view that quality education has wider benefits: it develops individuals in ways that help develop society more broadly.

In Zimbabwe, for example, the higher education policy emphasises student employability and the alleviation of labour shortages. But, as my research found, this isn’t happening in practice.

University education needs to do more than produce a graduate who can get a job. It should also give graduates a sense of right and wrong. And it should instil graduates with an appreciation for other people’s development.

Tertiary education should also give students opportunities, choices and a voice when it comes to work safety, job satisfaction, security, growth and dignity. Higher education is a space where they can learn to be critical. It must prepare them for participating in the economy and broader society.

This isn’t happening in Zimbabwe. Graduate unemployment is high and employers and policy makers are blaming this largely on the mismatch between graduate skills and market requirements.

Investigating Zimbabwe’s universities
My research sought to examine how a human development lens could add to what was valued as higher education, and the kind of graduate outcomes produced in Zimbabwe. I investigated 10 of the universities in Zimbabwe (there were 15 at the time of the research). Four were private and six public.

I reviewed policy documents, interviewed representatives of institutions and held discussions with students. Members of Zimbabwe’s higher education quality assurance body and university teaching staff were also included.

I found that in practice, higher education in Zimbabwe was influenced by the country’s socio-political and economic climate. Decisions and appointments of key university administrators in public universities and the minister of higher education were largely political.

In addition, resources were limited and staff turnover was high. Universities just couldn’t finance themselves through tuition fees.

Different players in the higher education system – employers, the government, academics, students and their families – have different ideas about what “quality” means in higher education. The Zimbabwe Council for Higher Education understands quality as meeting set standards and benchmarks that emphasise the graduates’ knowledge and skills.

To some extent, academics and university administrators see quality as teaching and learning that gives students a mixture of skills and values such as social responsibility.

But lecturers must comply with the largely top-down approach to quality. They tend to do whatever will enhance students’ prospects of getting employment in a particular market.

The educators and students I interviewed acknowledged that developing the ability to work and to think critically were both central to higher education. But they admitted that these goals were hard to attain. This was because of the country’s constrained socio-political and economic environment. Academics and students felt that they couldn’t express themselves freely and critical thinking was suppressed.

Stuck on a road to nowhere
The study illustrates how an over-emphasis on creating human capital – skilled and knowledgeable graduates – limits higher education’s potential to foster broader human and social development.

University education should do more, especially in developing countries such as Zimbabwe that face not just economic, but also socio-political challenges. Before building more universities and enrolling more students, authorities and citizens should consider what quality education means in relation to the kind of society they want.

It’s possible to take a broader view of development, quality and the role of higher education. This broader approach – one that appreciates social justice – can equip graduates to address the country’s problems.

The road ahead
Universities can’t change a society on their own. But their teaching and learning practices can make an important difference.

Because quality teaching and learning means different things to different people, people need to talk about it democratically. Institutional and national policies must be informed by broad consultations to identify the knowledge, skills and values they want graduates to have.

University teaching and learning should emphasise freedom of expression and participation so that students can think and act critically beyond university.

Also, academics don’t automatically know how to teach just because they have a PhD. Universities should therefore ensure that academics learn how to teach and communicate their knowledge. Curriculum design, student assessment and feedback, as well as training of lecturers should all support this goal of human development.

When universities see quality in terms of human development, their role becomes more than production of workers in an economy. It gives them a mandate to nurture ethically responsible graduates. These more rounded graduates are better equipped to imagine an alternative future in pursuit of a better society, economically, politically and socially.

Patience Mukwambo: Researcher, University of the Free State

The Conversation

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