MSH Mourns Death of Nelson Mandela, Fearless Advocate for Health and Human Rights

Photo credit: Nelson Mandela Centre of Memory

MSH is deeply saddened by the loss of Nelson Mandela (“Madiba”), South Africa’s iconic first black president who fought to overthrow the oppression of apartheid. Madiba’s unwavering commitment to reconciliation, peace, and human dignity were hallmarks of his  legendary “long walk to freedom.” In 1993, he shared the Nobel Peace Prize.

In later years after his retirement, Mandela revealed that his son and daughter-in-law had died due to HIV & AIDS and became a courageous advocate, defying the government’s denial of the epidemic.

At the XII International AIDS Conference in Durban, South Africa, during the week of July 9-14 2000, he delivered the closing address, “this is the one event where every word uttered, every gesture made, had to be measured against the effect it can and will have on the lives of millions of concrete, real human beings all over this continent and planet. This is not an academic conference. This is, as I understand it, a gathering of human beings concerned about turning around one of the greatest threats humankind has faced, and certainly the greatest after the end of the great wars of the previous century….We need, and there is increasing evidence of, African resolve to fight this war. Others will not save us if we do not primarily commit ourselves.”

Madiba worked tirelessly to end stigma and shame for those living with HIV & AIDS and became a strong supporter of increased prevention and treatment for the thousands living with the disease in South Africa and around the world. Health and human rights became the primary focus of his family foundation’s work as he worked to improve health care for the most disadvantaged.

Nelson Mandela was 95 years old.

“I am only one of thousands of young South Africans who left our country in our teen years, fleeing persecution for our political beliefs and actions, and believing that by leaving our country we would regroup and come back to contribute to the overthrow of the apartheid, racist regime,” said Bada Pharasi, MSH’s Country Representative in South Africa. “ Did we really believe that would happen? I must say that the overwhelming urge for us to go on with the struggle and belief was the specter of Nelson Mandela addressing us in “Freedom Square” one day soon. I speak on behalf of all of our staff of MSH South Africa when I say that Madiba’s passing has deeply saddened us, but that we will draw inspiration from his life.”

“Nelson Mandela was a singular, elegant remarkable man. Without equal. Of course, he knew nothing about me, but boy oh boy, did he mean something to me as I became aware of what I needed to do in the world. He was carving out a presence through sheer force of will and certain brilliance and served as this sort of distant light,” said Scott Kellerman, MD, MSH’s Global Technical Lead on HIV & AIDS and a pediatrician attending the 17th ICASA conference, to begin this weekend in Cape Town.

“A person of Nelson Mandela’s quiet strength, personal warmth, moral compass, and vision for a world of universal equality comes along only once in every few generations. His passing provides a moment for all of us to be re-inspired by his life and legacy,” said Jonathan D. Quick, MD, President and CEO of MSH.

MSH IN SOUTH AFRICA

South Africa has made substantial development gains and boasts a growing economy. Despite these achievements, South Africa still faces the largest HIV-positive population in the world. Apartheid is no longer law, yet the health system still retains many inequities from that era. A major challenge for the government of South Africa is improving the accessibility and quality of basic health services.

MSH started to provide technical assistance to the South Africa Government in 1997 under the USAID-funded EQUITY Project. EQUITY worked toward primary care for all and focused on an integrated package of essential services. Since then,  MSH has been providing technical assistance to strengthen health services with a particular focus on primary health care, district development, leadership development, management information systems, family planning, orphans and vulnerable children, medicines supply and pharmaceutical services, and priority health programs such as HIV/AIDS and Tuberculosis. This has been done with funding support from USAID, CDC, the Global Fund, and in close collaboration with the National Department of Health. The MSH approach has been to build local capacity of national, provincial and local decision makers, and transfer knowledge.

With the implementation of the National Health Insurance, the South Africa Government is taking on this new major challenge and MSH is expected to be one the partners that will provide technical assistance and support toward universal health coverage.

(This statement was originally published by Management Sciences for Health at msh.org.)

Remembering Madiba

Nelson Mandela, former President of South Africa, accepts the offer to wear an HIV-Positive T-shirt. Photo credit: Eric Miller

by Olehile Maurice Bada Pharasi 

I am only one of thousands of young South Africans who left our country in our teen years, fleeing persecution for our political beliefs and actions, and believing that by leaving our country we would regroup and come back to contribute to the overthrow of the apartheid, racist regime.

Did we really believe that would happen?

I must say that the overwhelming urge for us to go on with the struggle and belief was the specter of Nelson Mandela addressing us in “Freedom Square” one day soon. What was most amazing about Madiba is that, for decades, we led protest marches all over the world without even knowing what he looked like, for the regime had banned all pictures of him and all we had was an artist’s impression of what he should have looked like.

In recent months, we all knew Madiba was about to depart, as we could see his frailty and hospitalization. We should, therefore, accept that he deserves his rest, and we should accept that he had to depart from our midst.

I have been associated with MSH for a lot more than the almost 10 years that I have worked for the organization. I therefore know and deeply appreciate that MSH’s fight to ensure health for all and its fight for greater health systems for all have always taken into consideration our unique conditions in South Africa. I thank all of you for the support we have had as a nation over all the decades. Thank you, thank you. I would not be exaggerating by saying that MSH has been a conscious and deliberate participant in our struggle over the decades.

I know I speak on behalf of all our staff of MSH South Africa when I say that Madiba’s passing has deeply saddened us, but that we will continue to draw inspiration from his life. His well-documented ideals for a democratic South Africa will continue to inspire all.

(Cross-posted on the MSH Global Health Impact Blog.)

Nelson Mandela was joined by celebrities at a concert in London to celebrate his 90th birthday and promote his HIV/Aids charity, 46664. Photo credit: Getty Images.

Olehile Maurice Bada Pharasi (Bada Pharasi), M Pharm, is the MSH Country Representative for South Africa.

World AIDS Day: Getting to an AIDS-Free Generation

This piece is cross-posted from the MSH Global Health Impact Blog{Photo credit: Warren Zellman}Photo credit: Warren Zellman

I remember attending the Durban international AIDS conference in 2000, my first. That was the one where everything was going to turn around and we were going get a handle on the epidemic. Nelson Mandela spoke at that one, in a hall that was the size of three football fields. And the crowd was joyous, raucous, the noise was deafening and it was one of the most memorable days of my life.

Before Mandela took the stage, a choir made up of kids—none more than 9 or 10 years of age and many much younger—took the stage to sing tribute to the great man and those of us gathering there.

It was charming and sweet. Everyone had a huge grin on their faces. And then I realized that this group of kids was special, maybe overheard someone nearby or perhaps the MC say that this, “was THAT group.” All were infected with the virus, and as I watched these gorgeous children singing so strong, moving and smiling and clapping with everyone, I knew, knew inside, that they probably wouldn’t live much longer.

We are indeed a far cry from where we were then. And yet with all of our incredible advances, we see essential challenges in starker relief. What we’re discovering is just how hampered we remain in delivering care to those who need it most. It’s not that we don’t know how to deliver life-saving care to adults and children. The problem is that the health systems in many places still struggle to offer basic services. Our focus moving forward must be on strengthening health systems to decentralize to the most local unit, integrate with other key clinical services and ensure that programs are sustained.

A FUTURE FOR HIV POSITIVE CHILDREN

When I was in medical school, the reason why I chose pediatrics was because kids get better for the most part. There are tragic exceptions, of course, but most kids bounce back from illness and recover. They get to be kids. They grow up to be adults.

That’s not the case with pediatric HIV, or at least it hasn’t always been so. At each point in the cascade of care for infected children, there are barriers that until very recently were not really being talked about, and still are not being fully addressed.

Through my work at MSH, I became involved in the Interagency Task Team for the Prevention of Mother to Child Transmission, co-sponsored by UNICEF and WHO, and focused on advocating for improved HIV responses for children.  About a year ago, I was asked to co-chair the Child Survival Working Group within the IATT—a group made up of nearly 60 professionals representing nearly 30 organizations all dedicated to thinking about pediatric HIV issues. When I took over as co-chair, I asked the members for ideas on creating something lasting, something that can highlight what we should be thinking about improving HIV care for children.

STRENGTHENING THE HEALTH SYSTEM AT ALL LEVELS FOR ALL AGES

We all agreed: the existing primary response to pediatric HIV has been to further strengthen Prevention of Mother to Child Transmission (PMTCT) programming.  But in truth, a lot of kids are missed by PMTCT. Even with an absolutely perfect PMTCT system that captures every infected mother presenting for ante-natal care, there will still be a sizable proportion of women who never make it in to antenatal care, are never seen by a nurse or midwife, or a doctor during their pregnancy. They never get a chance to be tested for HIV during pregnancy and understand their HIV status—and their children will never have a chance to be protected from acquisition of the virus from their mothers. Thus hundreds of thousands of children continue to be born with HIV because PMTCT is predicated on women actually showing up at an antenatal care clinic and getting tested.

Our thought was to write a series of papers addressing all aspects of the care cascade for children born infected or affected by HIV. We wanted to highlight areas that have not received the type of attention needed—including case finding of infected children, linking these children to care and treatment, retaining them in care, ensuring adherence to medicine and addressing the myriad issues these children face.

Through our collection of essays, we show among other things, that the infrastructure and the health systems that are responsible for caring for kids are really suffering as well. It comes right down to health systems strengthening, not only for adults but also for pediatric care systems which are separate from those for adults and are often much less resourced.

We undertook this project to try to identify the areas that must be addressed in order to strengthen the care response across the life cycle of infected kids. This series became a reality through the generous support of UNICEF and the multiple organizations who participated in writing and reviewing this series of 11 papers, and through the financial support of the Canadian Department of Foreign Affairs, Trade and Development (DFATD).

GETTING TO AN AIDS-FREE GENERATION: ADVOCACY IN DC AND ABROAD

Advancing a health systems strengthening approach to HIV & AIDS for both adults and children requires more advocacy and education of decision makers: many current legislators were not in office for the passage and earlier reauthorization of PEPFAR; we therefore continue to educate lawmakers on the gains and the work left to be done—such as we are doing this week on December 2 in Washington, DC, at our event, Getting to an AIDS-Free Generation: Overcoming Remaining Challenges.

At the upcoming 17th International Conference on AIDS and STIs in Africa (ICASA), from December 7–11 in Cape Town, South Africa, we will continue highlighting the importance of addressing the epidemic, through capacity building and working in partnerships.

Getting to zero is only possible through:

  • building strong health systems
  • responding to the evolution of the epidemic
  • building local capacity

In honor of World AIDS Day and its theme of HIV and adolescents, the makers of Inside Storyhave made the film available to watch online for free on their website, starting December 1. Inside Story is a powerful film about an HIV-infected soccer player in South Africa (and a film for which I was honored to serve as technical director). Please join us in viewing the film and sharing it with others.