The Khayelitsha township in South Africa lies just 31.6 kilometers from the cosmopolitan Cape Town, yet is profoundly distant in health outcomes, exampled by Khayelitsha’s 2006 under five infant mortality rate that was 342% higher than that of the country’s Southern Peninsula as a whole. Our experience working in the emergency department of Khayelitsha District Hospital powerfully underscored the importance of understanding the constellation of social determinants that define individual health and inform healthcare decision-making. The disproportionate poverty, violence, and disease burden of the townships are underpinned by historical prejudice that has endured as social inequality. This marginalization is not a tragic relic of a bygone era, but rather an artifact being actively preserved and restored in a new light.
Located on the fringe of Cape Town, these townships are an illustration of apartheid’s lasting mark on South Africa. By design, they are amongst the most densely populated places on Earth, resulting in overcrowding that amplifies disenfranchisement through inescapable economic hardship and disease burden. A majority of the trauma that presented to the emergency department was derived from gangs composed of boys with no direction, no other option within an opportunity-barren landscape beget by a lack of community bond, itself a product of the destruction of vibrant communities by apartheid policies. Unquestionably there has been tremendous progress in South Africa; however, 20 years later, there are still sizable inequities that are too blatant to be ignored.
Sitting on the rocks of Clifton beach #3 was a moment that captured the inescapable contradictions at work in South Africa- the setting sun projecting its color wheel over the ocean, splashing on the jettisons of Table Mountain, seemingly in sync with the rhythmic snap of the electric fence placed atop a layer of barbed wire, protecting the perimeter of the beachside mansion behind us. Structural inequality of this nature cannot be tucked away, out of sight in the Cape Flats, Brazilian Favelas, or Southside Chicago.
In Xhosa, the word Khayelitsha means ‘our new home.’ Indeed, outside of the stabbings, assaults, overdoses, and preventable deaths Khayelitsha is home to a community of over one million people, a majority of which just want better lives and greater opportunity for themselves and their loved ones. Healthcare, particularly global health, puts one at the receiving end of a large sieve that has filtered out the communities, relationships, and everything else that composes an individual and presented you- the physician, the nurse, the student, the technician- with someone at their most vulnerable. A transformation toward a more equitable society does not happen overnight; yet, as members of the global medical field, we can help galvanize it by mustering within ourselves the same self-preservation and fortitude exhibited by those who are marginalized.
Content source: https://amaghc.com/2018-finalists/cusom/