South of the Limpopo River in South Africa lies an area that is harsh, hot and dry, with periodic heavy rain. A century ago mining companies explored the area and bought large tracts of land off poverty-stricken farmers, installing them as tenants. Black tribal groups dispersed when rinderpest killed their cattle. C. Louis Leipoldt was sent there as a school doctor. In 1937, he recorded the parlous health state of the white schoolchildren: many had chronic malaria, ‘red water’ (bilharziasis) and damaged hearts from rheumatic fever. They were so physically and mentally debilitated that he saw no future for them. Black children were worse off.1
A few months ago his analysis came to mind as a group of people (including JD) gathered around a campfire, reminiscing about their childhood in this area, a scant decade after Leipoldt's account. They escaped his predictions and enjoyed corporate, professional and artistic careers. Were they more intelligent, genetically protected, or born to more committed parents? Perhaps; but these explanations obscure important systemic reasons why they escaped the curse of the Bushveld.
First, these ‘escapees’ were white. Racial discrimination dominated South African life from its outset, but the apartheid regime codified the laws that gave white children privileged access to public services. They went to school and some of them then moved to boarding schools to gain admission to (segregated) universities. Unlike black children, they had opportunities that allowed them to move on with their lives.
Of course, the ‘escapees’ needed their health to realise this advantage. Public health campaigns implemented by a strongly centralised health department sent school doctors and nurses to the area to log health states, followed by campaigns against infectious disease. Widespread anti-malarial campaigns manifested at household level in mosquito nets, Flit insecticide sprayers and subsidised quinine tablets. Children became so afraid of stagnant water that most never learned to swim.
They were also just lucky. This was a dangerous area and, in an emergency, there was no doctor, people just died. Leipoldt records a family in which the father and three sons were killed by a lion. Snakebite was common, a cousin died of blackwater fever, a tiny mother nearly died in a homebirth of a 5.7 kg child. One survived what was tentatively diagnosed as rheumatic fever when she was well enough to be taken 200 km to the nearest hospital.
Leipoldt's stark Limpopo scenario has similarities to what occurred at the same time in Western Desert communities in Western Australia where mining and pastoral leases dispossessed Aboriginal people of their land. Infectious diseases like typhoid were a scourge; rape and prostitution were rife. Racist policies allowed a government-appointed ‘Protector’ control over the lives of Aboriginal children, with power to forcibly remove children from their families. The ‘stolen generation’ were supposed to escape their backgrounds and be given education and a better start in life. The communities, and the children themselves, were bereft. No provision was made for those who remained. For them, access to health care was poor. Accounts from missionaries at Mount Margaret talk of serious cases being denied access to the hospital at nearby Laverton and transported 120 km to Leonora, only to be shunted on to the hospital at Kalgoorlie, another 230 km away.2 Transport often required negotiating a ride on a horse-drawn cart or motor vehicle owned by a (white) prospector or station owner.
More recently in the Western Desert, employment and royalties from mining companies brought economic benefits, but this has also resulted in profound changes in diet. ‘Bush tucker’ disappeared, fresh fruit and vegetable were scarce and expensive to access. Packaged foods and high sugar drinks, on the other hand, were freely available. Not surprisingly, there is now an epidemic of diabetes and kidney disease, including cases of kidney disease in primary schoolchildren. Access to diagnostic and treatment services is still compromised, relying on localised outreach initiatives.
In Limpopo, democratic government came in 1994. More recently, the Australian government apologised for the profound harm inflicted on the stolen generation and promised to ‘close the gap’ in health. In both cases infant mortality is slowly declining, more black children go to school and training institutions are more accessible. Yet terrible inequity persists. While visitors in Limpopo's luxury lodges relive fantastic bush childhoods, many local people live in extreme poverty, with inadequate education and health care; they now also suffer from an HIV epidemic. In the Western Desert, the ‘big miners’ wield increasing political power in a highly unequal society while local people continue to face racism in their daily lives. In both, we see junk food, carbonated drinks and bottle shops in even small trading posts.
In both Limpopo and the Western Desert, children need a path to equity. They need education and good clinical care without having to escape or be stolen away. They need to see the possibility of going on to welcoming educational institutions, from which they can graduate to give a new face to public services, including clinical care. Sadly missing is direct government action against the health scourge that threatens their future. Governments need to ensure access to affordable fresh fruit and vegetables. They also need to take action against the purveyors of junk food – just as they took action against the malaria-carrying mosquito.