Garlic, beetroot and breakdowns

It’s easy to forget the details now, but JIM WARD reveals that managing transport during the HIV/AIDS epidemic in Southern Africa was one of the most challenging periods of his career.

Between 1998 and 2006, I knew of depots in some provinces that were losing employees almost every month, despite the Mbeki presidency’s insistent adherence to its stance of AIDS denialism.

As Amy Roeder, the development communications coordinator in the Office for Resource Development at Harvard School for Public Health, wrote in her outstanding article, The cost of South Africa’s misguided AIDS policies: “Even as the country’s neighbours ramped up prevention and treatment efforts, Mbeki – President from 1999 until he resigned – publicly challenged the scientific consensus that HIV causes AIDS. His health minister, Manto Tshabalala-Msimang, promoted herbal remedies, including beetroot, garlic, and lemon as alternatives for antiretroviral therapies (ARVs).”

We would do well to remember those sad days and to never allow that far-reaching governmental position to slip into history without comment. “More than 330,000 people died prematurely from HIV/AIDS between 2000 and 2005 due to the Mbeki government’s obstruction of life-saving treatment, and at least 35,000 babies were born with HIV infections that could have been prevented,” Roeder noted.

Many of those 330,000 came from the economically active workforce and their deaths had a huge impact. A whole stratum of workers, particularly those within certain age brackets, quietly disappeared from the workforce. 

In the days that followed, when you recruited drivers there would be responses from the very young, or old men nearing retirement age. Few individuals from between these categories would respond. In those dark days, doctors were absolutely forbidden to confirm even the most evident HIV+ cases, the entire topic being strictly taboo. Employees would get sick, weaken, grow thinner, start missing work and then pass away “from natural causes”. Everyone knew it was AIDS, but nobody said this out loud. The tragedy of the national pandemic was brought home to me by the death of Gibson*, a popular breakdown mechanic. 

Gibson was a reliable mechanic and repair service attendant who would attend to breakdowns and could sort out most of the problems trucks and trailers encountered out on the road. He enjoyed his work and was always available, going out to breakdowns at all hours without complaint, be they in North Pondoland, Durban, Umtata, or Kokstad. 

He would invariably manage to get the truck moving or get it home. His major disadvantage was having no driving licence, so he always had to be accompanied by a licenced driver. He could drive perfectly well, but not legally.

We spoke about this many times, and I applied some pressure, knowing we could increase his pay once he was reclassified as a breakdown mechanic. For this to happen, though, he had to drive himself. One weekend he applied for two days of leave and told me rather secretively that he “had to go somewhere”.

I didn’t ask questions; he had plenty of leave owing. He left and returned on Tuesday with a broad smile and a brand-new driving licence. He informed me he had obtained it from Tzaneen and had required the leave to have adequate time to get there and back using public transport (a complicated journey). It did seem remarkable that the Tzaneen testing centre was so hardworking and efficient that it conducted tests over weekends, but I let any suspicions slip quietly away. Certain financial arrangements with a contact had been made, and the Department of Transport – in their infinite wisdom – had seen fit to award him a licence. He was now a licensed driver, so good luck to Gibson.

There was never a breakdown van so frequently washed as his bakkie. It was always spotlessly clean and whenever he was needed, he would leap into it and drive off to attend to breakdowns – sometimes with an assistant, other times on his own. He was living his dream; he was an asset to us and had become a proper breakdown mechanic. He was one of the most fulfilled employees I knew.

Gibson started to look unwell around 1999 and then began to rapidly lose weight. He went to see a traditional healer, but this didn’t help. He gradually weakened, sometimes needing physical assistance with heavy work like trailer springs, brake drums, and truck batteries. Soon, he really struggled with heavy weights. He was barely coping.

Everyone had their suspicions, but nobody could definitively say what was wrong and in those days, before Barbara Hogan**, there was no treatment available. As the disease advanced, Gibson entered the no-man’s land between being medically boarded and dying. Doctors would refer to “an undisclosed illness”, but you didn’t need to be a doctor to know what was wrong. He soon began showing the terminal symptoms of end-stage AIDS (the illness no-one could mention) that would often present in hallucinations or episodes of odd behaviour. 

One morning, he became convinced that there was a breakdown to which he had to attend. He loaded his tools into the van and started driving… straight towards the fence. He stopped before he hit the fence, reversed, and did the same thing again. Back and forth he went in his deeply confused state, convinced that he needed to go to a breakdown that existed only in his mind.

This happened three times in succession, before a quick-thinking young man working on the wash bay witnessed it, ran forward, and removed the key to cut, cutting off the engine. Gibson stayed in the vehicle muttering about a breakdown. The key was brought to me and I went to see him; we immediately took him to a company doctor.

By that stage, although he was still tottering into work and clocking in, he had become very weak. His whole deterioration had taken under three months, but he soon needed assistance to walk and could no longer speak. The doctor eventually saw him, but of course still could not say what the problem was because of the ridiculous laws of the time. He simply told me that Gibson was very sick indeed, with a CD4 count of only 18, and that the family ought to be notified. We took him back a few more times, but by the end his mouth was filled with thrush, you could see all the bones in his skull, and he was unable to speak or eat. It was incredibly painful to witness the rapid progression of the disease. 

The last time I saw Gibson was in a hospital bed in KwaZulu-Natal. I think he recognised me, but I was never sure. I visited him with the operations controller and his foreman. He died the following day, only weeks after his hallucinatory breakdown episode and being boarded. 

Seeing this essentially good, hard-working man looking so small in the hospital bed will always remain a glaring example of a needless waste of a life. He was an employee who would drive 400km in an evening to attend to a roadside breakdown, change a prop shaft, or replace a spring pack. A person who had made such efforts to obtain his licence, he was reduced to just another breadwinner gone; one of countless lives that could have been saved had they been prescribed ARVs, instead of being told to eat garlic and beetroot. 

This brings back sad memories, but in retrospect it was only the beginning of a brutal harvest of lives cut short…

* Not his real name

** Barbara Hogan was appointed as the new health minister under Mbeki’s interim successor, Kgalema Motlanthe. Hogan made HIV/AIDS a national priority and initiated a national prevention campaign, helping to broker significant funding from the United Kingdom to help cover ARV costs.