Excuse my ranting, but I've been in South Africa for four weeks and the one question that continually wracks my brain is: How do you change culture without changing it?
I am a nostalgic person. I dream of the Victorian era to the days of flappers and prohibition, and of course, I dream of the 60s from which epic music arose. I dream of my childhood, of the days when we'd catch lightening bugs and roll down grassy knolls for hours, of days before the Internet and cell phones in which snail mail and punctuality existed. Yet, as nostalgic of a person as I may be, I simultaneously believe that communities must continue to evolve, preserving the delicacies of culture while moving forward to a more prosperous future.
My question to you is, how do you change a culture without changing a culture? How do you retain those qualities of a culture that produce the euphoric feeling when looking back whilst simultaneously propelling it forward for the greater good of the community? I was raised a sensitive person, both to other people's feelings as well as to cultural differences. "Treat everyone how you want to be treated" is a common phrase out of my mother's mouth, and although I do have my snarky moments and low points in which I find myself being critical of others or a tad bullish, I try to take a step back and think about the big picture, everyone is different, and it's OK for things not to go my way. As a "citizen of the world", I've always tried to maintain my sensitivity and am very slow to process judgements when in a foreign country. I've always had the mindset that criticizing a foreign culture is completely taboo and tried to avoid the "colonizer/Western/American" mindset that my way is the right way. But at what point is this a hindrance to improving a society? I'm much less afraid of criticizing myself, my peers, and my culture if I believe that the criticism is constructive and for the greater good. If the cultural norm is a hindrance to society, why not change the norm?
This leads me to the topic of health and the health care system in South Africa. For the last four weeks (a very small amount of time and not nearly enough to establish substantial opinions about anything) I've been interning in a clinic in the township of Crossroads. This clinic is specifically for the poorest people in Africa who receive their health care for free, subsidized by the government. Crossroads is a primary care facility in which the majority of patients come through with problems associated with hypertension and diabetes, stemming mostly from their poor diet and weight. Red meat and pap (corn meal similar to grits) are the staple diet of most South Africans, and unfortunately, it's this staple that is so detrimental to their health and the health of the country. Every day, I hear the doctor telling patients to stop eating salt, no more soda, no more candy, and try to exercise. Yet time and time again, the same patients come in with high blood pressure or out of control sugar and have no understanding of cause and effect. How do you get an entire culture to stop eating so much and get out and move (where is Michelle Obama right now? South Africa could use her).
The system here is being abused. Because patients do not understand that it is lifestyle that is causing health problems, they have not made the connection in changing those habits, but they have made the connection between pills and treatment. And because of their poverty, these pills are free, subsidized by the government. My question for the government is, wouldn't it be more advantageous to instead invest in lifestyle education and subsidies for healthy food so that pap and soda are not the "affordable" choice. In the end, isn't the "affordable choice" unsustainable and unaffordable?
Back to the question, how do you change a culture without changing its culture. I love the idea of large family meals of pap and a large braii of fresh red meats, dancing, music, and jolly conversing. But it needs to be learned that this cannot be the norm, but the exception, and that healthy foods need to balance these feasts out. Now there are plenty of patients in the clinic who do understand the doctors and follow their instructions religiously. I admire these patients greatly for their ability to overcome the social norms and work hard to become healthy and enrich their lives. And I worry about my attitude every day--am I too western, do I have the colonizer mentality? Or is my desire to impress upon people the advantages of a healthy lifestyle justified?
Over the next four weeks in Cape Town, my goal is to understand better the public health in South Africa, and learn what campaigns are contributing to the goal of a healthy population. From what I've witnessed so far, the public health system in South Africa is unsustainable as people are too reliant on the government's free health care and free medicine. I want to see what South Africa is doing to increase the health of its people so that they can spend less time in the long ques of community health clinics, and more time working and enjoying their lives. I'm excited about learning more at Crossroads and engaging in debate with the doctors and nurses over the best treatment options. In this time, I hope to finally understand how to improve a society without extinguishing its cultural vibrancy.
Note: This is not a problem of just South Africa. Look at the United States and our current obesity problem. Similarly, the US as a whole cannot afford the growing health care costs associated with unhealthy lifestyles. I hope to use this experience to better understand how I can contribute positively to society when I return home.
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