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1. Maladies of Modernity: Economic Structural Adjustment, HIV/AIDS, and the State of Health
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25 1 Maladies of Modernity economic Structural adjustment, hiV/aiDS, and the State of health It’s very worrying. They’ve been educated, and they have something they can give back to the country. But just when they reach that point, they depart this life. —Dr. Timothy Stamps, Zimbabwean minister of Health and Child Welfare Harare, also known as Sunshine City, is the capital of Zimbabwe, located on the Highveld or watershed plateau between the Limpopo and Zambezi Rivers. A city of profound contradictions, it is a place where glittering glass and steel high-rises stand side by side with shelters made of discarded wood and sheets of plastic, where cybercafés and the latest model Nokia and Sony Ericsson cell phones proliferate while the majority of the population of 1.5 million cannot afford even an in-house phone. The jacarandashaded streets of the low-density suburbs, which are situated mainly in the northern part of town and were formerly majority white, stand in stark contrast to the crowded usually treeless former (mainly black) townships or high-density suburbs of the city’s southern borders. It is in these latter areas that one gets the sense of the pulsating life of older African cities (see Rakodi 1995)—raucous backstreet beer halls, bustling streets, markets, backyard shacks, crowded buses, taxis, and emergency taxis, or ETs. Located along the railway line east and west of the city center, the industrial areas are the buffer zone for both these sectors. It is tempting to see this buffer zone as the dividing line between African and European, poor and rich, disease and health. While this would be an oversimplification of the social geography of the city, such a depiction would have some basis in truth, particularly during colonial times when “black slums sprang up all 26 Modernizing Medicine in Zimbabwe over, constructed of the simplest and cheapest materials: poles and dagga, grass and tins, tied and nailed together to form some sort of shelter.”1 In this thoroughly modern city, it is common to hear accusations of witchcraft, and many people live in fear of being bewitched, of being objects of persecution by tokoloshis (invisible creatures said to possess magical powers) and other supernatural agents or phenomena.2 Living in and traveling around Harare, one is aware of moving through a “heterogeneous modernity,” to use Clifford’s term, where the staccato rhythms of mbira mix with the bold sounds of African American R&B and hip-hop, where affluent teenagers, most often nose brigade, wear the latest urban gear of Fubu and Cross Colours and debate whether or not Tupac is really alive or dead while sipping cappuccino at the trendy Book Cafe, while their less affluent age mates beg for “a dollar please, Boss,” on the streets outside.3 In Harare, one gets the sense that linear history is broken, “the present constantly shadowed by a past that is also a desired, but obstructed future: a renewed, painful yearning” (Clifford 1997, 264). Harare’s shadowed past includes its establishment by European settlers initially drawn by rumors of the legendary riches of Ophir (Phimister 1988), a chimerical gold reef reportedly similar to that of South Africa’s Witwatersrand. Through the machinations of the British South Africa Company, De Beers, and Gold Fields of South Africa, plans were quickly developed to facilitate the accumulation of capital, much of the control of which was in foreign hands, and domination of the surrounding territory. Infrastructure provision, land use planning, and the implementation of measures necessary to ensure a low-cost pliable workforce ensured the maintenance of a comfortable lifestyle for European residents at the expense of local black Africans (Rakodi 1995, 256; see also Phimister 1988). Such infrastructure provided the internal scaffolding, the template, upon which postcolonial Harare, the seat of government, has fashioned itself and its relations with the rest of the country. Many travelers to other African countries are struck by the level of development as witnessed in Harare’s apparently sound infrastructure, which includes twenty-four-hour electricity, decent roads, modern architecture and urban planning, and general cleanliness. People used to say that Harare was not really Africa but a good place to visit as an introduction to the continent—Africa lite, as it were.4 As many Hararians will testify, though, things are worse today and the city is falling apart. “It’s bad, man, I tell you!” were the first words uttered by a friend of mine, Isaiah, when I returned in March 1999...