Epidemics: The Story of South Africa's Five Most Lethal Human Diseases

6. Conclusion

152 6 Conclusion As the five chapters of this book make clear, epidemics have at times been decisive in shaping South Africa’s history at both the public and private level. Either as creators of new scenarios or accelerators of existing processes and trends, their significance is apparent to those who recognise the importance of disease in the making of South Africa’s past. In demographic terms, the sheer number of lives claimed and births they rendered impossible means that the shape of every South African population pyramid bears their mark.No account of the demise of Khoekhoe society or of the country’s post-apartheid plight is completewithouttakingintoconsiderationtheepidemic factor. Moreover, to these deaths must be added their emotional, psychological and social cost to those left behind. When a history of private life, emotions and the family in South Africa comes to be written, epidemics will occur and reoccur throughout the text. 153 So powerful were the frightening associations that epidemics conjured up that the mere threat of one was enough to mobilise prejudices and prompt action on the public health, political or social front. Especially to South Africa’s long and wretched history of forced removals and racial segregation, epidemic expediency has been a notable and, at times, critical contributor. For biomedicine in South Africa, epidemics have usually spelled short-term defeat but longer-term success as breakthroughs like vaccination, antibiotics and antiretroviral drugs have rendered previous killer diseases preventable or at least treatable. The success of biomedicine in doing so strengthened its hand, epidemic by epidemic, over other medical systems resorted to by the population. Not the least important way in which this occurred was through the subsequent creation of official public health structures, enshrining biomedicine as the privileged, normative system of healthcare delivery. Nor is it only as scenario-creator or processaccelerator that epidemics are important to an understanding of South Africa’s past. The five chapters tellingly demonstrate that geographical mobility (especially of sailors, soldiers, impis, trekkers, truckers and migrant workers) has long been a central feature of southern African history. Even today 154 men-on-the-moveremainpivotaltothesubcontinent’s life and operation. It is also clear that epidemics sharply illuminate underlying attitudes, beliefs and outlooks, religious and lay, scientific and social, medical and folk. The life-and-death situations which they create call forth raw responses and emotions unvarnished by political correctness or cosmetic politeness. Pathogens prompt prejudices with the same dire effect as epidemics elicit accusations and insinuations. There is no way in which South Africa can escape its epidemic past.Unlike the millions of its victims,this cannot be buried. Confronting it and learning from it are what this book has sought to do. ...