Linda-Gail Bekker - extended interview

A longer version of this week's NS interview

What does winning the prize mean to you?
I'm overwhelmed. I think one of the aspects of working here in southern Africa is that you get on with the job -- you get lost in the day-to-day work, so when somebody stops and acknowledges you, it's a very pleasant surprise. It is also humbling because I know a lot of people in this part of the world doing great stuff, and I'm just one of them. Having said that, I'm very much enjoying my 15 minutes of fame - I'm not about to give it up!

What drew you to working in this field in the first place?
I was born in Zimbabwe, and came to UCT [the University of Cape Town] to do my medical degree because it was the Big Smoke. It was the late 1980s, and the HIV epidemic was just breaking for us. I remember a strong sense of frustration, anxiety, impotence -- I didn't fully understand what was going on, and wanted to know more. I went on to do my PhD in host immunology, which I am still fascinated by, but as time has gone on, I have used the laboratory side of my studies less, and I've been drawn to the hands-on side of things. I often say to people I'm really a closet social worker these days.

The HIV epidemic, together with the TB epidemic, is incredibly all-encompassing. One has to work in the community, and then one meets all the difficulties of our recently urbanised, socio-economically disadvantaged communities. And so one gets more and more caught up in community development. It has really become a most incredible vocation, where every single day of my life is different. There's just so much to do and the need is so huge. It's also incredibly exciting, as there's so much to learn. We haven't cracked it by a long shot -- there's still a tonne to do - but it doesn't feel like work, it feels like fun. I'm so lucky to get paid to do it.

What does the work involve? What's the plan?
In this part of the world, children are becoming infected with TB in huge numbers very early on. They don't get the disease immediately, but they become infected (much like it was in the pre-antibiotic era in your country). When you superimpose the HIV epidemic on top of that, you speed up the progress of the illness -- so the TB infection becomes [the] TB disease in young adulthood, because of their immune deficiency. We have to think of TB and HIV together almost as a new disease. That requires us to go back to fundamentals, but also to think outside the box. What will be the new interventions on top of the tried and tested ones, which seem to be insufficient at the moment? What else could we be doing?

It's said you marry science and humanity.
HIV and TB are just so much a part of our lives. A good part of our workforce live openly with HIV. They come to work and we look after them, but they also take their antiretrovirals. I have had TB and had to take treatment. It really is very tangible for us -- you're dealing with it not only at work, but in everyday life. It's been much more than just patients that I see between eight and five. They are often friends, colleagues, workmates. In addition, we work in six sites around Cape Town. We don't just parachute in, do our research and leave. We've established strong relations with the community.

There's been recognition that young people are particularly vulnerable. One of the things we've been doing is fundraising to build the youth centre where we're going to test a model of [having] comprehensive recreation, education and sexual and reproductive health services all under one roof. It's trying to break through that nihilism of: "My mother and father have HIV, my brother's died of Aids - I'm probably also going to go that way." Somehow, we need to break out of that and create some hope.

Are you engaged in the politics of South Africa?
Well, I think we are at heart activists, simply because, again, you can't work in this field and not be politically aware. We work hard to change policy, but through evidence. Our strategy is always [to] create or find the evidence, write about it, then convince people to change their policies if required, or to modify policy accordingly. It's a slow and often arduous process, and we know that.

Having said that, we are in a province of South Africa that has been incredibly open to research and to researchers. The Western Cape is very progressive in that regard. I guess we've been luckier than many. We feel very hopeful that we are now in a new era, where government wants to hear, and there's the strong sense that we're all swimming in the same direction, which I think is very helpful.

Having said that, there are lots of competing priorities in this country. How do you decide on housing versus prevention versus treatment? Somehow, we have to move all of these agendas forward in whatever way we can, and it's our job to find evidence to show what is the best, most cost-effective way of doing it. We are not the richest nation on earth, but we are not the poorest nation on earth, so somehow we've got to find that middle road.

Do you personally feel political? Do you vote?
Oh yes. I came from Zimbabwe, perhaps politically quite naive, to UCT, which was a very liberal university in those days. I had quite a political awakening as a result of that.

What do you mean?
I came to university in the 1980s, which was an incredibly volatile time in South Africa's history. And the 1990s were the most liberating and wonderfully eye-opening period. That initial . . . blissful, starry-eyed, honeymoon phase is a little bit over. We really do need to roll up our sleeves now and say, "What are the issues at hand?" And, of course, for me as an infectious diseases doctor, the 1990s have really been the hardest in terms of the HIV epidemic. We've seen the numbers sky-rocket. We've watched many people die. While the first world had opportunities to treat, we were scrounging around for the most basic of treatments.

Do you think there's been a lack of political leadership in South Africa?
Yes. Civil society became the leaders. We have had to take on the government on some occasions, and we have done that. On other occasions, we've taken on the pharmaceutical companies with the government. It's been about our patients and the people that we serve, so we've needed to take whichever side was required in order to further the agenda. Yeah, I think South Africa has huge challenges still. We stand here on the tip of Africa, and, some days, you kind of recognise that it's a big job, and how ever are we going to meet all the challenges? But the little triumphs along the way do count, and I think we are making progress.

How do you balance your work with the rest of your life?
I married someone who is in exactly the same field. He's the director of the HIV centre at UCT and I'm the deputy director, and we run the foundation together, so a lot of our work comes home. This is really a 24/7 thing and we're forever contemplating what the next steps are, what the strategies are. Also, we have a great team at work who can be relied upon, and I think that's the way to do it: learn to rely on others, and then a little bit of forward planning. And love what you do, so you don't mind doing it 24/7.

We have two grown-up children who live in England and are practically independent and on their own, but we also have a seven-year-old, Oliver. Maybe that's the other thing that happens. I've been reading a lot in the UK press recently about how women are having children a lot later. By the time I was qualified and had established my career, it was quite late in my life -- so I had Ollie when I was 40, and he is a great, great joy. He started life with an embryonic carcinoma, so the first three years of his life, we camped at the Red Cross children's hospital because he needed chemotherapy. Once you've got beyond that, you pretty much feel you could cope with most things!

Is there anything you regret?
I've loved being a mother. I think I could have quite enjoyed another child. But things happen the way they do, and you make the decisions. So, no, I don't think I have any regrets at all. The only thing is that I would [like to] have done more of everything. I just feel there aren't enough hours in the day to do everything one wants. I love to paint, and what I'm hoping is that as Ollie gets a little older, I'll be able to get back to painting.

Would you ever like to live anywhere else?
I'm inherently an African. My forefathers went up to Malsequa in 1894 - I'm fourth-generation. It's hard for me to think of living anywhere other than Africa. Certainly, in the immediate future, the work I do seems most relevant here. I lived for some time in New York and I loved it. Considering I had come from a very small backstreet town in the middle of Africa, I absolutely thrived in New York City. I think it's a wonderful city. But what makes me want to stay here for the moment is just the relevance. We feel very relevant in what we do, here, in this part of the world. I'm inherently a hands-on person. I like to engage with the community, with the staff. I think that's where my talent is. Robin, my husband, is the intellectual in the partnership. He's the guy who likes to ponder the data for days on end and see the intricacies of it. My talent is to get into the community and get my hands dirty.

It sounds like a perfect balance.
I think we are a good foil for each other. At the moment, it certainly feels right. It feels like we are contributing, which, to my mind, is actually a huge privilege, and that's the thing I think I would find hardest to give up. It's a huge privilege to feel like you really are in the right place at the right time, doing the right thing. And I imagine there are a lot of people who would give up a lot to be able to do that. I recognise it's something to be savoured for the moment.

Are we all doomed?
I don't think so. I'm an optimist at heart, but I can see why you would ask the question. When you look at the TB-HIV figures, you wonder what the next terrible virus or pathogen is that's waiting around the corner. On the other hand, the thing that strikes me daily is the resilience of humanity, so much so, that it often chokes me. Human beings find a way.

Certainly, if I have anything to do with it, I'll try to avert . . . some of the suffering and difficulties that we see, at least in this part of the world.

Sophie Elmhirst is features editor of the New Statesman

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The age of loneliness

Profound changes in technology, work and community are transforming our ultrasocial species into a population of loners.

Our dominant ideology is based on a lie. A series of lies, in fact, but I’ll focus on just one. This is the claim that we are, above all else, self-interested – that we seek to enhance our own wealth and power with little regard for the impact on others.

Some economists use a term to describe this presumed state of being – Homo economicus, or self-maximising man. The concept was formulated, by J S Mill and others, as a thought experiment. Soon it became a modelling tool. Then it became an ideal. Then it evolved into a description of who we really are.

It could not be further from the truth. To study human behaviour is to become aware of how weird we are. Many species will go to great lengths to help and protect their close kin. One or two will show occasional altruism towards unrelated members of their kind. But no species possesses a capacity for general altruism that is anywhere close to our own.

With the possible exception of naked mole-rats, we have the most social minds of all mammals. These minds evolved as an essential means of survival. Slow, weak, armed with rounded teeth and flimsy nails in a world of fangs and claws and horns and tusks, we survived through co-operation, reciprocity and mutual defence, all of which developed to a remarkable degree.

A review paper in the journal Frontiers in Psychology observes that Homo economicus  might be a reasonable description of chimpanzees. “Outsiders . . . would not expect to receive offers of food or solicitude; rather, they would be fiercely attacked . . . food is shared only under harassment; even mothers will not voluntarily offer novel foods to their own infants unless the infants beg for them.” But it is an unreasonable description of human beings.

How many of your friends, colleagues and neighbours behave like chimpanzees? A few, perhaps. If so, are they respected or reviled? Some people do appear to act as if they have no interests but their own – Philip Green and Mike Ashley strike me as possible examples – but their behaviour ­attracts general revulsion. The news is filled with spectacular instances of human viciousness: although psychopaths are rare, their deeds fill the papers. Daily acts of kindness are seldom reported, because they are everywhere.

Every day, I see people helping others with luggage, offering to cede their place in a queue, giving money to the homeless, setting aside time for others, volunteering for causes that offer no material reward. Alongside these quotidian instances are extreme and stunning cases. I think of my Dutch mother-in-law, whose family took in a six-year-old Jewish boy – a stranger – and hid him in their house for two years during the German occupation of the Netherlands. Had he been discovered, they would all have been sent to a concentration camp.

Studies suggest that altruistic tendencies are innate: from the age of 14 months, children try to help each other, attempting to hand over objects another child can’t reach. At the age of two, they start to share valued possessions. By the time they are three, they begin to protest against other people’s violation of moral norms.

Perhaps because we are told by the media, think tanks and politicians that competition and self-interest are the defining norms of human life, we disastrously mischaracterise the way in which other people behave. A survey commissioned by the Common Cause Foundation reported that 78 per cent of respondents believe others to be more selfish than they really are.

I do not wish to suggest that this mythology of selfishness is the sole or even principal cause of the epidemic of loneliness now sweeping the world. But it is likely to contribute to the plague by breeding suspicion and a sense of threat. It also appears to provide a doctrine of justification for those afflicted by isolation, a doctrine that sees individualism as a higher state of existence than community. Perhaps it is hardly surprising that Britain, the European nation in which neoliberalism is most advanced, is, according to government figures, the loneliness capital of Europe.

There are several possible reasons for the atomisation now suffered by the supremely social mammal. Work, which used to bring us together, now disperses us: many people have neither fixed workplaces nor regular colleagues and regular hours. Our leisure time has undergone a similar transformation: cinema replaced by television, sport by computer games, time with friends by time on Facebook.

Social media seems to cut both ways: it brings us together and sets us apart. It helps us to stay in touch, but also cultivates a tendency that surely enhances other people’s sense of isolation: a determination to persuade your followers that you’re having a great time. FOMO – fear of missing out – seems, at least in my mind, to be closely ­associated with loneliness.

Children’s lives in particular have been transformed: since the 1970s, their unaccompanied home range (in other words, the area they roam without adult supervision) has declined in Britain by almost 90 per cent. Not only does this remove them from contact with the natural world, but it limits their contact with other children. When kids played out on the street or in the woods, they quickly formed their own tribes, learning the social skills that would see them through life.

An ageing population, family and community breakdown, the decline of institutions such as churches and trade unions, the switch from public transport to private, inequality, an alienating ethic of consumerism, the loss of common purpose: all these are likely to contribute to one of the most dangerous epidemics of our time.

Yes, I do mean dangerous. The stress response triggered by loneliness raises blood pressure and impairs the immune system. Loneliness enhances the risk of depression, paranoia, addiction, cognitive decline, dem­entia, heart disease, stroke, viral infection, accidents and suicide. It is as potent a cause of early death as smoking 15 cigarettes a day, and can be twice as deadly as obesity.

Perhaps because we are in thrall to the ideology that helps to cause the problem, we turn to the market to try to solve it. Over the past few weeks, the discovery of a new American profession, the people-walker (taking human beings for walks), has caused a small sensation in the media. In Japan there is a fully fledged market for friendship: you can hire friends by the hour with whom to chat and eat and watch TV; or, more disturbingly, to pose for pictures that you can post on social media. They are rented as mourners at funerals and guests at weddings. A recent article describes how a fake friend was used to replace a sister with whom the bride had fallen out. What would the bride’s mother make of it? No problem: she had been rented, too. In September we learned that similar customs have been followed in Britain for some time: an early foray into business for the Home Secretary, Amber Rudd, involved offering to lease her posh friends to underpopulated weddings.



My own experience fits the current pattern: the high incidence of loneliness suffered by people between the ages of 18 and 34. I have sometimes been lonely before and after that period, but it was during those years that I was most afflicted. The worst episode struck when I returned to Britain after six years working in West Papua, Brazil and East Africa. In those parts I sometimes felt like a ghost, drifting through societies to which I did not belong. I was often socially isolated, but I seldom felt lonely, perhaps because the issues I was investigating were so absorbing and the work so frightening that I was swept along by adrenalin and a sense of purpose.

When I came home, however, I fell into a mineshaft. My university friends, with their proper jobs, expensive mortgages and settled, prematurely aged lives, had become incomprehensible to me, and the life I had been leading seemed incomprehensible to everyone. Though feeling like a ghost abroad was in some ways liberating – a psychic decluttering that permitted an intense process of discovery – feeling like a ghost at home was terrifying. I existed, people acknowledged me, greeted me cordially, but I just could not connect. Wherever I went, I heard my own voice bouncing back at me.

Eventually I made new friends. But I still feel scarred by that time, and fearful that such desolation may recur, particularly in old age. These days, my loneliest moments come immediately after I’ve given a talk, when I’m surrounded by people congratulating me or asking questions. I often experience a falling sensation: their voices seem to recede above my head. I think it arises from the nature of the contact: because I can’t speak to anyone for more than a few seconds, it feels like social media brought to life.

The word “sullen” evolved from the Old French solain, which means “lonely”. Loneliness is associated with an enhanced perception of social threat, so one of its paradoxical consequences is a tendency to shut yourself off from strangers. When I was lonely, I felt like lashing out at the society from which I perceived myself excluded, as if the problem lay with other people. To read any comment thread is, I feel, to witness this tendency: you find people who are plainly making efforts to connect, but who do so by insulting and abusing, alienating the rest of the thread with their evident misanthropy. Perhaps some people really are rugged individualists. But others – especially online – appear to use that persona as a rationale for involuntary isolation.

Whatever the reasons might be, it is as if a spell had been cast on us, transforming this ultrasocial species into a population of loners. Like a parasite enhancing the conditions for its own survival, loneliness impedes its own cure by breeding shame and shyness. The work of groups such as Age UK, Mind, Positive Ageing and the Campaign to End Loneliness is life-saving.

When I first wrote about this subject, and the article went viral, several publishers urged me to write a book on the theme. Three years sitting at my desk, studying isolation: what’s the second prize? But I found another way of working on the issue, a way that engages me with others, rather than removing me. With the brilliant musician Ewan McLennan, I have written a concept album (I wrote the first draft of the lyrics; he refined them and wrote the music). Our aim is to use it to help break the spell, with performances of both music and the spoken word designed to bring people together –which, we hope, will end with a party at the nearest pub.

By itself, our work can make only a tiny contribution to addressing the epidemic. But I hope that, both by helping people to acknowledge it and by using the power of music to create common sentiment, we can at least begin to identify the barriers that separate us from others, and to remember that we are not the selfish, ruthless beings we are told we are.

“Breaking the Spell of Loneliness” by Ewan McLennan and George Monbiot is out now. For a full list of forthcoming gigs visit:

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood