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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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.

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What Jeremy Corbyn can learn from Orwell

Corbyn’s ideas may echo George Orwell’s – but they’d need Orwell’s Britain to work. It’s time Corbyn accepted the British as they are today.

All Labour Party leaderships since 1900 have offered themselves as “new”, but Tony Blair’s succession in 1994 triggered a break with the past so ruthless that the Labour leadership virtually declared war on the party. Now it is party members’ turn and they, for now at any rate, think that real Labour is Jeremy.

To Keir Hardie, real Labour had been a trade union lobby expounding Fellowship. To the Webbs, real Labour was “common ownership” by the best means available. Sidney’s Clause Four (adopted 1918) left open what that might be. In the 1920s, the Christian Socialist R H Tawney stitched Equality into the banner, but during the Depression young intellectuals such as Evan Durbin and Hugh Gaitskell designated Planning as Labour’s modern mission. After the Second World War, Clement Attlee followed the miners (and the London Passenger Transport Board) into Nationalisation. Harold Wilson tried to inject Science and Technology into the mix but everything after that was an attempt to move Labour away from state-regulated markets and in the direction of market-regulated states.

What made the recent leadership contest so alarming was how broken was the intellectual tradition. None of the candidates made anything of a long history of thinking about the relationship between socialism and what the people want. Yvette Cooper wanted to go over the numbers; only they were the wrong numbers. Andy Burnham twisted and turned. Liz Kendall based her bid on two words: “Have me.” Only Jeremy Corbyn seemed to have any kind of Labour narrative to tell and, of course, ever the ­rebel, he was not responsible for any of it. His conference address in Brighton was little more than the notes of a street-corner campaigner to a small crowd.

Given the paucity of thinking, and this being an English party for now, it is only a matter of time before George Orwell is brought in to see how Jeremy measures up. In fact, it’s happened already. Rafael Behr in the Guardian and Nick Cohen in the Spectator both see him as the kind of hard-left intellectual Orwell dreaded, while Charles Cooke in the National Review and Jason Cowley in the New Statesman joined unlikely fashion forces to take a side-look at Jeremy’s dreadful dress sense – to Orwell, a sure sign of a socialist. Cooke thought he looked like a “burned-out geography teacher at a third-rate comprehensive”. Cowley thought he looked like a red-brick university sociology lecturer circa 1978. Fair enough. He does. But there is more. Being a middle-class teetotal vegetarian bicycling socialistic feministic atheistic metropolitan anti-racist republican nice guy, with allotment and “squashily pacifist” leanings to match, clearly puts him in the land of the cranks as described by Orwell in The Road to Wigan Pier (1937) – one of “that dreary tribe of high-minded women and sandal-wearers and bearded fruit-juice drinkers who come flocking towards the smell of ‘progress’ like bluebottles to a dead cat”. And though Corbyn, as “a fully fledged, fully bearded, unabashed socialist” (Huffington Post), might make all true Orwellians twitch, he really made their day when he refused to sing the National Anthem. Orwell cited precisely that (see “The Lion and the Unicorn”, 1941) as an example of the distance between left-wing intellectuals and the people. It seemed that, by standing there, mouth shut, Comrade Corbyn didn’t just cut his wrists, he lay down full length in the coffin and pulled the lid shut.


Trouble is, this line of attack not only misrepresents the Labour leader, it misrepresents Orwell. For the great man was not as unflinchingly straight and true as some people think. It is impossible, for instance, to think of Orwell singing “God Save the King”, because he, too, was one of that “dreary tribe” of London lefties, and even when he joined Labour he remained ever the rebel. As for Corbyn, for a start, he is not badly dressed. He just doesn’t look like Chuka or Tristram. He may look like a threadbare schoolteacher, but Orwell was one twice over. Orwell was never a vegetarian or a teetotaller, but, like Corbyn, neither was he interested in fancy food (or drink), he kept an allotment, drove a motorbike, bicycled, cared about the poor, cared about the environment, loathed the empire, came close to pacifism at one point, and opposed war with Germany well past the time when it was reasonable to do so.

In Orwell’s thinking about socialism, for too long his main reference point was the London Marxist left. Not only did he make speeches in favour of revolutions, he took part in one with a gun in his hand. Orwell was far more interested, as Corbyn has been far more interested, in speaking truth to power than in holding office. His loyalty was to the movement, or at least the idea of the movement, not to MPs or the front bench, which he rarely mentioned. There is nothing in Corbyn’s position that would have shocked Orwell and, should they have met, there’d have been much to talk about: belief in public ownership and non-economic values, confidence in the state’s ability to make life better, progressive taxation, national health, state education, social care, anti-socially useless banking, anti-colonialism and a whole lot of other anti-isms besides. It’s hard to be sure what Orwell’s position would have been on Trident and immigration. Not Corbyn’s, I suspect. He was not as alert to feminism as he might have been but equally, few men try to write novels from a woman’s point of view and all Orwellians recognise that Julia is the dark hero of Nineteen Eighty-Four. In truth they are both austere types, not in it for themselves and not on anyone else’s expense account either. Corbyn won the leadership because this shone through from the very beginning. He came across as unaffected and straightforward – much as Orwell tried to be in his writing.

Except, as powerfully expressed in these pages by John Gray, Corbyn’s politics were made for another world. What sort of world would he need? First off, he’d need a regulated labour market: regulated by the state in partnership with a labour movement sensitive to what people wanted and experienced in trying to provide it. He would also need capital controls, a manufacturing base capable of building the new investment with Keynesian payback, an efficient and motivated Inland Revenue, a widespread public-service ethos that sees the country as an asset, not a market, and an overwhelming democratic mandate to get things done. In other words, Corbyn needs Orwell’s Britain – not this one – and at the very least, if he can’t have that, he needs the freedom to act that the European Commission forbids.

There’s another problem. Orwell did not trust left-wing intellectuals and spent half his life trying to work out their motivations as a class who spoke for the people, went in search of the people, and praised the people, but did not know them or believe in them. True, Corbyn says he wants to be open and inclusive, but we know he can’t possibly mean it when he says it will be the party, not him or the PLP, that will decide policy, just as we knew it couldn’t possibly be true when he said he’d turn PMQs into the People’s Question Time. Jeremy hasn’t changed his mind in forty years, appears to have great difficulty (unlike Tony Benn) in fusing socialism to national identity or experience (Hardie, Ben Okri and Maya Angelou were bolted on to his Brighton speech) and seems to think that not being happy with what you are given somehow captures the historic essence of socialism (rather than its opposite).

Granted, not thinking outside the ­circle is an inherent fault of the sectarian left but some of our most prominent left-wing journalists have it, too. Working-class support for nationalisation? Good. Right answer! Working-class opposition to benefit scroungers and further mass immigration? Bad. Wrong answer! Would you like to try again? In his essay “In Defence of Comrade Zilliacus” (1947) Orwell reckoned that left-wing intellectuals saw only what they wanted to see. For all their talk of representing the people, they hated the masses. “What they are frightened of is the prevailing opinion within their own group . . . there is always an orthodoxy, a parrot-cry . . .”

The game is hard and he may go down in a welter of knives, yet Corbyn still has time. He may go on making the same speech – on the benefits of apple pie to apple growers – but at some point he will have to drop the wish-list and get on the side of the British people as they are, and live with that, and build into it. Only the nation state can even begin to do the things he wants to do. The quicker he gets that, the quicker we can see if the latest incarnation of new Labour has a future.

Robert Colls is the author of “George Orwell: English Rebel” (Oxford University Press)

This article first appeared in the 08 October 2015 issue of the New Statesman, Putin vs Isis