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5 November 2009

Linda-Gail Bekker – extended interview

A longer version of this week's NS interview

By Sophie Elmhirst

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?

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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.

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