In March, the Stop Stockouts Project and SECTION27 conducted human rights awareness workshops focused on the right to health in the Eastern Cape. We conducted workshops in East London, Hamburg, Nqileni Village and Lusikisiki on healthcare rights and tools for realising them such as complaints mechanisms, statement-taking and using stockouts reporting mechanisms in combination with activism and, when all else fails, litigation.

The workshops formed part of the work of Eastern Cape Health Crisis Action Coalition (ECHCAC) and its increased efforts to empower community members to claim the right to health. Empowered and informed communities are critical to achieving rights and the success of the Coalition’s work.

The good story, the bad story and the lived reality of rights

Though the exact degree to which South Africa has transformed is contested, it is clear that we have a mixed story to tell, rather than a purely good or a bad one.

An excellent Africa Check analysis of the ANC’s election campaign claims confirms this. Broadly speaking, significantly more people benefit from government provided housing, electricity, water, education, social grants and healthcare than in 1994. In healthcare in particular, many gains have been made, particularly in recent years. For example, the catastrophic decisions and foolish ideologies of the Mbeki administration have been corrected and the state now provides antiretroviral treatment to around 2.5 million people.

However, despite these achievements, drug stockouts and shortages continue to plague healthcare facilties countrywide. The healthcare system remains deeply inequitable. It is often experienced by poor black South Africans as if it continues to be designed and implemented by Apartheid architects. This is exacerbated by the almost ubiquitous disinterest displayed by the private healthcare sector in fulfilment of its moral and constitutional obligations as service providers of a fundamental human right.

The failing healthcare system in the Eastern Cape

The problems throughout our health system are particularly pronounced in the Eastern Cape. Though the National Health Act commits to ending the Apartheid in our healthcare system by “uniting the various elements of the national health system”, the vast majority of poor, black people living in the Eastern Cape suffer the indignity of daily violations of their right to healthcare services. As ECHCAC’s “Death and Dying Report” and the Coalition’s ongoing work in the Province indicates, the healthcare system in the Eastern Cape requires an urgent and comprehensive overhaul.

One example of the depth of the problem is emergency medical treatment. People in the rural Eastern Cape grew angry at the mere mention of ambulance services. Many report waiting up to eight hours before an ambulance arrives. Often, an ambulance never arrives or indicates that it cannot travel to a remote rural location. Stories of people dying whilst waiting for ambulances, or because there is no medically trained person assisting the driver of the ambulance, are common.

Phumzile, a participant in the workshop in Nqileni Village, exclaimed that he had not once in his life seen an ambulance in his community. Dave Martin, a community member in Nqileni Village in the Xhora Mouth area, has laid a complaint with the Eastern Cape Human Rights Commission (ECHRC) in a desperate attempt to rectify this situation. A nearby backpackers in the area has provided a bakkie as the community’s only “ambulance” for nearly ten years. Reports in other areas indicate that people are pushed long distances to healthcare facilities in wheelbarrows. When disaster strikes, the reality is that when people in these areas have no access to a car or money pay to hire one, preventable death becomes a serious possiblity.

In its response to this complaint, the ECDoH freely acknowledges that 600 ambulances are needed in the province for the fulfilment of the right to emergency medical treatment. The response dryly notes that “the provincial ambulance fleet currently stands at 300 with ambulances undergoing conversion such that by the end of the finanicial year the fleet will be around 400 (68%).” The ECDoH’s response lacks any sense of urgency or its constitutional obligations. Each and every ambulance missing exacerbates emergencies and contributes to preventable deaths. Each and every ambulance that is missing is a violation of the right to healthcare services.

Understanding, experiencing and accessing human rights

To add insult to injury, the Constitution, which demands the immediate remedying of this situation – and has done so for nearly 20 years since its enactment – is hidden from the people of the Eastern Cape. This deprivation of knowledge robs vulnerable people of a language of power with which to expose and oppose this serious and life-threatening deprivation of their rights. It is hidden in the pockets of a handful of progressive lawyers, the dusty drawers of public servants and policy makers and, most alarmingly, in the language of the privileged and the educated: English. This is a language that most people in the Eastern Cape do not speak or understand with anything approaching the confidence of fluency. Many, particularly in rural areas, do not speak English at all.

Despite this and the fact that translations of the Constitution were produced in all eleven official languages at its adoption, unsatisfactory attempts have been made to print and distribute them. For example, since at least October 2013, Constitutions in isiXhosa have been completely unavailable, the DoJCD citing the the need to halt printing to incorporate the 17th amendment before continuing printing. When they are printed, they are not made available in clinics, schools, post offices and other accessible public buildings and are rather ineffectively distributed on an ad hoc basis upon request and at specific workshops run by provincial departments of Justice and Constitutional Development.

Armed with one purchased copy of Bill of Rights for All – the Bill of Rights in all eleven languages published by Juta – and with a colleague fluent in isiXhosa, we began our workshops.

Movingly, yet tragically, this was all of the participants’ first meaningful, understandable encounter with the Constitution. A woman in Hamburg stopped Mluleki after his first sentence. Glowing, she said, “Can you just say that again—it was so beautiful”. He had read, in isiXhosa, a right directly out of the Constitution. It was her first time ever hearing it. Encouraged by this experience, we got participants in Nqileni to read the text of the Constitution themselves. The first woman to read caught herself halfway into her first sentence. She paused and looked up at the 20 or so community health workers, a sub-headman in host village Nqileni, pre-school teachers and community members. Smiling, she said “I like this one very much! Listen,” and read in isiXhosa the right to equality. We were distraught to have turn down request for copies of the Constitution at these workshops and explain that copies of the Constitution in isiXhosa simply weren’t available despite our best efforts and a growing campaign to ensure that the government print and effectively distribute them.

With this foundation, energised participants explored in detail the content of their right to access to healthcare services in the Eastern Cape. They were inspired by the knowledge that the daily battles that they face in accessing healthcare services are spoken to and captured elegantly in their mother tongue in the Constitution, and detailed in laws and policies enacted to make the rights in that Constitution real.

Language is power in the language of power

The success of ECHAC will depend in large part on the extent to which users of the healthcare system rise up in opposition to the persistent violations of their healthcare rights. To do so effectively, and to inspire belief that there is a purpose in doing so, people living in the Eastern Cape need a language of power with which to face the Eastern Cape Department of Health. This language of power is found in the Constitution and most particularly its Bill of Rights.

These workshops illustrate that language is power even in this language of power. When rights are taught in a language in which people learn, think, love, laugh, struggle and imagine, people interact with rights intimately and relate them directly to their lives and the world around them. Access to constitutions and constitutional education in isiXhosa is not an an added extra—it is a constitutional right. It allows people to imagine the realisation of constitutional rights in their words and feelings.

Ultimately, the message from the people of the people of the Eastern Cape is clear:

Ezempilo Zililungelo! Lungisa Isebe Lezempilo Sizophila!*

*Healthcare is a right! Fix our healthcare system so that we may live! DM