The daily commute to work on my bike had just become more interesting. After zigzagging through numerous blockades of felled trees, skidding up and down embankments and narrowly avoiding pedestrians on the pavement, I had come to a point where I could go no further. A community protest demanding piped water was going to trump my attempt at providing healthcare in the public sector. At least for today.

After a few minutes of futile discussion, it was clear I would be continuing what administrative work I could do from home. After all, while health is an ad hoc concern for people (usually only really considered when they are ill or need healthcare), water is a daily necessity. Getting water is a daily grind. Without water, health cannot be realised.

I idled lazily back along the gravel road, past eucalyptus plantation upon eucalyptus plantation – plantations owned by community members. I have witnessed these plantations spring up rapidly in virgin grassland adjoining a conservation site – a biodiversity tragedy – yet they provide additional income to a deeply rural community with a staggering level of unemployment. It’s hard to argue the case for nature when immediate economic realities stare you in the face. So, the gum trees continue to suck the water-table dry, periodically getting burned down due to the lack of any fire protection infrastructure or even a plan.

That evening, a stone’s throw from a large wetland peat bog with its ever-shallower river meandering through to the large lake system, I sat listening to the deafening silence. There was a faint night sky glow from the community 10km away who had recently received electricity. The sub-district has been one of the top-performing areas for electrification in South Africa – an achievement that has helped numerous learners study at night and also opened up access to information through media and the internet. Occasionally the silence is broken by an eclectic mix of neighbourhood tastes in music – another testimony to service delivery.

My mind wandered back 11 years, when evenings like these were characterised by the deafening chirps of a million frogs and insects all vying for a mate. I recalled those crisp evenings where it was so dark you could see the dark spots in the Milky Way.

Much had contributed to the disappearance of this, I mused – including the catastrophic drought and its subsequent impact on small local farming practices in the peat bog below me, the indiscriminate use of now widely available agro-chemicals, and the phenomenal increase in average overall individual wealth.

My district had gone from a mere handful of locally owned “bush” taxis 17 years ago to daily perpetual congestion of shiny new 4x4s gracing the town’s single street. Large multi-room brick residences have sprung up from the reed dwellings, and many car wash businesses pump out the latest tunes seven days a week.

Unfortunately, they also pump out chemicals into the groundwater, rivalling the used engine oil and other waste products from the numerous local mechanics who have no other means of disposal nor awareness of the carcinogenic effects.

The municipality had tried hard: along with one of the best electrification projects, it has also kept the roads without potholes, built one of the longest pavements ever seen in a rural area to keep school children and other pedestrians off the road. It has initiated skills development training for people with disabilities and delivered trucked water to those communities where the groundwater table had sunk below the borehole levels. It had briefly been successful with waste collection, although this seemed to be largely a stop-start affair and residents had taken to burning their rubbish dumps on a regular basis.

But with an increase in net wealth comes an increase in net waste and type of waste. The toxic fumes from the plastics and other materials, combined with the smog from cars and the brown haze from the slash-and-burn fires clearing land for crops and new eucalyptus plantations meant that most days now have a heavy haze and an acrid taste to the air.

The change in wealth has also contributed to a change in diet and levels of activity, spurring a rapid rise in hypertension, diabetes and obesity and a rise in recreational drug use. In addition, there are hidden factors such as light pollution, water pollution and air pollution, all likely to be contributing further to this rise in non-communicable diseases, cancers and mental health conditions. Costs the government will eventually have to carry.

Thankfully, severe acute malnutrition in children had been almost eliminated in the sub-district. But in the absence of quality health literacy and promotion, it has made way for more subtle and insidious childhood conditions such as micro-nutrient stunting, childhood obesity and related teenage hip conditions (SCFE).

Unfortunately, like so many other rural areas experiencing an overdue and necessary rise in socio-economic status, community awareness and regulations protecting health and wellness are sorely lagging. Rapidly developing technology has created opportunities to leapfrog strategies that pollute and cause disease (again, costs that will end up being paid for by the family, community and government) and still ensure improvements in access to water, sanitation, electricity and communication.

Tragically, the latest technology in tech and renewables together with examples we can draw from other African countries of community participation and engagement strategies, is being missed in favour of supporting archaic politically driven technologies in a flailing economy. The rush for self-enrichment, usually of the politically connected, means that humanity continues to obstinately refuse to learn from its mistakes. This leaves developing rural communities with all the hidden lemons of the sweet experience of “advancement”.

And so, as I watch an almost daily deterioration of this beautiful and potentially life-giving environment, I realise that simultaneous improvements in health and wealth, so necessary and just, cannot be at the expense of the environment – particularly if long-term resilience and gains are to be made.

The question – and it’s an essential one for our democracy and development – is: how do we work with communities and developers to ensure we achieve that balance? MC

The health worker who wrote this article has asked to remain anonymous. Maverick Citizen knows her identity.