Last week I exchanged the warmth of a European summer for a South African winter. I spent most of the week in Cape Town, in my role as a member of the Global Health Advisory Committee of George Soros’ Open Society Initiative. The OSI public health programme, with which I have been involved since its inception, supports the needs of a range of vulnerable populations. One group consists of people who are dying. OSI has played an important role in supporting the development of palliative care in many parts of the world, to reduce the number of people who die in unnecessary pain. Another group consists of those who are in prison, which in many parts of the world is effectively a death sentence because of the harsh conditions and the high risk of infectious diseases such as tuberculosis. Others include a range of people on the margins of mainstream society, so often overlooked by other NGOs, such as sex workers and drug users. OSI has been at the forefront of international efforts to implement harm reduction policies, such as clean needle exchange and the use of methadone. Then there is a group with which I have been particularly involved, the Roma (or gypsy) population of central and eastern Europe, a group that has been subject to appalling persecution for centuries and, as we have shown most recently in Hungary, continues to have much worse health status than the majority population. Even now, in some of the European Union’s newest member states, they are subject to severe discrimination. However, the older member states should not be complacent, given the now notorious episode at Prague airport when British immigration officials, who were briefly posted there to pre-screen passengers to the UK, refused boarding to a Roma journalist while allowing a colleague, whose circumstances were otherwise identical, to board the plane. The officials had to be withdrawn soon after, in part because the entire episode was filmed.The training course in Cape Town was a joint venture between OSI’s Public Health, Justice, and Human Rights and Governance programmes. Our aim was to explore how we could collectively use the expertise and experience from the different programmes to make the world a better place. Armed with a workbook and a substantial resource pack, which contained all you could ever want to know about a range of international legal instruments, we worked through the opportunities offered by combining law and health to address the issues of the various populations with which we were concerned. This was interspersed with a series of excellent panels and presentations drawing in particular on the way in which NGOs in South Africa had addressed the many recent challenges that country has faced. My role was to act as a resource person for the discussions on minority rights, providing background information on the Roma population. I was accompanied by Willem Odendaal, from the Legal Assistance Centre in Namibia. Willem’s expertise relates to the San people (sometimes referred to as Bushmen), who live in Namibia, Botswana, and (in much smaller numbers) neighbouring countries. He and his colleagues have been doing a remarkable job, providing much needed support for San people trying to uphold their legal and constitutional rights. Although the Roma and the San are clearly different in many ways, it was also striking how much they have in common, or rather, the extent to which mainstream societies have treated them in the same way. Both groups are seriously disadvantaged. Their communities are poorly served by basic health and educational facilities (graphically described, for the Roma, by the recent report “Ambulance not on the way”). They face widespread discrimination and often suffer gravely at the hands of the police. They are seen as in some way separate from the state, often denied the necessary paperwork to access services. The plight of the San is especially severe, as they face pressure to move off traditional lands to make way for game parks and diamond mining, among other things. Like indigenous people everywhere, they have terrible health problems, in particular alcoholism and tuberculosis. Yet when they queue at health clinics, which often can only be reached after long journeys, the majority population walk straight to the front of the queue, as if the San people didn’t exist. Some time ago, with Judith Healy, I edited a book looking at how health systems meet (or more often don’t meet) the needs of the diverse groups within society. Among the indigenous populations we included, along with the Roma, Native Americans, First Nation Canadians, Australian Aborigines, and New Zealand Maoris. From what I now know, we should clearly have included the San.
I am extremely grateful to Willem for helping me, and the other participants on the course, to understand the challenges that the San continue to face and to my colleagues in OSI for bringing public health, legal and human rights people together in a way that allowed us to learn so much from each other.