KALAHARI PEOPLES
FUND SEEKS SUPPORT FOR URGENT RESEARCH:
FOOD SECURITY,
AIDS RISK AND MDR-TB PREVALENCE IN TSUMKWE NAMIBIA
Tax-deductible contributions
to the project may be made securely via Paypal on this site, or by mail
to: Kalahari Peoples Fund, PO Box 7855, Austin, TX 78713-7855. Thank
you!
STATEMENT OF
THE PROBLEM BY DR. RICHARD B. LEE:
Tsumkwe is the administrative
center of the San-populated subdistricts of Tsumkwe East and West. Ju/’hoansi
and !Kung San constitute over 75 percent of the subdistrict’s numbers.
In 2008 a pilot study was conducted to evaluate the vulnerability of
Ju women to HIV infection. An unexpected finding was that HIV infection,
though present at low levels (3-5 %), is not a major health concern.
By contrast TB was far more prevalent with multi-drug-resistant (MDR)
strains on the rise. Of 70 patients currently in treatment for TB, only
two have tested positive for HIV.
Food availability and
nutritional adequacy play major roles in TB and AIDS epidemics in several
important ways. Undernourished people have increased vulnerability to
initial infection, the course of the illness is more rapid, and without
adequate nutrient intake, drug treatment regimes are far less effective,
driving up rates of non-adherence to treatment protocols. Non-adherence
in turn fosters drug resistance in patients, necessitating resort to
second-line drug treatments and sharply poorer prognoses.
Despite the importance of food
security there is little current information on the topic. In the 1990s
Dr. Polly Wiessner carried out food security studies in several villages.
These valuable baseline studies are in need of updating…What are the
sources of food actually consumed by the urban population of Tsumkwe,
and what is the extent of undernutrition? San townspeople rely on a
variety of food sources including store-purchased, farm-grown, and even
foraged wild foods. Cash for purchasing food comes from wages, old-age
and disability pensions, casual labor, and sales of crafts.
Our preliminary findings indicate
that a significant percentage of the San residents of Tsumkwe town,
especially in the informal settlements have insecure and shifting food
supply. By contrast, the population of the outstation settlements, at
distances 10-60 km from Tsumkwe, are able to procure food of greater
reliability and variety.
The purpose of this research
is two-fold: first to document more systematically the sources of food
and dietary composition and sufficiency for a sample of resident-households
in Tsumkwe town; and second to relate these findings to vulnerability
to infection and response to treatment regimes. If possible we will
divide the study population into those in treatment for TB and a roughly
matched control group.
Alcohol consumption and over-consumption
is frequently implicated as a intermediate factor in affecting nutritional
status, reducing the effectiveness of drug treatment and negatively
impacting treatment outcomes. Our research will also attempt to gauge
the impact of alcohol consumption on health and nutritional status.
SPONSORSHIP AND CLEARANCES
The overall research plan will
be sponsored by the research wing of the HIV Unit at the University
of Namibia, Dr. Scholastika Iipinge, of the Faculty of Medical and Health
Science and Director of the HIV Unit, will help us implement the program
and obtain the necessary clearances. It will also be closely coordinated
with Ministry of Health and Social Services staff at the Tsumkwe clinic,
and the proposal will be presented to the leadership of the Nyae Nyae
Conservancy as the relevant local entity representing the interests
of the San people. As well, the staff of the Nyae Nyae Development Foundation
of Namibia, Windhoek, will be consulted. The field season for which
funding is requested will run from May 1st to August 15,
2009.
PERSONNEL
Principal Investigator:
Richard Borshay Lee is a University
Professor Emeritus, in Anthropology and International Health at the
University of Toronto. Prof. Lee has over forty years experience working
with the Ju/’hoan San in Botswana and Namibia and is a recognized
authority on San ecology, nutrition, and social and economic change.
Project Staff:
Steven Sovran, M.D. Research
Associate, is currently a resident in general medicine at the University
Health Network, and a Masters student in Medical Anthropology. Dr. Sovran
will focus his research on TB/HIV co-infection, drug treatment adherence,
and nutritional sequelae.
Elizabeth McCarville M.A.,
Research Associate, is a Masters student in the Faculty of Social Work
at the University of Toronto. She holds a Masters in International Health
from Edinborough and has wide experience in African health and development
in Tanzania, Malawi, Uganda and Rwanda. Ms. McCarville will be responsible
for administering the food and nutritional survey instrument.
Hannah Rosenberg, Research
Assistant, is an upper level undergraduate majoring in medical anthropology
and International Development at McGill University. She will work with
Elizabeth McCarville carrying out the food and nutritional survey.
Dr. Aimee Webb, Ph.D. Emory
University, is a Post-Doctoral Fellow in medical and nutritional anthropology,
University of Toronto. Dr. Webb will not be in the field but will
assist the research team in designing and adapting standard nutritional
and dietary survey instruments from WHO, FAO and other sources.
BUDGET
While airfares for the personnel
are being sourced elsewhere, funding is requested for local transport
costs accommodations costs and modest perdiem and translator expenses
Van Rental for trips to and
from the Tsumkwe field $1000.00 USD
Per diem expenses 3 persons
X $20.00 p.d. X 60 days 3600.00
Accommodations two rooms at
Government Rest house
$30 p.d. X 60 days 1800.00
Interpretors’ services $15.00
p.d. X 40 working days 600.00
Internet Access, telephone
and faxes 400.00
Total: $7400.00
SIGNIFICANCE OF THE PROJECT
In dealing with former hunter-gatherers
like the Ju/’hoansi, familiar from books, films and TV specials, there
is a tendency to admire them from afar and a reluctance to acknowledge
the dramatically changed circumstances in which they now exist. The
Kalahari Peoples Fund has been a key player in the attempt to bridge
these two realities, with care and respect for traditional culture and
an active engagement with the contemporary problems that negatively
impact their future. The study we are preparing to undertake should
yield valuable insights about food, health, and survival strategies
of 21st century San, and in close consultation with indigenous
rights organizations such as the Nyae Nyae Conservancy, will provide
a basis for designing interventions that could improve Ju/’hoan food
security, diet diversity, and self-sufficiency and overall health.
Signed RBLee
Richardb.lee@utoronto.ca
Feb. 12, 2009
Tax-deductible contributions
to the project may be made securely
via Paypal on this site, or by mail to: Kalahari Peoples Fund, PO Box
7855, Austin, TX 78713-7855. Thank you!
