Elma de Vries (left) with the artists André Rose and Janine Allen-Spies
This is the speech delivered at the opening of the art exhibition Eureka! A journey delving into artisanal diamond mining at Nelson Mandela University’s Bird Street Gallery in Gqeberha on 3 March 2023. Eureka! is an exhibition of art works by André Rose, a public health specialist and photographer, and Janine Allen-Spies, known as “The Brusher”, an artist and image philosopher at the University of the Free State. They interviewed informal miners in the Kimberley region over many years and produced a number of artworks as a result.
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Research shows that these social determinants, the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of their daily life, can be more important than healthcare or lifestyle choices in influencing health.
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Good afternoon
It is wonderful to be here.
I would like to ask: what role can art play to help health professionals to expand our understanding? And can there be a dance between the health sciences and the arts?
This exhibition originated from an interdisciplinary observational ethnographic study. The artists listened to the stories of artisanal miners, or zama zamas, in Kimberley. They heard about and saw abject poverty. They saw how the occupational health of the miners was at risk, with the absence of PPE[1] meaning a higher risk of silicosis and TB, for example. They saw how invisible people can be – undocumented, not seen by the municipal authorities that should be providing water and sanitation. They also heard about imagination and about hope, that lives will change if a precious diamond is found. You will see artworks of the piles of soil that they dug up, covered with old carpets to protect it. Hoping it might yield a diamond.
Book lovers will know that the great Zakes Mda also wrote about illegal miners in The wayfarer’s hymns[2]. He, too, looked at the invisible people driving an enormous, undocumented economy. Mda, too, shows the intersection between waning health and a state which turns a blind eye.
As health professionals, and everyone in the audience, we can be enriched by the angle from which an artist views the miners, seeing them as human beings with imagination and hope. When we see our patients or clients, it is not just a disease; it is a human being who comes from a particular context, who has particular hopes. In public health, we talk about the social determinants of health (SDH)[3]. These are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of their daily life. These forces and systems include structural factors, such as economic policies and systems, social policies and political systems.
SDH includes factors such as income, unemployment and job insecurity, education, working conditions, food insecurity, early childhood development and access to health services.
The World Health Organization’s (WHO)[4] focus on the social determinants of health represented a major shift in thinking, challenging the purely biomedical notions of disease and recognising, instead, the role played by global and national political economies in creating health inequities.
Research shows that these social determinants can be more important than healthcare or lifestyle choices in influencing health. For example, numerous studies suggest that SDH accounts for around 50% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.[5]
Detail from “Cracked dreams” by André Rose
Let us look at one of the miners depicted in the “Cracked dreams” artwork. If he were to become ill, would it be due only to biomedical factors and his own lifestyle choices, or are the SDH factors the major factors – such as the difficulty of finding legal employment, forcing him into illegal mining, where the working conditions are harsh, there is no occupational health protection, there is food insecurity, which affects the early childhood development of his children, and there is no access to water and sanitation? Does SDH, so beautifully depicted in this exhibition, play the biggest role in affecting his health?
As this exhibition is about hope, I would like to read you a poem about hope, by poet Caitlin Seida[6].
The title of the poem is “Hope is not a bird, Emily, it’s a sewer rat”[7].
Hope is not a bird, Emily, it’s a sewer rat
Hope is not the thing with feathers
That comes home to roost
When you need it most.
Hope is an ugly thing
With teeth and claws and
Patchy fur that’s seen some shit.
It’s what thrives in the discards
And survives in the ugliest parts of our world,
Able to find a way to go on
When nothing else can even find a way in.
It’s the gritty, nasty little carrier of such diseases as
Optimism, persistence,
Perseverance and joy,
Transmissible as it drags its tail across your path
and
Bites you in the ass.
Hope is not some delicate, beautiful bird, Emily.
It’s a lowly little sewer rat
That snorts pesticides like they were
Lines of coke and still
Shows up for work the next day
Looking no worse for wear.
I conclude that, yes, there can be a dance between the arts and the health sciences. The arts can help us to see humanity in its many dimensions and deepen our understanding.
Thank you.
See also:
End notes:
[1] Personal protective equipment.
[2] Mda, Zakes. 2021. The wayfarer’s hymns. Penguin: Cape Town.
[3] Scott, V, et al. 2017. Addressing social determinants of health in South Africa: The journey continues. Chapter 8 in South African Health Review. Health Systems Trust. Available at: https://www.hst.org.za/publications/South%20African%20Health%20Reviews/8_Addressing%20social%20determininants%20of%20health%20in%20South%20Africa_the%20journey%20continues.pdf.
[4] World Health Organization Commission on Social Determinants of Health. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: WHO. Available at: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1.
[5] Park, H, Roubal, AM, Jovaag, A, Gennuso, KP, and Catlin, BB. 2015. Relative contributions of a set of health factors to selected health outcomes. Am J Prev Med, Dec 2015, 49(6):961-9. Available at: https://www.ajpmonline.org/article/S0749-3797(15)00405-5/fulltext.
[6] Seida, Caitlin. 2018. My broken voice: Poetry from the edge and back. Athens, Ohio: Verdigris Visions Press.
[7] After a poem by Emily Dickinson called “‘Hope’ is the thing with feathers”.
- Eureka! A journey delving into artisanal diamond mining is open to the public from 6 to 29 March at the Bird Street Gallery in Gqeberha's city centre. The doors open at 10:00 and the gallery closes at 15:00.
- Photography: Izak de Vries