I’ve been living in South Africa for two and a half months now. For about thirteen years before that I worked as an arts manager in NHS hospitals, and more generally in the field of arts and health in the UK – from which I’m taking a brief break.
This blog is founded on the premise that (in the UK) we are largely ignorant of the breadth and depth of innovative practice in what we might call ‘arts and health’ in South Africa. If (as is extremely likely) you know more about this than I do, please feel free to comment and add any news and information.
Last August I attended a conference in Potchefstroom – a small town with an ambitious university (NWU), and met a Malawian academic who told me that as a music student 15 years before he had been sent into psychiatric units as part of his BA. Malawi is not South Africa, but to my shame, this was something of a wake-up call. I would be hard-pressed to name a UK music course with such strong health links dating back to the 1990s. And the context for this conversation was a conference on Music & Wellbeing held by a newly established niche-research group at NWU (North-West University). NWU also has Musikhane,a long-established programme of community music education allied to social development. One part of Musikhane, I was told, involves university students learning musical traditions from the elder members of local rural communities, then teaching these back to their grandchildren, along with an offering of ‘Western’ techniques – and precious access to expensive instruments. The teaching aims to cross one of the many chasms created by the complex, deep-running consequences of apartheid and capitalism, which together pushed employment into mines and urban centres and stripped rural communities of a generation of work and identity. The strange circularity of elder-to-student-to-child makes for a complex, mediated kind of traditionalism – and in a country where the idea of traditional racial identity remains hugely, actively problematic it is not without problems, but it represents nonetheless a real immersion in the local community, and a challenge to students’ sense of social responsibility.
But the notion of social responsibility in the arts is – I would contest – more embedded here than in the UK. The arts played a large and public role in the Struggle – music in particular is associated strongly by non-South Africans with South African politics, but so here is the visual art of luminaries like William Kentridge and David Goldblatt. The importance of art as documentation and protest (see for example the 2010’s The Bang Bang Club) is constantly reiterated; and the country’s most iconic artists are overtly political. South Africa lacks the embarrassment we have had to contend with for years in the UK around engaged practice. This is at last changing in the UK, thanks in part to artists like Grayson Perry who engage with the politics both of their practice and of the society around them. Grayson was once acerbically critical of hospital-based art, but now his work graces the UCH Macmillan Cancer Centre and Harefield Hospital; for me he represents a shift in thinking in the world of ‘high’ art, about how heath, art and society might interact.
But there remains a vestige of the notion of art as a pure form, as something necessarily disengaged, self-referential, high-brow, exclusive. Something bouncing off four white walls back at itself, and accruing wealth as an investment – for me an idea epitomised in events like Frieze, where non-buying visitors have their own day-at-the-fair, charged to feel awed by displays of wealth and untouchability. And of course the high-end gallery system is as exclusive and monied here as anywhere, yet even an organisation as successful as David Krut Projects, which represents some of the priciest artists around, sets its centre in Maboneng, an ambitious, fashionable and partially successful reimagining and reclamation of inner city space to create a healthier Johannesburg.
The Maboneng phenomenon is itself problematic – to a certain extent it serves to emphasise its own barriers, to make people more wary of the areas around it which, like the meniscus around a bright light, seem darker and less ‘known’ by comparison. Artist Vaughn Sadie used his brilliant Streetlights project to challenge the way its architecture creates a hipster bubble inside a poor area, disrupting (for example) the routes taken by the large number of people engaged in ‘informal recycling’ (pushing huge cubes of the city’s rubbish to recycling centres for a small fee). But it remains a brave choice to put an expensive art studio in the centre of (this) town, to pull people in from the wealthy suburbs, students from the local universities, artists from all over the world – to present a real challenge the city’s compartmentalisation, to start the conversation that Sadie continues.
So – even if it is in reaction to its limitations – perhaps this engagement on the part of the big-hitters contributes to the fact that community-based arts practice is thriving in South Africa. The Outreach Foundation, for example, works in Hillbrow – one of Johannesburg’s most challenging areas, “with high incidence of HIV/Aids, women abuse, refugee influx, urbanisation and degradation of urban environments, drug dealing, prostitution and crime” – to give “children, youth and adults the opportunity to engage with arts, culture and heritage activities that facilitates communication, participation and community building”. It is notable that almost all the charities offering support to young people living in the most challenging circumstances imaginable – orphaned, homeless, sick – offer the arts. No-one seems to ask what the point of creativity might be in these extreme situations – it is taken for granted that they have a central role to play.
In the UK we have described an ‘arts and health’ sector as a means of supporting work across a range of disciplines which broadly address issues relating to health. As the Outreach Foundation’s statement of intent demonstrates, the junction between health and society is more obvious in a country which struggles with such extremes of access to wealth, power and education. This work might not be called ‘arts in health’ here – but it is happening, and at an astonishing level. South Africa, moreover, is moving in a different direction to the UK. It is in the process of establishing its first National Health System – based on National Health Insurance – while the NHS slides ever-closer to fragmentation and privatisation.
Here you can see the impact of a two-tier system. Two-tier in fact becomes a misnomer; for many there is no tier. Access to (conventional) healthcare is sporadic, limited, sometimes non-existent – dependent on rural clinics miles from homes or overcrowded public hospitals. There is the norm, which is poverty, and there is Medicare and Medicaid, which I am told means slick service, as well as access to complex health interventions like transplants (only kidney transplants can be carried out in the public health system). The new NHS here will seek to address this gross imbalance. There will undoubtedly be problems with its institution, but the direction, for now, is clearly towards better access for all, while UK health (and, for that matter, arts) systems are undoubtedly moving towards limited access for the poor and (notional) excellence for rich. Local hospitals are under threat, small arts centres close, but major established institutions survive, to be pushed as business-generating centres of excellence.
Underpinning this approach is the idea that a concentration of wealth at the ‘top’, into clearly segmented, saleable disciplines will drive innovation – new drugs, new procedures, new technology. It could be argued that this kind of innovation has led us straight to a health industry profiting now from the healthy paranoid.
Real innovation, certainly of the kind needed to address how we live with chronic disease and our own fear of ageing in a culture which prizes youth and ‘growth’ above everything, is demonstrably inaccessible to these intellectual silos. It will come rather from collaborations, cross-disciplinary work, from imagination and lateral thinking, from working together to make things new.
South Africa, for all its current political frustrations, still buzzes with this sense of making things new. Yesterday I learnt of two brilliant projects: The Kieskamma Trust, a community organisation based in the rural Eastern Cape, which “strive[s] to address the challenges of widespread poverty and disease through holistic and creative programmes and partnerships”; and the Memory Box Project, based out of the University of Cape Town, which has expanded from the original memory boxes (you can hear all about them here) into other avenues, including a projects using body mapping and personal narratives to address body-perception and isolation in people living with HIV or AIDS.
I am very new here; these are only the very first things I have heard about – the definition of scratching the surface. But arts/health practice is everywhere here, and it engages with everything that is most challenging, and most awe-inspiring about this country. It could teach us much about the growing health inequalities we face in the UK, and how the arts might address them. I hope to add more projects as the year continues, and to open our eyes a little to the wealth of knowledge and experience in this country.