Dr Tlaleng Mofokeng: “I think it is important to never forget why you started doing the work that you do.”

Mamaili Mamaila

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Sexual And Reproductive Justice, Thrills With Dr. T And More! America has had a pivotal period in politics over the last few weeks. Brett Kavanaugh rose to the highest court in the land as he was confirmed as a US Supreme Court Justice by the US Senate this past weekend. On the other hand, Dr. […]

Sexual And Reproductive Justice, Thrills With Dr. T And More!

America has had a pivotal period in politics over the last few weeks. Brett Kavanaugh rose to the highest court in the land as he was confirmed as a US Supreme Court Justice by the US Senate this past weekend.
On the other hand, Dr. Christine Blasey Ford who accused him of sexual assault dating back to the 1980’s has had to wallow back into a hole of shame following a series of harassments against her family, death threats and many other atrocities that she will most likely have to live with for the rest of her life.

The impact of the conservative, anti-choice Kavanaugh having a say in the Supreme Court – which is now dominantly conservative, will certainly have dire consequences for women and their reproductive health choices all over the world.
Ever since the rise of President Donald Trump as the leader of the free world, alliances between marginalised groups are now more important than they have ever been. In conversation with Dr. Tlaleng Mofokeng who is a renowned general practitioner and activist for Sexual & Reproductive Justice, we unpacked sexual activism, life and politics.

M: Do you think that the global rise of the Right Wing has trickled down to South Africa? Specifically in relation to sexual and reproductive rights.

T: The simple answer is yes. Whatever they do has had an effect on us for many years. And it’s not just limited to health impact or the issues that I deal with. Every now and then whenever there is an economic report, there’s always a reference to the US and Chinese markets and how all of them have an impact on third world countries.

So the issues are not limited to health but, I do think that not enough has been spoken about in terms of impact of foreign aid and advancing of foreign policy in the context of the US. Even before Trump, that’s how white supremacy functions through capitalism. So for us in South Africa, the only thing Trump has done is put a bigger spotlight on the issues because a lot of us who work in the field of sexual and reproductive health rights, experienced similar problems with the second Bush presidency.

Because a lot of Republican presidents are very conservative and harbour very hateful views. Not just abortion or access to contraception but homophobia, xenophobia and all of those things that are not affirming of people’s human rights. If you look at the funding and the structure of healthcare in South Africa, the funding around HIV programmes and anything that’s aimed at young women reproductive health-wise, a lot of those programmes are implemented by the national Department of Health together with US-based funders or granters. In this instance, the reason we have a big problem in South Africa is that of the relationship with our own national government, NGO’s as well as the presidential emergency fund from the United States in response to HIV.

They use their money that comes with these conditions which are unconstitutional and unethical in how they instruct grant recipients that they should not involve themselves in any advocacy, information-giving and clinical services related to abortion care. So if you get any money from the United States for whatever reason, even if it’s not related to abortion care, because they don’t fund abortion services. They fund family planning, HIV services and they’ve got other relationships with other departments beyond health.

The restrictions of that money, because of how Trump has expanded that, means that people like myself who work in this space then don’t have allies because the people who were civil society allies who have then signed on to this cannot work with us even though they do not offer abortion services. They can’t even give information or referrals. So those are the types of problems that we are currently dealing with.

M: In which other ways does this limit your progress in this field?

T: It’s very limiting but it’s also unconstitutional and unethical. The limitations are a result of the Bush presidency because he did exactly the same but his [actions] were confined to those NGO’s who were doing abortions and he didn’t expand it to other healthcare services. Unfortunately, South Africa didn’t recover from the clinics which were shut down, the health workers which were lost who were providing these services or civil society organisations and women-led movements had to shut down because there was absolutely no funding and no one would work with them then. It’s another assault on a system that was already weakened by the previous George Bush presidency.
M: Your work requires you to travel quite extensively. In-between all of this jet-setting, how do you remain the rooted Qwa-Qwa girl that we can all relate to?

T: I think it is because it is who I am. So there isn’t a public person and a private person. I am who I am and I think that possibly, overtime then people find me relatable because they know what I am about and they know what they will get when they talk to me. This is actually a good thing because you find that people who don’t agree with you don’t waste their time because they know that you are solid and that you stand for what you stand for. But I think it is important to never forget why you started doing the work that you do. You know, I speak about sexual pleasure very openly and people always try to filter you. I’m not just talking medicine. I’m talking medicine in a way that anyone can find different parts that they identify with. This whole thing of finding balance between work and private life, for me, doesn’t exist. And I’ve never tried to pursue balance because I don’t believe that you can be balanced but I do believe that you can be fully present where you are.

M: How does your activism make your work as a doctor better?

T: In your first year when you start your medical training, one of the very first things you go through in family medicine is the principles of medicine, the ethics of care and the thing that always stood out for me is one of the principles that, as a doctor you must always be an advocate for your patients. You are the expert scientist with the knowledge in terms of disease process management but there is still a lot more that you can learn from your patients. That has stuck with me throughout my undergraduate training.

The thing that kept coming after that is that I must be an advocate for my patients but to do that properly you need to understand the context that people live in and the context of their illness. You start to see the patient profiles and disease profiles and the question is, “why are black women getting sick and unable to adhere to medication from a doctor’s point of view?” There was definitely more to patients than just the person standing there in front of me. And then, of course, the issue of systems. You can look at the department of health as a system, you can look at documentation as a system, you can look at pharmaceuticals and options that are available as a system, you can look at capitalism as a system, and you can look at patriarchy as a system. How do all of these things impact my patient? And my patients then were majority black women. It became very clear that the issues that they face are around sexual and reproductive healthcare. When things go wrong there, those consequences and complications often change and alter someone’s life and the outcomes were not positive. So those questions and everything else that I was observing led me to the place I am now.

M: What have you been able to identify as the biggest challenge that women face in the public healthcare system?
T: The sexuality of young, black women is already problematised from even official government communication. Things like keep your legs closed, stay in school, say no to blessers – all this rhetoric and slogans without meaning or understanding troubled me then already. Especially with the response to HIV, I mean I was at UKZN at the beginning of HIV in pharmaceutical academia and biomedical research. I was already bothered by how the healthcare system interacts with people in general. It started to become young black women, sex workers, women in the rural areas who can’t just get into a taxi or bus to the nearest big hospital. When I started working in Johannesburg during my internship and community service, a lot of programmes are not coming to you because you fall under urban areas. Yet the people who live in those spaces are people who are migrating from rural areas and looking for jobs and undocumented migrants – where do they go for healthcare? The first thing anyone gets asked if they need any type of service is your identity document and your proof of residence. So how are systems themselves creating barriers to access to services? And how much of those structures themselves, enable violence towards people. When young girls go to the clinic dressed in school uniform, people already accuse them of having sex even though they have not even said anything. As if they don’t have rights to access healthcare and these rights are in the constitution. There is a lot that is exerting itself on individuals.

M: How are you able separate yourself from your activism in order to assist those who need your voice the most?
T: That comes with personal development and work that’s continuous because you can’t commit to these twitter processes and not challenge yourself within those processes because there is power to being a medical doctor and a middle-class black woman who speaks the way that I speak. So it’s being aware of how that power exerts itself, not just in spaces that I occupy but also the people that I am working with. It’s the classic power dynamic between a patient and a doctor which is already skewed in the doctor’s favour. Being an ally is an active thing.

You’re not just an ally because you say you are, it’s something you project. If you believe in the rights of everybody, you can’t just say that you are an ally to black lesbian women. They will tell you if you are an ally because of your actions and your commitment to the cause. And once you are aware like I have been for a long time, human rights principles is what I stand for therefore any violation of human rights is problematic for me. And I use my power and privilege in certain spaces deliberately because I can. If I introduce myself as a sex worker in a lecture, people are going to be more intrigued about why I’m calling myself a sex worker. But if a sex worker had to do that, they would probably walk out in disgust. Human rights are human rights and they shouldn’t depend on your level of education.

That’s how you decentralise yourself. But you can’t decentralise yourself if you are doing the things you are doing to centre yourself and fill in gaps. If you are a saviour you can’t decentralise yourself if you always want to be seen to be doing the right things. If you are doing things for the ego, you will always want to be the centre.

M: We are headed to the polls next year. Are you hopeful about anything that political parties are putting forward, in relation to sexual and reproductive justice?
T: The big thing for me is that the work should happen immediately after an election and in-between the next election. What we tend to do in South Africa is that we get very hurried and we wake up during the election season talking about accountability but where are we in-between? A lot of us do work in-between often with very little support. And then it becomes a question of is it really fair for civil society on its own to bear the grant of a government that is not accountable. Why isn’t the government not doing what it’s supposed to be doing? With everything I know about the global gag rule and global funding systems, there is still so much that I do as Dr. Tlaleng. We have allies in the US who are also working on this but unless we demand from our politicians that they put our issues in their manifestos. If you are a woman, who needs contraceptives and modern choices, who needs safe accessible abortion care, a person who needs transition health whether it’s hormonal or surgical. Intersex children or adults, a sex worker who requires occupational care how are you okay to vote? Are you represented in these manifestos? Are you okay to vote for political parties which don’t represent you and your needs? We need to start looking beyond infrastructure and development.

There have been many promises since 1994 and we are still stuck here. How much of the policies that they’re implementing are apartheid policies who were meant to exclude black people? The issue of funding models, why has that not been looked at in all these years to the point where you have things like fees must fall? So we need a political party that will take our history into consideration and commit to proper policy changes that will talk to the current profile and demographics of South Africa. And if they’re not doing it, we shouldn’t be voting for them. We should be demanding to see ourselves and solutions that mirror our problems as opposed to just superficial policies with no substance.

M: Let’s talk about, “Thrills With Doctor T”. How did that come up and how was the experience?
T: Moja Love approached me with an idea to create a show that’s developed for black women. I was very involved in terms of content to a point where I became the associate producer. I wouldn’t put my name on anything that is not in line with my own principles or affirming of the way I talk about sex. So sexual pleasure is important, sexual health is important and sexual rights are important. So we developed the show with those three issues in a triangle so that whatever we were talking about, we were always looking at those three issues and if whatever the topic is has impact on them. So if we were talking about sex toys, or couples exploring other sexual arrangements like swinging, or how young people can disclose their HIV status to their partners, the usual menopause or health-related stuff like abortion care, why sex worker rights and decriminalisation is important in South Africa. All of these things are things that I am personally involved with. Even the guests were on there because I wanted them on the show because we knew that they understood and were comfortable with talking about these issues. So we would not have someone who is not in tune with the topic on the show. That’s why the show was so well done and why we had such rich conversations. Season two is planned but because it was my first time hosting my own TV show, we wanted to get the first season out and see how people received it so that when we go onto season two, the production team has a sense of what people love and it gives us the opportunity to broaden the discussion because so much happens in terms of trends locally and globally so we did not want to produce too much, too soon and miss out on the developments that are happening in certain spaces. Season two will come but we did not want to rush the process.

That’s why I do the work that I do. In terms of sexuality and reproduction because for black women, when it goes wrong there, your entire life’s course is affected and not always positively.