Director’s Statement

Have we forgotten the point of public health?
By Jonathan Smith (See Biography)

Num­bers form the foundation of pub­lic health.  But in a sense, pub­lic health is over­run by the very num­bers that strengthen the field.  We take indi­vid­u­als and we group them, we strat­ify them, divide them, com­pare them.  But we never iden­tify them.  There are actu­ally strin­gent rules in place to ensure that the iden­tities of our research sub­jects are com­pletely erased: we reduce them to a number.

This can be appropriate in some contexts, and the impor­tance of num­bers in pub­lic health can­not be over­stated. Numbers possess the power to create policy and shape rhetoric, all of which are activities that are hopeful attempts to create change for the better.  What happens, though, when this polit­i­cal rhetoric falls on deaf ears? What hap­pens when the num­bers that we so adamantly defend in pub­lic health fall short in pro­duc­ing any true value to the peo­ple who are affected by the dis­eases that we study?

I came to realize the limitations of traditional research when I received an email from the National Union of Mineworkers in regards to a research proposal: “I should also cau­tion you that there has been an out­cry about never end­ing researches that are done within the min­ing sec­tor and the peo­ple end up feel­ing like guinea pigs of some sort with­out see­ing or ben­e­fit­ing from the out­comes thereof.” What is the point of research if there is no real ben­e­fit? For well over a cen­tury, gold min­ers have been sent home with dis­eases and left to die. That is the bot­tom line. Today, lit­tle has changed except the rhetoric and num­bers that high­light the sit­u­a­tion.  I became acutely aware that the end result of any research conducted on this issue is that min­ers con­tinue to die.

Does an individual’s story have a role in pub­lic health? In almost all cases, the pub­lic health com­mu­nity says no.  Maybe because sto­ry­telling is very polit­i­cal, it all depends on who is telling it and how it is told; how the author wants to con­vey his point.  If I told you the story of Godzilla back­wards, it would be about a moon­walk­ing dinosaur that rebuilds Japan.  So in this sense, sto­ry­telling has failed to catch on in aca­d­e­mic dis­course.  Does that mean it fails to have aca­d­e­mic rigor? Of course not. It is sim­ply dis­carded as such because num­bers are much more com­fort­able.  In the con­text of gold min­ing in South Africa, the same story of TB in the min­ing indus­try has been heard for over a cen­tury. In this case, num­bers have failed us; there is no com­fort.  They get us no where.  In turn, sto­ries are all that remain.

Peo­ple, in fact, are not num­bers.  They are, as I last checked, peo­ple.  They have human char­ac­ter­is­tics. Living with the families of miners in South Africa, I learned that poor, black, former gold mine work­ers are no dif­fer­ent from any­one else. But all too often, we look upon them as “them,” as in “Not Us” or “Other.” This is done for reasons I cannot yet under­stand.  They have lives.  They have senses of humor. They have argu­ments with their sons about play­ing music too loud. They have wives who they love, and who they fib to about liking their cooking. To the rest of the world these men dis­ap­pear, but to their fam­ily and com­mu­nity these men are ever present.  Unfor­tu­nately, as the numbers on this subject all too eagerly tell us, the end result is always death.  A point­less, need­less death; TB is cur­able and eas­ily pre­ventable.  HIV is pre­ventable and treat­able.  The solu­tion to damming this river of dis­ease that flows back into these men’s homelands as a result of this situation is not rocket sci­ence: treat the patient with TB until he is cured.

I hope They Go to Die pro­vides a unique and never-before-seen per­spec­tive on this issue from the view of the person most affected by it, the person at the center of it: the former miner. By examining this issue from this perspective, I hope my film offers an in-depth, unbiased understanding of the complex legal, health, and human rights ques­tions sur­round­ing this pre­ventable tragedy.