In the belly of South Africa’s alcohol beast
The country has always had a drinking problem, but the pandemic-prompted alcohol bans – and their aftermath – have lifted the veil on just how dysfunctional we are.
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30 October 2020
In the beginning there was booze. The first cargo of slaves brought to the Cape – 174 souls stolen from Angola – arrived on the Dutch East India Company ship Amersvoort on 28 March 1658. Eleven days later, Jan van Riebeeck wrote in his journal of the pressing matter of the education of the newly acquired property.
“To animate their lessons and to make them really hear the Christian prayers, each slave should be given a small glass of brandy and two inches of tobacco, etc. Within a few days these slaves will be brought under a proper sense of discipline and become decent people.”
And so it started. Slavery ended in 1834, colonialism in 1961, and apartheid in 1994. Yet we are not free. More than 360 years after Van Riebeeck and his invaders used alcohol to subdue us, it is still the spoonful of sugar that makes the oppression go down.
The dop system, which paid farmworkers a portion of their wages in drink, was made illegal in 1960 but continued until the epoch-ending 1994 elections. Only in 2003, when a new Liquor Act was passed, was it outlawed. But it was back in the headlines – and in the courts – in 2007 and is probably still practised.
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Yet, until 1962, it was illegal to “supply liquor to natives”. This disparity created and nurtured a vast illegal market for shebeens, where lawlessness was even more rife than in other parts of the black experience. That remains the case, even though what are now called taverns have been veneered with legality.
South Africa has the highest incidence in the world – 12.2% of all babies born – of people who have foetal alcohol syndrome, a spectrum disorder caused by drinking during pregnancy. This is a life sentence of unfair challenges, often including alcohol dependency.
As much as 30% of our population has either succumbed to alcoholism or is in danger of going that way. Only two countries in Africa and five in the world consume more alcohol each year. Our road death rate is double the global average, not least because drinking and driving appears to be a national sport. Contestants, one in five of whom are too intoxicated to drive legally, seem to earn extra points for killing pedestrians.
Losing the key to moderation
Those are the World Health Organization (WHO) figures for South Africans aged 15 and over. Thing is, according to the Human Sciences Research Council, some of us start drinking at 10.
Add to that our unhealthy but justifiable disdain for authority past and present and our predilection for violence – both inevitable consequences of living under the heel of a jackboot for so long – and it isn’t difficult to see why we have a drinking problem that spills over into the rest of our lives. We lock our social, political and economic shackles ourselves by boozing so much that we lose the keys to moderation.
Of course, other nationalities of inebriates are available.
“People who’ve been defeated often are granted the luxury of destroying themselves by the conquerors.” That’s Pete Hamill, the US journalist and writer, on drinking. He took his last sip of the strong stuff, a vodka and lime, amid mobsters and other fellow travellers towards oblivion in a New York bar on New Year’s Eve 1972. Then 38, he died on 5 August 2020, an old man with an old man’s problems. But not drunk.
Many are not afforded a happy ending. F Scott Fitzgerald’s celebrated 1936 Esquire magazine series on the perils of piss artistry – the headline on the first piece was “The Crack-Up” – starts thus: “Of course all of life is a process of breaking down, but the blows that do the dramatic side of the work – the big sudden blows that come, or seem to come, from outside – the ones you remember and blame things on and, in moments of weakness, tell your friends about, don’t show their effect all at once.”
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Hamill and Fitzgerald were of Irish stock, a bloodline known for its high alcohol content. But whereas Hamill grew up poor and uneducated in Brooklyn – he left school at 15 – Fitzgerald was born into a well-to-do Minnesota family, published at 13, and started at Princeton University at not quite 18, only for alcohol to land him in hospital eight times in five years. He died at 44.
This thing doesn’t care how much money you have. Or don’t have. Or where you have been put on life’s inequality scale. Or simply where you are. Given the chance, it will take it all. If you’re poor, you are far closer to the precipice. But, should you stray near enough to the edge, fall you will.
According to the WHO, alcohol contributes to 3 million deaths a year as well as to the disabilities and poor health of millions. It’s responsible for 5.1% of the global burden of disease, and is the leading risk factor for premature mortality and disability among those aged 15 to 49 years, accounting for 10% of all deaths in this age group.
South Africa’s alcohol problem
Alcohol abuse was a crippling issue in South Africa long before Covid-19 ripped up the script of life. But it is exponentially more urgent now that we’ve seen our trauma wards when they aren’t awash with people who are there – along with their drunk and sober victims – because of what went wrong while they were ginned up to the gunwales.
“When the alcohol ban came into effect there was a rapid and massive decline in the amount of blunt and penetrating trauma that we saw, and fewer motor-vehicle related accidents,” said Adalbert Gordon-Ernst, an anaesthetist at Groote Schuur hospital who lectures at the University of Cape Town. “The confounder is that fewer people were on the roads because of lockdown. But there were fewer gunshots, stabbings and assaults. That gave us much needed breathing room because half of the hospital [staff] was reassigned to deal with Covid. So it worked in our favour.
“I neither condone nor condemn the alcohol ban. I drink socially, and I’m all for adults behaving like adults. But it did highlight what a huge problem alcohol is in this country and how deeply entrenched it is.”
Gordon-Ernst needed no reminding of that on 1 June, when the liquor stores reopened: “The ban allowed us to imagine a world where alcohol-related trauma wasn’t happening. When it was lifted, it was worse than ever before. The [booking] board overflowed, and it became a crisis. It was a huge strain on my colleagues on all fronts. I’d never seen our resources stretched to that point.”
The spike in trauma cases “saturated our system, and we were working with fewer staff dealing with regular surgical emergencies because we were reaching peak numbers of Covid patients who had to be looked after”.
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Before the ban, which started at midnight on 27 March, more than 42 000 people would flood hospitals with alcohol-related trauma cases every week, according to the South African Medical Research Council. During prohibition, that crashed to around 29 400 – a decrease of 30%. A second ban, declared without warning on 12 July, lasted until 17 August. Again, less blood flowed.
“I’m not pro-prohibition – we know it didn’t work in the United States – but as a diagnostic intervention it was amazing to see what happens if you take this away,” Gordon-Ernst says. And when it comes back. “I’m glad I’m not a lawyer or a judge. We don’t take the Hippocratic oath anymore, but we don’t judge the patient we are treating. We don’t care whether it’s the victim or the perpetrator. We have a duty to look after that human being. But every doctor, especially if you see wave after wave of trauma, you do get annoyed. You get burnt out. You get angry. And it eats away at your mental health. That is part of the lived experience of being a doctor in South Africa in the state healthcare system.
“I think we were so used to it that suddenly having the veil lifted to see what it could be like was eerie. It was disquieting to arrive on call, and there were only four or five cases booked and not a board that’s overflowing. And then waking into a nightmare made it worse than ever before.
“I’m worried that we’re going to be in a cycle. Is there going to be another alcohol ban? And then will there be a lull? And then will it come back with a vengeance? That’s not a way to fix things.
“None of us, as doctors, were complaining that we were seeing fewer trauma cases. And none of us were gunning for a total ban on alcohol. But when we heard it was being lifted, we all braced ourselves, and it was, ‘Oh, fuck …’. And sure enough – boom! We were in the belly of the beast. And we don’t know the long-term effects.”
Good to know doctors are human. And thanks, Jan van Riebeeck, for everything.
