Search Results for: Atul Gawande

Drought In Post-Apartheid Cape Town: An Interview with Eve Fairbanks

(Morgana Wingard/Getty Images)

Cape Town, South Africa has been suffering a three-year drought. Despite government intervention, citizens have taken matters into their own hands, tapping springs and modifying their homes and behavior. Their innovations prove the necessity of civic involvement and DIY innovation to endure the kind of natural disasters that will increasingly plague civilization due to climate change.

United in a common struggle, the drought has also leveled the racially divided city’s physical and social barriers in profound ways. At HuffPost Highline, Johannesburg-based journalist Eve Fairbanks examines the way Cape Town residents of different classes are using the opportunity to help and learn from each other—with white privileged residents expanding their concept of “community” to include the black South Africans previously known as “them.”

The drought has dissolved what Fairbanks calls the “infrastructure of privilege,” luxuries like pools, gardens and long showers, as well as a sense of security.  Some people in Cape Town view the drought as the inevitable reckoning with apartheid. But is this new camaraderie also a fantasy?


In your piece, you report on the aquifer of meaning below the story’s surface, examining the surprising psychological and social dimensions of the city’s relationship to its resources.  At what point during your reporting did these layers of meaning emerge?

I love your word “aquifer.” Table Mountain, the crag that lords over Cape Town, has unusual aquifers whose depth and abundance of water are still unplumbed. Cape Town was designed for a relatively small white population, and for centuries it relied, unlike other cities, only on surface dams. Some scientists believe that tapping the Cape Flats aquifer — a vein of water that runs from the mountain to the sea ─ would solve the city’s water issues, at least in the medium term. The problem is the aquifer runs straight through several of the largest townships in the city. So to tap the aquifer would mean displacing a population. Experts said that they had to be kicked out of their homes. So these people have very good reasons not to trust experts.

It struck me that no technocratic solution to a problem like drought or climate change, or exists in a vacuum. You can’t sit in an office — as the Cape Town government has tried to do make their drought plan as neutral as possible — and diagram a solution. People have feelings and commitments about things like water that are many, many-layered.

I also really love science. I often find metaphors for social life buried in apparently technical scientific aspects of the stories I cover — the geology of the landscape of a political piece, the weather, the biome, and so on. Scientists still don’t know the contours of the Table Mountain aquifer, or what outcome tapping it would have; it parallels the profound psychological disconnect between the experts and the people they serve.

Are there other reporters or science writers whose work inspires you?

I kind of wish there wasn’t the category of science writing! So much great classical writing didn’t see itself as separate from science, since science is how we interpret the world, and we’re in the world.

One of my favorite Shakespeare passages is Mercutio’s monologue where he mentions the atom to make more vivid a riff on blame and responsibility. My favorite John Donne poems use the compass and map as visual metaphors for vague things like love or the soul. In Donne, tying those things to objects of scientific inquiry is part of the argument that they’re real.

Every writer needs science, even novelists. Once you’re making any kind of description of a landscape, or even reflecting on human motivations in politics or love, you’re entering the territories of geology, botany, physics, and psychology. I think people are sometimes scared of science, though, because it’s become a specialty. Some of the most vivid, moving conversations I’ve had related to my writing were with scientists who told me about uncertainty in physics, about botany, or about the way objects’ behavior changes according to their size.  These relate to deep questions about the scalability of projects, the singularity of truth, and so on, and give me a different way to think about abstractions like relationships or class, to make them real as forces.

Science writing today, in some cases, seems pretty specialized, and the presumption is that the science writer in a magazine is responsible for transmitting the findings of studies to the layman. This can remove the writer from the story. In some science writing, I don’t see a lot of confidence on the part of the author to ask, “Does this accord with my experience? Could this finding be wrong?” My favorite writers who incorporate science are working with science over the longer term, and they tend to be really interested in the essence of science — the history, the scientific method — rather than super excited by what it can prove.

I love Atul Gawande and Oliver Sacks because they incorporate their own journeys and doubts into their science writing. They aren’t making proofs or touting answers to social problems offered by a hot new study. Simon Schama, the historian, actually uses science obliquely but wonderfully in his writings on how landscape formed cultures. I was inspired by Ann Fadiman’s The Spirit Catches You and You Fall Down. She invested years in understanding the science, but at heart it was a story about science’s limits. I also love Ben Adler at City & State. He’s doing what used to just be called geography. He writes things like landscape and infrastructure in a scientific way, but he’s deeply interested in how these things influence politics and vice versa.

It’s interesting how your story suggests that technology won’t necessarily solve all of humanity’s resource problems — that a change in simple civilian behavior is necessary. Doesn’t that contradict the ongoing fantasy of industrial civilization?

I think most of us feel the limits of the industrial fantasy now. But we’ve also built our civilization on it to the extent that we don’t know what we would do without it. The solutions we’ve imagined tend towards a rewinding of the tape back to a purer, more natural innocence. But that isn’t possible. In my own life, change has often come through some unintended break in the plan: a breakup or a firing or whatever, something that throws things into disarray and makes me live a different way. That was what I hoped to suggest with the Highline piece: that accelerating climate change, in some ways, may force its own solutions by making certain ways of life literally untenable.

I do foresee a growing conflict between government and its citizens. Governments, including in Cape Town, are tired of “politics.” They want to get away from criticisms by becoming increasingly technocratic, in the hopes that technocratic solutions will be perceived as neutral. In Cape Town, though, this desire translated into dictatorial, smug, and detached behavior, a deep distrust, and even rejection, of solutions that came from the public.

After I published the piece, the government closed the spring I highlighted in it, cementing the whole thing over, a real “paved paradise and put up a parking lot” move. It amazed me, because the spring was so small, but it was such a symbol of people’s capacities to rise above social divisions and entitlement. It amazed me the government couldn’t see how important that would be to people in the city. But I think the possibility that citizens could create their own solutions to social problems, however much governments play lip service to this ideal, really threatened the Cape Town government insofar as it suggested it might be dispensable.

You grew up in Virginia, a region still imprinted by slavery and segregation. Thinking of Cape Town’s drought, do you see any analogs in America for the way natural disaster can help build community relationships or dismantle racial divisions?

I’ve lived in South Africa for nine years. After a few years, I began to get the impression that whites here are really uncomfortable with their rarefied position in society. They know that it is both unsustainable and unjust. We tend to think of elites as evil, selfish automatons. But they’re also human, with innate moral intuitions.

In South Africa this moral intuition has tussled with a powerful fear of loss. So I was surprised by the explosion of joy in Cape Town when the drought forced elites into a somewhat less privileged position. I also wasn’t surprised. It was like disaster freed people to do what they had longed to do but, in the reigning political language and interpretation of human self-interest, could barely articulate to themselves that they wanted, which was to be more equal, and closer to everyone in their community.

It’s hard to imagine such a scenario in America. We’re such a lucky country, and we’ve managed to insulate ourselves so much from all kinds of bad fortune. In the 1980s, before white rule in South Africa ended, the novelist J.M. Coetzee wrote a book called Waiting for the Barbarians. I think that’s how we feel in America ─ we’re waiting for some kind of extraordinary shift or upending of inequality and subtle segregations; we’re in a state of terrified hypervigiliance. I can’t imagine what exactly will break it. But I do think that more people will be happy with a sea change in the American way of life than currently expect themselves to be.

Do you think the Cape Town’s reclaimed sense of self — and the changed norms drought has brought — will stick?

I talked to a middle-aged Californian recently who grew up during a drought in the state, and he told me he still feels a visceral horror when he sees a tap running and implores his wife and children not to flush every time. I think we should also recognize the more drastic attitudinal shifts probably take work to maintain — public messaging, continual nudges from the more ardent citizens to their family and friends. I worry more about the permanence of the social changes, partly because the government is set against social flux it doesn’t control.

You’re writing a book about post-apartheid South Africa. Can you tell us a little bit about that?

I think there are really strong parallels between South Africa and America — between the conflict some people in the West feel between maintaining their society and letting newcomers in. Post-apartheid South Africa is that tension in miniature. For decades, a physical barrier was erected between white and non-white South Africa and that barrier has fallen. It’s an incredible place to witness some of the tensions and changes that face the whole world, but in a contained environment, it’s almost like an experiment.

My book is about two people — a black former freedom fighter and a white lawyer who fought for the apartheid regime in the most elite army unit — confronting those changes. It doesn’t really make an argument rather but tries to show us, like a play would, what happens when people try to leave their pasts behind while living in a world that offers constant reminders, nostalgic and painful, of those pasts.

The physical environment of South Africa becomes a ghost that can’t be exorcised: the informal segregation that still exists with housing and the neighborhoods people live in; the sense of nonbelonging and alienation in the cities — new in demographics, old in visual symbols and patterns of human association — that haunts both blacks and whites alike. Both blacks and whites here feel that the other group holds the real power in society, which is so reminiscent of America right now. I’m hoping the book will leave a lasting image of a particular country, but also hold a mirror up to America and Europe.

My Daughter Died, But I’m Still Mothering Her

neo8iam via Pexels

Jacqueline Dooley | Longreads | January 2018 | 20 minutes (5,067words)

In July 2016, when we got the results of my 15-year-old daughter’s CT scan, my friend Babs introduced me to a new term: “anticipatory grief.” The scan showed that tumors in Ana’s lungs were noticeably larger than they’d been three months earlier, and masses in her abdomen had multiplied. Having been through this eight years earlier with her then 16-year-old son, Killian, Babs recognized that what we were dealing with wasn’t just a bad scan. It was a turning point in Ana’s disease — the Inflammatory Myofibroblastic Tumor, a rare form of pediatric cancer, she’d been diagnosed with four years earlier. defines anticipatory grief as “the normal mourning that occurs when a patient or family is expecting a death.” As if there was anything normal about preparing to mourn my child’s death.

I didn’t like the term. I wasn’t ready to start grieving.

Babs suggested I reach out to a local hospice organization. I recoiled at the thought. Ana looked and felt good. I was sure her oncologist would find a drug to slow her progression until some miracle of modern medicine revealed a cure. It seemed impossible that Ana would die. I had no frame of reference or spiritual foundation for the enormity of that kind of loss.

Ana’s oncologist switched her to a new medication, but made it clear that this likely would only slow things down. Although it was disappointing, we still had hope. Ana glowed with health, at least outwardly. Maybe this new treatment would work better than the others had. Maybe.

Read more…

Rich Teeth, Poor Teeth: Life Along the Dental Divide

A free, two-day clinic in Salisbury, Maryland drew thousands in desperate need of dental care. (Photo by Linda Davidson / The Washington Post via Getty Images)

She means well, but I dread the dental hygienist. The judgmental tone in her voice is probably just exhaustion; the only dentist I can afford to see has an office that’s a in perpetual spin of budget-seeking patients. I’m one of scores of people who’ll sit her the chair today, and whenever I leave, I hear someone standing at the dreaded reception desk trying to argue their way out of a bill in an embarrassed tone.

Sometimes I’m in that corner too, wheeling and dealing for a way to swing basic treatments with money I don’t have. To my shame, I often go months or even years between routine cleanings, opting to spend money on debt or bills or food instead.
Read more…

Salt, Sugar, Fat, Repeat: A Reading List on Restaurant Chains

The first restaurant chain in the US, the late-19th-century Harvey House, popped up in train stations and followed the rapid growth of rail travel. It disappeared decades ago, but the project of connecting huge swaths of land with the promise of culinary sameness lives on. In a country that currently seems fractured and exhausted by its own divisions (at least from across the Canadian border, where I live), are chains a unifying force, a common denominator — or yet another arena in which cultural and political tensions play out?

Here are some of my favorite reads on America’s restaurant chains, from the generically upscale to the proudly down-home. They cover politics, economics, regional identity, and even (surprise!) food.

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A Brief History of Solitary Confinement

Eastern State Penitentiary, c. 1876. Via Wikimedia Commons.

Jean Casella and James Ridgeway | Introduction to Hell Is a Very Small Place: Voices from Solitary Confinement | The New Press | February 2016 | 20 minutes (5,288 words)


Below is Jean Casella and James Ridgeway‘s introduction to Hell Is a Very Small Place, the collection of first-person accounts of solitary confinement which they edited together with Sarah Shourdas recommended by Longreads contributing editor Dana Snitzky. 

* * *

Imagine you’re locked in the cell, and don’t know if you’ll ever get out.

Imagine a corridor flanked by closed, windowless cells. Each cell may be so small that, inside, you can extend your arms and touch both walls at the same time. The cell contains a bunk, perhaps a solid block of poured concrete, with a thin plastic mattress, a stainless steel toilet, maybe a small table and stool. A few personal possessions—books, paper and pencil, family photos—may be permitted, or they may not. The door to the cell is solid steel.

Imagine you’re locked in the cell, and don’t know if you’ll ever get out. Three times a day, a food tray slides in through a slot in the door; when that happens, you may briefly see a hand, or exchange a few words with a guard. It is your only human contact for the day. A few times a week, you are allowed an hour of solitary exercise in a fenced or walled yard about the same size as your cell. The yard is empty and the walls block your view, but if you look straight up, you can catch a glimpse of sky.

Imagine that a third to a half of the people who live in this place suffer from serious mental illness. Some entered the cells with underlying psychiatric disabilities, while others have been driven mad by the isolation. Some of them scream in desperation all day and night. Others cut themselves, or smear their cells with feces. A number manage to commit suicide in their cells. Read more…

Humane Endeavor

Longreads Pick

An interview with doctor and New Yorker writer Atul Gawande about end-of-life care, his writing career, and his early days on Bill Clinton’s political team.

Published: Nov 20, 2014
Length: 17 minutes (4,478 words)

Longreads Best of 2012: Edith Zimmerman


Edith Zimmerman is founding editor of The Hairpin and a contributing writer to The New York Times Magazine. She’s also written for GQ, Elle, The Awl and This American Life

I’m not a doctor, but … (always a confidence-inspiring way to start a sentence!), these pieces on healthcare were two of the best articles I read this year.

Atul Gawande’s “Two Hundred Years of Surgery,” New England Journal of Medicine

I like everything by Atul Gawande, who is somehow both an accomplished surgeon and a New Yorker staff writer—I don’t know if I’d rather be his mother, wife, or patient, although I would DEFINITELY not want to be his daughter. (“Hey Dad, I just got eight retweets for my joke about yogurt, are you proud?”) Anyway, this piece was a fascinating look at the history of surgery, told with warmth and humor.

Michael Wolff’s “Let My Mother Die,” New York magazine

On the current state of end-of-life care in America, and how it can and should be improved. One of the most affecting, excellent articles I’ve ever read.

Read more guest picks from Longreads Best of 2012

(Photo by Victor G. Jeffrys II)

What can hospitals learn from a national restaurant chain like Cheesecake Factory? 

‘It is unbelievable to me that they would not manage this better,’ Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. ‘I don’t know anything about medicine,’ he said. But when I pressed he thought for a moment, and said, ‘This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.’

This is not at all the normal way of doing things in medicine. (‘You’re scaring me,’ he said, when I told him.) But it’s exactly what the new health-care chains are now hoping to do on a mass scale. They want to create Cheesecake Factories for health care. The question is whether the medical counterparts to Mauricio at the broiler station—the clinicians in the operating rooms, in the medical offices, in the intensive-care units—will go along with the plan. Fixing a nice piece of steak is hardly of the same complexity as diagnosing the cause of an elderly patient’s loss of consciousness. Doctors and patients have not had a positive experience with outsiders second-guessing decisions. How will they feel about managers trying to tell them what the ‘best practices’ are?

“Big Med.” — Atul Gawande, The New Yorker

More from Gawande

“There was a moment in sports when employing a coach was unimaginable—and then came a time when not doing so was unimaginable. We care about results in sports, and if we care half as much about results in schools and in hospitals we may reach the same conclusion.”

“Coaching a Surgeon: What Makes Top Performers Better?” — Atul Gawande, The New Yorker

See more #longreads from The New Yorker