Fair Trade/African TB

Program 0151 December 18, 2001

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(This text has been professionally transcribed, However, for timely distribution, it has not been edited or proofread against the tape.)

PAUL RICE: Clearly the low price to the farmer, that savings is not being passed on to the consumer. Rather that savings is being soaked up by the industry.

KEITH PORTER: This week on Common Ground, Mexicoís coffee crisis. Plus, South Africaís fight against tuberculosis.

mama lillian : It starts like having a flu. Having a flu you cough continuously. And restless at night. You donít sleep. They can sleep all, but you never. Even if you donít cough, thereís no sleep. Thereís that to it.

KRISTIN MCHUGH: Common Ground is a program on world affairs and the people who shape events. It's produced by the Stanley Foundation. I'm Kristin McHugh.

PORTER: And I'm Keith Porter. You wouldnít necessarily know it based on the price you paid for your morning cup of coffee, but thereís a worldwide coffee crisis. No need to worry if youíre addicted to caffeine-thereís plenty of coffee to go around. The crisis is a matter of economic survival for thousands of coffee farmers worldwide. The prices theyíre being paid for their beans are so low some of them are abandoning their fields.

MCHUGH: There is hope for these struggling farmers. A small but growing fair trade movement bypasses the middle man in an attempt to pay the farmers a fair price. As Common Ground Correspondent Tatiana Schreiber reports, even with fair trade, improving the quality of life for small-scale coffee producers will be a long-term struggle.

[sound of birds singing, someone walking through a field, and people speaking]

TATIANA SCHREIBER: In the mountain community of Majobal in the highlands of Chiapas, Mexico, Juan Perez-Hernandez stands among flowering coffee trees looking across a ravine to a jutting promontory called "Mut Vitz," or "Mountain of Birds." Thatís also the name of a new coffee cooperative here, made up mostly of Tzotzil speaking Mayan Indians. The co-op grew rapidly after its founding four years ago, but this year Perez-Hernandez says things have changed.

JUAN PEREZ-HERNANDEZ: [via a translator] Many have left, like 45 people just in one community. And here in Majobal, two or three have left as well. And they have a coffee field, but they canít maintain their family anymore from the coffee. Thatís why they have left.

SCHREIBER: Farmers were being paid six pesos or less per kilo of coffee beans at the end of this seasonís harvest. Thatís about 20 cents a pound. And there was little farmers could do about it. After caring for the trees for several years until ready to harvest, harvesting their fields three times during the season, carrying the heavy sacks of beans up and down mountainsides on their backs, and cleaning and drying the beans, the farmers haul them to the nearest buyer. Another Mut Vitz farmer describes what happens next.

MEXICAN COFFEE FARMER: [via a translator] The buyer begins to check, and see howís your coffee. He begins to shake like this-[sound of hands rubbing together]. He say, "Ah, your coffeeís not good. Itís a little bit damaged. Itís not good. Iíll give you three or four pesos a kilo." He say, "Do you want it or not?" Well, of course we could go somewhere else. But if we go to another buyer, it the same. The same.

SCHREIBER: These local buyers are derisively called coyotes because theyíre known to do what they need to, to pay the lowest price, including fixing their scales in order to under weigh the beans. Itís to avoid the coyotes and deal directly with coffee buyers in the US and Europe that farmers are organizing into co-ops and seeking relationships with so-called "fair trade" buyers.

PAUL RICE: Fair trade is both a market and a movement.

SCHREIBER: Paul Rice is Executive Director of TransFair USA, the organization that certifies fair trade products in the US TransFair links small farmer cooperatives with US buyers who promise to abide by fair trade principles.

RICE: So by selling directly, what these co-ops are able to do is jump over several different middlemen in the chain and capture the profit margins that historically have been captured by the middlemen. So fair trade is a way for farmers to not only improve their income but also to develop viable businesses that allow them to become more empowered and more independent in the local and international market.

SCHREIBER: Rice says the current crisis is due to speculation on the international coffee commodity market, a big supply of low-quality coffee from new growers in Asia, and runaway profits on the part of industry.

RICE: We see this when we look at the sales reports and the profit reports that are coming out of industry giants-Folgerís, Sara Lee, Starbucks, other major players in the industry are all reporting tremendous growth in sales and in profits. And so clearly the low price to the farmer, that savings is not being passed on to the consumer. Rather that savings is being soaked up by the industry.

SCHREIBER: But some segments to the industry have chosen a different model. The first fair trade company in the US, called Equal Exchange, was founded 15 years ago, and like all that followed pledged to pay farmers a guaranteed minimum price, which today is set at $1.26 per pound. If the world commodity price goes higher than that, fair traders pay five cents a pound more than the market rate. The buyers also agree to establish long-term trading relationships with co-ops, provide them with advance credit, and help them establish environmentally sound farming practices. Equal Exchange hasnít suffered from these policies. Itís become a multimillion dollar a year business. But how are the farmer co-ops doing?

[sound of people talking in the background]

SCHREIBER: Itís clear that profits from fair trade sales have helped some co-ops buy warehouses and roasting facilities, and even invest in their own communities by buying corn grinding machines or vehicles. But in Chiapas, Mexico, at Mut Vitz headquarters, a tumble-down concrete building with no more facilities than some tables and chairs, farmers are painting a less than rosy picture of how things are going. A delegation from the US is visiting the co-op, and Juan Perez-Hernandez explains through a translator what happens to the money farmers get through fair trade.

PEREZ-HERNANDEZ: [via a translator] What we do is we pay them money because we have to pay them a fee for transportation. Transportation to the beneficio in Veracruz. So itís like theyíre receiving less than that.

SCHREIBER: Mut Vitz hasnít yet had the money to build their own warehouse. And by the time they paid for transportation and processing to get their coffee ready for export, of the $1.26 per pound fair trade price, co-op members are taking home less than 50 cents. Itís still much better than what theyíd get from the coyotes, but from that 50 cents a pound, farmers also have to pay for any labor theyíve hired. Last year each co-op member took home a total of about $600 for the coffee.

[a woman speaks in Spanish]

SCHREIBER: One of visitors wants to know how much a family would need in order to pay for food, medicine, and other necessities.

[people speaking and laughing]

SCHREIBER: When they stop laughing the farmers say they donít know what theyíd need. As it is, most of them live in one-room, dirt-floor houses. And since theyíve put most of their small holdings in coffee, theyíre running out of beans and are living on tortillas alone. They donít have the money to keep their children in school, and few continue beyond primary school. One of the problems is that although the co-op believes it could produce 50 containers of fair trade coffee, it only sold four this year, itís best year yet. The rest went to the coyotes because fair trade buyers are in short supply. In the US, for example, fair trade sales still make up less than one percent of the total market.

[Sound of someone hacking plants with a machete]

SCHREIBER: Still, most farmers are determined to keep pressing on. Using only machetes because they have no other tools, they clear the weeds around their trees, build terraces on the steep hillsides, make huge piles of compost which they apply to each tree, keep the trees carefully pruned, and regulate the amount of shade.

MEXICAN COFFEE FARMER: [via a translator] Well, we have made a change in our organization. They say to improve the plant you should use chemical fertilizers. But as we know, we have realized thatís not good, using agro-chemical fertilizer. It attacks the soil and it also attacks the body. Itís like a poison. It makes us sick and makes the soil sick. After awhile the land doesnít produce anymore. And also itís killing our bodies. So, here we have made a change to use organic fertilizer. Itís better for everyone, not just us-for everyone-to help other people.

SCHREIBER: All 750 Mut Vitz farmers are pledged to use only organic methods. And this year they hope to gain their organic certification. That will help some because the fair trade minimum for certified organic coffee is 15 cents a pound more than for conventional. Coffee farming is back-breaking work and organic methods require even more effort. The price considered fair for that work was set by the European fair trade system in 1988 and has been raised only once. It rises and falls with the market price. And at least one fair trade buyer in the US thinks thatís a problem.

[sound of food processing equipment]

SCHREIBER: Dean Cycon runs Deanís Beans, a small fair trade roasting company in western Massachusetts.

DEAN CYCON: Now, Iíve always had the question. Itís a very legitimate question. Well, how come a $1.46 is fair one day and $2.00 is fair the next day? Doesnít that mean that the $1.46 wasnít fair the day before? And thatís why I think that fair trade is only one mechanism among a handful of things we have to do to change the cycle of poverty in coffee.

SCHREIBER: Cycon and his company are involved in a range of development projects in coffee communities. And heís also thinking of ways buyers could share some of the risk of the up and down coffee market with the farmers.

SYCON: So weíre thinking of using futures, which is a commercial mechanism, buying futures in coffee, to hedge risk. And usually thatís done by the brokers to hedge their risk. But weíre looking at jointly buying futures with the farmers so that if the price of coffee plummets after the agreement is made the buyer would cash in his future, because he could have gotten the coffee cheaper. And if the price of coffee rises the farmer can cash in his future because, gee, if he didnít make his agreement yesterday, but made it today he would have gotten more money. So we can take the volatility and the risk out by sharing it together.

SCHREIBER: Another thing buyers could do is simply buy more fair trade coffee. Paul Rice at TransFair is working hard on that goal and says so far 105 coffee companies have signed on.

RICE: These companies are starting small, dipping their toe in the water, making sure the customers want it, measuring sales, and as sales grow they are starting to roll out additional coffees. For example, Green Mountain Coffee Roasters launched fair trade last year by converting their six organic coffees to fair trade. And sales growth was so dramatic that at the end of the year they decided to more than double their fair trade volume for this year.

SCHREIBER: Green Mountain doubled its fair trade volume from 3 percent of sales to 6 percent, still a very small proportion. But the company plans to keep buying fair trade coffee and thus assure its customers that their money is going to democratically run small farmer co-ops. Thatís what the fair trade label says. But some alternative trade watchers think the fair trade claim can be misleading.

ALMA GONZALEZ-CABANAS: [via a translator] In some regions many farmers who are in fair trade use immigrant labor-Guatemalans-that arenít paid nothing, in miserable conditions. But they are trading in fair trade. So, where is the justice?

SCHREIBER: Anna Gonzales-Cabanas studies alternative trade at the College of the Southern Border in Chiapas. She says that the strict rules governing who can participate in fair trade are enforced through yearly inspections by monitors from the international fair trade system. She thinks they are too far removed to accurately assess local conditions. Gonzales-Cabanas also thinks that fair trade is creating divisions in coffee growing communities, between those groups that can make it into this market and those that cannot, simply because some have more access to the needed fax machines, computers, and foreign connections.

[a rooster crows]

SCHREIBER: Itís clear that lack of infrastructure has been a challenge to Mut Vitz in the politically charged state of Chiapas.

PEREZ-HERNANDEZ: [speaks in the background]

SCHREIBER: Perez-Hernandez tells the visiting delegates that Mut Vitz canít get a phone in their office because the telephone company said the community was too small. Now it says it canít be done because the community is in the conflict zone.

PEREZ-HERNANDEZ: [speaks in the background]

SCHREIBER: The delegates promise to go home and share what theyíve learned.

[a woman pats tortillas by hand]

SCHREIBER: While his wife makes tortillas one morning, one Mut Vitz member, a young father of three, says heís not planning on giving up.

MEXICAN COFFEE FARMER: [via a translator] For us to abandon our coffee-no, I donít think we could abandon it. No. Itís better for us to continue struggling to put in more effort, and to keep going. Because I donít think itís right to abandon your work. Thatís what I think.

SCHREIBER: They know itís not an easy road. But many farmers want to keep trying and are counting on the fragile promise of fair trade. In Chiapas, Mexico, Iím Tatiana Schreiber, for Common Ground.

MCHUGH: South Africaís tuberculosis battle, next on Common Ground.

PORTER: Printed transcripts and audio cassettes of this program are available. Listen at the end of the broadcast for details, or visit our Web site at Common Ground is a service of the Stanley Foundation, a nonprofit, nonpartisan organization that conducts a wide range of programs designed to provoke thought and encourage dialogue on world affairs.

MCHUGH: Tuberculosis kills two million people around the world each year. The disease is curable, but the number of sufferers is still expected to grow by a billion over the next two decades.

PORTER: All but wiped out in Europe and America, this silent epidemic continues to ravage the developing world, and itís getting worse. There are now large numbers of people suffering from mutated strains of TB, that resist even the best drugs. As Common Ground Correspondent Eric Whitney reports from South Africa, health officials are struggling to stop these new super bugs before theyíre out of control.

ERIC WHITNEY: Patients crowd the halls of this public health clinic on busy Sammy Marks Square in downtown Pretoria, South Africa. Generally a pretty healthy looking bunch, they wait patiently for attention from one of the four nurses in their authoritative blue jackets-or maybe the lone doctor to review a chest x-ray. Miriam Uste is the nurse in charge.

MIRIAM USTE: Daily we see about 105 people here. On a Monday, Wednesday, and Friday, thereís sometimes more, sometimes less. Of course Mondays, Wednesdays, and Fridays we have TB clinic.

WHITNEY: Scenes like this are the stuff of medical history books in the US and Europe. Only a handful of clinics on either continent would see this many TB patients in a day, and most clinics have none at all. After all, TB has been curable since the 1950s. But you wouldnít know that in South Africa, where Sister Uste doesnít predict that sheíll be going out of business anytime soon.

USTE: Yeah, definitely TB is increasing. I can just explain to you: we admitted, last year 200 patients for the whole year, and this year we are at 390 patients. SoÖ

WHITNEY: For this clinic?

USTE: For this clinic. So yeah, itsÖ.

WHITNEY: The World Health Organization says that a country needs to have a cure rate of at least 85 percent to begin solving a tuberculosis epidemic. So far the Sammy Marks clinic is keeping up as well as any place in South Africa, curing three-quarters of the patients who come through its doors. Nationwide, only six in ten who get TB survive.

DR. REFILOE MATJI: When one compares where we started four years back, really thereís been a major improvement. Because then, 1996, our cure rate was just about 50 percent.

WHITNEY: Dr. Refiloe Matji, is the TB Control Director for South Africaís seven-year-old democratically elected government. From the apartheid era it inherited a poverty-stricken populace and a patchwork of sometimes contradictory approaches to healthcare. Tuberculosis was an epidemic that existed underneath the official radar in South Africa for many years.

MATJI: Itís not that itís a new problem. Itís just that there were no monitoring systems and people were not able, did not know how big the problem is. People are now aware that there is a problem of TB.

WHITNEY: The problem turns out to be about 250,000 strong and growing. The government spends one hundred million US dollars a year fighting TB, but health officials expect the number of new infections to continue growing for at least another decade. In theory, solving the problem seems simple: the disease is fully curable with a regimen of antibiotics that only costs about $25 from start to finish. But Dr. Marcos Espinal, a health officer with the World Health Organization, says it isnít as easy as it sounds.

DR. MARCOS ESPINAL: Thereís a misconception that TB only needs drugs. TB also needs the full strategy, needs the infrastructure of the primary healthcare sector to deliver that strategy.

WHITNEY: The reason it needs a strategy is because if the drugs are misused the bacteria that theyíre supposed to be fighting can mutate into antibiotic-resistant strains, known as multi-drug resistant, or MDR-TB. MDR-TB is a more efficient killer, and says Espinal, incredibly expensive to fight.

ESPINAL: In the US, just the treatment regimen for MDR costs up to $15,000. And when you include hospitalizations, counseling, etc., etc., it goes to $180,000 per patient.

WHITNEY: South Africa may be a long way from having its TB epidemic under control. But by at least adopting the WHO-endorsed treatment strategy, the number of MDR-TB infections should go down. Dr. Espinal says other developing countries are making it work, among them Cuba, Vietnam, and Tanzania.

ESPINAL: What I think they have in common, political will. The government decided to face the issue. The government put in place their resources, their human resources-financial as much as they can-to fight this disease. And it can be done.

WHITNEY: South Africa TB Control Director Dr. Matji says their country has the will to fight TB. Itís pledged to find and treat each and every citizen who gets the disease. But thatís only one of the challenges here.

MATJI: Iíd like to mention in Africa our problems are not only TB. Malaria is also demanding. Weíve just gone through a cholera epidemic where a lot of work again had to be put in. So itís not only finances, but really itís that holistic approach.

[sound of a car starting]

WHITNEY: The political will to fight tuberculosis in South Africa is personified in its nurses, or sisters as theyíre called here. Theyíre the ones who animate the global strategy to fight TB in local communities. The strategy is called DOTS, an acronym for Directly Observed Treatment Short course.

SISTER TINY KAPOLA: [talking while driving in a car] I am Sister Tiny Kapola and then I do Direct Observed Treatment Short courses on clients. Some of them, they are squatter camp clients who are not employed, who donít have places to stay. And then I have to follow them up, right to the squatter camps. For example, at Marabasdad.

WHITNEY: Marabasdad is where Sister Kapola spends most of her mornings, on the dirty streets crowded with walkers, among the hundreds of low shacks thrown together out of whatever their residents could scavenge. Her job is to track down patients who are on DOTS and help them stick to the drug regimen.

[Many people talking with Sister Kapola]

WHITNEY: Everyone at Maravasdad seems to know Sister Kapola. Walking its narrow passageways, she points out many who sheís helped to cure, like these older women that she finds sitting outside a makeshift tavern this morning, passing blue plastic pitchers of local beer.

[people talking in the makeshift tavern]

WHITNEY: TB patients in Marabasdad are more likely to be what public health practitioners call "defaulters," which means theyíre prone to stop taking their treatment before the six months necessary to fully eradicate it from their bodies. If the drugs arenít taken religiously, TB can come roaring back and create more dangerous mutant strains. So Sister Kapola is careful to track each one down. She tries to be understanding and nonjudgmental.

KAPOLA: Yeah, those were my defaulters, but we managed to trace them and got them and then I gave them treatment regularly until they were discharged.

WHITNEY: So they were former patients, and now theyíre cured?

KAPOLA: Yeah, they are cured. But then you see, they go back to drinking and all that because they donít have anything to keep themselves busy. And thereís nothing that you can do. You try to advise, but then look at their conditions under which they live. So, itís very, very, very difficult.

WHITNEY: Sister Kapolaís efforts donít go unappreciated. Nor could she be effective without help from the community that she serves. Sixty-year-old Mama Lillian is a longtime community activist and one of Sister Kapolaís best connections. She helps her find those who are in need of treatment and knows TB signs and symptoms well.

MAMA LILLIAN: It starts like having a flu. Having a flu you cough continuously. And restless at night. You donít sleep. They can sleep all, but you never. Even if you donít cough, thereís no sleep. Thereís that to it. Those joints are always tired, you know. You canít, a mouthful of water, you canít pick it up. Thereís nothing that is nice when you want to eat. Even the very tea you used to drink you canít drink it anymore. The taste is no more.

WHITNEY: Only about 10 percent of people who carry TB bacteria ever become ill with the disease. But those who do get sick tend to come from places like Marabasdad. People without steady access to healthy food, or enough food, and people who are forced to sleep many to a room, where exposure to someone whoís infected is constant and inescapable. But that doesnít mean TB canít be defeated here. Mama Lillian is living proof.

MAMA LILLIAN: TB can be cured. I am one of them. I had TB also. Iím a TB case, but Iím cured now. But now Iím cured. I donít even scared to tell the people that TB can be cured, because I saw it with myself. The wind could blow me left and right, the way I was first. But I attend the clinic for six months. And here I am: fit, no wind can blow me again [laughs].

WHITNEY: There would likely be more success stories like Mama Lillianís if the government could afford more nurses like Sister Kapola, to seek out and monitor everyone who has TB in this large, sprawling country. Many people here still live lives of subsistence in remote areas. It frustrates public health officials, like the WHOís Rajish Gupta, that the problem simply isnít being solved when a proven strategy exists to beat it.

RAJISH GUPTA: In fact, it was rated by the World Bank as one of the most cost-effective health interventions out of all health interventions. Weíve come up with the strategy. Now thereís certain things that are just historical processes of the way the world works, the distribution of resources. And itís time for the donor countries and for industrialized countries to really step up to the plate and do their job.

[sound of a TB patient coughing]

WHITNEY: The consequences of not bringing TB under control in South Africa are played out here, at the Jose Pearson Tuberculosis Hospital in the impoverished Eastern Cape Province. Itís recently been expanded to add a ward exclusively for patients who suffer from multi-drug resistant TB. The hospital houses about 350 patients at a time. Among them on any given day are about 20 children.

[sound of children talking in the TB hospital]

WHITNEY: Itís not known exactly how many South Africans suffer from multi-drug resistant tuberculosis. But itís estimated that their numbers grow by about 2,500 a year. Because the drugs to fight MDR-TB are so expensive, the government and its partners are trying to set up a pilot program that will allow them to access the medications at a deep discount. But the WHOís Gupta says that the multinational committee that controls access to the cheap drugs is reluctant to hand them over to countries like South Africa-countries without a strong track record of fighting ordinary TB.

GUPTA: The drugs to treat MDR-TB, itís kind of like the last line of defense against TB. In the last 20 years thereís only been 13 out of 1,300 new molecular entities for infectious disease use. Thatís not good. So we have to do good with what we have for right now. And with second-line drugs, those are a last line of defense. So we have to protect their use.

WHITNEY: But Gupta says the WHO is not abandoning those countries that donít qualify for the new lower drug prices. He says it offers assistance in building the capacity to beat ordinary TB, using the Directly Observed Treatment Strategy, or DOTS, which is the foundation of fighting MDR-TB.

GUPTA: It can really only be conducted in areas with a good DOTS program, because itís a simple principle. If you canít manage patients for six months, for drug-susceptible TB, then how are you gonna manage this drug-resistant TB which requires 18 months of treatment, and a lot more complexities?

[sound of people and vehicles in a busy area]

WHITNEY: Back in the squatter camp of Marabasdad, these debates over global health policy seem very far away. Sister Kapola and the other nurses who care for the TB patients here are simply doing the best they can with what resources they have. Should South Africaís government decide to start distributing the new AIDS drugs to its citizens, theyíre optimistic that they could administer them well. Theyíve already won the peopleís trust. For Common Ground, Iím Eric Whitney in Pretoria, South Africa.

PORTER: Cassettes and transcripts of this program are available. The transcripts are free; cassettes cost $5.00. To place an order or to share your thoughts about the program, write to us at: The Stanley Foundation, 209 Iowa Avenue, Muscatine, Iowa 52761. Please refer to Program Number 0151. That's Program Number 0151. To order by credit card you can call us at 563-264-1500. That's 563-264-1500.

MCHUGH: Transcripts are also available on our Web site: Commongroundradio is all one word. Our e-mail address is For Common Ground, Iím Kristin McHugh.

PORTER: And I'm Keith Porter. Cliff Brockman is our Associate Producer. B.J. Liederman created our theme music. Common Ground is produced and funded by the Stanley Foundation.

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