The lush valleys surrounding this historic seaport city are home to vineyards that make wines famed for their undertones of green pepper, passion fruit, and freshly cut grass. They are also home to thousands of children whose mothers drank while pregnant, sentencing them to brain damage.
South Africa's cape region has the highest recorded levels of fetal alcohol syndrome (FAS) in the world.
Over the centuries, wine farmers paid black and colored workers in wine, creating a culture of binge-drinking and alcoholism. And while some healthcare professionals estimate that up to 70 percent of South Africa's hospital cases may be attributed to alcohol – from domestic abuse and traffic accidents to rape and murder – it is children born to alcoholic parents who suffer the most.
But while the country's healthcare system is busy combating AIDS, private groups, including wine companies, are making a difference in the fight against the scourge.
"I always hear 'We've got limited resources;' ach, it's a mind-set," says Leana Olivier, director of the Foundation for Alcohol Related Research in Cape Town, and a former official at South Africa's Department of Health. "The biggest resource is the human being herself. Women have the right to get information and to know that they can make choices and have strength within themselves."
The struggle over alcohol in South Africa goes back to the early 1600s, when the first Dutch colonial governor planted the first grape vine in Cape Town to provide wine for ocean-going ships rounding the Cape of Good Hope.
How drinking became a scourge
For centuries, the only choice most South African farm workers in the Cape region thought they had was: red or white. Until the practice was banned in 1980, farmers paid part of their farmworkers' wages with bottles of wine. This so-called "dop system" continued illegally as recently as 1991, when a health care survey found that 20 percent of Cape vineyards still paid their workers with wine.
The dop system may be illegal, but many farmworkers and rural South Africans continue to binge drink after pay day, either driving into town to spend their monthly wages on locally available cheap wine, sold in "paap saks" or soft aluminum foil pouches, or simply waiting for mobile "shabeens," or bars, to drive onto the farm and sell booze by the liter.
The habit of binge drinking is now ingrained in South African culture at all social levels, researchers say. In the Northern Cape town of De Aar, the rate of FAS babies is 122 per 1,000 live births, according to recent research by the Medical Research Council in Cape Town. By contrast, FAS levels in the US are between 0.1 per 1,000 and 0.67 per 1,000.
"There's a tolerance of drinking in South Africa, not only among the uneducated; it's right through our culture," says Ms. Olivier. Unfortunately, she says, there is little recognition that alcohol can be damaging to a woman's fetus.
"The aim is to change behavior, provide logical information for the mothers. If we can catch them when they become pregnant, at least we can still do something. After they become pregnant, the damage is done."
The solution seems clear-cut: Provide counseling about the dangers of drinking for women of child-bearing age through medical clinics; run public information campaigns on billboards and Television; and put warning labels on bottles of spirits.
But Sandra Marais, a senior researcher for the Medical Research Council, and professor at the University of South Africa in Cape Town, says that South Africa is far behind in recognizing the problem of fetal alcohol syndrome and doing something about it.
"If you have several brief interventions with a birth mother, usually at a health clinic, to give women information on how drinking can affect a baby's health, that is where you have to start, where you can make a difference," says Dr. Marais.
But when Marais and her colleagues asked health clinic workers if they would try out a simple questionnaire with birth mothers, "they were willing, but they felt they didn't have the time," she says. "When you have a waiting room full of people, and you have a questionnaire in front of you, even the most experienced clinic workers will rush through it. It all depends on how it is done."
Wine companies look for solutions
But while the government hospitals and clinics may be feeling overstretched – understandably so, in a country that has the largest number of AIDS patients in the world – the wine industry itself is starting to pitch in to find solutions, and to prevent FAS.
Beyerskloof Vineyards, the premier winery using indigenous pinotage grapes, is the first vineyard in South Africa to put labels on their bottles – a common practice elsewhere – warning pregnant women of the dangers of drinking. The founder, Beyers Truter, has also established a foundation, the Fetal Alcoholism and Interrelated Treatment Help Fund (FAITH) to raise funds for research, for information campaigns, and for smaller charities that help communities affected by FAS.
"We have experienced the upside of wine – seeing the world, going to great restaurants – but we have to publicly acknowledge that there is a downside to our product," says François Naude, managing director of Beyerskloof Vineyards in Stellenbosch.
"Underaged children have killed themselves driving after drinking Beyerskloof Pinotage. Husbands have beaten their wives after drinking Beyerskloof Pinotage. And women have hurt their unborn children by drinking Beyerskloof Pinotage," says Mr. Naude. "We felt some social responsibility in regard to our industry to do something about this. We don't need to sweep this under the rug."
Tisha is an 11-year-old whose mother, now dead, drank during pregnancy. As a result, performs at about a five-year-old's level. She may never learn to read.
Tisha's foster mother still calls her "my miracle baby."
"The doctors gave her a week to live," says Vivian Lourens, who has cared for Tisha since she was an infant. "That's when I get my back up. There's no way this child is going to die. They said she would never walk. She walked at 18 months. She had so many things wrong with her, but you wouldn't know it now. Obviously, she was meant to live."
As foster parents, Ms. Lourens and her husband, Peter Lourens, had seen some hard cases, but Tisha was different. She didn't even know how to suck a bottle and probably had never been fed by her mother, who was found in her cardboard shanty home, unconscious and drunk."They always blame farmworkers, that's where everyone still fingerpoints, but it happens all over the world, at all levels of society," says Peter Lourens.
Starting from zero knowledge, the Lourenes have become experts by necessity, researching on the Internet and joining parents support groups, such as www.FASlink.org, for tips on how to help a child affected by FAS. Today, the Lourenses get calls from researchers and parliamentarians, and once, by the office of President Thabo Mbeki, to learn about FAS.
From a child that doctors had given up on, Tisha has blossomed into a buoyant spirit at home and at school. She knows all the letters in her name, but cannot put them in correct order. She is great at physical activities, including swimming and ballet, and her sparkly personality has made her into a poster child for FAS.
"I'm famous," says Tisha, sitting on Vivian's lap one recent afternoon.
"She's been on TV," says Vivian.
"And on radio," chimes in Tisha.
"We really want to get to a potential parent, like a school girl, and tell her about the dangers of drinking. Then, secondarily, to a mother who already has a FAS baby, here's the best way to handle one."
But what the Lourens care about most is the children they already provide foster care for. "I've always said I've got a big mouth, and I will fight to get help for my children," says Vivian. "I just think about those who don't have that skill. What will they do?"