By Stuart Rennie
The New York Times has an article this week with the ambitious title ‘Why Africa fears Western Medicine’ by Harriet A. Washington, author of the generally well-received book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. The title is ambitious, because it is a short opinion piece about a rather large question. And some might say: the question itself is questionable, considering that most Africans have little access to Western medicine, and hence have little to fear. And in my experience, those who finally do gain access, if anything, are often a bit too trusting. But let’s take the bait, and examine Washington’s mini-theory anyway.
According to Washington, the African fear of Western medicine basically has two roots. First, there have been serious abuses in medical research on the African continent. Second, there have been cases of unintentional harm on African patients by Western medical practitioners working in sub-standard, less-than-hygienic working conditions. Taken together, this has led to a deep-rooted suspicion of Western medical science and health care workers that Africa, in its current state, can ill-afford.
The arguments and examples in support of this mini-theory are not altogether convincing. Some cases of abuse (by Drs. Bezwoda, McGown and Swango) cited by Washington are new to this reader, and I am grateful for the (bad) news. But one wonders how many people in Africa have heard of these doctors and what they have done. A more prominent case involves Wouter Basson, former head of the South African chemical and biological weapons unit, but I venture that most Africans who have heard of Basson don’t regard him as a ‘doctor’ or a ‘researcher’ at all, but nasty racist lackey of the Apartheid state.
Washington puts forward the case of the Bulgarian health workers in Libya as an example of ‘unintentional harm by Western health practitioners in resource-poor countries’ thesis. She also suggests that there is a lot of HIV infection in Africa going on by Western health care workers using unclean needles, because allegedly they have no alternative. As support, she wheels in the 2003 study by David Gisselquist et. al. that claims that ‘up to 40%’ of HIV infections in Africa are due to hospital-based infection, rather than (say) heterosexual activity or mother-to-child transmission. To say that the methods of that study are controversial would be putting it mildly. I’ve heard that epidemiology graduate students in our local school of public health use the Gisselquist study as a punching bag.
Perhaps Washington is looking too much to discrete events to explain African attitudes towards Western medicine. Whatever distrust there is should be situated within the colonial past and the neo-colonial present of Africa, and not the actions of particular individuals. Reasons for general distrust, including distrust towards Western medicine, are not hard to find on a continent familiar with various forms of exploitation. There is a bigger story to be told, and maybe Washington can tell it, but not in an 800 word opinion piece.
Stuart Rennie is a Research Assistant Professor in bioethics at UNC-Chapel Hill. He’s project manager for the NIH/Fogarty bioethics grant and ethics consultant for UNC-Gap projects in the Democratic Republic of Congo and Madagascar.