How not to explain African distrust of Western medicine
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.
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1) The blog seeks to criticise an Op-Ed, not an 'article' as Rennie claims: Adjudging the writing as if it were an article is absurd: It is, by definition, opinion. But it is opinion supported by facts of which Rennie admits being unaware.
2) Mr Rennie admits unfamiliarity with most of the cases and facts cited "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."
3) Rennie makes rather large, transparently apologetic and nonsensical assumptions about what black Africans know or do not know�— and based upon what? His knee-jerk reaction to abuses of which he was ignorant before he read them in the Op-Ed yesterday?
4) Of course, Basson is regarded as a physician : He remains one, still licensed and practicing, or does Rennie not know this either? On what factual basis does he presume to know how black Africans percieve Basson? If Rennie really wanted to know, not simply to take potshots at the Op Ed thesis, he would research these attitudes: I did , rather easily. Basson's trial was SA's longest and a very high-profile proceeding. There is ample evidence of widespread outrage, even now. And Basson was accused to killing blacks in several countries, not merely in SA
This criticism is a rather sloppy bit of apology.
- by Athena on Aug 1, 2007 at 11:58 AM | link
Athena,
I would like to respond to your comments. First, I think you are right that I should not have said I was reponding to an 'article', I should have said 'op-ed' or 'piece.' I should have made that clearer in the beginning, rather than at the end of what I wrote.
However, your other comments are uncharitable and misguided. First, I am not sure what you mean by 'transparently apologetic.' I hope you don't mean that I condone the abuses. There is nothing in what I wrote -- or what I have ever written on this blog or elsewhere -- to support that view. My point about the abuses that Washington cited is that they are not common knowledge. I stand by that; honestly, did you know of them? The Pfizer meningitis trial in Nigeria or the AZT trials during the 1990's (for example) are better known, and in my opinion, have probably had a bigger impact.
As for my 'nonsensical assumptions', note my use of qualifiers in the post: 'in my experience', 'some might say', 'I venture' and so on. These were meant to signal to the reader that what follows are partly subjective or speculative claims. The signal was apparently not clear enough.
I do know that Basson is still practicing medicine (the information was in the Wikipedia link I put in the text), and I was in South Africa during his trial. It is a researchable question what the attitudes of (especially South) Africans are towards Dr. Basson. My impression -- from being there, reading the papers and articles, talking to people -- was that he was viewed more as a monster than a medical practitioner or representative of Western medicine. If well-designed qualitative studies show otherwise, I stand corrected. (Athena: please elaborate on the research on these attitudes that you have already done 'rather easily'.) In the meantime, a better example for Washington's argument might be the 'ordinary' doctors involved in the Steve Biko killing and its cover-up.
The intellectual point I wanted to make was this: Washington tries to give causal explanations for a certain phenomenon ('fear of Western medicine among Africans'). Questions can be raised about the phenomenon (what is it's magnitude? how can it be measured?) or the causal explanations for it. Washington bites off more than she (or anyone) could chew in an op-ed, I feel, but the topic deserves a book, and Washington has the talent to write a rich historical account on this subject.
- by Stuart Rennie on Aug 1, 2007 at 4:15 PM | link