[NYTr] Why Africa fears Western medicine

[All the News That Doesn't Fit]

[Aside from the reasons cited here, African nations have also
experienced incredibly rapacious greed and exploitation at the hands of
Western drug companies who want to make an obscene profit on their HIV
drugs, vaccines and other products.  And in the case of Libya, not
mentioned here, is the context of distrust engendered by the CIA
and the strange maneuverings involved in the Pan Am 103 bombing over
Lockerbie. -NY Transfer]

International Herald Tribune - Jul 31, 2007
http://www.iht.com/articles/2007/07/31/opinion/edwashington.php

Op-Ed:

Why Africa fears Western medicine

By Harriet A. Washington

To Westerners, the repatriation of five nurses and a doctor to Bulgaria
last week after more than eight years' imprisonment meant the end of an
unsettling ordeal. The medical workers, who in May 2004 were sentenced
to death on charges of intentionally infecting hundreds of Libyan
children with HIV, have been freed, and another international incident
is averted.

But to many Africans, the accusations, which have been validated by a
guilty verdict and a promise to reimburse the families of the infected
children with a $426 million payout, seem perfectly plausible. The
medical workers' release appears to be the latest episode in a health
care nightmare in which white and Western-trained doctors and nurses
have harmed Africans - and have gone unpunished.

The evidence against the Bulgarian medical team, like HIV-contaminated
vials discovered in their apartments, has seemed to Westerners
preposterous. But to dismiss the Libyan accusations of medical
malfeasance out of hand means losing an opportunity to understand why a
dangerous suspicion of medicine is so widespread in Africa.

Africa has harbored a number of high-profile Western medical miscreants
who have intentionally administered deadly agents under the guise of
providing health care or conducting research. In March 2000, Werner
Bezwoda, a cancer researcher at South Africa's Witwatersrand
University, was fired after conducting medical experiments involving
very high doses of chemotherapy on black breast-cancer patients,
possibly without their knowledge or consent. In Zimbabwe, in 1995,
Richard McGown, a Scottish anesthesiologist, was accused of five
murders and convicted in the deaths of two infant patients whom he
injected with lethal doses of morphine. And Dr. Michael Swango,
ultimately convicted of murder after pleading guilty to killing three
American patients with lethal injections of potassium, is suspected of
causing the deaths of 60 other people, many of them in Zimbabwe and
Zambia during the 1980s and '90s. (Swango was never tried on the
African charges.)

These medical killers are well known throughout Africa, but the most
notorious is Wouter Basson, a former head of Project Coast, South
Africa's chemical and biological weapons unit under apartheid. Basson
was charged with killing hundreds of blacks in South Africa and
Namibia, from 1979 to 1987, many via injected poisons. He was never
convicted in South African courts, even though his lieutenants
testified in detail and with consistency about the medical crimes they
conducted against blacks.

Such well-publicized events have spread a fear of medicine throughout
Africa, even in countries where Western doctors have not practiced in
significant numbers. It is a fear the continent can ill afford when
medical care is already hard to come by. Only 1.3 percent of the
world's health workers practice in sub-Saharan Africa, although the
region harbors fully 25 percent of the world's disease. A minimum of
2.5 health workers is needed for every 1,000 people, according to
standards set by the United Nations, but only six African countries
have this many.

The distrust of Western medical workers has had direct consequences.
Since 2003, for example, polio has been on the rise in Nigeria, Chad
and Burkina Faso because many people avoid vaccinations, believing that
the vaccines are contaminated with HIV or are actually sterilization
agents in disguise. This would sound incredible were it not that
scientists working for Basson's Project Coast reported that one of
their chief goals was to find ways to selectively and secretly
sterilize Africans.

Such tragedies highlight the challenges facing even the most idealistic
medical workers, who can find themselves working under unhygienic
conditions that threaten patients' welfare. Well-meaning Western
caregivers must sometimes use incompletely cleaned or unsterilized
needles, simply because nothing else is available. These needles can
and do spread infectious agents like HIV - proving that Western medical
practices need not be intentional to be deadly.

Although the World Health Organization maintains that the reuse of
syringes without sterilization accounts for only 2.5 percent of new HIV
infections in Africa, a 2003 study in The International Journal of STD
and AIDS found that as many as 40 percent of HIV infections in Africa
are caused by contaminated needles during medical treatment.

Even the conservative WHO estimate translates to tens of thousands of
cases.

Several esteemed science journals, including Nature, have suggested
that the Libyan children were infected in just this manner, through the
reuse of incompletely cleaned medical instruments, long before the
Bulgarian nurses arrived in Libya. If this is the case, then the Libyan
accusations of iatrogenic, or healer-transmitted, infection are true.
The acts may not have been intentional, but given the history of
Western medicine in Africa, accusations that they were done consciously
are far from paranoid.

Certainly, the vast majority of beneficent Western medical workers in
Africa are to be thanked, not censured. But the canon of "silence
equals death" applies here: We are ignoring a responsibility to defend
the mass of innocent Western doctors against the belief that they are
not treating disease, but intentionally spreading it. We should
approach Africans' suspicions with respect, realizing that they are
born of the acts of a few monsters and of the deadly constraints on
medical care in difficult conditions. By continuing to dismiss their
reasonable fears, we raise the risk of even more needless illness and
death.

[Harriet A. Washington is the author of "Medical Apartheid: The Dark
History of Medical Experimentation on Black Americans From Colonial
Times to the Present."]