Explaining African fears of Western medicine

Today the New York Times has an article 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 do have 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 really 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) hetrosexual 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 exploitation. There is a bigger story to be told, and maybe Washington can tell it, but not in an 800 word opinion piece.

A world of pain

Pain is oddly subjective and universal. Although you may sympathize, you cannot literally 'feel my pain.' It's mine. But everybody, regardless of historical period or culture, knows what pain feels like: it hurts. And in hurting, it debilitates. Pain has been installed in us (and other sentient beings) for good evolutionary reasons: we need to know when our bodies are damaged. But, unfortunately, pain is a crude messenger. Pain often continues on, and even increases in strength, when we have already long got the point.

The journal Anesthesia and Analgesia is not exactly daily fare of the average bioethics worker, but the July issue contains a number of fascinating articles about the ethics of pain management. One striking consideration is the unequal global distribution of untreated pain. Pain may be universal, but access to pain management is certainly is not: if you suffer from chronic or acute pain, you are better off being Austrian than African. The former stands a good chance of getting opiate or non-opiate treatments; the latter is more likely to have to bite the bullet. And given the HIV/AIDS epidemic, the effects of war, poor sanitation, and the effects of treatable (but not treated) diseases, there may be just more pain needing treatment -- and not getting it -- among poor countries.

While there is distributive injustice in untreated pain between rich and poor countries, the undertreatment of pain is a worldwide phenomenon. Contributors to Anesthesia and Analgesia tackle explanations of the undertreatment of pain, what is ethically wrong about the status quo, and what to do about it. There seems to be a consensus that legal and political pressures (remember the 'war against drugs'?) about potential drug abuse and addiction have hindered aggressive pain treatment by clinicians, even in better-off nations. There are also cultural barriers, such as the belief that pain is natural and inevitable, or that it is a sign of a strong moral character to bear pain than have it relieved. Authors work both sides of the ethical street, arguing that appropriate pain management should be regarded as a human right while also documenting the social and economic consequences of untreated pain.