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http://www.nytimes.com/2007/07/31/opinion/31washington.html

July 31, 2007
Op-Ed Contributor
 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
H.I.V., 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
H.I.V.-contaminatedvials 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. (Dr. 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. Dr. 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 H.I.V. or are actually sterilization agents in disguise.
This would sound incredible were it not that scientists working for Dr.
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 H.I.V.  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 H.I.V. infections
in Africa, a 2003 study in The International Journal of S.T.D. and AIDS
found that as many as 40 percent of H.I.V. infections in Africa are caused
by contaminated needles during medical treatment. Even the conservative
W.H.O. 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 re-use 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."


-- 
www.michaelbalter.com

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Michael Balter
Contributing Correspondent, Science
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