Inside Africa: Decolonizing African Medical Care
nattrass
“Until racial disparities in medical care are addressed on topic and policy levels, not much will change for the better. Education in the medical field often leaves out certain minority groups - specifically Black and anyone else with darker skin - and a long history of colonialism and oppression of African peoples which dehumanized and exploited them have impacted the way they receive medical care. It has impacted the way their doctors diagnose and treat them and their access to competent health care.”
This is something a young medical student in the UK saw. Twenty-year-old Malone Mukwende, who just completed his second year of medical school at St. George’s, University of London, frequently found himself wondering how certain symptoms would look on darker skin when his textbooks showed examples of rashes, blue lips and other indicators of various diseases on light skin. He recognized that as a doctor, he would have difficulties treating patients with dark skin like him because he was never taught what to look for or how to accurately describe what he did see using the correct terminology.
With this in mind, he started taking steps to help create a handbook titled “Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin” that would help address this issue and make the teachings in medical school more inclusive and possibly life-saving as soon-to-be doctors armed themselves with the knowledge necessary to provide competent health care across demographics. Otherwise, Black people and anyone else with darker skin tones will continue to be “othered” in medical care. The handbook will include a collection of images of symptoms on different skin tones, reflecting more accurately diverse patients. It will also provide guidelines to help health care workers learn the language needed to describe what they see.
This practice of “othering” is not new and could find its roots in European colonialism in Africa in the late 1800s to early 1900s. Colonialism came at a time when Europeans were revamping their own understanding of disease and health care, and Africa became the place to not only share the new medical practices, but for a fair amount of experimentation. Medical trials did not have a clear definition or standard for “human subjects,” and Africans were seen almost as test subjects to try out vaccines and other kinds of medications or medical treatment. Globally, these standards were not set already and would not be until after World War II. However, with the attitude that using these untested treatments and medications in colonial Africa was better than “doing nothing,” African people suffered from side effects that they would be left alone to struggle with in their communities without support or help from the colonizers.
When European medicine was introduced in Africa during colonization, traditional medicine was practiced, varying from region to region, country to country. A World Health Organization report from 2001 defined traditional medicine as “a diversity of health practices, approaches, knowledge, and beliefs incorporating plant, animal, and/or mineral-based medicines; spiritual therapies; manual techniques; and exercises, applied singly or in combination to maintain well-being, as well as to treat, diagnose, or prevent illness.” These practices are also called complementary or alternative medicine, and, in many situations, can be used to supplement Western medicine. Traditional and Western medicine often sit side by side, like in Sierra Leone where a young boy with a broken arm can go to a traditional healer for a salve and animal claw for treatment while just up the road, the neighborhood “auntie” who also works at the clinic next door cleans out another boy’s cuts with an iodine solution and administers a shot of antibiotics after a bad bicycle accident.
As comfortably as the two share the same space, this has not always been the case in all African countries as, during colonization, traditional medicine was outlawed in many countries. Like in Burkina Faso, where these practices were considered “harmful and dangerous” by colonizers and outlawed until the West African country’s independence. It was not until the 1980s that traditional medicine began to be regulated by Burkina Faso’s government and associations were created, though most Burkinabés use traditional medicine. Back in Sierra Leone, traditional medicine is legal as long as it is not dangerous. Other countries have their own versions of traditional medicine, like the South African inyangas or witchdoctors, Basotho herbalists, who are heavily regulated compared to some traditional medicine practitioners, and Kenyan birth attendants. All experience some level of regulation, similar to their counterparts in Western medicine and are often used to complement or supplement each other.
Western medicine is not a lost cause in Africa by any means. It can and often is used to address health in a region where developing countries might struggle with medical concerns such as pandemics, epidemics and simply the general burden of disease that is not common worldwide. Sub-Saharan African doctors have their work cut out for them, and there simply is not enough of them in many cases. Globally, there is an estimated health worker shortage of about 4 million, though this is made worse in Africa due to Africa-born doctors leaving in droves. This physician “brain drain” drives doctors away from their homes in search of better opportunities abroad with better lifestyles and working conditions. The pressure moves on to the remaining doctors and health care workers who struggle to move the medical field forward on the home front.
More limitations come in the form of inaccessible drugs. Despite the need for them in a region often struggling to battle malaria, HIV and other prevalent diseases, practically none of the needed drugs are produced in the region. Instead, valuable resources are spent on importing foreign-produced medications at the expense of those with little income. Limited access to expensive medicines contribute to the struggle health care workers face, though most African countries are unable to produce them internally due to restrictions set by the Current Good Manufacturing Practices enforced by Western governments. The required man-power and training are not there in most cases. However, countries like Morocco, Tunisia, and South Africa are making great strides in pharmaceutical manufacturing.
Unequal access to health care - especially health care which includes diverse populations - continue to be a problem despite the many who push forward. Doctors like Oheneba Boachie Adjei, Bosede Afolabi, and Kachinga Sichizya have gained international recognition and work tirelessly to provide the needed manpower to address Africa’s health needs, with support from traditional medicines squashed down for so long.
