ETHIC IN AFRICA (FIRST PART)

Theme : ethics and health in Africa

Title : between tradition and modern medicine: the ethical challenges facing Africa  

In Africa as in other continents, health remains a major concern. If being healthy means being mentally and physically sound, it should also be highlighted that good manners are necessary when dealing with people’s health; otherwise the target set might not be reached. When administering healthcare, the conditions that should be met, as concerns the topic we are discussing, are ethical. We will, in the lines below, ponder over the relationship between ethics and health in Africa.  In order to discuss this interesting and itching issue we would like to focus on a rather original questioning of our theme. What are the ethical challenges for health in an African continent faced with the burden of tradition and the rational pressures of modern medicine? We will firstly talk about the African conception of illness and the drawbacks of medical progress. We will recall some distressing facts in order to excavate some ethical principles. These principles are not always obeyed. They are sometimes bypassed. That is the reason why we shall end our reflection with some proposals and an example. 

ILLNESS AND CULTURE

The understanding of physical or mental illness, its causes and its cures, is sometimes conditioned by cultures. The cultural context is important for medical care, and the treatment of diseases must first abide by the laws of science and take culture into consideration if it is to be efficient and satisfactory. It is worth mentioning that every individual lives in a specific cultural context.

 Culture is all about the lifestyle of a group deeply rooted in the way they adapt to a given environment, it is their vision of the world; similar ways of thinking, acting and doing, similar attitudes, aspirations and practices.

In western civilisation where science and individualism prevail, good health is understood as the absence of diseases, particularly the absence of germs and viruses. That is why medical care is based on evidence and a kind of objectivity that hardly considers the culture of the patient. In African tradition where community spirits and parental links prevail, health is a much more complex issue and the recovery from an illness or a spell is more than a simple technical elimination of a plague or an affliction.

There have been tremendous headways in medical science and medicine has remarkably evolved in the last fifty years. It now appears as the evolution of an art linked to a culture, to a global science. There is, for example, aesthetical surgery thanks to which several people can get rid of physical impairments. We could also mention the victory over some terrible diseases like tuberculosis. This improvement on the well being of humans brings about a longer life expectancy in African countries and the world. This is reinforced by the discovery of many vaccines and their availability in African countries. It could be mentioned that this was possible thanks to industrial and commercial revolution and thanks to science and technology.

DRAWBACKS OF MEDICAL PROGRESS : THE PROBLEMS FACING AFRICA

We would like to emphasise that despite medical progress, the African continent is still lagging behind. There are many causes to explain this: improper medical practices, the uneven distribution of available medical resources in the world; the outbreak and the spread of deadlier epidemics and diseases; the negative role of trade monopoly, intensive business activities and the surge in profit, the failure to compensate traditional health systems. There is imbalance between the available funds for health research in Africa and the diseases responsible for greater mortality.

The disease burden has become a prime indicator to assess health, reforms, developmental policies, planning, the distribution of resources and so on. Traditionally, the disease burden was assessed on the basis of epidemiological methods and statistics upon morbidity and mortality. Some criteria can be used to quantify the disease burden, namely:  the impact of premature deaths and incapacities.  The assessment of the future of specific sanitary interventions. Whatever the criterion used, the burden of the world morbidity heavily cripples developing countries, particularly in Sub Saharan Africa. Let us discuss the situation in some of these countries.

-Immunization

The mortality rate for children and mothers is still high in Africa. More Immunization campaigns should be organised in order to bring it down. This is true for diseases such as tetanus, diphtheria, meningitis, TB, poliomyelitis, whopping cough, measles, yellow fever, and hepatitis B. parents either neglect to respect the immunization schedule or they start and fail to complete. Immunization is ineffective if it is Incomplete. In Africa these diseases often lead to the death of the child before he/she is one year old.  A child who is not vaccinated against poliomyelitis might be crippled for the rest of his/her life.

Also linked to vaccination is the issue of imbalanced diet. The lack of vitamin A for instance, leads to the death of approximately I0 600 children in Cameroon each year. To tackle this problem, the government of Ivory Coast decided to set up the AYAME children’s home in the South West of Ivory Coast. It is henceforth of utmost importance for the pregnant woman  and for the child to have a healthy or balanced diet

-AIDS:as concerns this disease, it is obvious that patients do not easily adhere to anti retro viral treatment. More sensitization campaigns should be organised. Besides, people find it economically difficult to have access to drugs that can combat AIDS. Apart from South Africa which has been allowed to manufacture Anti retro viral drugs, the other African countries are faced with the shortage of drugs, and many people die because of this.

In Cameroon, for instance, the health personnel sometimes misappropriates the ARV destined to patients in order to sell at a higher price, thus penalising AIDS patients. Pr Victor Anomah Ngu, former minister of Public Health in Cameroon is about to complete a treatment against this disease: Vanhivax (Victor Anomah NGU HIV Vaccine), he now needs about two thousand million to move forward in his research. This vaccine has proven its effectiveness as it has helped many people to recover after having been treated with it. Professor ANOMAH NGU is sure that his discovery will be an appropriate solution. 18 people have been cured by the vaccine of this 82 year old professor.

-Malaria: Malaria is a great killer in Africa. In the Far North Region of Cameroon, 183 941 cases of malaria were recorded in 2007 only. 960 deaths were officially recorded.  Many die because they take drugs to which the parasite has become stubbornly resistant. Many patients cannot have access to more effective new medicines such as: Artesunates, Amodiaquin, and Arthemeter-Lumefantrin. The reason is that all health centres are not provided with them because they are remote from regional headquarters. 

There are some preventive steps that are taken to make the fight more effective. One can name the distribution of impregnated mosquito nets among others.

Blood Transfusion :It is worth mentioning that blood donations to save the lives of those who suffer from anaemia are rarer and rarer ; according to the WHO, only 39% of the 80 million blood units that are collected all over the world come from developing countries whereas they represent 82% of the population of the world. Every country should take measures to overcome this shortage and the hazards linked to blood transfusion like the contamination of certain diseases, etc.  This is an emergency since 5% of HIV AIDS Infection is caused by blood transfusion.

Other miscellaneous problems :

As other parts of the world, Africa is hit by climatic changes. These changes not only bring about some modifications in the ecosystem but also give birth to new germs that represent a threat to humans. It is hence obvious that micro organisms are sensitive to global changes although the way they will react is still a mystery.

Smoking:  40% of students smoke in Cameroon. Such figures should be causes for alarm. Youth are at risk of catching cardiovascular diseases and cancer.

Other alarming facts

Contagious diseases, malnutrition, paediatric diseases, maternal and prenatal problems and epidemics are still a major concern for health care in Africa. 

Despite a considerable reduction of infant mortality, the rate is still 20 times higher than in developed countries. Despite another significant reduction in maternal morbidity/mortality the number of African women who die because of problems linked to pregnancy is still 100 times higher than in developed countries.

 Life expectancy has increased in the last two decades; yet it is still shorter than in industrialised countries. In addition, it is dwindling again due to current epidemics, wars, genocidal killings and other happenings which jeopardise health and life.

According to UN sources, 90% of 300 million cases of severe malaria leading to a millionth death each year, mainly of children under the age of 5, are recorded in Africa. By 2025, over 80 million Africans might die of AIDS and about 90 million people will be suffering from TB.

Sub Saharan Africa represents about 10%of the world’s population. At the end of 2006, approximately 39, 5 million people were living with HIV/AIDS in the world, 63% of whom were found in Sub Saharan Africa. Africa has one of the highest rates of HIV spread in the world. Of 4.3 million new infections in 2006, 2.8 were in Africa. Still in 2006, 2.1 people died of AIDS. This represented 72% of all deaths linked to AIDS in the world.  

In most African countries, the percentage of the budget devoted to health it low: less than 10%. The majority of AIDS control programmes are supported by foreign funds. Whenever this support dries up many initiatives to counter AIDS are hindered. This has for instance been the case of screening tests. The earnings of AIDS patients dwindle because of their ill health. They thus permanently need permanent support in order to have at least the subsistence revenue that may help them to minimise worries that can worsen their situation. 

Of 1450 new drugs sold in Africa between 1972 and 1997, only 13 could fight tropical diseases. It is the pharmaceutical industry itself that shortlists, sponsors and manages these studies. The choice of drugs and their appraisal are systematically biased. On one side, laboratories want a return on their investments, on the other side, local authorities find it hard to conceive an unequivocal and coherent drug policy which can enable them to better control the work of laboratories.

The dichotomy between scientific interest and commercial dividend is exacerbated in underdeveloped countries because of the wide gap that exists between the industrial requirements of the drug and the poverty of southern nations. At the end of the 1990s, the turnover of the pharmaceutical industry in the world (€ 380 thousand million) was higher than the Gross National Product of Sub Saharan countries (€ 300 thousand million).

There are many reasons for this: the overwhelming poverty of Africa, the high number of opportunistic infections due to HIV/AIDS patients : TB, typhoid, meningitis, Burili ulcer, etc. modern health facilities/infrastructure are few ; the illiteracy rate is high, the available data are patchy ; the lack of transportation  and/or communication means in case of emergency, the absence of a political will, political instability (there is currently an epidemics of  cholera in Zimbabwe), armed conflicts, civil wars, backward habits, hazardous health practices, and despair;

Having said this, we can now discuss the question of ethics in the domain of health in Africa. Ethics here actually means bioethics as it is related to life.