by Bintou Ahmadou, Johns Hopkins University, Baltimore
Nelson Mandela said “education is the most powerful weapon which you can use to change the world”. Whilst it is true that in Africa many still do not have access to basic education, many have had the privilege of being educated and are saddled with 2-3 letter acronyms e.g. M.D and Ph.D. In most instances however, acquisition of these titles more times than not has blinded many to ever-changing realities on the continent; especially as they relate to developments in the field of health. Holders of such titles continue to rely on and dispense information that may at times be outdated and not reflect current developments in the medical field. This process hampers the work of organizations and governments involved in the development and institution of solutions to these health concerns, as people continue to rely on the opinion of the educated.
As a scientist, one thing remains certain, the more I learn, the less I know. With World Health Organization (WHO) reports showing unequivocally that infectious diseases are the leading cause of death in low-income countries, scientific and medical research remains one of the central elements through which these problems are addressed. Hence, progress obtained after decades of hard work and mammoth resources spent attempting to understand and curb diseases, comes to a screeching halt when physicians refuse to arm themselves with currently available data. Realizing that knowledge keeps evolving is one of the key lessons to learn if we want to make positive changes in Africa. A case in point is the evolution of the treatment of HIV/TB co-infection.
Tuberculosis (TB), one of the most debilitating diseases known to man is caused by a single bacterium. It is estimated that this bacterium is responsible for up to 4400 deaths daily and infects over a third of the world’s population. It should therefore have come as no surprise that people infected with HIV would have a higher risk of developing TB. This notion was however nonexistent until a few years ago when doctors, treating patients attending two adjoining clinics in South Africa – an HIV and a TB clinic – realized that they were treating the same patients for both diseases. This prompted the merging of the two clinics and ultimately better patient care. With 2 billion people infected with TB and the ever growing HIV-positive population, this observation furthered our education, gave us more insight in our battle against this deadly HIV/TB partnership and enabled implementation of practices that have had a significant impact on the global treatment of this co-infection.
Such battles are, in most instances, taken up by international organizations such as the WHO, together with governments. In their involvement, they often appear to be forcing populations to comply with their demands, attached as requirements to any assistance they provide. Part of this criticism lies in the fact that in numerous cases, these demands are seen as being contradictory to the cultures of some of the communities within which they work. In recent years, however, this previously negative aspect is evolving alongside the research done, as the parties concerned are beginning to understand that more can be achieved if you talk to a man in a language that goes to his heart (Nelson Mandela).
The treatment of multidrug and extensively drug resistant TB is a perfect illustration of this shift in attitudes. In this instance, it is recommended that patients be committed to specialized clinics for the duration of their therapy which lasts at least 18 months. In countries such as South Africa, where most often than not these patients are the sole-bread winners of their families, this has fostered a reluctance to get proper treatment, thus leading to further transmission of these hard to eradicate diseases within their communities. Forearmed with this knowledge, in South Africa, a community-based treatment approach is now currently being tested to determine the success of home care treatment by health care professionals.
Although we are years from ascertaining the success or failure of this practice, this is one example out of many current compromises between international organizations and the local communities within which they provide support. These abovementioned cases clearly reflect developments in the field of medical research and healthcare, as well as the willingness of the parties involved to take into consideration the social realities of the communities within which they are called to act.
As people who have the power to make a difference in even one person’s life, and especially for those who are educated researchers and practitioners, and have insight into the various cultures, it is imperative to be armed with current knowledge before encouraging or discouraging treatment courses and/or the work of international organizations. This knowledge would ultimately promote forward thinking in the implementation of changes that would ensure better qualities of life and increased life expectancy, thus benefiting our communities greatly.