1 September 2014

Africa: Medical Racism and the African Patient

opinion

In his book, Infections and Inequalities, Paul Farmer writes that we live in a world where infections pass easily across borders, while resources, including cumulative scientific knowledge are blocked at customs. The recent outbreak of Ebola in West Africa is a case in point. The World Health Organisation has warned that the number of Ebola cases could rise to 20,000 largely because the medical staff in these West African countries do not have the resources to deal with the rapid spread of the virus.

West Africa and Western medicine have a history that reaches back to the 19th century. By the early 19th century, the medical folklore, which went hand-in-hand with the European colonial project in Africa, considered the region "the white man's grave". The notion of the white man's grave emerged due to the high death rate of Europeans in West Africa in the 19th century. Scholarly studies show that in quantitative terms the mortality rate during that period was usually between 300 and 700 per thousand per annum for any group of European newcomers to West Africa.

Modern science shows that Europeans died in large numbers in West Africa simply because they lacked immunity to yellow fever and malaria, an immunity that many Africans developed in childhood. However during the 19th century Europeans believed that Africans had something in their DNA, which equipped them to survive the climate in the region. The "Africanist discourse" shaped the thinking of the medical establishment of the time. According to the Africanist discourse, "Africa produces monsters". Christopher Miller, an academic based at Yale University, explains that the Africanist discourse is a poor relation lexically and institutionally, to the prestigious and well-endowed study of the "Orient".

In the 21st century, the discourse has changed slightly, so has medical folklore. Today's medical folklore is characterized by its use of sophisticated codes to talk about diseases and disorders that are associated with black Africans. In his book, The Origins and Consequences of Medical Racism, John Hoberman argues that many diseases and disorders have been "effectively coded 'white' or 'black', depending on whether they are associated with modernity (white) or socially backward (black) ways of life." The prevailing view is that black Africans living in Western countries are the diseased 'other' who pose a threat to the health of whites. Modern medical folklore essentially regards African immigrants living in Western countries as an infectious "reservoir of diseases" - to use Hoberman's phrase. Another feature of this perspective is an overarching theme that often ties African diseases to sexuality. Hence, as American scholar Abby Ferber points out, "disease becomes a metaphor in this discourse, invoked again and again."

Against this background, Australian politicians such as Pauline Hanson have in the past associated African refugees with the threat of diseases such as tuberculosis, hepatitis, AIDS and other contagious afflictions. According to Heather Worth, an associate professor at the University of New South Wales, the first settlement of African refugees in New Zealand in 1993 led the public, politicians and government officials to call for mandatory HIV testing. In Israel, blood donated by Africans was, until 2007, discarded by Israeli hospitals because of the belief that Africans are diseased.

The foregoing partly explains the large research output, which focuses on African immigrants and infectious diseases in Western countries. According to Farmer, The history between Western medicine and West Africa teaches that "diseases that predominantly afflict the poor are unlikely to garner funding for research and drug development, unless they begin to 'emerge' into the consciousness and space of the non-poor."

While Ebola explosions largely afflict African people living in poverty and health care workers who serve the poor, the recent Ebola outbreak has put Western Europe on alert. The Guardian reports, "from Austria to Ireland, Spain to Germany, there have been at least a dozen cases of West Africans with mild flu symptoms being isolated until it was established that they were not suffering from Ebola."

The consensus among scientists is that the Ebola virus does not pose any risk to the general public in Western countries with well-resourced public health care systems. However, African refugees living in foreign countries are often impacted by disease outbreaks such as the recent Ebola eruption in more ways than one. Disease outbreaks pose a threat to the health of refugees directly, but also have a significant impact on the resettlement chances of African refugees to Western countries or any other country for that matter. In fact, research shows that outbreaks of diseases such as measles, rubella and hepatitis A have disrupted the resettlement of African refugees several times since 2004.

What comes to mind is an observation once made by microbiologists, husband and wife team, René and Jean Dubos that "tuberculosis was, in effect, the first penalty that capitalistic society had to pay for the ruthless exploitation of labour." Medical literature is replete with evidence that the world's burden of disease disproportionably affects black Africans, just as the husband and wife Dubos team argue, many Africans also know that the poor health situation in Africa exists largely due to colonialism, imperialism and global inequality.

Majavu is the Book Reviews Editor of Interface: A Journal For and About Social Movements. He is a PhD candidate at the University of Auckland, New Zealand.

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