Wednesday, 26 April 2006

What exactly is wrong with me?

The scramble on all fours
There was a time in West Africa as Europeans traverse the land exploring, charting and discovering land, people, rivers, resources and trade route that this area was know as the White Man’s Grave – the scourge of malaria and yellow fever decimated who dared visit.
However, the knowledge of the land did help in what eventually became known in history as the Scramble for the Partition of Africa. My vision of scramble makes those conquering tribes look more savage than the natives and the land they were scrambling for.
To paraphrase the Merriam-Webster Online Dictionary, it involves moving or climbing on all fours to struggle unceremoniously for a possession – Africa’s land, people and resources.
Dragons be there in the unknown
However, know the lay of the land is very useful, but that common knowledge is hardly available to the Chinese whose government considers topological maps classified and even edits out certain detail of maps ensuring they are too unreliable for motorists to consider using those directions for journeys to the hinterland.
Dragons be there, begins to make sense.
However, reading the travails of my friendly blogger in Nigeria on NaijaBlog as he tries to shake off the problems with malaria and other diagnosed issues, I do wonder about how health issues in Africa are properly addressed for the main populace.
Trivialising malaria
I do remember in when I lived in Nigeria, every fever was classified as malaria and we almost all self-medicated especially where there was no health insurance with a family doctor service attached.
Fortunately, in my early years, we always had the luxury of a family doctor and treatments that dealt with most ailments that afflicted us.
The treatment for malaria then involved the ingestion of a component of quinine normally as chloroquine sulphate and marketed as nivaquine. My father was always able to use that medication without problems; my mother however could not tolerate that drug.
At that time doctors were aware of the intolerance and contra-indications usually manifesting as itching palms and soles that it was sometimes administered intramuscularly with an antihistamine.
None of which worked for my mother despite the fact that she did tell the doctor who thought he knew better that the drug should be off limits – he eventually learnt as my mother bloated up in reaction to the drug – an emergency ensued and eventually she was fine.
Banking on the inefficient
Then, I never knew malaria was that much of a scourge as we all considered it to be, so it is sad that as we marked the Africa Malaria Day, the World Bank was found wanting in the way they publish results, offer financial assistance and provide effective drugs for the treatment of malaria.
This accusation appeared in the Lancet a very reputation science journal and is corroborated in the flimsy defence that the World bank gives as to the projected spends rather than what they have done.
I would hate to question the competence and vision of the president of the World Bank Paul Wolfowitz (neo-con proponent of the Iraq War as US Deputy of Defense under Donald Rumsfeld) in ensuring that the goals of the World Bank are met effectively, efficiently, fully and accountably most especially in public health issues all around the world.
This topic is not one of those where governments have to meet the political, moral or economic pre-requisites of the American sense of good governance but one of urgency in preventing catastrophe in desperately affected areas.
Diagnosing the Brief Illness
The more serious issue pertains to a disease called Brief Illness because a majority of published obituaries in the Nigerian newspapers seems to have people who have succumbed to Brief Illness.
Maybe for reasons of circumspection the real causes of death cannot be published most especially if it is related to AIDS, there is another problem of proper diagnosis on the one hand and the other of useable medical histories.
From the tale of my NaijaBog friend, arriving at a proper diagnosis has been fraught with convention and opinion; the former on the assumption that he has malaria and the latter that it might be typhoid or something else.
It is a shame that there is no proper codification or analysis to pin this issue down, that he has therapeutic amelioration for malaria only to end up with another diagnosis related to some bacterial infection.
Many Nigerians do not have the benefit of a good diagnosis of their ailments for effective treatment to be administered for a guaranteed recovery for diseases and ailments that would not last days in better-equipped and knowledgeable settings.
You are now because of history
Where we have Nigerians of means who can avail themselves of international medical expertise; the lack of a medical history or poor knowledge of genetic issues leave doctors in the West having to deduce problems, which may not be common to their demographic.
For instance, cosmetic surgery works well for Caucasians, but those activities require a different approach with black skin for the fact that scarring is more obvious.
The lack of knowledge of pre-disposed, pre-existing, congenital or even tropical conditions when consulting Western medical personnel means paying for care will not result in an equivalent cure.
Personal miracles lacking verifiable proof
Beyond medicine we have the hold of herbal or traditional medicine where medicine men, witch doctors or even religious soothsayers offer all sorts of cures for every kind of ailment.
There is a possibility and many do get cured from their testimonies, but not many can provide medical proof of a pre-existing condition that has received a touch of the miraculous.
Part of the society is also entranced by superstition that it is possible for some to believe that a serious or chronic medical condition is as a result of some voodoo activity of enemies or detractors.
The witch doctors feed into this mentality milking the victims of all resources, comforting the hapless customer with fear in the hope that some remote coercion can lift the hex off the person leading to a cure.
It makes you wonder which century we are in.
Tackling the bottlenecks
The approach to medicine in Africa needs to change; we have not been able to grapple with healthcare enough to address health properly.
The governments and ministers who thwart every attempt to objectively address health issues with religious and ignorant pronouncements need to be brought to book first then condemned for trying to turn that challenge to their rotten opinions into a race or religious argument.
We cannot continue to sacrifice Africans to ideology and politics when there is much to be done to deal with issues that decimate some of our most productive talent and resources.

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