Really enlightening (and sad) op-ed from Harriet Washington in the NYTimes. She works off the recent release of the Bulgarian nurses from Libya charged with consciously infecting children with HIV. Washington explores the more widespread fear of medicine in certain parts of Africa, and where the truth underlying the psyche of the charges–though not the truth of the charges in that actual case.
Africa has harbored a number of high-profile Western medical miscreants who have intentionally administered deadly agents under the guise of providing health care or conducting research. In March 2000, Werner Bezwoda, a cancer researcher at South Africa’s Witwatersrand University, was fired after conducting medical experiments involving very high doses of chemotherapy on black breast-cancer patients, possibly without their knowledge or consent. In Zimbabwe, in 1995, Richard McGown, a Scottish anesthesiologist, was accused of five murders and convicted in the deaths of two infant patients whom he injected with lethal doses of morphine. And Dr. Michael Swango, ultimately convicted of murder after pleading guilty to killing three American patients with lethal injections of potassium, is suspected of causing the deaths of 60 other people, many of them in Zimbabwe and Zambia during the 1980s and ’90s. (Dr. Swango was never tried on the African charges.)
In other words, though again in this case these people were not guilty, the fear itself is not completely irrational.
Such tragedies highlight the challenges facing even the most idealistic medical workers, who can find themselves working under unhygienic conditions that threaten patients’ welfare. Well-meaning Western caregivers must sometimes use incompletely cleaned or unsterilized needles, simply because nothing else is available. These needles can and do spread infectious agents like H.I.V. — proving that Western medical practices need not be intentional to be deadly. Although the World Health Organization maintains that the reuse of syringes without sterilization accounts for only 2.5 percent of new H.I.V. infections in Africa, a 2003 study in The International Journal of S.T.D. and AIDS found that as many as 40 percent of H.I.V. infections in Africa are caused by contaminated needles during medical treatment. Even the conservative W.H.O. estimate translates to tens of thousands of cases.
In fact regarding the Bulgarian case, this unintended infection (perhaps even prior to the arrival of the Bulgarian nurses) was in fact the cause of the children’s infections. If true, this would make the charges of the Libyan government not as crazy as they seemed prima facie.
Certainly, the vast majority of beneficent Western medical workers in Africa are to be thanked, not censured. But the canon of “silence equals death” applies here: We are ignoring a responsibility to defend the mass of innocent Western doctors against the belief that they are not treating disease, but intentionally spreading it. We should approach Africans’ suspicions with respect, realizing that they are born of the acts of a few monsters and of the deadly constraints on medical care in difficult conditions. By continuing to dismiss their reasonable fears, we raise the risk of even more needless illness and death.