Monday, August 24, 2020

Is Traditional Medicine Africa's Secret Weapon Against COVID-19?

 Covid-19 infections across Africa are on the rise. Although the confirmed number of infected people on the continent is still about 5 per cent of the global total, and the rate of increase seems to be slowing, hopes that Africa would escape the pandemic relatively unscathed are fading.

In many countries, especially those south of the Sahara, already creaking public health systems will struggle to cope with an influx of critically ill patients needing intensive care. This region hosts just 3 per cent of the world’s conventionally trained medics, who face one-quarter of the global disease burden armed with just 1 per cent of its financial resources for healthcare.

Even so, the continent does have resources that can help it cope. Not only has it had extensive experience battling epidemics of infectious disease, such as the Ebola outbreak in 2014 and the Aids and cholera pandemics, it also has a wealth of traditional medical expertise that it has barely begun to exploit.

Talk of indigenous medicine is often greeted with condescending colonial stereotypes of witch-doctors peddling snake oil. This is not helped by the ridicule inspired by leaders like former Gambian strongman, Yahya Jammeh, who claimed to be able to cure Aids using massages and a herbal concoction, or by the attempts by the regime in Madagascar to market an unproven and similarly ineffective cure for Covid-19. Back in 1969, Kenya’s first president, Jomo Kenyatta, condemned traditional healers as “lazy cheats who want to live on the sweat of others”.

Yet while quacks and fraudsters doubtless exist, there is compelling evidence that the majority of practitioners are skilled and experienced, and that their herbal prescriptions can be effective. As one recent study notes, scientific research “continues to validate therapeutic claims on medicinal plants made by traditional practitioners”. The Kenya Medical Research Institute also rejects the notion that they are inferior to conventional remedies.

Recognising this, the World Health Organization and the Africa Centre for Disease Control are collaborating in the use of traditional medicine as a basis for potential remedies for Covid-19. Indigenous medicine can also help offset manpower shortages where there are very few conventionally trained healthcare workers. Across Africa, there is one doctor for every 40,000, but one traditional healer for every 500.

By integrating their expertise and knowledge into the existing national health system, with appropriate safeguards, countries can bolster the deficit in medical personnel. This eases the burden on the public health system, freeing up resources to be employed in dealing with emergencies like Covid-19.

Three years ago, Kenya’s parliament adopted a new health law requiring the government to do just this. To date the law remains unimplemented. Apart from depriving the country of a valuable asset in the war against Covid-19, the lack of official recognition leads to continued stigmatisation of traditional medicine and makes it difficult for the public to distinguish between fraudsters and genuine practitioners. It starves the sector of the investment needed to translate indigenous knowledge into cheap, standardised and accessible medical services and products.

The problem exists across the continent. While most countries had by 2018 developed national or state level laws and regulations to govern traditional medicine, only three African states, Benin, Ghana and Mali, reported having an existing national plan for integrating it into their national health services. Such plans should be an urgent priority.

To tackle Covid-19 effectively, and ensure that it is able to provide affordable and sustainable medical services in the long term, Africa will need to mobilise all its resources. It would be a tragedy if, in this fight, the continent failed to use its most effective weapon: its people and their knowledge.


Wednesday, May 13, 2020

Our Worst Foe Is Civilization

In November of 1871, the then Prince of Wales, the future King Edward VII, contracted typhoid fever, a deadly disease which at the time was blamed on sewer gas, a noxious vapor which arose out of the modern conveniences that were a feature of middle- and upper-class homes. Water closets had been heralded by sanitary science as the safest and most efficient means for disposal and, despite the foul smell they were associated with, having one was still considered a privilege. “The pestilence that walketh in darkness” the Times called it, declaring that “our worst foe is Civilization”.

Today the world is stalked by another pestilence, one that does not spare the wealthy and has already afflicted the current Prince of Wales. In the words of the Times 150 years ago, "it is a more terrible, more constant, and far more insidious danger which now occupies the foreground in public anxiety”. Much of the concern is driven by the fact that Covid-19 is not just a disease of the poor. As Prof Alex Broadbent of the University of Johannesburg asks: “Would we care about the increased risk of fatal pneumonia that Covid-19 might cause in Africa, if it did not also greatly increase the risk of fatal pneumonia for prime ministers, business people and university professors, including those in countries where infectious disease and its terrors are supposed to be of historical interest only”? As sewer gas did, coronavirus has “shifted the focus away from the fever dens of the poor to the bedchambers of princes and, more frequently, "ordinary middle-class houses" as sites of disease and death”.

The pandemic is devastating more than just health systems. It is also shattering the illusion of safety engendered by systems which for centuries have concentrated global resources in a few societies, families and individuals while leaving many across the globe without access to basic life-sustaining necessities. And once again, the blame is being laid at the door of “Civilization”, this time in the form of globalization. "It's globalization that has allowed covid 19 to spread around the world at such incredible speed" declares Deutsche Welle, decrying how reliant the West has become on cheap medicines and products from China and India. illustrating just how dependent the world has become on just one economy, China. declares John Gray.

The coronavirus has hugely increased, at least in the short term, the costs of global inequality and exploitation. The question is whether “civilization” will win out as it eventually did in London, where following the Prince's recovery, sanitary reform became a national priority. Will the global pandemic pave the way for reform of the global system to make it more equitable or is John Gray right when he declares in the New Statesman that “the era of peak globalisation is over”?

Undoubtedly, continuing along the same path would entail the powerful accepting vulnerability as the price of inequality. After all, while the poor are paying a steep price for a disease that the wealthy are primarily responsible for spreading, Max Fisher and Emma Bubola note in their piece for the New York Times, that “in an epidemic, poverty and inequality can exacerbate rates of transmission and mortality for everyone”. Therefore in the absence of a vaccine (and a viable one is reckoned to be 12-18 months away), as long as the poor continue to get sick, so will the rich and powerful. How those at the top of the global food chain, be they the citizens of the global North or elites in the global South, act to reduce that vulnerability will depend on the extent to which they are willing to share the wealth along with the diseases.

On the other hand, while it is true that economic globalization has been taking a pummeling of late, a significant retreat as Gray prophesies seems unlikely. Already, there is talk of reopening economies and resuming normal life. Yet without globalization and the accompanying “worldwide production and long supply chains”, the new normal would be an expensive one. It is questionable whether countries like the US and Germany could afford to produce goods and medicines at the cost that they import them from countries like China and India. Or whether their citizens would be willing to forgo access to cheap iPhones to protect the one-percenters.

The other option open to the rich and powerful to reduce their vulnerability is to reform the global systems rather than retreat from them. That will require recognition that their privileged lifestyles are underwritten, as Umair Haque, the London-based consultant and author, notes, by “centuries … of colonialism, capitalism, supremacy, patriarchy”. That has created a world where Europe, which grows no coffee, can make 5 times more from coffee exports than sub-Saharan Africa which does. The global vulnerability to diseases like covid 19 rests on such distortions and inequalities.

Changing this will be impossible if the mold is not broken. And building a world that works for everyone will require more than just tinkering at the edges. As Haque puts it, “without building global systems, nothing much will change”.

At the close of the 19th Century, the scourge of sewer gas was not resolved by reducing the number of flush toilets within individual homes and retreating back into a world of cesspools and outhouses. It was ended through improvements in the unseen plumbing and infrastructure that ensured the sewer system worked for everyone. Not only did London get a new sewer system but in the 1870s and 1880s, hundreds of patents for sewer trap designs as well as water closets and flushing devices.

Similarly, the coronavirus pandemic can provide an impetus for a flood of ideas on how to construct a better global order, rather than for retreating from it. Doing so will not be easy or cheap. But it can be done if the West is willing to invest the resources that it has taken from the rest of the world. And to stop taking a dump on them.