Richard G. Lugar Center For Richard G. Lugar Center For

Rural HealthRural Health

By: James A. Turner, D.O.By: James A. Turner, D.O.

Challenges of Global Health:A Doctor’s Experience In Kenya

Richard G. Lugar Center for Rural HealthBy: James A. Turner, D.O.

““Ex Africa Semper Anquid Novi”Ex Africa Semper Anquid Novi”“Out of Africa, Always Something New”“Out of Africa, Always Something New”

Roman Scholar, Pliny the Elder, A.D. 23-A.D. 79Roman Scholar, Pliny the Elder, A.D. 23-A.D. 79

Queen Victoria—Great Queen Victoria—Great BritainBritain

““Scramble” for Africa in Berlin, Scramble” for Africa in Berlin, London, Paris, Rome, late 1800s.London, Paris, Rome, late 1800s.

““Terra Incognita” limited knowledge Terra Incognita” limited knowledge of coastline only.of coastline only.

“We have been giving away mountains and rivers and lakes to each other, only hindered by the small impediment that we never knew exactly wherever they were”.

Lord Salisbury British Prime Ministry

10,000 African tribal and political groups 10,000 African tribal and political groups amalgamated into 40 European colonies and amalgamated into 40 European colonies and protectorates.protectorates.

African rulers who resisted colonial African rulers who resisted colonial rule died in battle, executed, or rule died in battle, executed, or exiled.exiled.Guerilla warfare “scorched earth” Guerilla warfare “scorched earth” tactics.tactics.

European rule, by treaty and conquest, European rule, by treaty and conquest, awarded Britain 2 million square miles, awarded Britain 2 million square miles, France with 3.75 million square miles.France with 3.75 million square miles.

Hall of Mirrors, Palace of VersaillesHall of Mirrors, Palace of Versailles The peace treaty for the “war to end all The peace treaty for the “war to end all

wars”.wars”. German colonies in Africa divided among German colonies in Africa divided among

allied victors.allied victors.

By 1930s revolts ended, colonial By 1930s revolts ended, colonial states entrenched states entrenched Over 16,000 Christian Missionaries Over 16,000 Christian Missionaries serve Africaserve AfricaOften the only opportunity for Often the only opportunity for educationeducation

Nobel Peace Prize—Nobel Peace Prize—19931993

Born in 1918 in South Africa, baptized Born in 1918 in South Africa, baptized into Wesleyan (Methodist) Church into Wesleyan (Methodist) Church and sent to school. There he was and sent to school. There he was

given the name “Nelson”.given the name “Nelson”.

Pearl Harbor, December 7, Pearl Harbor, December 7, 19411941

Massive changes in infrastructureMassive changes in infrastructure PortsPorts RoadsRoads AirportsAirports Supply DepotsSupply Depots Mining ActivityMining Activity

1941 – Atlantic Charter – supporting 1941 – Atlantic Charter – supporting the rights of all people to choose the rights of all people to choose their own government and destiny.their own government and destiny.

375,000 Africans of British colonies 375,000 Africans of British colonies and 80,000 from and 80,000 from

French colonies fought in WWII.French colonies fought in WWII.

Churchill/Roosevelt 1943 Churchill/Roosevelt 1943 Meeting In CasablancaMeeting In Casablanca

President Roosevelt visited Ghana, President Roosevelt visited Ghana, “appalled at the poverty.”“appalled at the poverty.”

““To give independence without To give independence without preparation for the business of preparation for the business of government, is like giving a child a latch-government, is like giving a child a latch-key, a bank account, and a shotgun.”key, a bank account, and a shotgun.”

Post WWII, universities began to study the Post WWII, universities began to study the archaeology, sociology, and politics of Africa as archaeology, sociology, and politics of Africa as the “cradle of mankind”.the “cradle of mankind”.

1959 – Dr. Leaky in Tanzania – “Dear Boy” 1.8 1959 – Dr. Leaky in Tanzania – “Dear Boy” 1.8 million years old. million years old.

“ “Lucy” first Homobid to walk upright –Lucy” first Homobid to walk upright – 3.2 million year old skeleton found in Ethiopia3.2 million year old skeleton found in Ethiopia..

Economic activity left to multi-national Economic activity left to multi-national corporationscorporations Europeans begin to lose Europeans begin to lose interest as few regions offered interest as few regions offered immediate wealthimmediate wealth Tribal chiefs—indirect rule—government orders Tribal chiefs—indirect rule—government orders..

Workers often isolated in company ownedWorkers often isolated in company owned camps near camps near farms or mines in wretched living conditions.farms or mines in wretched living conditions.

Economic activity left to multi-national Economic activity left to multi-national corporationscorporations Europeans begin to lose Europeans begin to lose interest as few regions offered interest as few regions offered immediate wealthimmediate wealth Tribal chiefs—indirect rule—government orders Tribal chiefs—indirect rule—government orders..

Workers often isolated in company ownedWorkers often isolated in company owned camps near camps near farms or mines in wretched living conditions.farms or mines in wretched living conditions.

““Get to know your district and your Get to know your district and your people. Keep an eye on them, collect people. Keep an eye on them, collect tax if possible, but for God’s sake, don’t tax if possible, but for God’s sake, don’t worry headquarters”. District officer in worry headquarters”. District officer in Nigeria Nigeria 10,000,000 citizens. 10,000,000 citizens. 9 European administrators.9 European administrators.

The Coming of TyrantsThe Coming of TyrantsFirst 10 years of independence, 40 successful coups and countless attempts.Claim to “clean up the morass of corruption, tribalism, nepotism, and restore honest and effective government”In recent study, 59 of the wealthiest people in Africa held long-time government positions, worth at least $3.9 billion, 40% held off-shore.GDP of Nigeria with 14,000,000 is $10 billion ”The names of honest ministers and senior officials would fit on back of a postage stamp.”

First 10 years of independence, 40 successful coups and countless attempts.Claim to “clean up the morass of corruption, tribalism, nepotism, and restore honest and effective government”In recent study, 59 of the wealthiest people in Africa held long-time government positions, worth at least $3.9 billion, 40% held off-shore.GDP of Nigeria with 14,000,000 is $10 billion ”The names of honest ministers and senior officials would fit on back of a postage stamp.”

““We see Africa as probably the greatest open field We see Africa as probably the greatest open field of maneuver in the world-wide competition of maneuver in the world-wide competition between the communist block and the non-between the communist block and the non-

communist”.communist”. President Kennedy, 1962President Kennedy, 1962

Challenges of independenceChallenges of independencePoorest and least developed continentPoorest and least developed continentHarsh climateHarsh climate16% adults literate, 3% secondary16% adults literate, 3% secondaryeducation—shortage of skilled manpowereducation—shortage of skilled manpowerPopulations tripled from 1950—1980Populations tripled from 1950—1980Urban population doubled every 10 years--Urban population doubled every 10 years--seeking jobsseeking jobsGeneral Motors, DuPont and Bank of America General Motors, DuPont and Bank of America

have assets that exceed GDP of all Africa.have assets that exceed GDP of all Africa.

10% of world’s population10% of world’s population 70% of world’s cases of HIV70% of world’s cases of HIV Over 20,000,000 deaths, 30,000,000 infected, Over 20,000,000 deaths, 30,000,000 infected,

3,000,000 new cases/year3,000,000 new cases/year ½ infected before age 25, most die by age 35, the ½ infected before age 25, most die by age 35, the

most productive yearsmost productive years Crisis denied or dismissed by dictators and “racist Crisis denied or dismissed by dictators and “racist

propaganda to dampen the reproduction capacity of propaganda to dampen the reproduction capacity of Africa”Africa”

Majority of cases of HIV are still not diagnosed – Majority of cases of HIV are still not diagnosed – stigmastigma

Polygamy “Grazing”Polygamy “Grazing” World Health Organization “prevent orphans” with World Health Organization “prevent orphans” with

treatment treatment Over 14,000,000 HIV orphans in AfricaOver 14,000,000 HIV orphans in Africa Commercial sex workersCommercial sex workers

MalariaMalaria Anophlephes mosquitoAnophlephes mosquito Fever, sweats, pain, coma and Fever, sweats, pain, coma and

deathdeath Only behind diarrhea illness Only behind diarrhea illness

(dehydration) as world-wide killer (dehydration) as world-wide killer of childrenof children

Gates Foundation--$5,000,000,000 to fight HIV, TB, Gates Foundation--$5,000,000,000 to fight HIV, TB, “worst thing on the planet” Malaria“worst thing on the planet” Malaria

Corruption – poorly administered programsCorruption – poorly administered programs Severe manpower shortage in health profession, little Severe manpower shortage in health profession, little

primary careprimary care 60% of foreign aid – USAID, NGO, some faith-based60% of foreign aid – USAID, NGO, some faith-based

never--leaves the U.S.never--leaves the U.S.

PEPFAR -- $15,000,000,000 six drugsPEPFAR -- $15,000,000,000 six drugs Provided (no generics), in U.S., 20 Provided (no generics), in U.S., 20

drugs availabledrugs available Due to viral resistance and unreliable Due to viral resistance and unreliable

healthcare structure, prolongs life on healthcare structure, prolongs life on average of only 4 yearsaverage of only 4 years

Neglected DiseasesNeglected Diseases Tropical infections, endemic in low-Tropical infections, endemic in low-

income populations in Africa, Asia, income populations in Africa, Asia, and the Americasand the Americas

Up to 1,000,000 deaths per year and Up to 1,000,000 deaths per year and global disease burden equivalent to global disease burden equivalent to HIV AIDSHIV AIDS

With weak immune system, these With weak immune system, these diseases even more deadlydiseases even more deadly

Pain management in economically Pain management in economically deprived countries.deprived countries.

Neglected DiseasesNeglected Diseases Bacterial InfectionsBacterial Infections

LeprosyLeprosy Buruli UlcerBuruli Ulcer TrachomaTrachoma CholeraCholera

Viral DiseasesViral Diseases Yellow FeverYellow Fever Dengue FeverDengue Fever Japanese EncephalitisJapanese Encephalitis

Neglected DiseasesNeglected Diseases Kala-azarKala-azar African Sleeping SicknessAfrican Sleeping Sickness Chagas DiseaseChagas Disease

▪▪Worm ParasitesWorm Parasites SchistosomiasisSchistosomiasis Lymphatic FilariastisLymphatic Filariastis OnchocerciastisOnchocerciastis AscariastisAscariastis TrichuriasisTrichuriasis HookwormHookworm

Yellow FeverYellow Fever Mosquito-borne virus – proven 1900 Mosquito-borne virus – proven 1900

by Walter Reedby Walter Reed Attacks liver, black vomit, die within Attacks liver, black vomit, die within

daysdays No specific treatmentNo specific treatment Vaccine, repellents, nettingVaccine, repellents, netting

Guinea WormGuinea Worm Ingest contaminated water with larvaeIngest contaminated water with larvae 100 million at risk100 million at risk Worm ruptures through skinWorm ruptures through skin Months to heal – incapacitated, may die from Months to heal – incapacitated, may die from

bacterial infectionsbacterial infections Carter CenterCarter Center

Leishmaniasis carried by the Tsetse Fly –Leishmaniasis carried by the Tsetse Fly – Sleeping SicknessSleeping SicknessMany forms cutaneous and visceral – endemic in Africa and Many forms cutaneous and visceral – endemic in Africa and Middle EastMiddle EastMicroscopic, rod-shaped parasiteMicroscopic, rod-shaped parasiteFever, weakness, liver failureFever, weakness, liver failureNo satisfactory treatmentNo satisfactory treatment

River blindness (Onchocerciasis) “Black Fly”River blindness (Onchocerciasis) “Black Fly” Leading cause of blindnessLeading cause of blindness Parasitic worm – causes intense immune Parasitic worm – causes intense immune

responseresponse Scars corneaScars cornea

Schistosomiasis (Blood Fluke)Schistosomiasis (Blood Fluke) Found in mummiesFound in mummies 300 million people infected world wide300 million people infected world wide Larvae – penetrate skin in fresh water Larvae – penetrate skin in fresh water

–– “ “swimmer’s itch”swimmer’s itch” Invades bladder and liver, die from Invades bladder and liver, die from liver failureliver failure

Projects designed by foreign “technocrats” Projects designed by foreign “technocrats” with little sense of African realitieswith little sense of African realities

500,000 children die of measles, 5 500,000 children die of measles, 5 cents/vaccinecents/vaccine

1,000,000 pregnant women with untreated 1,000,000 pregnant women with untreated syphilis, 25 cents/medicinesyphilis, 25 cents/medicine

HIV—multiple medications, complicated to HIV—multiple medications, complicated to take, side effects, blood tests, and must take, side effects, blood tests, and must battle opportunistic infectionsbattle opportunistic infections

United Nations’ United Nations’ 2000 Millennium –2000 Millennium –

Development GoalsDevelopment Goals

Energy ProductionEnergy Production

Economic Growth Requires Economic Growth Requires EnergyEnergy

Energy, like any commodity, Energy, like any commodity, requires decent governance, requires decent governance, functioning institutions, and functioning institutions, and

efficient markets..efficient markets..

50 years after “Independence Era”, African 50 years after “Independence Era”, African prospects are bleaker than everprospects are bleaker than ever

Per capita income 1/3 lower than next poorest Per capita income 1/3 lower than next poorest region, South Asia and lower than in 1980.region, South Asia and lower than in 1980.

Continent GDP is $120 billion comparable to Continent GDP is $120 billion comparable to Mexico.Mexico.

50% illiterate, life expectancy falling50% illiterate, life expectancy falling Most nations bankrupt, Western Aid provides 50% Most nations bankrupt, Western Aid provides 50%

of government/public services.of government/public services.

If we cannot end now our differences, at least we can help makeIf we cannot end now our differences, at least we can help makethe world safe for diversity. For in the final analysis our mostthe world safe for diversity. For in the final analysis our most

basic common link is that we all inhabit this planet. We allbasic common link is that we all inhabit this planet. We allbreathe the same air. We all cherish our children’s future. breathe the same air. We all cherish our children’s future.

And we are all mortal.And we are all mortal.

President John F. Kennedy