TCS Daily

Pruning The Constant Gardener

By Damon B. Ansell - August 8, 2005 12:00 AM

Growing up in Africa, I witnessed first hand the benefits of prescription drugs. My stepfather, a South African, survived polio as a child in the 1940s; 40 years later, I survived a severe case of malaria while I was living in Kenya.

Considering my upbringing, I was discouraged to learn that Focus Features was developing a film version of John Le Carre's book, The Constant Gardener, which will open on Aug. 26. The story is a penetrating criticism of drug companies and the abuse of poor people to further cures for wealthy Westerners. I believe that this criticism is founded on disrespect and misrepresents both Africa and the pharmaceutical industry.


When it came time to test Jonas Salk's polio vaccine in 1955, the National Foundation for Infantile Paralysis turned to the five largest pharmaceutical companies in America because they had the expertise and experience necessary to administer the trial. Fifty years after my stepfather survived polio, a global effort to eradicate polio has largely succeeded. So far this year, there are only 827 reported cases of polio worldwide. Imagine if we could say the same about AIDS, or malaria.


When I contracted malaria from parasites carried by mosquitoes, I was treated with quinine sulphate, the substance that makes tonic water taste different than seltzer water. Quinine was first isolated from species of the cinchona tree in 1820. It is not a very remarkable plant, except that it cures and prevents malaria and many minor ailments besides.


Tropical parts of Africa have emerged as the leading world suppliers of quinine bark derived from the cinchona tree. In that sense, the prevalence of the cinchona tree and the inability to save lives with quinine is yet another African paradox. According to the Centers for Disease Control, an estimated 700,000 - 2.7 million persons die of malaria each year, 75% of them African children. I was lucky.


Le Carre's 500-page effort to blame drug companies for our global failure to address African disease epidemics is not all that original. Instead, this kind of blame is a convenient way of distorting the truth. Surely the problem is dire, and there are many factors involved, but papering the problem with tinsel and calling it an Oscar won't improve the availability of quinine tablets or anti-retrovirals.


Movie studios capitalize on the shortest common attention span, and therefore must gloss over certain complicated details. For example, Africa lacks health care workers who are trained to administer pharmaceutical drugs. Health care workers are at high risk of contracting AIDS themselves, a tremendous disincentive for joining the profession. Poor working conditions cause health care professionals to leave their posts. Over 18,000 nurses have fled Zimbabwe alone. Even if U.S. dollars grew on baobab trees, stifling regulations and licensing restrictions prevent health care workers from opening new clinics. Importing medical equipment requires heavily restricted permits often obtained by bribe, adding costs that raise the suspicion of aid agencies.


Meanwhile, governments are deeply suspicious of civil society and the institutions that support it. The public doubts whether their governments can manage public health programs. Long experience has taught that governments will loot public agencies to build palaces, arm their militaries, and travel to luxury resorts.


Still, it isn't helpful to call African governments corrupt. Corruption is no excuse to wash our hands of global health problems. Ultimately the problem is one of scalability: the world community can prevent two-thirds of child deaths in Africa but we can't deliver treatment. Rather than imposing a Western blueprint on African societies, however, we must take a good long look at the way that heath care (in whatever available form) is actually provided in Africa and craft our policies accordingly.


We must consider a pan-African approach to share best practices and skills.


We must support African institutions and tie our confidence in those institutions to aid dollars.


We must admit that aid organizations cannot create a sustainable health care system for Africa -- Africa must do it herself.


We must acknowledge that government policies create poverty, and that conditions of poverty are conducive to the spread of diseases like AIDS and malaria.


And we must celebrate successes to instill hope.


The Infectious Diseases Institute in Uganda is one such success story. It was built and remains largely funded by the pharmaceutical company Pfizer, Inc. The institute trains doctors to treat AIDS patients and administer anti-retroviral drugs. So far, it has trained 320 doctors from 15 different countries. On average, and far exceeding expectations, each doctor trained 83 additional people over the first five months after leaving the institute. Training the trainers is important because the flow of drugs to Africa is increasing but education in how to use them is not.


In the fight to save lives in Africa, we must respect the complexity of the problems involved. Governments must play a role; Nigeria recently agreed to a plan that ties debt relief to government transparency. The media must play a role in disseminating information that increases educational awareness and incites behavioral change. And the private sector must play a role: De Beers was one of the first companies in Africa to provide anti-retrovirals for its employees.


In my father's house in Karen, Kenya, a suburb of Nairobi, we have several Le Carre novels on our shelves. I enjoy his spy novels, but I am disappointed that he has so poorly misrepresented Africa's greatest tragedies. In the future, I hope that Le Carre will stick to cloak-and-dagger intrigue rather than alluding to a mistaken sense of reality.


Damon B Ansell is a co-founder of Uhuru


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