African voices (finally) get to tell their stories about health efforts

Health workers rest outside a quarantine zone at a Red Cross facility in eastern Sierra Leone in this file picture from December last year. Baz Ratner/Reuters

There have been several complaints about how the story of the response to the Ebola outbreak in Liberia, Sierra Leone and Guinea is being told in the media.

The main protests have been about the fact that the stories sometimes do not match reality on the ground, that you are more likely to hear about US and European volunteers and donations from global health agencies than about frontline African health workers and community volunteers doing much of the work.

American journalist and academic Howard French recently wrote an open letter to the producer of 60 minutes, a US TV programme, criticising its feature on ebola in Liberia by correspondent Lara Logan:

“In that broadcast, Africans were reduced to the role of silent victims. They constituted what might be called a scenery of misery: people whose thoughts, experiences and actions were treated as if totally without interest… Liberians not only died from ebola; many of them contributed bravely to the fight against the disease, including doctors, nurses and other caregivers, some of whom gave their lives in this effort. Despite this, the only people heard from on the air were white foreigners…”

Health stars tell their stories

There’s nothing new about this, which is why Francis Omaswa, an African health leader and Nigel Crisp, a former CEO of the National Health Service in England, have edited a collection of essays African Health Leaders: Making Change and Claiming the Future.

They invited a cast of several global health stars from Africa to reflect on their work and achievements, public health challenges in Africa and what must be done to address them now and in the future.

The book gives a vivid sense of the public health landscape in Africa, and of the similarities and differences in challenges and potential solutions over time and across the countries: from the immediate post-colonial period to Alma Atta, from HIV to the millennium development goals.

However, the book is long on challenges and short on how they came to be; long on achievements, but short on personal stories of the journeys that led to them; long on potential solutions but short on why they are not already in place. In some parts it reads almost like a journal article, a policy statement or an NGO report.

Recounting events brings stories to life

But in the parts where it comes alive, the book is deeply satisfying. For example Peter Mugyenyi details the early years of the HIV response in Uganda; Miriam Were writes about initial scepticism about her community programmes in Kenya; and Chisale Mhango gives an account of her work combating maternal mortality in Malawi.

My favourite chapter is written by Omaswa. There was a certain bite and clear-headedness to this chapter, a commitment to tell it like it is.

Omaswa traces weak leadership in health in Africa to when Africans went “begging for advice and money and got both in exchange for… self-respect, self-confidence and self-determination… and were forced to accept and implement solutions they knew would not work.”

For him, “until and unless we Africans… feel the pain and the shame of our situation we will not have the commitment to take the actions needed.”

He proposes that African health leaders establish vibrant and independent think tanks to generate local evidence and hold corrupt governments to account.

I wish more authors were as candid as Omaswa.

Rwandan health minister Agnes Binagwaho describes impressive progress in the Rwandan health sector and adds this throwaway comment: “Now that our system has been independently evaluated … those who did not think that it would work in the past are starting to look at our vision in another way.”

The three paragraphs that followed were about the need for donor confidence. I wish she discussed what she meant by this in more detail.

Having two audiences blunts the message

Perhaps the book is not as confronting as it might be because of its double audience.

The book is addressed to Africans, although it is not clear which category – health workers, policy makers, researchers, politicians and emerging leaders. It is also addressed to foreigners. The editors write that it is “about Africans re-claiming their place as leaders in health” because, like the Ebola feature on 60 minutes, “most accounts of health and health care in sub-Saharan Africa are written by foreigners.”

But having double audiences necessitates what the African-American social scientist W.E.B. Du Bois described as double consciousness: “This sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity.”

What would the book read like if all the authors had intended to address Africans?

We also rarely got to meet the authors, and they do little to help emerging global health leaders in Africa and elsewhere think through a path for bringing improved health to their people.

This book could have started this dialogue more robustly, but what it’s done is a good beginning. I can’t wait for another book, a sequel perhaps, which takes on these issues more directly. There are too many things we don’t talk about in global health.