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Divining without Seeds

Divining without Seeds: The Case for Strengthening Laboratory Medicine in Africa

Iruka N. Okeke
Copyright Date: 2011
Edition: 1
Published by: Cornell University Press,
Pages: 240
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  • Book Info
    Divining without Seeds
    Book Description:

    Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa.

    The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers-including malaria-to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.

    eISBN: 978-0-8014-6090-6
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface
    (pp. ix-xii)
    Iruka N. Okeke
  4. Acknowledgments
    (pp. xiii-xvi)
  5. Abbreviations
    (pp. xvii-xviii)
    (pp. 1-8)

    On a typical day at a health center in southwestern Nigeria, patients arrive long before the outpatient clinic opens. Most patients are infants or young children, strapped to the backs or held to the breasts of tired young mothers. Babies wear pretty cotton print outfits and rubber shoes or slippers, perhaps with white socks. A trip to the clinic is an important outing, even if the visiting child is precariously close to death. Hospital visits place patients and their guardians in close proximity to some of the most highly respected members of their community. Mothers wear traditional apparel that permits...

    (pp. 9-20)

    Anyone who has lived in malaria-endemic Africa has probably been a victim of the febrile diagnostic quandary, whether they know it or not. Personally, I have only vague recollections of the month of my final examinations for the bachelor’s degree at a Nigerian university. During reading period and exam weeks, my days began before dawn with frantic studying crammed in before the evening, when I was regularly felled by fever and headache. I had made three visits to the university health center in as many weeks. Each time, my temperature was taken, and I was examined by a medical doctor....

    (pp. 21-37)

    The untimely death of Ogonim, the only child of the protagonist in Flora Nwapa’s epic novel Efuru, illustrates the consequences of failing to intervene quickly and effectively in fevers in malarious areas.¹ Set in an Ibo town close to the Niger River in the early twentieth century, the text depicts the time when Western medicine had arrived in Nigeria but was not yet widely available or trusted by the populace. The characters in Nwapa’s tale journey to distant hospitals in the event of major or unusual illnesses, particularly for surgery, but they treat most illnesses in the home or with...

    (pp. 38-49)

    In 1844, in Zeitschrift für rationelle mediz, a treatise exhorting physicians to apply scientific thought and methods to medicine, Jacob Henle wrote:

    Only in medicine are there causes that have hundreds of consequences or that can, on arbitrary occasions, remain entirely without effect. Only in medicine can the same effect flow from the most varied possible sources. One need only glance at the chapters on etiology in handbooks or monographs. For almost every disease, after a specific cause or the admission that such a cause is not yet known, one finds the same horde of harmful influences—poor housing and...

    (pp. 50-64)

    Between 1990 and 2000, childhood deaths from malaria rose across Africa. Substantial advances in the treatment and prevention of other major killers of children, particularly oral rehydration therapy for diarrhea and vaccination against pneumonia bacteria,¹ were offset by increases in malaria mortality. Although the failure to identify and properly implement key preventive interventions has contributed to the continuing prevalence of this disease, malaria parasites do not appear to have become more virulent. The rise in childhood mortality was largely attributable to the emergence and spread of resistance to antimalarial drugs. Resistance to chloroquine, sulfadoxine-pyrimethamine (Fansidar), and newer antimalarials appeared first...

    (pp. 65-90)

    Only the wealthiest African patrons of allopathic medicine can afford to have personal physicians. The rest visit overburdened and understaffed health institutions, usually only when they are very young, pregnant, or severely ill. Patients do not necessarily visit the same institution each time, so that whatever facets of their medical history are documented tend to be fragmented, and prescribers have very little opportunity for patient follow-up. Prescribers rarely express concerns about the difficulties inherent in charting patients’ progress, however. For the most part, they simply do not have the time or resources to do so.¹ Typically, the health system processes...

    (pp. 91-105)

    One of the pathologist ‘ṣẹgun Ojo’s lifelong gripes has been the steady decline of medical laboratory science in Nigeria. Aware of the pressing need to train a generation of competent laboratory diagnosticians and researchers, he committed himself to building the expertise necessary to remedy diagnostic insufficiency. I initially encountered Dr. Ojo in graduate school, when he was a lecturer, researcher, and consultant pathologist at western Nigeria’s Obafemi Awolowo Teaching Hospitals complex. Formally and informally, he mentored residents and students working in subdisciplines as diverse as clinical chemistry, biochemistry, microbiology, and pathology, and encouraged many young practitioners to pursue careers in...

    (pp. 106-124)

    Despite media images that portray Africa as a disease-plagued continent and the concerns expressed, even by medical and public health experts, that in Africa health targets are often set but rarely achieved,¹ some well-planned and properly implemented programs have met with success. Smallpox was eradicated, guinea worm and polio have almost disappeared, and campaigns to control other vector-borne or vaccine-preventable diseases, notably measles and river blindness, are making impressive progress.² Many effective strategies for disease control are disarmingly simple: clean water, adequate nutrition, and depletion of the vectors, such as mosquitoes, that transmit infection. These interventions, which have been primarily...

    (pp. 125-140)

    The chief nursing officer at Ikeja General Hospital, who was always addressed as “Chief Matron,” spoke for ten minutes at a staff orientation in 1990. During her talk, she pleaded that new doctors enter at least a presumptive diagnosis into patient case notes after examination, along with their initial prescription: “A diagnosis is valuable when nursing staff have to manage emergencies,” she explained. As a new pharmacist attending that orientation, I could not understand why Chief Matron devoted half of her allotted time to something so obvious. Fresh out of Nigeria’s premier pharmacy school and an internship at a university...

  15. CONCLUSION: The Feasibility of Laboratory Diagnosis in African Settings
    (pp. 141-162)

    In May 2009, the Annals of Tropical Medicine and Hygiene published an audit of diagnostic services in the Tanga region of Tanzania. The audit was performed roughly five years after Tanzania had committed to an ambitious health care reform program, which commendably included a stated intention of ensuring access to high-quality and effective laboratory services whenever these were required for diagnosis. The findings were, as described by the report’s Tanzanian authors, “depressing”:¹ most of the labs failed to meet the Tanzanian national recommendations. As few as eighty-four personnel staffed thirty-seven health laboratories, most of whom lacked training in diagnostic laboratory...

  16. Notes
    (pp. 163-186)
  17. Works Cited
    (pp. 187-212)
  18. Index
    (pp. 213-222)