Divining without Seeds
The Case for Strengthening Laboratory Medicine in Africa
Publication Year: 2011
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.
Published by: Cornell University Press
Title Page, Copyright, Dedication
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I am privileged to spend much of my time teaching and performing research in one of America’s foremost liberal arts colleges. I work with some of the bright-est young students and some of the most talented biologists in the world. Much of my work is molecular biology, and I am amazed at how many times I get asked about the relevance of my work to health, particularly in Africa, where ...
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As my ideas took so long to crystallize into a book, it is impossible to acknowl-edge everyone whose comments, work, questions, and criticisms helped to pro-duce the manuscript. I cannot but begin by thanking the health workers and scientists who are devoted to addressing infectious diseases in Africa. Many I know personally, some I have even cited, still more I know by reputation alone, ...
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Ohne Diagnostik keine vernünftige Therapie. Erst untersuchen, dann urtheilen, dann helfen. (Without diagnosis, there is no rational treatment. Examination comes first, then judgment, and then one 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, ...
1. The Power of Sight
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It is no exaggeration to say that without the microscope doctors 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 bach-elor’s degree at a Nigerian university. During reading period and exam weeks, my ...
2. Fever: Is It Malaria?
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The first prerequisite for learning anything is thus utterly lacking— The untimely death of Ogonim, the only child of the protagonist in Flora Nwa-pa’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 ...
3. Fever: Beyond Malaria
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I confess myself unable to differentiate certain cases of malarial In 1844, in Zeitschrift für rationelle mediz, a treatise exhorting physicians to apply 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 ...
4. Drug Resistance
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...“Achilles heel” in global efforts to combat HIV, tuberculosis, and Between 1990 and 2000, childhood deaths from malaria rose across Africa. Sub-stantial advances in the treatment and prevention of other major killers of chil-dren, particularly oral rehydration therapy for diarrhea and vaccination against pneumonia bacteria,1 were offset by increases in malaria mortality. Although ...
5. Viral Hemorrhagic Fevers
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These outbreaks illustrate the high price exacted by introducing mod-ern medicine . . . without due attention to good medical practice.— S. P. Fisher-Hoch et al. “Review of Cases of Nosocomial Lassa Fever Only the wealthiest African patrons of allopathic medicine can afford to have personal physicians. The rest visit overburdened and understaffed health institu-...
6. Detecting Covert Infection ahead of the Final Diagnosis
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One of the pathologist ‘S· e· gun 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...
7. Diagnostic Certainty and Disease Control
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Before attempting the heroic cure of disease, we seek first to 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 prop-erly implemented programs have met with success. Smallpox was eradicated, ...
8. Origins and Outlook of Diagnostic Insufficiency in Africa
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My dangerous idea is that we have in hand most of the information we need to facilitate a new golden age of medicine. And what we don’t have in hand we can get fairly readily by wise investment and 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. Dur-...
Conclusion: The Feasibility of Laboratory Diagnosis in African Settings
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We have the research knowledge, but it is a question of getting it 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 re-form program, which commendably included a stated intention of ensuring ac-...
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Page Count: 240
Publication Year: 2011
Series Title: The Culture and Politics of Health Care Work