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Divining without Seeds

The Case for Strengthening Laboratory Medicine in Africa

Iruka N. Okeke

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

Series: The culture and politics of health care work

Title Page, Copyright, Dedication

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pp. 1-6


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pp. vii-8

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pp. ix-xii

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 brightest 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...

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pp. xiii-xv

As my ideas took so long to crystallize into a book, it is impossible to acknowledge everyone whose comments, work, questions, and criticisms helped to produce the manuscript. I cannot but begin by thanking the health workers and scientists who are devoted to addressing infectious diseases in Africa. Many...


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pp. xvii-18

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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....

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1. The Power of Sight

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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...

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2. Fever: Is It Malaria?

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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...

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3. Fever: Beyond Malaria

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pp. 38-49

Over a century and a half later, Henle’s eloquent description of the problem of confounding causes with effects remains applicable to the case of fevers in Africa. Despite scientific advances in the understanding of specific febrile illnesses, the treatment of fever continues to be based on empirical symptoms rather than...

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4. Drug Resistance

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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...

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5. Viral Hemorrhagic Fevers

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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...

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6. Detecting Covert Infection ahead of the Final Diagnosis

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pp. 91-105

One of the pathologist Segun 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...

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7. Diagnostic Certainty and Disease Control

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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...

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8. Origins and Outlook of Diagnostic Insufficiency in Africa

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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...

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Conclusion: The Feasibility of Laboratory Diagnosis in African Settings

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pp. 141-161

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...


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pp. 163-186

Works Cited

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pp. 187-211


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pp. 213-222

E-ISBN-13: 9780801460906
Print-ISBN-13: 9780801449413

Page Count: 240
Publication Year: 2011

Edition: 1
Series Title: The culture and politics of health care work