Of Doctors and Borders

AGADEZ, Niger—My great-grandfather Emmott O’Keefe was a doctor. He made house-calls in Northern North Dakota on a dogsled and carried with him a small black leather bag. Inside, Emmott kept various combinations of useless herbal remedies and semi-potent painkillers—not a single drug capable of prolonging someone’s life. His cooing bedside manner was the only weapon against his patients’ ailments.

This was a century ago.

Today’s hospitals, on the other hand, boast prescription prowess, the hallmark of modern medicine. Hundreds of drugs comprise an impressive pharmaceutical arsenal available to the modern doctor. If you’re lucky, you’ll live to be a hundred with perfect teeth and a six-minute mile.

Yet such optimistic prognosis is not available to everyone.

Take, for example, one-year-old Hassan. Admitted a week ago for malnutrition, pneumonia, and anemia, he is now naked, pale, and wide eyed; his frail ribcage is clearly visible through almost translucent skin. I hold his hands to the blood- and urine-stained mattress as a nurse in flip-flops sticks him repeatedly with a needle, trying to transfuse a unit of expired blood.

A fly lands on his eyeball and he doesn’t blink. The intravenous line slips out of his forearm and sprays blood all over the floor. The nurse throws her hands up in the air, chucks the unit of blood in the trash, and bends down to wipe up the mess with a dirty wad of cotton. Yet he doesn’t cry; the room echoes with labored breaths and his mother’s muted sobbing. Perhaps she is remembering a strikingly similar scene from six months ago, when Hassan’s twin brother died of pneumonia.

This morning, I asked a pediatrician if Hassan had been tested for AIDS. He shook his head and explained, in halting French and broken English, “With children, there’s no point in invoking a social stigma when there’s nothing I can do to treat them anyway. So what do I do? If he gets malaria, I treat it. If he gets pneumonia, I treat it. And I will let him die without the burden of knowing. That’s what I have.”

In some places, like the Central Hospital of Agadez, doctors still carry the small black leather bag of my great-grandfather’s generation. These doctors still administer false hope in lieu of the real thing.

The AIDS crisis in Niger is acknowledged neither by doctors, who refuse patients tests, nor by epidemiologists, who subscribe to much deflated AIDS rate statistics. Though the percentage of infected individuals here is many times greater than the most heavily affected countries in the West, Niger is not South Africa, where as much as 40 per cent of the population is HIV positive, and almost all of them have no idea. In African nations like these, AIDS is rife and medications are next to impossible to come by.

In 2001, generic drug manufacturers surfaced in countries such as India and Brazil that could produce and sell crucial AIDS drugs at a fraction of the retail price. Due to the reduced costs, combination drug therapy could potentially reach up to two to three times as many people as before. Yet 39 American pharmaceutical companies came out in ardent opposition to sharing their secret recipes. They claimed intellectual property was violated. But what about Hassan? Or his brother? And the nameless thousands?

Even though the Food and Drug Administration eventually caved, these drugs are still conspicuously absent from the African interior. About 500,000 Africans receive the antiretroviral medications they seek, but 4.7 million still need them. Our current efforts are simply insufficient. It is not enough to share precious intellectual property rights. We need to be willing to aggressively counteract AIDS with all the ammunition our trillion-dollar pharmaceuticals can provide.

Our world is one divided and sub-divided by arbitrary lines drawn in the sand. These lines make it easy for us to sleep at night, far from the Central Hospital, where patients rot in their own filth and the stale Saharan summer heat. Regardless, a simple truth remains: our drug companies are preventing these sick and dying people from accessing appropriate treatment because of their birth on the wrong side of these imaginary boundaries.

Meanwhile, our cushier side is too distracted by a superficial world of reality TV and cosmetic surgery to even notice the whole continent left behind in the race we call “progress.”



James H. O’Keefe ’09, a Crimson editorial editor, is a human evolutionary biology concentrator in Kirkland house. He is currently researching Nigerois healthcare in Agadez.