Crews in Liberia removing the victims of Ebola to crematoriums.
Ebola is everywhere in the news, replacing Israel and Palestine, replacing Russia and the Ukraine, or typhoons in the Philippines, even IS beheading of westerners has had to play second fiddle to the prospect of the Walking Dead in our daily lives. I wrote a short introduction to the literature on Western Medical interventions in the rest of the world, as sort of intro to Medicine and Science of imperialism if you will. I am posting it for your pleasure below, as I have been so swamped with school and work that my ability to blog has been severely curtailed.
Health workers suit up in for work in Ebola contamination zones.
“Historical Legacy of Colonial Medicine and Science: Some Implications of Consequences of Eurocentric Science a Literature Review”
The imposition of a model of scientific experimentation by the powerful developed nations in medicine and science has led to a debate about the nature of the western derived research oriented science that may not take into account the interests of the subjects of these studies. The model of bioethics and its universality when the discourse has been dominated by imperial, colonial and post-colonial powers since the rise of modern scientific medicine in the nineteenth century taints the science and medicine as it impacts vulnerable and less politically powerful constituencies. This dominance has come under scrutiny as the underlying motivations, of the so called scientific and humanitarian efforts of the western powers, is increasingly being questioned as a more holistic, human rights approach may be the path to social reform.
Image courtesy of Wellcome Trust
Colonial Medical Practice
Looking at European practitioners of tropical medicine, Neill documents how the research and development of treatments for diseases in the tropics were driven by the assumed superiority of these representatives of the imperial powers and how their ethical systems based on an ideal of laboratory research resulted in the discovery of pathogens but limited in their approach to treatment. The researchers and practitioners ultimately served the interests of the colonial powers. Examples from the French colonial practices in West Africa established patterns that during an epidemic of Sleeping Sickness in French controlled Guinea and British controlled Serra Leone the health experts advocated and established concentration camps to isolate and treat victims with largely ineffective arsenic based medications. I think the study seems especially pertinent as it explains some of the background to resistance to medical practitioners in the current Ebola epidemic.
Dutch Colonial Images
The Sleeping Sickness epidemic of the turn of the 20th century is speculated to have been the result of disruptions of the local ecology by the colonial enterprises were enough to set off an epidemic. Neill states “Even at the time, most people agreed that there was a relationship between the rapidity of the disease’s spread and large-scale colonial development projects, economic activities, and military conquest.” The medical culture and the political and economic system of colonialism conflicted as the needs of the commercial interests would thwart the best medical practices this created an us versus them conflict in which the medical practitioners ended up deferring to other interests.
French African Policy
The development of an ideology of “pure science” by J.C. Koningsberger and others in the in the Dutch East Indies in the early part of the 20th century is shown by Goss to be another means by which the cultural imperialism of the west was used to dominate indigenous peoples. When, Indonesia was a Dutch colony, the administration and political elites utilized science, although real and useful, as a propaganda tool to justify maintaining its control of the region, especially in the post-World War One era. Nationalist sentiments among the aspiring classes of the native Indonesians who demanded research hospitals of their own to assume some of the responsibly and status of western science were thwarted by the colonial authority until just before the Japanese occupation in World War Two in Goss’s research. The Dutch system turned objective science into a tool for exploitation. It is ironic in my view that the lack of willingness to recognize the abilities of the Indonesian intelligentsia in part resulted in the independence movement. Instead of inviting the local people racist and cultural attitudes of western superiority fueled the resentment of those whom the imperial westerners were supposedly bringing into the enlightenment of the west as Said has so clearly expounded.
Blatant Racist Imperialism of the 19th Century
Science and imperialism are linked in the development of western science. Arnold shows that India had its own well developed medical traditions when the British gained ascendancy over the subcontinent. The Indian science has been considered to be degenerate by Orientalist writers as a result of Muslim occupation and the chaos after the breakup of the Mogul Empire. The mythology being that western intervention came to rescue a formerly advanced scientific tradition that had succumbed decadence, and needed to be saved from the vicissitudes of fate.
The introduction of the British colonial administration actually disrupted the development of Indian science and medicine which, Arnold shows, has until recently been seen as the introduction of British advanced scientific methods into a stagnant Indian landscape. Arnold states “The idea of a simple diffusion of a monolithic and progressive Western science into passively recipient extra-European lands has been challenged from several standpoints.” Diffusionist views, often held to be the model, considered science to be neutral and not culturally biased, now seems to be somewhat naïve. The idea of a passive indigenous population receiving dollops of western scientific medicine was and is not practical. The interaction between colonial administrations and indigenous subjects had to be mediated by the local practitioners and accumulated field knowledge on the ground. This can clearly be seen in the evidence of people in West Africa running from medical practitioners dressed like aliens, or even attacking aid workers if there is not a proper communication and cooperation.
Last edited by Blackleaf; May 11th, 2014 at 11:40 AM..www.prisonersofeternity.co.uk
British Empire Personified. Rule Britannia.
It is the hierarchical dominance of the British science establishment over the local colonial science and the increasingly marginalized indigenous science in India that is a hallmark of the dominant Eurocentric scientific paradigm that has pervaded science since the 18th century and led to the biases in medical practice to this day. This is reflected in the faith in the civilizing mission of western science and its breakthroughs in technology in the industrial revolution. Indian nationalists often accepted this model of following the western lead to modernity but others rejected it as leaving India always subservient to the West.
Photograph from “The Decline and Fall of the British Empire” (Corbis)
Members of a British army polo team in Hyderabad, India.
This model of development has had repercussions in modern attempts to fight out breaks of disease as well as the imposition of European based testing models on developing countries. Garrafa and Lorenzo point out that the US and other developed countries perform clinical trials in involving poor third world subjects and the use of double standards in research are a form of moral imperialism. The WMA General Assembly rejection of attempts by the USA to modify the Helsinki Declaration to allow this type of research has led to the American abandonment of the Declaration and developing regional seminars to train local practitioners to spread the model preferred by the US. This is a case of “Indirect Moral Imperialism.”
Case studies such as that of clinical trials studying “the prevention of vertical transmission of HIV between pregnant women and their babies” used placebos in the control group, which was denounced as unethical. Other examples including the infamous case of the Tuskegee Syphilis study where patients were denied access to penicillin as Smolen writes among many others condemning these actions. The scientists doing the research did not inform the patients of the availability of the drug. Also the director of the program, one Dr. John C. Cutler, ran a program for the Public Health Service and the National Institutes of Health, in Guatemala where patients were deliberately infected with sexually transmitted diseases. This is a case of racist and imperialist medical practice. While there have been efforts to curb such blatantly unethical practices, as noted in the “Belmont Report,” it does not address the basic inequity of a system that pits powerful corporations and medical-governmental-industrial complexes against poor peoples around the world with little institutional support.
Doctors with ‘patients’ in Tuskegee Syphilis Experiment
Research done by Hewitt and Amola on the local cultural response to an Ebola outbreak in 2000 – 2001 in which surveys were done of students, adults and survivors of the outbreak among the Acholi people of northern Uganda has shown that practices of traditional healers have a sound basis. These include isolation of those suffering from an outbreak. Care giving is limited to survivors of an epidemic, or to the elderly, if survivors are not available. Placement of clear identifiers outside the house where the victims are located, and maintaining quarantine for a month after recovery of survivors are among these ongoing practices. This is thought to be a tradition that has preceded the colonial period and mirrors modern medical practice in many respects. Others such as refraining from sex and promoting harmony within the family were also recommended by traditional healers. The research found that other practices related to burial had a negative effect but that with communication between the local traditional healers and the health workers, the local people modified their practices. The ill ran away from ambulance’s sent to take them to the hospital largely because of the practice of not informing relatives of the death of the patient and a fear that westerners would sell body parts. Recommendations suggest a greater sensitivity to cultural practices and working with traditional healers rather than stigmatizing them. The study indicates that unlike the common belief among international health care workers that traditional practices are a hindrance to healing, that they can be helpful as local people have developed their own methods to deal with epidemics.
Toumi takes the position that the UNESCO Declaration on Bioethics and Human Rights argues for the medical education system to teach redistributive justice in global health care with an emphasis on the interconnected nature of the world and its heath. Instilling a bioethics that reflects the universal rights of man, there will come a generation of doctors who focus on the needs of the populace of the world as a whole. The need for this holistic approach is an argument that is hard to deny in the face of current world epidemics in which the neglected developing nation health care systems have become the breeding grounds of biological disease. In this there is a basis for hope that a genuinely redistributive allocation of resources will finally compensate for the imbalances caused by the scientific exploitation of the rest of the world by the western powers over the last couple centuries. The medical necessity of insuring global health security may point the way once it is clearly shown that western science has, while helping develop cures for diseases, also is implicated the generations of human misery.
Looks like my footnotes don’t transfer from word to my blog. If anyone has an idea as to how that works let me know. I am not really up to reformatting everything into MLA style at least not tonight. I will post the bibliography from a previous version, it is not comprehensive but at least it does list the sources I quote. I will have to go back in at some point and put in MLA in text citations, but as a blog, and not an academic paper this should be adequate.
Arnold, David. Science, Technology and Medicine in Colonial India. Port Chester, NY, USA: Cambridge University Press, 2000. ProQuest ebrary. Web. 5 October 2014.
Garrafa, Volnei, and Lorenzo, Claudio. “Moral Imperialism and Multi-centric Clinical Trials in Peripheral Countries.” Cadernos De Saúde Pública, 24.10 (2008): 2219-2226.
Goss, Andrew. “Decent Colonialism? Pure Science and Colonial Ideology in the Netherlands East Indies, 1910–1929.” Journal of Southeast Asian Studies, 40.1 (2009): 187-214.
Hewlett, Barry S. and Amola, Richard P. “Cultural Contexts of Ebola in Northern Uganda.” Emerging Infectious Diseases. 9.10 (2003) 124–1248.
Neill, Deborah. Networks in Tropical Medicine: Internationalism, Colonialism, and the Rise of a Medical Specialty, 1890–1930. Palo Alto, CA, USA: Stanford University Press, 2012. Print.
Smolin, David M. “The Tuskegee Syphilis Experiment, Social Change, And The Future Of Bioethics.” Faulkner Law Review 3.2 (2012): 229-251. Academic Search Complete .Web. 30 Sept. 2014
Toumi, Rabee. “Globalization and Health Care: Global Justice and the Role of Physicians.” Medicine, Health Care and Philosophy, 17.1 (2014): 71-80.