P 15

African Contributions to Global Health

Panel abstract
Medical histories in and on Africa have often focused on Euro-American missionaries, philanthropists, humanitarians, scientists, and organizations. For a long time, discourse on innovation was based on the (tacit) understanding that new developments occur in the West, while lower-income countries in other parts of the world adopt them only after some delay. Challenging these unidirectional models, this panel focuses on African contributions to global health. What knowledge, practices, or applications have been designed for improving health in Africa and have become relevant to global questions of health?
While our panel is motivated by present-day concerns to respond to challenges in health systems, it is based on the premise that intercontinental exchanges in public health share a much longer trajectory, starting before the onset of colonialism and continuing after the Second World War with the emergence of international health politics.

Time: Saturday, 30/06/2018, 8.30 - 10.30 am
Venue: Hörsaalgebäude, HS 17

Benjamin Brühwiler (University of Basel, Switzerland)

Olayinka Susan Ogundoyin (Bowen University, Iwo, Nigeria)
Julia Vorhölter (University of Göttingen)
Sofiane Bouhdiba (University of Tunis, Tunisia)


Paper abstracts

Olayinka Susan Ogundoyin
Patients as Health Seekers: the Contribution of Communication Styles to Positive Health Outcomes in a Typical African Country

Background: Communication is an important aspect of any consultation process as patients visit the hospital with the sole aim of seeking medical care. There are different communication styles that are common between doctors and patients. This study seeks to investigate the implication of these different communication styles on positive health outcomes in Nigeria. Methods: Three research methods were used; they are the survey, direct observation, and the in-depth interview. Accidental sampling technique was used to select 420 patients. The respondents were sampled across three out-patient departments (surgical, medical, and obstetrics and gynaecology). Purposive sampling technique was used to select 60 doctors whose consultation processes were observed, three doctors who were heads of departments, and three patients from the three out-patient clinics for in-depth interviews. Data obtained were subjected to Pearson’s correlation and multiple linear regression analyses at 0.05 level of significance. Qualitative data were analysed thematically. Results: A positive correlation was established between mutuality and patients’ care-seeking behaviour (r = 0.25), mutuality (β = 0.05) and default (β = 0.19) have relative effects on care-seeking behaviour. The in-depth interview with the doctors and patients indicate that the educational status of patients and use of clear and simple language without the use of technical terms enhance their care-seeking behaviour. Conclusion: Mutuality as a type of communication style is perceived to enhance patients’ care-seeking behaviour. Doctors should be encouraged to adopt this communication style so that patients can be bold to ask questions if need be.

Julia Vorhölter
A Pioneer of Psy. The First Ugandan Psychiatric Nurse & Her (Different) Tale of Psychiatry in Uganda

In Africa, the emergence of a ‘modern’ mental health regime centred on psychiatry is often portrayed as a unidirectional intervention by ‘the West’. Analyses ranging from medical histories of colonial psychiatry to more recent studies of global mental health focus mostly on the role of external actors and the ways their actions impact(ed) on local populations. Uncritical studies simply reduce the complexity of African therapeutic landscapes to a ‘treatment gap’ and see the introduction of ‘science-based’ mental health approaches as necessary ‘civilizing’ missions. Critical studies emphasize the harms of psychiatric interventions and celebrate local healing practices instead. Both approaches are problematic: they ignore the many interconnections between what are essentially highly dynamic treatment regimes that cannot be neatly designated as African or Western, portray local populations as largely passive, and neglect the multiple ways in which psychiatry has been embraced, adapted, and disrupted by Africans themselves. This paper challenges simplistic depictions of ‘Western’ psychiatry in Africa by providing a portrait of Rashwana Selina, the first Ugandan psychiatric nurse who – after having been sent to the UK in the 1950s for training – became a central figure in Ugandan psychiatry. In her late 70s at the time I interviewed her, she reflects on her life and career and her formative role in the development of psychiatric care in the colonial and postcolonial era. Her tale of Ugandan psychiatry emphasizes cooperation, mutual acknowledgements, and pluralistic leadership and thus breaks with typical images of and dichotomies between white doctors and supposedly inferior African medical staff.

Sofiane Bouhdiba
The Epidemiologic Transition in Pre/Post-Colonial Africa: End of the Process?

I propose to study the epidemiologic transition in Africa between pre and post-colonial times. The epidemiologic transition has been defined in 1971 by Omran Abderahmen as the shift from a sanitary situation dominated by bacterial, viral, and parasitic diseases (malaria, plague, cholera, rabies, smallpox, etc…) to a health profile where the main causes of mortality are lifestyle diseases (road injuries, cancers, cardiovascular diseases, stress pathologies, etc…). Epidemiologic and demographic transitions (decline in both fertility and mortality levels) are two demographic phenomena closely related. In fact, a population who has achieved its epidemiologic transition will reduce mechanically its infant mortality and increase its life expectancy, contributing to the general decrease in mortality rates. On the other hand, a rising number of surviving seniors will increase the prevalence of diseases specific to the elder, as cancers, mental troubles, or cardiovascular pathologies. Many African populations can be considered today in the third stage of the process (on a total of 4 stages). In such populations, lifestyle pathologies (cancers, stress, cardiovascular diseases, respiratory diseases, etc…) are now dominating the national epidemiologic profile. For example, today, cardiovascular diseases represent the first cause of mortality in Northern Africa, while the second position is occupied by unintentional injuries (mainly road incidents) and malignant neoplasm. But global health is not homogeneous in Africa. In other regions in Africa, the epidemiologic profile is completely different, as the majority of the population is still dying from infectious diseases.