From Togo to the World: a critical perspective on the Global Health policies 3


Medicine as an art between science and culture

Togo is a small country in West Africa with an approximately size of Croatia or Costa Rica. It was colonized by the Germans and the French and today there are around 6 million people living in this thin portion of land.

Despite Togo’s small geographic size, it possesses great cultural, religious, and climatic diversity. Togo’s climate ranges from tropical to savannah, there are more than 40 different languages spoken, and is a multi-religious country with a large diversity of Animistic religions – including a well-known one called Voodoo-, Christianity and Islam.

But, which part of this information could be interesting for discussions on health and medical themes? Why is this important for Global Health?

As a European medical student who has studied medicine for 5 or 6 years at a university that has based its pedagogy mostly from North-American bibliography, I feel that I am not prepared to be a global doctor. The reason is simple: medical schools train students to be doctors in their own countries and for its own cultures. The lack of cultural diversity in education does not prepare students to practice global medicine.

The point is complex and without a clear answer. Although we are all human beings, Homo sapiens sapiens, with a very similar genetic codification, the practice of medicine cannot be generalized into one global health model, but it must be adapted to the local cultures where it is practiced.

Science is to medicine, like the human body is to the human being. Western medicine is nothing without modern science. But it is much more than the simple knowledge of the biochemical reactions or the pharmacological effects at the human receptors. Medicine needs facial expressions. It needs moods and affection. And the reason is because medicine is a human creation for a human consumption.

When a doctor is working on the emergency service in Togo, he is usually called to care for a patient who is in coma. Frequently, this patient comes accompanied by his sister who doesn’t speak the official language of the country. After a great effort to understand what has happened, the doctor finds that the family lives far away and that the patient was unresponsive for an indefinite period of time. The patient needs ventilatory support. And then, the doctor will need to ask for some clinical analysis. However, to do it, the patient’s sister must pay before any laboratory test could be requested – from the blood collection tubes to any other supplementary investigation. Furthermore, his sister tells that before he fell into a coma, he has consulted a traditional healer who had given him some plants that no one’s know.

It’s hard to be a doctor in Togo.

Some people can argue that Togo is an undeveloped African country, with poor literacy rates, deficits in the transport and communication systems, disinvestment in the health sector or where the people used to go to a traditional healer before coming to the hospital. Nevertheless, those are not my points and this is not the moment to discuss them.

The problem of traditional healers is not the traditional healers itself, but the fact that western medicine doesn’t know how to accommodate with them.

Western medicine around the globe is taught with a very limited epidemiology and little awareness about world diversity. If theories about the human genetics are increasingly defending the inexistence of races but the similarities within our species, medical science frequently forgets about the huge multiplicity of human cultures, which necessarily have a tremendous influence on the medical approach and treatment.

It’s time to understand that North-American epidemiology on “afro-american people” is not the epidemiology on the black people. It’s high time to understand that “western medicine” cannot be an imposition from the western cultures in other parts of the world.

Instead of trying to recognize logistical and political problems based on wealthy and technological differences, global health policies should look and research first on the cultural and environmental differences, which are a fundamental goal to promote an efficient patient care.

Medicine, from the beginning, is an attempt to keep Man a Human Being. In Togo, or in any other country, people experience similar types of suffering while they are in the hospital. Even when cultures change the way medicine is practiced, all doctors remember their patient’s tears or their longing for relief to the end of their lives.

However, we are now living in an increasingly global world, and medicine must follow its steps. If global health policy should make an international pressure in governments like the Togolese to invest more on the health system, those policies might also not forget that medicine, to be efficient and useful to the people, must be adapted and conformed with the environment where it is practiced. And the answer to that is not simply applying scientific knowledge indifferently all over the world, but mostly research all over the world.

For this reason, we need a global research, we require an adapted medicine. And for this reason, even if it’s hard today to be a doctor in Togo, it is worth being a doctor in Togo!

Photo credits: Phil Sandys. Segbé, Togo. 2008.
 foto  Tomás Melo Bandeira is a fifth year medical student from NOVA Medical School, Lisbon, Portugal.

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