At the end of a discussion on the dangers of the AIDS epidemic in Africa, a Zambian acquaintance commented: "I've been out of work for several weeks. The choice I face is to die of hunger tomorrow or of AIDS in ten years." His dilemma is one I have seen echoed many times in African countries. It has given me a clearer understanding of one of Africa's greatest threats: the hopelessness of the dispossessed.
Zambia's health problems are similar to the situation in most African countries, where unrelenting poverty and widespread disease reign, and hopelessness represents reality. Paradoxically, and painfully, it exists among the most vibrant, warm, and energetic people I have met in my travels around the world.
Because of its economic impact on Africa, the AIDS epidemic is reversing decades of slow improvement in child survival, life expectancy, educational progress, and economic growth. The UN agency dealing with AIDS issues, UNAIDS, estimates that the GDP in the countries most affected by AIDS will decline by eight percent by 2010.
By that same year, according to projections established by the U.S. Census Bureau, sub-Saharan Africa will have 71 million fewer people than normal due to AIDS. By contrast, the bubonic plague is estimated to have killed approximately 30 million people in Europe during the Middle Ages.
Unfortunately, the stigma of AIDS persists in most African countries. Progress in raising awareness has been slow despite the efforts in education and the work of non-governmental organizations. Particularly in rural areas, health problems remain acute. The health services and infrastructure are inadequate and a lack of trained medical personnel is widespread. This problem is exaggerated by the continued exodus of doctors and nurses towards the industrialized nations of the world.
It is a well known fact that many diseases affecting both children and adults could be addressed with minimum resources if they were employed strategically. Diarrheal and respiratory infections, measles and malaria represent the greatest threats to children's health. In addition to which, HIV/AIDS and malnutrition cast an ominous shadow.
It is estimated that African women are 175 times more likely to die during childbirth and pregnancy than women in industrialized countries. If equitable healthcare systems are to be effective, resources must be redirected from curative care in urban settings with high tech equipment to primary and preventive care.
Health problems in Africa cannot be considered in isolation and are not the sole responsibility of Africans themselves. Ways must be found to help people more directly.
Corruption drains the critical resources needed to improve people's health and education. According to statistics released by the African Union, corruption costs the African economies more than 148 billion dollars a year. This figure represents 25 percent of Africa's gross domestic product (GDP).
If foreign aid is to be effective it must bypass corrupt governments and work through non-governmental organizations with a proven record of transparency and effectiveness. The practice of bribes and corruption by foreign companies must be curtailed. With this in mind, the industrialized nations should enforce and publicize their own national laws.
In the last few years, excessive emphasis has been placed on economic aid to Africa, which has become a photo-opportunity for the rich and famous. African countries, however, need more than financial aid. They need their human resources to be trained in their own countries, an approach which is cheaper and more effective than training them overseas. At the same time, the industrialized countries should stop the brain drain of countries living at the limit of their possibilities.
If they are committed to assist Africa and its people, financial institutions and donor governments must closely monitor how their funds are spent. Unrestricted financial loans can be more detrimental than helpful, since they only contribute to the corruption of local elites. They need also to put to end loan modalities which lead to a reduction in the social and health services made available to the majority of the population. In a continent ravaged by hopelessness such actions could contribute to a renewal of hope.
Dr. César Chelala is an international public health consultant. He has carried out health-related missions in over 45 countries worldwide.
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