VIS Dispatches

One of the most nauseating sights for me is the display of opulence by AID agencies in the midst of want and abject poverty. But not after I recognized that AID is never meant to achieve what its givers loudly proclaim in the public. It is all a matter of the givers interest who then goes on to imprison the recipient of  the aid in a bid to keep attracting more while all along the greatest beneficiary of the aid is its giver, mainly through implementing agencies, consultants and other semi-skilled minders imposed on recipients as a conditionality. Whilst I could rest at ease with this knowledge, the idea that aid is used to robe its recipient of their dignity and to propagate operations tantamount to crimes against humanity is not only unsettling but extremely annoying to those affected by these operations directly and are powerless.

The proliferation of the global health movement in the 2000 decade, spearheaded by philanthropy to lift developing countries (and I mean Africa) out of poverty was attended by over-investment in single diseases that became elevated above the general health of citizens. Entire health systems became realigned to receive, respond and crave for HIV/AIDS money, often doled through donor institutions operating autonomously but disguised as agents of recipients governments. The enormity of the funds simply had the African expertise shunted (or if willing to play an inconsequential second fiddle co-opted to facilitate covert operations that even they were not in the know) out of the gravy train as the donor agents went ahead to set up research outposts to gather unsuspecting Africa women and children ready for large pharma research.

My experience has been with the inequality involved in the so called partnerships into which Africans are sucked in, their priorities re-oriented, their intellectual property stolen and careers damaged as they line up to become programme officers and research assistants to help recruit research clients, execute the research and produce the so called peer reviewed publications that seem to be at the heart of every expatriate “health aid worker”! That shall be a topic of another day.

I am more concerned that the African researchers and physicians have become unsuspecting agents of bad, unethical research against their own people in exchange for a miserable racist dole in comparison to their partners from “donor countries”.  A report by the   THE REBECCA PROJECT FOR HUMAN RIGHTS UNITED AFRICANS FOR WOMEN & CHILDREN RIGHTS NATIONAL COUNCIL OF NEGRO WOMEN  on NON-CONSENSUAL RESEARCH IN AFRICA THE OUTSOURCING OF TUSKEGEE shockingly surmarises how our researchers, physicians and governments have been abetting crimes against humanity in their insatiable appetite for the green buck. The report offers the following summary:

United States biomedical researchers and pharmaceutical companies are conducting and
paying African doctors to conduct unethical and illegal testing of human subjects.  Non-
consensual research on human subjects is an atrocity that occurred in Tuskegee, Alabama,
and in Guatemala for over forty years.  Once outlawed in the U.S., medical researchers
began experimenting on thousands of human research subjects without their consent in
Cameroon, Ghana, Namibia, Nigeria, Uganda, South Africa, Zimbabwe and other African
countries.  

Believing they were receiving routine medical care, some African women and children were
used to test medication for HIV, malaria, and meningitis, often resulting in infection, and/or
even death. These unethical research practices coupled with the failure to get signed
informed consent violate multiple U.S. and international laws.

The Rebecca Project recommends holding congressional hearings, convening a ?Global
Leadership Ethical Research Forum? through the Council on Foundations for government
and private funders, Food and Drug Administration (FDA) reform, and further collaboration
with advocates and law enforcement to help protect victims and whistleblowers by ending
these Crimes Against Humanity.

US is not the only culprit, but mainly the champions of the so called Global Health, whose origins is in the North.

As usual I don’t expect to see or hear any concern from anyone, yet when it will become obvious that the entire African genomic material is being harvested into biomedical repositories for the sake of research that has no obvious benefit then we shall know that we have screwed up ourselves big time. But I expect Africa to continue sleeping for the heads of medical research institutes and Ministries of health will not see this and if they do, they will be told it is porojo by those that pay them!

How much does the Kenyan government commit towards science and technology?  Well, just slightly over $1 million yearly – a very small amount of money. Compare this with the Tanzanian allocation of $185 Million annual budget. If Kenya pushed its budgetary allocation towards 1% of her GDP, this would amount to about $300 million (about KES 24B), nearly twice as much as TZ. That would give our scientists and researchers a great leverage to engage in generating ideas that can contribute to wealth creation. That should be the scientists clarion call to the Government of Kenya (GoK). Here are some links showing what the GoK has in the past made intention of putting into Research & Development.

1. Sometime in 2003-2 http://www.scidev.net/en/science-and-innovation-policy/features/optimism-sweeps-through-kenyas-science-community.html

2. In 2008: http://ip-kenya.blogspot.com/2008/06/2008-budget-300-million-fund-to-promote.html

NEPAD has been in existence since 2003 and has undergone changes to become the African Ministerial Council on Science and Technology (AMCOST) mainly as an advocacy body for the growth of Science and Technology in Africa. However, it does not appear to have any specific funds to spur this growth but relies on individual governmentst to commit research and development funds. A good example of this is Tanzania that now commits 1% of its GDP to research and development. Kenya can learn from her neighbour and think strategically to increase her contribution to innovative R&D. Kenyan scientists must, like the learned friends who gobble endless amounts of money on one commission of investigation after another, press the case for increased funding by clearly stating that no growth and development can occur without funding productive R&D.

We hear this statement made over and over again, that policy makers in the less developed countries will not take up research findings. To try bridge the gap between recommended best practice and policy, the research world has been trying all sorts of tricks…building up collaborations with aid–recipient countries, disseminating their research findings in the media and yes, supplying copies of systematic reviews to government officials who do not have access to the internet. Despite these efforts uptake of research findings into policy have largely failed.

I would like to illustrate the current research environment in many poor countries by drawing reference to  two branches of the practice of medicine; general practice and psychiatry. With the research world-mainly composed of donor outfits from the more affluent world being the doctors and the poor helpless countries being the patients for which research finding are prescribed to cure ailing health systems. In the practice of general medicine the patient out of pain or discomfort, voluntarily approaches the doctor who runs tests and then prescribes treatment. Compliance to medicine in general practice in most cases is high with majority of patients imbibing most of the drugs prescribed. In poor countries however the relation between recipient countries and the researchers can be aptly compared to the practice of psychiatry in an asylum. The patient has no insight of his/ her malady, in many cases the patient even denies being sick, the psychiatrists then prescribe drugs many of which incapacitate the patient even more and compliance to this kind of medicine is pathetic at best.

Most research agenda are run from the West. More recently most of these agendas are aligned to what has been referred to as MDGS. In many cases there is little pull from recipient countries and the priority lists of the researchers and the lists of the policy makers could never be different than they are currently. Maslow describes that before humans and systems can actualise, the basic needs have to be satisfied. Poor countries need to be given a chance to define their priority research areas then contract these out to researchers who then provide solutions i.e. putting the donkey before the cart. If for example the priority of policy makers at the Ministries of Health is to have hot tea all day through. Then this needs to be researched to ensure that steaming tea is served to policy makers all day. It’s only after this has been sorted that second, third or fourth items in the list can be addressed.

Providing lengthy pieces of research findings reports or copies of systematic reviews full of unintelligible jargon to policy does not lessen the pain of swallowing findings which are constantly being shoved down the throats of many policy makers.

Empty promises

I once read a 300 page motor vehicle magazine; in it were five different articles and adverts of products that could increase a car’s fuel efficiency. The first article stated that using the right tyre pressure would reduce fuel consumption by at least 10 %. The second was on a radiator coolant that promised to cut fuel consumption by at least 25 %. The third article was on driving speed, that accelerating to the correct speed and maintaining that speed to your destination could save you another 20 % (practical?- Nay, especially in a city riddled with potholed roads or unending traffic jams). The fourth article was on special high octane gasoline that promised to cut fuel consumption by another 15 %. Finally was an advert on heavy duty spark plugs that promised to do the magic and cut consumption by a cool 30 %. I did a quick back-of-the-envelope calculation and found by adhering to the advice and fitting the said parts I would be saving 100 % of fuel (10 + 25 + 20 +15 + 30) and say goodbye forever to the fuel vender at the corner of my street who I had always suspected of lacing fuel with kerosene and tampering with the pump meters. Buying that magazine could not have come at a better time, and the whole idea could not have sounded sweater. Policy makers are constantly being bombarded to take up and implement barrage research findings, they have been listening to the music from researchers for far too long and have realised that the sum total of individual research findings do not add up to proposed gains in disease or mortality reduction, as I painfully learnt having spent money on car parts and receiving speeding tickets for doing 50 on 20 Km/h stretches. The resentment has grown. In a few cases confusion has bedevilled these policy makers as in a recent case where one prominent journal reported that eradicating small pox in Africa might have paved way to the emergence of HIV, that small pox had a protective effect from the HIV virus. My take on this story is different – could the small pox vaccine have been laced with agents which gave rise to HIV, if one is to offer a plausible explanation to the chronological link between disappearance of small pox and emergence of HIV? – that is a question we can ponder about some other time in some other forum.

To reduce childhood mortality, researchers have proposed all sorts of interventions: zinc, ORS, prophylactic septrin, ACTs, bed nets, polyvalent vaccines, routine de-worming, iron supplementation, use of DDT to eradicate mosquitoes…. most of which have might have worked but whose sum total has not even matched half the promised targets. Under-five mortality in many poor countries has remained at the same level for the last 30 years or as long as enumeration has been done in these countries. As long as the empty promises continue to be peddled by an unchecked research inc., pessimism will grow among the policy makers and increasingly among poor populations making it harder to implement findings.

Confabulations

The measurement of disease burden in Africa is a concoction of findings from poorly conducted surveys and mathematical predictions based on imagined parameters. In a recent report about the global mortality burden for children, a new model was used to estimate this burden in the less developed world. The authors of the report pat themselves on the back stating that the new estimates were similar to previous estimates. The parameters that went to these models were however the same ones that have been used over time. It borders insanity to continue estimating mortality in Africa using the same old methods, expect different outcomes and when you come up with the same findings blow up your trumpet on the consistency of your quackery. The bottom line is that Ministries of Health in Africa have no idea of what the health systems ail from. That is why vertical programs will initially over-estimate burden of a specific disease and then when years later when the burden is accurately measured praise its efforts for bringing down that disease.

The Magic bullet

Most of sub-Saharan Africa has been at war for the last odd half century. Starting with wars fought at independence and the civil wars and coups that followed in many of these new states. The mention of armoury or connotations to bloodletting weapons or bullets sends chills down the spines of the bravest Africans. Many of these research findings have been christened “magic bullets” to end years of disease in Africa, not surprising they were never received with open arms. Or some like the Structural adjustment programs (SAPs) recommended by the World Bank can be argued to have achieved the target that they were intended. After many years of war and disease, Africa does not need magic bullets to sort out its health problems but needs workable and sustainable solutions. Removal of trade barriers within Africa and internationally so that the economic engines can begin humming, being allowed to manufacture cheap drugs, accruing benefits gained from findings of endless years of research on poor populace and most importantly being allowed to set and run its own agenda on research.

As a young scientist, I have been in institutional research for the last now over 7 years, during which i have come around from singing unproductive public health research mantra to asking if science can actually solve Africa problems. There are too many ‘me-too-publications’ in public health research that carry no potential to change anything apart from creating new jobs for the old-timers to conduct countless ‘paper-based publication-oriented reasearch’.  Of course interspersed with a couple of ground breaking works that re-orient the direction of the research gravy trail. There just is not any government that will be able to implement every single policy spewed from the cacophony of consumptive research driven by a profusion of publications to attract funding rather than solve problems.

One important thing has been evident though  – that innovation is driven by innovative individuals who must have a freeway to not only ask but solve specific problems, or lead to a new way of wealth creation. The identification of these innovative researchers cannot be effectively accomplished within behemoth institutions riddled with politics of peer supremacy, uneven legalism and lopsided allocation of funds. Allow me to proffer the hypothesis that for Africa to gain from science it ought to hand the means to conduct innovative reasearch to its own young scientists. But as i have previously observed in this blog, the of lack of funds and good institutional backing constitute a tenuous link to the realisation of this dream.

Enter the concept of garage science. True innovativeness is driven by passionate and obsessed workers from garage (non-institutional) sites, eg Silicon Valley innovations and Indian cottage industries. Small and Medium businesses Entreprises (SMEs) in Kenya have received reasonably good support from microfiance institutions and through facilitatory government role. However, for SMEs to survive they must turn in profits pretty quickly. A similar approach to encourage young scientists to venture into small to medium scale productive research in futuristic areas like energy production and renewable sources of energy, biotechnology, information technology among others should be considered. A deliberate policy to establish publicly secured venture capitalism to assist in setting up laboratories and buying initial equipment can lead to a growth in productive research and development with a possiblity of coalescence into formidable large scale research enterprises.

You can read more on garage approach to science by following the links below:

http://sciencecareers.sciencemag.org/career_development/previous_issues/articles/1680/toolkit_designing_your_laboratory/

Biotechnology Garage

Micro-brewing

Do-It_Yourself Biology

This blog is not about denigrating anyones or organization character but it is not also a fishing ground for small minded individuals who cannot  bear criticism. It is meant to be a place where local African scientists, researchers, artists and academics can broach sensitive issues that continually threaten their careers and ambitions but also a forum to offer courage to each other as they advance their interests. It is also a forum to share interesting findings and solutions to problems. For a starter, here is the blog disclaimer.

Just found this great article done by Tom Odhiambo  – a lecturer at the University of Nairobi – coming a day after my article on Funding African Scientists. It goes to underscore the dorminant theme of frustration within the academic and research circles occassioned by lack of funds. Read it Here - How philanthropy culture can benefit Kenya.

Yesterday we said goodbye to a young Kenyan scientist whose career began less than 2 years ago following the attainmet of an MSC. We say goodbye to many aspiring scientists who never get an opportunity to pursue a scientific path. The next day it will be you and then finally me  – and that will either put a nail in the coffin on your source of daily bread, but worse of all scientific ambition. The bottom line is always the lack of funds – because a foreign funded principal investigator has to downsize or close shop. The simple reality is that African scientists are basically employees of foreign funded programmes that conduct research within pretty narrow constraints determined by the wind of global health or international funding agencies. They are always being imbued with “capacity” to justify colossal sums of money solicited using the front of “capacity building”. Whilst there is a vast need to build capacity among Africans for science, those of us trapped in search settings all too well know how this has established a servile dependence that is the ultimate killer of innovativeness as we try to outdo each other to please our employers so that we can merit support of this or that education opportunity. Worse, just to beat the desperation, we get into studies that we care little about just because that is what was available. The danger of such decisions becomes evident after the sponsoring projects come to an end and the realisation of vertical competence that cannot find accommodation within industry – not to mention our higher institutions of studies that are killing fields of young, bright and determined minds. Worse, even with a PhD and a couple of academic papers, extremely few (if any) can get onto becoming scientific leaders or attract stable grants to last a few years enough to set up indipendent research basis.

My experience in the last 11 years since completing medical school is that it is a tough landscape for the African scientist. And i have moved on from being the innocent and impressionable scientist waiting for my turn on the chain to become a leader to asking the tough questions – can Africans become scientific leaders within their own country’s without funds being made available locally? The straight answer is no. Chances are that you probably are very afraid of reading this article and think i am insane to write such a critical piece if you are labouring so hard within a programme where you hope that an opportunity will become available for you to make it. Forget it and begin to face the reality…look all around you, look yonder in the past and into the future and fit all probablistic models, regress them and you will probably notice the most significant factor for you to make it as a successful scientists will be the variable of funding and its source thereoff. And then realize that there are no local sources of funding for scientists…what??? Take a look through the web and see if there are any places as an African scientist you can get funds readily even with strong strings attached. You will be shocked that intentions of organisations such as Africa Union (AU) and NEPAD (RIP) have all come to nought. Take a trip to the web everyday, you will see new funding opportunities popping all over but they are for most part unavailable to Africa and if so only through institutions from countries where the funds originate…yes, it means you cannot lay claim to these funds and you must dance to the tune of he who pays the piper. If African science has to rely on these funds then the equation AFRICAN SCIENCE=RIP can be proven correct to a large extent with great certainity.

What about our own National Council for Science and Technology (NCST) – hit this web and see if you will succeed http://www.ncst.go.ke/? A few years back  i started developing a point of care clinical software application  – see http://www.viskenya.com – and needed some little funds to try out the system at the Kenyatta National Hospital. Having left my former employment at a KEMRI collaborative programme and joinned the University of Nairobi to complete training in paediatrics, i wanted to use my epidemiological and software programming skills to set up a paediatrics electronic medical records system. I figured out that this system would lead to better handling of data, improve the efficiency and accuracy of clinical and laboratory work but also provide me with some funds to support its development and deployment as part of my studies. I was never able to get hold of any meaningful contact at NCST nor find out a way for making an application for funds. Needless to say, i discontinued my studies in paediatrics and went back to my old job that does not support clinical training and took up an epidemiological job to meet my financial needs. Although this piece of work has grown through a lot of unpaid personal sacrifices and is now deployed in some public hospitals, it exposes how even the little funding set aside to support innovative research in Kenya is not accessible to aid the growth of local scientific talent….enough of the depressing thoughts what can be done?

In my former days at High School and Univeristy, besides science i relished practical activism until i heeded ‘wise counsel to shun activism’ and pursue science. But now i realise that for African science to grow, we have to be heard and seen locally and not in some distant lands in some high impact journals. We have to appeal to the local entrepreneurs, bankers, philanthropists, politicians and leaders to come to our rescue by setting up an endowment fund to cater for the scientific growth of local scientists. I will give a simple example of success in Kenya: The Starehe Boys Centre (SBC) where i studied and that has continued to produce excellent talent. SBC relied on goodwill from a vast array of donors (individual and corporate) but its foresighted founder the Late Dr. G. W. Griffin realised that this would be unsustainable and set up an endowment fund through generous contributions from all sources. At the death of Dr. Griffin, the fund was large enough to be able to provide a high quality free education for 200 boys from poor families forever.

I believe Africa can fund its own research, however minimal to begin with, because science is about answering our own problems: dirrhoea, pneumonia, population explosion, lack of water, energy needs, food problems and social problems. Yes we can and we need all citizens of good will to set up a fund for our best brains to think through and create solutions to our problems. This kind of fund can augment what the government makes available for research – but such public funds must be accessible to scientists with ideas and increased to a reasonable amount.

Whether in good or bad faith, help us pass around this message to build a momentum to for our country to begin paying for science using local resources.