Biomedical colonialism or local autonomy?: local healers in the fight against tuberculosis

Analiza el papel de los agentes médicos autóctonos y sus conocimientos en las campañas antituberculosas contemporáneas en el África subsahariana. Sitúa la medicina contemporánea, llevada a cabo en África en la herencia cultural de la medicina colonial, para comprender el marco histórico en el que se desarrollaron, a partir de los años setenta del siglo XX, las estrategias de la Organización Mundial de la Salud de promoción y desarrollo de las medicinas 'tradicionales'. En los proyectos sanitarios analizados, se evalúan las prácticas médicas locales y se entrenan a los agentes autóctonos para integrarlos en actividades estrictamente biomédicas: identificación de síntomas, remisión a hospitales o supervisión de tratamientos farmacológicos.The article explores the role played by indigenous medical agents, and their knowledge, within contemporary tuberculosis campaigns in sub-Saharan Africa. To understand the historical framework within which the World Health Organization devised its strategies to promote and develop traditional medicine as of the 1970s, the article contextualizes contemporary medicine as a cultural legacy of colonial medicine. Under the public healthcare projects analyzed in the article, local medical practices were assessed and indigenous agents trained so they could take part in strictly biomedical activities, like symptom identification, referrals to hospitals, or supervision of drug treatments.Trabajo realizado para la obtención del Diploma de Estudios Avanzados (DEA) en el programa de doctorado Salud: Antropología e Historia, bajo la dirección de la profesora Rosa María Medina Doménech

Preventing tuberculosis among health workers in Malawi

OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers. METHODS: The study involved 40 district and mission hospitals. Staff and patients were interviewed in order to determine whether the guidelines had been adopted. In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers. In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers. A similar method was used to determine the proportion of primary- school teachers who were registered with TB in 1999. FINDINGS: The guidelines were not uniformly implemented. Only one hospital introduced voluntary counselling and testing for its staff. Most hospitals stated that they used rapid systems to diagnose pulmonary TB. However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB. The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999. CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented