cholera in africa

calling the medical instrument in?

Quite a morning along Spa Creek as the winds howled from early morning until the snow started about 0845. The traffic was awful but I’d prefer careful driving than insanity. Yet now around 3.45 in the afternoon, it’s beautiful with unpredicted sun and chilly air.

I opened one of my newspapers this morning to the news of a major cholera outbreak in southern Africa. Excuse me? A major outbreak which has taken more than 4,000 lives over the past two years but it’s on page 4? Seriously?

The article blamed poor infrastructure in the seven affected countries, the severe effects of climate change, and the paucity of inoculations for these populations as reasons for this particular outbreak.

Cholera is exceedingly dangerous, spreading easily in water corrupted by human feces. A single infected person engaging in poor hygienic behaviour is a primary reason that it spreads so easily. The bacterium also works quite efficiently inside a body so the dehydration can kill an infected person within a few hours. Modern day outbreaks are generally only in ‘lesser developed’ portions of the world, places where the infrastructure is poor.

Ok, Cynthia, but we aren’t largely readers in southern Africa so ‘too bad, so sad’ is likely your response. Yes, but here is a place we could actually make a tremendous difference relatively easily if we chose to help. And I stress if we chose to help as Americans.

We tend to turn to the federal government as the first responders with any instruments of power. Medical statecraft is not meant as a joke but is actually a powerful and far less expensive tool than sending military troops or negotiating a trade pact. USAID, the sixty-four year old development arm of the United States, offers aid for structural improvements to prevent crises. AID’s budget of less than $6 billion is a pittance compared with the lasting impressions it imparts on those receiving help but its role is in long-term development rather than immediate response to a health crisis.

U.S. Navy hospital ships visit various ports globally as a measure of our goodwill towards—and overall recognition of—populations in need. The efforts to provide basic dental and inoculations support those in need while also providing training efforts for medical personnel who are not being used in the ‘field’ at the moment of their port visits. Similarly, Army medics have historically deployed to Africa to help with similar activities.

Medical statecraft is also a function of the multitude of not-for-profit organisations working in Africa for decades. Religious groups often proselytise and send medical missionaries across much of the world, including southern Africa. Large organisations like Americares or Doctors without Borders-USA are domestically-based groups targetting immediate health assistance beyond any government aid.

The Carter Center at Emory University and similar organisations provide medical assistance to disadvantaged populations throughout Africa and much fo the lesser developed world. While neither this group nor any of the not-for-profits are gvoernment agencies, use of the medical tools of statecraft can be a citizen-drive activity rather than solely done by the government.

I understand why we are tired of medical issues and largely don’t want to hear about another problem or anyone needing help in the world. We are worn out but we also have many advantages and options that allow us to help others. We do it out of good will but it can also advance our national interests.

Medical statecraft is hardly a joke but is a powerful and underappreciated approach to the world. It is also far less expensive than sending military troops or negotiating a trade pact. Historically, the U.S. Navy sent hospital ships to various ports globally as a measure of our goodwill towards—and overall recognition of—populations in need. The efforts to provide basic dental and inoculations helps those in need while also providing training efforts for medical personnel who are not being used in the ‘field’ at the moment of their port visits. Similarly, Army medics have historically deployed to Africa to help with similar activities.

China learned from our 2004 humanitarian activities, leading to the PLAN eventually developing its own humanitarian/disaster capacities. Fast forward to 2020 when China aggressively lured lesser developed states into their orbit by offering PRC-developed vaccines to combat Covid, often with much poorer medical outcomes than the U.S.-produced alternatives. Beijing, however, attempted to message it cared about the populations of less advantaged states in a manner more consistent with decades of U.S. assistance provided by the Agency for International Development rather than as a much bigger neighbour trying to push around smaller states as Beijing’s aggressive activities around Asia was signalling over the past decade. China’s shift towards offering vaccines showed Americans were by 2020 no longer the only medical support available. Sure, China’s vaccines required extra (sadly, often undelivered) doses to provide comparable results to mRNA vaccines from the United States but the PRC was using a mechanism that Africans and Southeast Asians needed in the absence of other options. Their governments preferred our hospital ships and our vaccines but had to take the options available to address their population’s immediate needs.

I am not arguing medical statecraft supplants other instruments but it is an additional one, often employable in a true crisis, to impart positive reactions to the United States and its potential as a friendly state in the future as we look at the consequences of events like cholera outbreaks. Actions create consequences.

We would do well, however, to note the barrage of reports we are seeing these days about various illnesses—some thought long gone while others like cholera are definitely preventable—encroaching on the world. Just two days ago I read about syphilis cases exploding in the United States, for example. This also occurs as Covid cases, albeit an apparently lesser strain continue to bedevil many people worldwide. There are multiple causes for any of the problems but they also arise at a time when we are ready to put health dangers in our rear view mirrors but the illnesses are not so willing. Wonder if we would do well to get out ahead of these things?

Thanks for considering this column today. I welcome your many thoughts! I appreciate your time.

Be well and be safe. FIN

John Eligon and Jeffrey Moyo, ‘Deadliest Cholera Outbreak in Past Decade Hits Southern Africa’, NYTimes.com, 13 February 2024, retrieved at https://www.nytimes.com/2024/02/13/world/africa/cholera-outbreak-zimbabwe-zambia-malawi.html

Mayo Clinic, ‘Disease Conditions: Cholera’, mayoclinic.org, retrieved at https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287

Ali Rogin, Claire Mufson, and Satvi Sunkara, ‘Syphilis in U.S. was once nearly eradicated. Here’s why it’s surging again’, PBSNewshour.org, 11 February 2024, retrieved at https://www.pbs.org/newshour/show/syphilis-in-the-u-s-was-once-nearly-eradicated-heres-why-its-surging-again

USAID, ‘Basic Budget for 2023’, usaid.gov, retrieved at https://www.usaid.gov/basic-page/budget