Divining Without Seeds: The Case for Strengthening Laboratory Medicine in Africa(The Culture and Politics of Health Care Work)

Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa. The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers—including malaria—to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.

Table of Contents:
Introduction 1. The Power of Sight 2. Fever: Is It Malaria? 3. Fever: Beyond Malaria 4. Drug Resistance 5. Viral Hemorrhagic Fevers 6. Detecting Covert Infection ahead of the Final Diagnosis 7. Diagnostic Certainty and Disease Control 8. Origins and Outlook of Diagnostic Insufficiency in Africa Conclusion: The Feasibility of Laboratory Diagnosis in African Settings Notes Works Cited Index

About the Author :
Iruka N. Okeke is Associate Professor of Biology at Haverford College. She is coeditor of Antimicrobial Resistance in Developing Countries.

Review :
"The lack of laboratory diagnostic capacity in Africa threatens the lives of millions. Iruka N. Okeke's readable expose is a wake-up call."-Keith P. Klugman, William H. Foege Professor of Global Health, The Rollins School of Public Health, Emory University "Well before anyone else was worrying about it, Iruka N. Okeke, through her research, was calling attention to the problems of drug resistance caused by insufficient diagnosis preceding treatment in Nigeria and other parts of Africa. Treatment on the basis of nonexistent diagnosis is like driving a car in the rain without a windshield wiper. It can waste scarce resources of both patients and governments, place unnecessary selection pressure for drug resistance to evolve, and worst of all, deny patients the correct treatment that could cure them and sometimes save their lives. The only reason it is done now is that there are no immediate alternatives. All this has been well recognized by scientific and health system experts, but Okeke's book Divining Without Seeds brings that message to a nonspecialist audience. Health ministers, donor agency operatives, and bureaucrats would do well to read this passionate account of the need for prompt, accurate, and affordable diagnostic facilities. Driving blind may work for a while, but eventually we need to be able to see the road."-Ramanan Laxminarayan, Director of the Center for Disease Dynamics, Economics & Policy and Associate Research Scholar and Lecturer in Economics, Princeton Environmental Institute "Written by an expert in the fields of microbiology and infectious diseases, this book addresses a major problem preventing appropriate health care delivery in Africa, namely, the lack of diagnostic technologies. It is a call to action for attention to an area of medicine that has long gone unrecognized for its importance not only to the healthcare of the patients in developing nations but also those living in more industrialized countries."-Stuart B. Levy, MD, Tufts University School of Medicine "In this beautifully written book Iruka N. Okeke interweaves the problems of Africa, the history of infectious diseases, and her own life experience to make the compelling case that the near-total lack of basic laboratory diagnostic services continues to be a major cause of mortality and morbidity throughout that continent."-Thomas F. O'Brien, MD, Brigham and Women's Hospital and Harvard Medical School