Thursday, June 23, 2005

Ottawa East African Imprisoned For His Own Good?

Onyango Oloo Ponders on the Ethics of Forced Treatment...

1.0.Introducing Abdullahi Fourreh, Ethiopian Born Canadian...

Yesterday (Wednesday, June 22, 2005), when I was traveling from Montreal, I decided to pick up the Ottawa Citizen during a pit stop in Kingston, Ontario.

The front page was dominated by three stories- a report from the Canadian Security Intelligence Service warning that the ongoing war in Iraq is creating a new set of battle-hardened "jihadists" poised to carry out terrorism for years to come-with Canada not being immune to their attacks; a glimpse of one of those two British kids who were conceived and have grown up under the public glare

graduating from




Sandhurst- the favourite college for

past(like
Gen. Yakubu Gowon), present and future African coup makers; and a sneak preview of a story in the business section about the demise of

Jack Kilby, the legendary co-inventor of the integrated chip.

NONE of those stories held my attention for more than thirty seconds.

A smaller story("Judge Orders man with TB held after he refuses care”), also on the front page, involving an Ottawa resident originally from Ethiopia engrossed me so much that I not only re-read the story twice, but has now inspired this digital that you are just starting to read.

A few minutes ago I went to the Ottawa Citizen web site to try and retrieve that story so that I could link it here- alas, no such luck.

Instead I found out the Citizen's same town rival,the turgid, screeching right wing tabloid the OttawaSun carried the story here and the same report was cited by the Ottawa bureau of the Canadian Broadcasting Corporation.

For some weird reason, it would appear that the only other non-Canadian outlet to carry the story was the Chinese news agency.

Since you, dear reader-unless you live in Ottawa, Ontario or some other part of Canada- may not be able to get your hands on that particular hard copy of the Citizen to read the story for yourself, I have taken the liberty to excerpt this section of Jake Rupert’s story:

Abdullahi Fourreh, 51, has been diagnosed with pulmonary tuberculosis. He also has kidney failure and severe diabetes. In January, when he was diagnosed with tuberculosis, he initially followed his doctors’ advice and took a mixture of medications. However, the medications made him ill with vomiting, nausea, diarrhea and other symptoms. Doctors changed the medications three times in an attempt to find a course with milder side effects. But each time, Mr. Fourreh quit because the drugs made him feel worse. Finally, he convinced himself that he didn’t have the disease, and the doctors were, at best, incompetent or, at worst, trying to kill him.

The Ottawa Public Health Department obviously holds a drastically divergent interpretation of Abdullahi's medical condition-especially after a Health Worker dealing with Abdullahi contracted tuberculosis.

As we speak, Abdullahi Fourreh is in custody-apparently for his own good as well the wider public’s health and safety.


2.0. The Ethics and Social Justice Implications of Forced Treatment

I decided to write on this topic because it brings up many ethical, social justice, legal, medical and practical concerns that I have about the whole idea of incarcerating people for their own good.

In the late 1980s and early 1990s Cuba was denounced around the world for her open practice of placing in quarantine those who were diagnosed with HIV and AIDS. Many people (and not just confined to the right wing nut bars who hate Cuba around the clock and keep hallucinating about a pro-capitalist post-Castro restoration of neo-colonialism)- many people were concerned about the widespread perception that this was an infringement of people's right to movement and other fundamental democratic freedoms.

However according to this BBC report, Cubaleads the world in the fight against HIV/AIDS.

Naturally, friends of Cuba will trumpet these achievements as you can see from the passage below:

AIDS policy in Cuba has evolved in unique and sometimes controversial directions. These policies have depended on close epidemiologic surveillance. In the most controversial of Cuba's policies, HIV-positive patients previously were temporarily separated from the general community during an educational and evaluational process in one of several national sanitariums.

Historically, the sanitarium policy originated in the mid-1980s, when several military officers returning from Africa were found to be infected with HIV. Although these officers were viewed as war heroes in Cuba, public health officials feared a rapidly increasing epidemic as other Cubans returned from Africa. Partly due to a long tradition of treating patients with communicable infections in comfortable sanitariums, the government initially supervised the construction of an inpatient facility for HIV and AIDS patients near Havana. Because patients who tested positive for HIV were required to live there, the compulsory aspect of the policy received criticism from outside Cuba,, as well as praise for its apparent success in controlling the epidemic and its humane approach to patient care.,, Homophobia, by our observations, did not influence HIV policies; for instance, one of the most widely known and highly respected Cuban advocates for HIV patients is the openly gay and HIV-positive family physician, Doctor Juan Carlos de la Concepción.

As the epidemic was brought under control and as more was learned abouttransmission, the compulsory components of Cuba's HIV policies were eased. Residence at the HIV sanitariums has become voluntary for all except those who demonstrably have placed others at high risk through their conduct and those unable to care for themselves. Although sanitariums provide services in 13 of Cuba's 14 provinces, the proportion of HIV-positive patients entering these facilities has declined, as more people have opted for outpatient treatment. A large majority of newly diagnosed patients, estimated at 70-80 percent, currently choose ambulatory treatment and do not enter a sanitarium. The patients whom we interviewed at the national sanitarium near Havana all expressed a preference to remain living there, because they were able to maintain their family and work relationships while staying in close contact with the health professionals whom they trusted. These interviews showed a probable change in attitudes among HIV patients since 1993, when another U.S. group studying AIDS in Cuba found more evidence of frustration with the restrictions imposed by prior sanitarium policies.58

Screening for HIV has occurred at a much higher rate than in other countries at comparable levels of economic development. In a population of somewhat more than 11 million, approximately 2 million tests are performed annually. Since 1987 mandatory testing has been done for specified groups: patients diagnosed with other sexually transmitted diseases and their partners, patients admitted to hospitals or undergoing outpatient surgery, pregnant women during the first trimester and at delivery, prisoners, public health employees, Cubans traveling abroad, workers in the tourism industry, and merchant sailors.58 In addition, as patients obtain primary care services from family physicians, they receive encouragement to undergo voluntary testing.

Overall, Cuba's AIDS policies have achieved successful results, in comparison to both economically developed countries and other countries in the Third World. Until early 1996, the number of HIV positive patients was 1,199; 429 cases of AIDS had been diagnosed, with 287 deaths (Cuban Ministry of Public Health data, 1996). Although the Ministry of Public Health acknowledges that some HIV-positive patients remain undiagnosed and has developed estimates of their numbers, the very extensive mandatory and voluntary screening programs indicate that the problem of underreporting is less severe than in other countries.

The technical level of AIDS services in Cuba equals or surpasses that in other countries. From our observations, Cuban physicians have succeeded in implementing all diagnostic and therapeutic procedures for HIV disease that currently are used in the United States. CD4 counts are monitored closely for all HIV-positive patients. Medications for treating the infectious and neoplastic complications of AIDS are usually available, despite difficulties due to the U.S. embargo. The newest generations of antiviral agents enter clinical practice rapidly in Cuba, including recently the protease inhibitors. Additionally, care plans encourage the use of immunologically active materials that are readily available from Cuban producers. For instance, interferon alfa has been offered since the mid-1980s as a routine part of prophylaxis along with other immunizations. The leaders of Cuba's HIV program attribute the relatively low death rate among HIV patients partly to these additional features of AIDS prophylaxis. More systematic evaluation of these immunologically active medications in HIV care comprises a focus of current Cuban research.

SOURCE.

I was discussing this issue with a very good friend of mine who is in the health/medical profession and she was telling me that she could see where the Ottawa Public Health Department was coming from saying it was a tough but necessary call to valorize the health of the wider community over the privacy rights of a single individual.

What I am endeavouring to put across here is that these matters are rarely so clear cut.

3.0.Traditional Therapies and Pulmonary Tuberculosis

Nevertheless, being the contrarian that I often play, I want to don the robes of the Devil's Wakili and argue Mr. Abdullahi Fourreh's case for a second.

For instance:

Can we contemplate the implications of the Canadian court order if it turns out that Abdullahi Fourreh is RIGHT and the Ottawa medical establishment is proved eventually wrong?

How about if he does not in fact, have a confirmed diagnosis of tuberculosis?

Alternatively, how about if Abdullahi Fourreh does have a strain pulmonary tuberculosis which is RESISTANT to ALL the pharmacological interventions and options currently available within the Canadian health system?

Is it possible that there are traditional, non-Western, perhaps herbal remedies that are MORE effective in thwarting pulmonary tuberculosis?

My scientific, health and medical professional friends are probably scoffing with sneering disbelief at my first suggestion- muttering under their breath:

"Don't be asinine Oloo. Of course the first thing they did was to carry out extensive laboratory tests to verify if Mr. Fourreh had pulmonary tuberculosis."

My Canadian friends may rush to remind me that Canada has a LONG HISTORY of battling TB and refer me to this link,while their more bigoted anti-immigrant xenophobic compatriots may seize on the Fourreh case to recycle racist campaigns from years gone by like the following diatribe.

As you can see, I have anticipated the most predictable objections to my line of argument, so why don't I just ignore that carping for a few minutes and proceed with my demonic advocacy?

Over the years, the medical establishments in Asia, Africa, Latin America and slowly, North America have come to appreciate and embrace traditional therapies as complementing, rather than undermining orthodox “modern” Western medicine.

For instance here is what happening in Cambodia about TB.

Here is what the South Africans are doing.

And of course, how could I leave Cuba out of the mix?

Read this fascinating paper by Gerard Bodeker on planning for cost-effective traditional therapies.

Here is a link to an abstract from a publication in the Netherlands about pulmonary tuberculosis and traditional therapies in Malawi.

From the same source, a link to an analysis of 150 cases of pulmonary tuberculosis hemoptysis treated with combined traditional Chinese and western medicine by Zhong Xi Yi Jie He Za Zhi.

And speaking of China, for a mere $699.95 (US) you can get yourself a six month supply of herbal medicine to battle TB after visiting this URL.

The Medical Anthropology Quarterly edition of June 1997, Vol. 11, No. 2, pp. 183-201
had an article entitled Sociocultural Aspects of Tuberculosis Control in Ethiopia by Norbert L. Vecchiato of the Department of Anthropology, University of Washington, Seattle.

In the September 1999 Journal of Tuberculosis and Lung Disease there is an article that looks at Traditional healers as tuberculosis treatment supervisors.

And here is a snapshot of the changing face of TB in the era of AIDS that I would like to cite now and come back to in a few minutes- and not just because it has somethingto do with Kenya. You should read it in conjunction with the following document.

What I have been struggling to say is that the jury IS STILL OUT about whether or not traditional therapies can be totally discounted when it comes to combatting pulmonary tuberculosis, and therefore we should resist the temptation to dismiss Abdullahi Fourreh as just another illiterate African immigrantin Canada who is embarassing his "educated" fellow Africans with his "backward" and "superstitious" objections to modern and effective, life saving medical interventions.

4.0. Is Abdullahi Fourreh a Delusional AIDS Patient in Denial?

Way back in the early 1990s when I was still living right here in the Greater Toronto Area, I was approached by the Black Coalition for AIDS Prevention (Black CAP) to act as a "buddy" for a certain Canadian citizen who was born somewhere in the vicinity of Kenya- but not Uganda, Tanzania, Somalia, Sudan, Eritrea or Ethiopia-so keep guessing.

At that time, I was one of the staff people in the Yonge/Carlton offices of Africans United To Control AIDS(AUCA) an organization formed in September 1990 by a group of Ugandan, Kenyan and other African health professionals and community development workers in Toronto.

The reason why I was approached by a Black CAP community outreach worker to act as a buddy was because I had not only undergone their Train the Trainer sessions as an HIV/AIDS educator and working for a sister organization; it was also because they were having problems with a certain male client of theirs who was in a hospice for people with full blown AIDS. This client had completely rebuffed any overtures of support from the (female) support person from Black CAP. The organization then contacted me because they felt there were both gender and cross-cultural barriers that militated against support for this individual. As it happened, the person from Black CAP also happened to be a fellow programmer at CKLN 88.1 FM and therefore she was able to give me a full briefing as someone she knew personally.

Soon after, I was introduced to someone I will just call "P.X." today for the purposes of this essay. I can talk about "P.X." after almost fifteen years because he is no longer among us in the land of the living; I have also changed certain details of his story. "P.X." had lived in Canada for several years and had acquired citizenship during his sojourn in this country. He had also acquired an immune deficiency syndrome at some point in his life.

Problem was, "P.X." was CONVINCED that he was not infected at all. In fact, the way he told me the story- he was convinced that his doctors had "deliberately infected" him with a deadly poison during what he told me was a routine hospital visit. Nothing could convince him otherwise. He had written to (then) Prime Minister Brian Mulroney; (then) Ontario Premier Bob Rae; (then) New York mayor David Dinkins; Magic Johnson and about all the most prominent personalities you could think.

A very affable man, "P.X." shocked me with his revelation that he was still having unprotected sex with a certain woman(known to me) from his community living also right here in Toronto (later on through one of my female contacts in that community we discreetly and indirectly persuaded that woman to get tested and phew! She was in the clear) as well prostitutes in New York, Ottawa, Windsor and other Canadian cities. At the same time, "P.X." had traveled twice to Nairobi and came back with the wonder drug du jour- KEMRON- which he showed me samples of.

At first I gave "P.X." the benefit of my doubt until it became apparent from other conversations that I will leave out of the public domain that "P.X." had lost contact with reality a considerable time before I actually met him for the first time.

It is around this time that a physician friend of mine from another African country introduced me to one of her Canadian professional colleagues who familiarized me with the concept of dementia in AIDS patients. This helped to put some of the often contradictory things "P.X." told me into perspective. I could see a very highly intelligent man grappling with the reality of a potentially fatal health diagnosis basically by pretending that the medical condition that all his doctors had told him about simply did not exist- as far as he was concerned.

So, of what relevance does the PX story have to do with Abdullahi Fourreh?

You know, I was wondering if perhaps the pulmonary tuberculosis afflicting Abdullahi is or is not one of the opportunistic infections thrown up by an underlying HIV/AIDS condition that he may be suffering from. As indicated in the Kenyan citation, pulmonary TB is often one of the defining characterstics of HIV/AIDs for those who embrace the orthodox view of AIDS. Some of the other things mentioned- problems with his kidneys may also indicate yet some other opportunistic infections.

So there is a POSSIBILITY that the Ottawa Health Department is aware of the HIV/AIDS diagnosis, but BECAUSE of STRICT PRIVACY LAWS in Canada, can not talk about HIV infection for fear of being hit by a multi-million dollar law suit. This is of course, pure conjecture and wild speculation on my part.

5.0. Consider This Possibility: Abdullahi Does NOT Have HIV/AIDS or TB!

If we keep our hopefully broad minds completely open, let us entertain another scenario:

Abdullahi Fourreh has some medical problems but he has been totally misdiagnosed by a Western medical establishment that galloped to judgment because of his East African origins blinded by the assumption that Abdullahi must somehow be afflicted by pulmonary tuberculosis and by association, HIV/AIDS, and is therefore a threat to public health and safety.

Misdiagnoses are not unheard of you know folks.

I am NOT asserting that this is in fact the case.

I am just saying that perhaps we should investigate all the possibilities.

As many of you know, my views regarding the whole HIV/AIDS discourse is very conflicted as you can discern from this essay I wrote several months ago entitled Ignoring Big Pharma's Headache.

What is one to say definitely about the Abdullahi Fourreh case?

I have shared my own ruminations with you dear reader.

What do YOU think?

Onyango Oloo
Toronto

2 comments:

BoyScout said...

I am scratching my head: having failed to connect the soldiers to TB. How??

http://demokrasia-kenya.blogspot.com/2005/06/ottawa-east-african-imprisoned-for-his.html

And the last sentence should be corrected to read:

I have shared my own ruminations with you dear BoyScout.

What do YOU think?


Of course I am trying to figure out an alternative scenario at the moment.

Laterz,
BoyScout

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