Methods, knowledge and action competence on global injustice in medical care using the example of the Corona pandemic.

glokal e.V. has been working for more than 15 years in the production of power-critical educational materials, especially on postcolonial and racist continuities and resistant perspectives of BIPOCs. In our new project “Medical Care for All – Methods, Knowledge and Action Competence on Global Injustice in Medical Care using the Example of the Corona Pandemic”, we dedicate ourselves to the entanglements of colonial and racist continuities in the field of medicine. In addition, we want to make recommendations for action / demands and resistant perspectives of BIPOC’s and allies visible.

The aim is to sensitise medical professionals who travel to the Global South or work with refugees/BIPOCs here to the problem of racism in medicine through the educational materials produced in the project and subsequent workshops, and to provide them with alternative possibilities for action. To this end, we will produce materials in 2023 as part of research workshops.
In 2024, test workshops are planned in which the developed material will be applied to the target group of international medical workers and in which you can become active as potential multipliers or present your work there. We would be happy about a long-term cooperation. Since the topic is still very little dealt with in Germany, the whole thing is still exploratory and will most likely be continued with us after the project period until the end of 2024.

To give you a better understanding of our perspective, here is an excerpt from the project proposal:
“Development education on unequal treatment of people in medicine: based on the Corona pandemic, many historical continuities can be shown, for example, how the Global South has always served as a field of experimentation for medicines or how Western doctors act as white saviors. White doctors and medical students travel to the Global South and are sometimes sent there as experts on missions in which they overestimate their personal competences out of internalised dominance. This can sometimes result in immense and sometimes fatal damage if the medical group in question goes on missions that do not correspond to their actual competence and level of training. The training of medical personnel, especially of development workers from the Global North, is inadequately tailored to missions in the Global South. One example is the standardisation of medical services (keyword skin cancer) for white people. This poses a threat to the health of non-white people (not only) in the Global South. We want to sensitise people to these and other issues with educational offers on the topic of Medicine for All! and show alternative possibilities for action.

Knowledge about global and local power relations has grown enormously in and through development education work in the last 10 years. Nevertheless, Bendix (2018) notes that the elementary connection between Western modernity thinking, colonialism and development is hardly addressed pedagogically, although postcolonial critique has found its way into teaching materials in recent years. Racist and stereotypical representations of the South or the African continent are also less common at the level of representation, but German actors are still portrayed as the helpers and saviours of the helpless. As a result, equal cooperation with, for example, partners from the Global South or people from the diaspora is hardly possible. The majority society tends to associate these people, albeit unconsciously, with the “victims”. On the other hand, this structure often obscures the view of possibilities for action, because the people from/in the Global South and their innovative strategies for dealing with the situation are not perceived as self-determined actors and their solutions are not heard in the Global North.

This issue of representation is closely linked to the fundamental issue of global inequality in the distribution of medical care, which was particularly evident in the corona pandemic. Calls were made for the abolition of vaccination patents (https://www.medico.de/impfsoli). Here, too, it can be shown that it is structures that have been maintained over centuries, as well as Western systems such as patent law, that prevent or at least impede the global production of vaccines. In particular, human medicine and its didactics, the approval of medicines, the testing of side effects, vaccine research as well as the global distribution of medical goods, especially vaccines, must be critically and feministically scrutinised.
The fact that the Global South has always served(ed) as an experimental field for medicines (Bonhomme 2020) has received a sad renaissance in the Corona Pandemic. The Corona Pandemic has once again made it clear that the medical field has only insufficiently been dealt with in its entanglements with colonial continuities in a discrimination-sensitive manner and has not been incorporated into the development policy context.

Three years after the outbreak of the COVID-19 pandemic, about 80% of the world’s population in the Global South still do not have access to corona vaccines. Pre-orders in the Global North for vaccine doses to contain the pandemic were three times the actual population. In the Global North, around 1.3 billion doses were secured unused in stockpiles in 2021 alone. The WHO’s COVAX strategy resulted in a global inequitable distribution in which people in the Global North have increased access to vaccines compared to people in the Global South. The strategy was to have 70% of the world’s population immunised by the end of 2022. Currently, this goal can only be achieved in the Global North. On the African continent, about 20% of the population could be immunised by November 2022, in Europe the figure is about 75%. In summary, countries in the Global North have 2.7 times as many vaccine doses available as all countries that should be covered by the COVAX strategy, although these countries have three times as many inhabitants as the Global North (cf. data.one.org). In the last years of the Corona pandemic, it could be observed in South Africa, for example, that the medical care of BIPOC and other vulnerable groups is worse positioned compared to the average. One example: the common pulse oximeter measuring devices measure three times less accurately in black people than in white people. This led to unequal diagnosis in oxygen saturation in BIPOC corona-infected people. Due to this misdiagnosis, BIPOC were often intubated too late. As a result, more BIPOC died of corona infection in South Africa compared to white people. In 2021, the Rhineland-Palatinate newspaper ran the headline “the virus from Africa”. What was actually meant was the discovery of the Delta variant by a research institute in South Africa. Black people receive worse care than white people, especially in the field of dermatology. Human medicine in the global South teaches symptoms of, for example, cellulitis, skin cancer, Kawasaki disease, Lyme disease or pityriasis versicolor exclusively on white bodies (cf. www.blackandbrownskin.co.uk). BIPOC from the Global South, on the other hand, are calling for a database of racism-sensitive therapies and institutions as well as comprehensive development education on the interconnectedness of racism and medicine (https://www.borders-in-motion.de).

Development education on the unequal treatment of people in medicine: based on the Corona pandemic, many historical continuities can be shown, for example how the Global South has always served as a field of experimentation for medicines or how Western doctors act as white saviors. White doctors and medical students travel to the Global South and are sometimes sent there as experts on missions in which they overestimate their personal competences out of a helper complex. This can sometimes result in immense and sometimes fatal damage if the medical group in question, out of a helper complex, embarks on missions that do not correspond to their actual competence and level of training. The training of medical personnel, especially of development workers from the Global North, is inadequately tailored to missions in the Global South. One example is the standardisation of medical services (keyword skin cancer) for white people. This poses a threat to the health of non-white people in the Global South. This reality contradicts the Geneva Declaration of the World Medical Association which states “I will not allow considerations of age, illness or disability, creed, ethnic origin, gender, nationality […] to come between my duties and my patient”.

In particular, human medicine and its didactics, the approval of medicines, the testing of side effects, vaccine research as well as the global distribution of medical goods, especially vaccines, must be critically and feministically scrutinised, as the CIS male norm still prevails here. Side effects and new approvals of medicines are especially researched on CIS male bodies. This sometimes has fatal or health-damaging consequences for FLINTA persons, because, for example, symptoms of illness are recognised too late or medication is adjusted too much. In addition, CIS men are disproportionately found in the positions of chief physician or specialist. Women, e.g. in the global south (patients), have to tell doctors (CIS men) about gender-related diseases. This can be an obstacle for sick patients to seek treatment at all. Especially in developmental medical constellations, counselling or treatment sessions may then only be conducted in the presence of a second FLINTA person. If this second person is in a family relationship to the first, this can again lead to the fact that no comprehensive, detailed counselling or treatment can be carried out. Often, medical professionals in development contexts lack knowledge about cultural nuances of the respective field. For example, a member of the Seawatch medical staff told us that at some point in their missions, they switched to giving out glucose tablets because the local cultural thinking seems to be: a doctor who doesn’t give a shot or a tablet is not a good doctor.

Medicine played a key role in colonialism on the African continent. Even renowned German researchers such as Robert Koch had an inglorious role here, for example in research on smallpox, malaria, sleeping sickness or cholera (Bonhomme 2020). Drugs and vaccines were tested in the local colonial periphery, but the results and products of the research were not used locally across the board. Rather, they were used strategically to give colonial powers an advantage. During the tests, there were devastating misjudgements and deadly consequences, for example in the use of the arsenic-containing agent Atoxyl. In addition to Koch, the stories of many German tropical researchers need to be told. For example, Claus Schilling was involved in questionable experiments in Togo as early as 1905. Years later, he infected 1000 prisoners in the Dachau concentration camp with malaria in order to conduct further research experiments. Connections between Eugen Fischer, the founder of the Kaiser Wilhelm Institute and Josef Mengele’s “research” at the Otto Suhr Institute in Berlin also need to be addressed. (cf. Eckart, Medizin und Kolonialimperialismus 1884-1945) The subject area of medicine thus stands in a centuries-old entanglement with colonial and anti-Semitic continuities. In their propaganda, anti-Semites in the global North have repeatedly accused Jews of being responsible for the outbreak of diseases such as the plague. German medical practitioners and their experiments in the global South during the colonial period made a deadly contribution to the industrial mass extermination of European Jews during the Shoa. Especially development policy actors from Germany and Berlin have a responsibility to critically engage with these interwoven aspects of history and the resulting continuities into the present day, in order to be able to develop practical recommendations for action based on this critical analysis.
It can be stated: due to colonial continuities, Black people are insufficiently considered in medical care and receive worse care. In addition, BIPOC are exposed to stigmatising diagnoses, such as the so-called Mongolian stain or Morbus Mediterraneus. These stigmatising diagnoses can sometimes have fatal or health-damaging consequences, as serious illnesses are sometimes recognised too late and preventive measures can only be taken inadequately (cf. https://www.aerztezeitung.de/Medizin/Morbus-Bosporus-ist-ein-Vorurteil-246216.html).

The project is funded by Engagement Global with financial support from the BMZ, as well as from budgetary funds of the state of Berlin – Landesstelle für Entwicklungszusammenarbeit.