Editor's Choice

Find your voice and use it

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7507.0-g (Published 30 June 2005) Cite this as: BMJ 2005;331:0-g
  1. Fiona Godlee (fgodlee{at}bmj.com), editor

    An African child pulls herself slowly to her feet. With blank face and infinite care born of exhaustion, she unwraps one swollen leg and then the other from among the rags she is lying in and pushes herself up. She sways under the weight of her distended belly. It's not clear where she is going or why, but the world watches, stunned for a moment into a silence of grief and guilt. And then the tears flow, and the money.

    That was Live Aid 1985, the video that shocked millions out of their musical “feel good” and into opening their purses. Twenty years on, what has changed? Africa's children are still starving and dying in their millions, two thirds of them from preventable disease, but it's no longer about charity—it's about politics. Money is still urgently needed in the form of aid and debt relief, but more importantly we need to change the rules of exchange around the world. By the end of next week we will know whether eight men meeting in Scotland have found the political will to change those rules in ways that could change the world.

    Several articles this week show how disastrous the current rules have been for Africa, particularly in denuding it of skilled health professionals. In an open letter to Tony Blair, Chris Lavy describes the harsh realities of surgical practice in Malawi (p 46). James Johnson calls on developed countries to become self sufficient in skilled health professionals, but as with so many global issues this will only work if the United States joins the effort. In what Johnson calls a “deadly coincidence,” the US wants a million more doctors and nurses over the next 15 years, exactly the number needed by sub-Saharan Africa if it is to meet the millennium development goals (p 2). Omar Ahmad proposes an international framework to govern the recruitment of health workers, including the payment of compensation by rich countries to poor countries (p 43).

    Better still, Africa is finding its own solutions. The Commission for Africa's report has adopted many of the health strategies developed by the African Union, something that Lola Dare and Eric Buch applaud in their editorial (p 1). Growing confidence in its own social values can be seen in the Organization of African Unity's charter on the rights and welfare of the child. This is framed in terms of the responsibilities and duties of children, in clear contrast to Western values as enshrined in the UN convention, which emphasises children's rights and needs. Timimi suggests that by promoting individualism as a universal model, the West is exporting unhappiness and mental illness, as well as losing an opportunity to learn the benefits of more family centred cultures (p 37).

    So apart from the shift from charity to politics, something else is different this time round—Africa has found its voice and is being heard. Doctors too must find their voice. At various times in history, doctors have been agents for change. The child on the video screen is unlikely to be alive now. But Africa is rising to its feet and needs support. Our silence is no longer an option.

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