AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2002, Volume 4, Number 1.

Out of Africa

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Post 9-11 in Kenya

A Peace Corps physician working in Africa relates the impact of the September 11, 2001 terrorist attack on Americans and others in Africa.

Robert C. Davidson, MD, MPH

On September 11, 2001, the world changed. The terrorism tragedies at the World Trade Center and the Pentagon have affected every American in some way. I thought you would be interested to hear how it has impacted my work and Americans living in eastern Africa.

I was working in Malawi on September 11. We first heard the news when the information officer at the American Embassy in Lilongwe called over to the Peace Corps to inform them of the terrorist attacks. I am sure most Americans in the US turned to their television and followed the tragedy live. No television was available at the Peace Corps office, but we were able to get the BBC on short wave radio. It seemed surreal to be sitting in a small office listening to a British newscaster describe what was going on in New York and Washington. Rumors began flying. The first was that the US Air Force was going to shoot down commercial airplanes that were veering off course. The US Embassies in eastern Africa were placed on high security alert. Memories of the embassy bombings in Nairobi and Dar es Saalam were still fresh in many peoples' minds.

Back in my hotel room, I was able to get the BBC television channel and watch the incredible videos of planes flying into the World Trade Center. I sat there with tears in my eyes and a mixture of sadness and anger. I wanted to be with people, so I walked down to the lobby. An obvious African Muslim man looked at me and smiled. He said, "I guess the US is finally getting a taste of what the Palestinians have been getting." In the bar were a group of Americans sitting in a corner. I did not know any of them and usually would have avoided them, thinking we probably had little in common but our citizenship. They were ex-military contractors working on a project at the US Embassy. They were loud, cigar-smoking, beer-drinking Texans who fit the stereotype of the Ugly American. However, they were American, and I needed to be with some countrymen. I could take only about an hour of their increasingly hostile attitude that "we should "bomb the **** out of whomever did it." I could, however, identify with their anger and need for the US to do something.

Over the ensuing 3 months, the aftermath of the attack has continued to affect us on a daily basis. A number of the volunteers were frantic with worry about friends or family in the New York area. The usually unreliable Kenyan telephone system was completely overloaded. All we could get was the recorded message in Kiswahili that "all lines are busy, please try again later." Then we began getting families, and even a couple of congressional offices, calling to find out when we were sending the volunteers home. There was no terrorism in Kenya, and the volunteers were probably safer at their sites than they would be trying to fly back home. This would be impossible for a few days anyway, since all flights to the US were cancelled. Things slowly returned to a relative calm until the 2 follow-up events occurred that affected us more than the initial attack. The first of these was the anthrax mailings, and the second was the US attack on the Taliban in Afghanistan. Because humor is important in these times, I want to relate a few of the anthrax stories in Kenya.

By way of background, anthrax is naturally occurring and quite common in eastern Africa. The Masaii herds of cattle are universally infected with it, and spores are everywhere in the soil. It is not uncommon to get cutaneous anthrax infections that respond nicely to doxycycline. One of the volunteers was diagnosed with cutaneous anthrax by a local physician and started on antibiotics. She happened to mention to her parents in a weekly e-mail that she was being treated for anthrax with no other explanation. That prompted a panic call from the parents to the Peace Corps headquarters in Washington asking what the hell was going on. The headquarters' staff gave the parents my phone number, and, of course, the inevitable call came at 3:00 a.m. "Was their daughter being flown out in an Air Force medical evacuation plane? Was I a real doctor? CNN should know that Peace Corps volunteers are being attacked by bioterrorists." When I was finally able to explain what was going on, her parents seemed skeptical but at least somewhat reassured. The next day I developed an information sheet on anthrax and sent it to all the volunteers so that we could avoid similar situations with their families.

Several days later, I got a call from an obviously distraught volunteer teacher who said her headmaster was demanding that all the teachers in the school be flown to Nairobi for examination and given prophylactic antibiotics against anthrax. The headmaster's demand was precipitated by a package my caller had received. She had sent to the Planned Parenthood Association in the US for some brochures on HIV/AIDS prevention that she planned to incorporate in her teachings. The brochures arrived in an envelope. She opened the package while sitting in the teachers' lounge. As she tore open the envelope, the gray/brown powdery insulation spilled out onto the table causing a panic among the teachers, who ran to the headmaster's office yelling, "Anthrax, anthrax." I was able to assure the headmaster that there was no risk of anthrax. I did ask her to put the package in a plastic bag and send it to me in Nairobi where I would have it tested. I never heard from her again. However, the next day I got a call from a family doctor colleague from the US who was working in Kenya at a mission hospital. There was a group of students from a church school in the US who were in Kenya for a bible study program at a mission school. The bishop in the US called the mission hospital in Kenya to demand that all the students be placed on Ciprofloxin as prophylaxis against anthrax. My colleague had tried unsuccessfully to calm the bishop. He needed, he said, "some muscle from the US Government." I was able to help him by contacting a CDC research physician working in Kenya whose advice, I guess, had enough "muscle."

The War on Terrorism has had a more sinister effect in eastern Africa. Both Kenya and Tanzania have huge Islamic populations, some of whom are fundamentalists very close in ideology to the Taliban brand of Islam. As much as we say that the US attacks are not attacks on the Islamic faith, they are perceived as just that—attacks on Islam. There have been several anti-US demonstrations with the ritualistic US flag burning in major cities. The real effects on volunteers are subtler. Americans who board a matatu, a Nissan bus that is the local mode of public transportation, are told, "Watch out. Bin Laden is sitting in the back seat." Popular beach resort areas have been declared "off limits" because they are predominately Islamic and have sub-groups suspected of being allied with the terrorist network. All in all, America's War on Terrorism makes an already stressful job that much more difficult.

It is sad that the world must go through this destructive phase. Most eastern Africans, including most members of the Islamic faith, endorse US actions. I understand the need for closing down the terrorist threat to the US and the world. I only hope we will be equally committed to rebuilding and supporting the countries we attack. I also hope the world can understand that we attack terrorism by fostering the development of Third World countries in a more lasting way than bombing them.

My best wishes to all of you for a peaceful 2002.

Daktari Bob
Area Peace Corps Medical Officer for Eastern Africa.

Robert Davidson, MD, MPH, is professor in the Department of Family and Community Medicine at University of California, Davis, where his interests include both rural health and the organization and financing of health care systems. In the past few years, he has served as both the director of Rural Health and earlier as the medical director of Managed Care for the UC Davis Health System. Out of Africa is an on-line journal of his odyssey in the US Peace Corps as the area Medical Officer in Eastern Africa.

The views expressed are those of the author and do not represent the opinions of the Peace Corps or the United States Government.

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