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Between Donor Interest, Global Models and Local Conditions: Treatment and Decision-Making in the Somalia-Finland Tuberculosis Control Project, 1981-3.

https://arctichealth.org/en/permalink/ahliterature307311
Source
Med Hist. 2020 01; 64(1):94-115
Publication Type
Historical Article
Journal Article
Date
01-2020
Author
Kaisa Harju
Author Affiliation
History of Sciences and Ideas, PO Box 8000, FI-90014, University of Oulu, Finland.
Source
Med Hist. 2020 01; 64(1):94-115
Date
01-2020
Language
English
Publication Type
Historical Article
Journal Article
Keywords
Antitubercular Agents - history - therapeutic use
Communicable Disease Control - history - methods
Finland
Guidelines as Topic
History, 20th Century
Humans
International Cooperation - history
Lung - diagnostic imaging
Radiography, Thoracic - history
Somalia
Tuberculosis, Pulmonary - diagnosis - drug therapy - history - prevention & control
World Health Organization - history
Abstract
Despite numerous global health initiatives after World War II, tuberculosis still poses a major threat in sub-Saharan Africa. This article examines one attempt to tackle this problem: the Somalia-Finland Tuberculosis Control Project. Conducted in the 1980s as a bilateral development aid project between the two countries, it became the most extensive - and expensive - tuberculosis initiative in Somalia in that decade. An interesting feature of the project is that, despite a lack of previous experience in tuberculosis work in developing countries, the Finnish partner decided not to follow the WHO global guidelines designed to standardise tuberculosis activities across the developing world. Instead, Finns established their own treatment programme based on X-ray and short-course chemotherapy - otherwise rarely used in clinical practice in Africa. Through a close reading and comparison of the correspondence, project plans, memos and minutes, the article analyses the formation of this strategy. Focusing on ground-level decision-making, it argues that the decisions were based not only on a belief in the superior clinical effectiveness of these methods, but also on the fact that they better suited Finnish ambitions and project logic. Thus, the article supports the notion that donor perspectives on resources and project objectives determined what was seen as feasible treatment in a developing country. By shedding light on the debate between the supporters of short-course chemotherapy and the WHO standard treatment strategy, it also contributes to the early history of DOTS (directly observed treatment, short course).
PubMed ID
31933504 View in PubMed
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