CCSD - Issues

Community Centric Sustainable Development

Tuesday, January 18, 2005

Medical Open Access

The great value of information at the front lines
Dr. Edwin Mapara from Botswana

Subj: [hif-net-at-who] Open access (16)
Date: 1/18/2005 8:12:51 AM Eastern Standard Time
I have just had an open access article published in the December 2004 PLoS Medicine Journal (, "Picturing AIDS:Using images to Raise Community Awareness," co-authored with Prof David Morley [see note below].

Since then close to 200 colleagues have received a copy in Botswana across all sectors, and are academically surprised that what was a "condemned" village initiative in Health Promotion in Lobatse, Botswana, is being used in London. The icing on the cake was to stand with the Director General on the same platform at the World Health Organisation headquarters, Geneva on World AIDS Day 2004 and in a seminar for the WHO staff the following day in Geneva, talking and discussing the same PLoS Medicine, open access, article.

For the medical colleagues in Primary Health Care and in the districts, it is a worth-while open access resource, for its content, concepts and context! If this article was in a restricted publication, it might have only been in the hands of 20 or so consultants at the referral hospitals in their "restricted" offices and another 20 or so bureaucrats at the Ministry ofHealth on the shelves as a "decoration"!

Foreign researchers told our leaders in the 1990s, that "...using pictures is shock tactics, to cause fear and does not work!" Twelve years later in 2002, the "Picturing AIDS" strategy was a documented a "best practice" and is being replicated nation-wide. I first met with Prof David Morley on the 31st January 2003 at a seminarat the Institute of Child Health, where I shared my experiences of usingTeaching Aids At Low Cost (TALC) pictures (colour photos) to empower traditional doctors, traditional birth attendants, teachers, students, soldiers, People living with HIV/AIDS, commercial sex workers, the out of school youths, the media, the Church, the civil service.... and not least, the health care workers for whom the TALC slides were intended for in the first place.

People wanted to "...see AIDS" in the early days of the HIV/AIDS pandemic. We (Athlone hospital) obliged and used the 1989 TALC slides, with photos of Africans, to show HIV/AIDS. At the same time we addressed denial and the silence "...taboo subject" that is very loud in the developing countries.

Sadly HIV/AIDS has been so "medicalized" and is the domain of the priviliged few specialists, financialy, while the grassroots people who are being researched on rarely receive the feedback and do not benefit from the resources in "millions" that are earmarked for them. The biomedical model has disempowered the masses in the developing countries, who must take their own health in their hands, especially with the massive brain-drain.The Open Access Movement will at least inform, educate and communicate to us some wonderful works, experiences and best practices of others to spur us on.

Why re-invent the wheel? Africa has a lot of "restricted" Research Reports / Consultancy Reports on bookshelves or cupboards at headquarters gathering dust! Meanwhile every other donor funder's proposed proposal has "...15% for the consultant..." we shall hire, usually from Europe or America, to come and solve a local African problem.

The bureaucratic leaders tell the locals, the natives, that they must volunteer their services or presence. Taking a line from Jorge, our bureaucrats have a lot to answer for as; "There is no such a thing as a free lunch". Somebody has to pay (Jorge E.Maldonado). Picturing AIDS as an awareness strategy has been the fishing line that has been given to Botswana, partially answering Helen; "Personally I wish that people could to be taught how to fish (given the means to sustain themselves), so that they can stop being "victims" and free themselves from the bondage of free fish (endless charity) (HelenStrong)."

With Gordon Brown coming on board, we might see more people being taught how to fish than get the free fish! It took a while for the Picturing AIDS strategy to be accepted as the foreign consultants said, "... it goes against health promotion teachings!" I believe that pictures for the picturate and literature for the literate are viable ways of reaching the community!

For me, articles/publications in open and restricted journals are all worthy to look at. What matters is information that will make adifference. As for the publishers, they should have a choice to publish where they want to. There is a lot of time that goes into publishing a "worthy" scientific article, that I might not be able to do, being a "hands on" medical officer in a remote district hospital where I am expected to be "everything", with the exception of a researcher.

Even trying to get money for research is another battle in our set-ups. It is easier to squeeze water from a rock! If an open article or resticted article with the valuable health information will help another colleague to save a life or improve the quality of life of a society, I am happy!

Sub-Saharan Africa has roughly three "Twin Tower" disasters every day or one Tsunami disaster, 150 000 deaths, per month in health related deaths. Sadly, the majority of deaths are preventable but the information is mostly "restricted"!

We saw the pictures of the Twin Towers. We saw the pictures of theTsunami. Have we seen the pictures of HIV/AIDS? The scenes from these two tragic events that moved the world are even more shocking than the majority of TALC slides that my team in Botswana used for teaching, where Health Promotion Specialists talk of "shock tactics" and have held us back for many years.

The HIV/AIDS pandemic in Africa is "iatrogenic!" The Health Promotion curriculums have to be re-visited! If that will be done through the Open Access Approach, let it be so. Do we need Nelson Mandela to talk "open access" about his family to take a point home, when there are Open Access Publications!

As we discuss open access and restricted access publications, give a thought to the developing countries, where a lot of us live on less than a dollar per day! Sadly, even the life saving information is medicalized! Sorry for my round about way of supporting the Open Access Movement, as a process of empowerment in the village, de-medicalization, rationalisation, de-bureaucratisation and southernalisation especially in addressingHIV/AIDS.


[HIF-net-at-WHO profile: Edwin Mapara is a medical doctor trained at theUniversity Teaching Hospital, Lusaka, Zambia. He is currently studying at the London School of Hygiene and Tropical Medicine. He is a former chief medical officer of Athlone Hospital, a 175-bed district hospital in Lobatse, Botswana, where he established the Athlone AIDS Awareness Programme, a model which is now being replicated in other district hospitals in Botswana. Edwin has a special interest in HIV/AIDS and the use of health information materials - especially TALC clinical slides -for sexual health promotion. ]

[Note from HIF-net-at-WHO moderator: Edwin Mapara and David Morley'sarticle is available free at: ]

HIF-net-at-WHO: working together to improve access to reliable information for healthcare providers in developing and transitional countries. Send list messages to . To join the list, send an email to with name, organization, country, and brief description of professional interests.


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