Gabon, April 2009
Elodie Kibweme was a fourth-year medical student at the Omar Bongo University in Libreville, Gabon. She wanted to specialise in malaria research and particularly in drug resistance. Being highly motivated and energetic she devoured the few outdated books on the subject in the library, and then started visiting the local Internet Café close to the University on a weekly basis.
If her pocket money would allow, she would spend hours scanning for scholarly articles on drug resistance, as this is what she considered the biggest problem for effective malaria control in her country.
However, as the gross national product of Gabon was too high because of oil revenues, WHO’s HINARI scheme would not allow the University full access to scholarly articles, and in the Café the problem was the same: she could only access and read a few abstracts before her time was up. Her frustration and disappointment built up, as she desperately wanted to join the malaria research programme at the Albert Schweitzer hospital in Lambarene, but was not able to communicate with scientists there, or to gain sufficient knowledge to be enlisted in their programme.
When Elodie was finally interviewed her hopes diminished further when she was being asked on the latest developments in the field of drug resistance research. A week later she was informed that her application was turned down. Desperate, she turned to some international scholarships, but none of these wanted her either. After her graduation Elodie got a secretarial job at a local Bank and her dreams to become a medical practitioner to serve her country to reduce the burden of malaria were shattered for good.
Access problems in Africa
The story above is fiction. But Elodie’s story is a fact of life for thousands of young scientists and students in the developing world.
Access to information is a basic human right. It is a condition for professional and public participation. For most people living in the developed world this is considered normal but access to information in developing countries remains pitifully small. As of December 2009, only 8.7% of the African population has access to the internet, compared to 53.0% and 76.2% of the European and US populations, respectively.
The inequity of access to information has two major forms: a) access, and b) the openness of access.
Access. Although access remains low at present, Africa also knows the highest growth rate of usage for the period 2000-2009, a trend which is likely to continue. The cyber café industry is undergoing massive growth across the continent, thereby rapidly expanding the community in search of medical information. Ghana alone has more than 150 cyber cafes, covering all major cities. Access in Universities and research organisations, however, remains only a fraction of that observed in developed countries. With the exception of South Africa, Mauritius, and most of North Africa, African universities are seriously constrained in the use of ICT by a lack of computer stations and a lack of access to affordable high-speed Internet connectivity. Indeed, the 2006 African Tertiary Institutions Connectivity Survey (ATICS) summed up the situation as “too little, too expensive, and poorly managed.” The survey report goes on to say that “the average African university has bandwidth capacity equivalent to a broadband residential connection available in Europe, [and] pays 50 times more for their bandwidth than their educational counterparts in the rest of the world.” Under such conditions only senior staff has access, leaving the majority of students destined to find information elsewhere (back to the cyber cafés).
Openness of access. But absence of access and connectivity is only part of the problem. Even with a designated computer and 24/7 access (again, this is rare) access to medical information provides an additional hurdle. The primary obstacles are no longer technological but are related to issues of content licensing, distribution, and access control. The importance of ensuring that developing countries have access to the latest medical research was recognized by WHO in 2000, and this led to the HINARI initiative, a partnership with science publishers that provides free or low-cost online access to 3,750 journals for researchers working in the poorest countries. However, actual access has not met promises. A recent study published in BMC Health Services Research noted that users in African countries reported problems in accessing journal content through HINARI due to the technical requirements for login and authentication. Furthermore, because HINARI focuses on providing access at the institutional level, it does not fully address the access needs of practitioners, journalists, policymakers, and others who may not be affiliated with major institutes (and work from cyber cafes). In short, not only computerised access itself, but actual access to information that matters, is far from optimal.
So whilst in the developed world we have the latest scientific knowledge at our fingertips, we deprive young scientists in developing countries of it.
Information builds knowledge. Knowledge empowers. Empowered people are better equipped to develop their country.
So why is it that access to scientific information is so difficult for young scientists in the developing world? It’s simply because they cannot afford the high subscription fees for scientific journals.
This is what we work hard for to change – at MalariaWorld. We believe that it is unethical to deprive doctors in developing countries of the latest scientific information in their field whilst children are dying in their hands. Put differently: Is it tolerable that publishers make huge profits on scientific information that the global research community has gathered but not make it accessible to those most in need of it?