Epidemic Illusions: On the Coloniality of Global Public Health
By Eugene T Richardson
Foreword by Paul Farmer
A physician-anthropologist explores how public health practices—from epidemiological modeling to outbreak containment—help perpetuate global inequities.
In Epidemic Illusions, Eugene Richardson, a physician and an anthropologist, contends that public health practices—from epidemiological modeling and outbreak containment to Big Data and causal inference—play an essential role in perpetuating a range of global inequities. Drawing on postcolonial theory, medical anthropology, and critical science studies, Richardson demonstrates the ways in which the flagship discipline of epidemiology has been shaped by the colonial, racist, and patriarchal system that had its inception in 1492.
Deploying a range of rhetorical tools, including ironism, “redescriptions” of public health crises, Platonic dialogue, flash fiction, allegory, and koan, Richardson describes how epidemiology uses models of disease causation that serve protected affluence (the possessing classes) by setting epistemic limits to the understanding of why some groups live sicker lives than others—limits that sustain predatory accumulation rather than challenge it. Drawing on his clinical work in a variety of epidemics, including Ebola in West Africa and the Democratic Republic of Congo, leishmania in the Sudan, HIV/TB in southern Africa, diphtheria in Bangladesh, and SARS-CoV-2 in the United States, he concludes that the biggest epidemic we currently face is an epidemic of illusions—one that is propagated by the coloniality of knowledge production.
Fevers, Feuds, and Diamonds: Ebola and the Ravages of History
By Paul Farmer
In 2014, Sierra Leone, Liberia, and Guinea suffered the worst epidemic of Ebola in history. The brutal virus spread rapidly through a clinical desert where basic health-care facilities were few and far between. Causing severe loss of life and economic disruption, the Ebola crisis was a major tragedy of modern medicine. But why did it happen, and what can we learn from it?
Paul Farmer, the internationally renowned doctor and anthropologist, experienced the Ebola outbreak firsthand—Partners in Health, the organization he founded, was among the international responders. In Fevers, Feuds, and Diamonds, he offers the first substantive account of this frightening, fast-moving episode and its implications. In vibrant prose, Farmer tells the harrowing stories of Ebola victims while showing why the medical response was slow and insufficient. Rebutting misleading claims about the origins of Ebola and why it spread so rapidly, he traces West Africa’s chronic health failures back to centuries of exploitation and injustice. Under formal colonial rule, disease containment was a priority but care was not – and the region’s health care woes worsened, with devastating consequences that Farmer traces up to the present.
This thorough and hopeful narrative is a definitive work of reportage, history, and advocacy, and a crucial intervention in public-health discussions around the world.
Partners In Health Rwanda: Lessons In Eliminating Barriers To Quality Care
Published by Forbes on 26 March 2020
By William A. Haseltine
“In late February, Dr. Krishna Reddy, Country Director of ACCESS Health India, and I traveled to Rwanda to learn more about health systems strengthening from an organization that has proven itself to be a formidable leader in the field: Partners in Health and the affiliated University Global Health Equity….
… Partners In Health and ACCESS Health have a lot in common, particularly when it comes to our mission, core values, and desired impact. We are looking forward to future opportunities to coordinate and collaborate on projects that help us deliver care to people no matter where they live, and no matter what their age.”
Opinion: The anti-virus to global epidemics? Strengthen the health systems
Published by Devex on 25 March 2020
By Alice Bayingana and Miriam Frisch
“Three months into the COVID-19 outbreak, we are starting to see history repeat itself. Just as the Ebola outbreak in 2014-16 took an enormous toll on Liberia, Sierra Leone, and Guinea, where more than 11,000 lives were lost, this new disease is quickly spreading around the world.
The Ebola outbreak in West Africa was significant, not only due to deaths from the disease but because it exacted harm to the health system’s ability to respond to even the most basic of needs within the country, with a huge loss in the health care workforce. Today we have seen similar breakdowns of health systems due to COVID-19 beyond treatment of the disease…
… It has become clearer now more than ever that global health is truly the responsibility of each one of us.”
Read the full article here: https://www.devex.com/news/opinion-the-anti-virus-to-global-epidemics-strengthen-the-health-systems-96790
Rwanda is training health workers for an interconnected world
Published by The Conversation on 23 February 2020
By Phaedra Henley
“Growing scientific evidence shows that environmental transformations such as climate change and pollution are linked to people’s health. The number of extreme events is increasing, often driven by human activities, and they often pose an immediate threat as well as having long-term health impacts. This is a future for which health professionals must be prepared…
… The interdependency between humans, animals and the environment is becoming more pronounced. It’s time to approach health problems in a broad, interdisciplinary way. The attitudes and practices of the health workforce will have to change.”
Creating Space for New Leaders with Dr Agnes Binagwaho
Published by Amplify on 12 July 2019
By Samia Kemal
“The first time I met Dr. Agnes Binagwaho, Vice Chancellor of the University of Global Health Equity (UGHE) and former Minister of Health of Rwanda, I was at Yale University for Global Health Corps’ Training Institute. After myriad sessions on leadership development, diversity, the equity agenda, and more, I began to re-evaluate my career in communications; did these buzzwords hold any tangible value in my life?
Dr. Agnes Binagwaho’s words were the first to cut through the noise: “there are no complex solutions, only complex excuses.”
In sitting down with Dr. Agnes, I wanted to further understand the challenges that women in the health sector face. From Vice Chancellor to Physician to Minister to Professor to Senior Advisor, Dr. Agnes has held various leadership positions and is well-known in the global health world for her work in strengthening health systems. Now, she’s chairing the International Conference Committee for the 2019 Women Leaders in Global Health conference to be hosted by UGHE in Kigali, Rwanda (November 9–10). After a year of working within her organization, I was curious about what advice she’d have for a young professional like myself.”
Read the full article here: https://medium.com/amplify/creating-space-for-new-leaders-with-dr-agnes-binagwaho-5b9c641cf460
Next Steps Towards Universal Health Coverage Call for Global Leadership
Published by BMJ on 24 May 2019
“Gerald Bloom and colleagues argue that the G20 is uniquely placed to facilitate crucial actions to accelerate progress towards universal health coverage
Universal health coverage (UHC) has been identified as a priority for international development by the G20, the World Health Organization, and the United Nations General Assembly. Since it was explicitly incorporated into the sustainable development goals (SDGs) as target 3.8, much effort has been expended on promoting UHC. Here we focus on four areas that, on current trajectories, are unlikely to achieve sufficient progress to meet the target. These are also areas for which G20 can provide substantial leverage: the principle of “leaving no one behind,” particularly in migrant health and genuine support for primary care; reliable domestic financing, which requires enlightened leadership and deliberate dialogue between finance and health sectors; harnessing and regulating medical and technological innovation; and mutual learning and harmonised aid among donor countries. We call on G20 leaders, who will meet in Osaka in June 2019, to take concrete action on these issues.
This article is based on a policy brief prepared by a working group convened by the Government of Japan as host of the Think 20 summit in Tokyo in May 2019. Our work has received input from a wide ranging global group of thought leaders, some of whom represent civil society, including patients and the general public.”
Read the full article here: https://www.bmj.com/content/365/bmj.l2107
How Rwanda Could Be the First Country to Wipe out Cervical Cancer
Published by Mosaic on May 7 2019
By Sophie Cousins
“Girls began queuing at their local school with their friends, waiting for their names to be called. Many were apprehensive. After all, most of them had not had a vaccination since they were babies. It was 2013 and a new vaccine had arrived in Kanyirabanyana, a village in the Gakenke district of Rwanda. Reached by a reddened earth road, the village is surrounded by rolling hills and plantations growing crops from bananas to potatoes. Unlike the 10 vaccines already offered to young children as part of the country’s immunisation programme, this vaccine was different: it was being offered to older girls, age 11–12, in the final year of primary school.
Three years before, Rwanda had decided to make preventing cervical cancer a health priority. The government agreed a partnership with pharmaceutical company Merck to offer Rwandan girls the opportunity to be vaccinated against human papillomavirus (HPV), which causes cervical cancer…
… Rwanda’s decision to partner with Merck wasn’t without its critics. In a scathing letter to the Lancet, German public health researchers voiced “serious doubts” that the HPV programme was “in the best interest of the people”. A major issue, they contended, was that while the burden of cervical cancer in the region was substantial, there were far more pressing diseases to vaccinate against, such as tetanus and measles.
Rwanda’s then Minister of Health, Agnes Binagwaho, replied publicly in a letter co-signed by two US researchers. They said that Rwanda already had very high vaccination rates for tetanus and measles, and asked: “Are the 330,000 Rwandan girls who will be vaccinated against a highly prevalent, oncogenic virus for free during the first phase of this programme not regarded as ‘the people’?”
Read the full article here: https://mosaicscience.com/story/rwanda-cervical-cancer-hpv-vaccine-gardasil-cervarix/
How Bill and Melinda Gates Are Transforming Life for Billions in the 21st Century
Published by Fortune on April 18, 2019
By Clifton Leaf
“The Gates Foundation is transforming the lives of billions of people—but it wouldn’t be the force it has become without the distinctive visions of the couple behind it. …
… If Bill’s superpower is speaking truth to the mighty, Melinda’s may well be hearing the truth of the unmighty—and then internalizing and sharing that secret, often brutally repressed wisdom. For a generally soft-toned speaker, her voice has the command of a church bell. But those who know her say her truly uncanny talent is simply the ability to listen….
… The argument for optimism has some awfully good evidence in Rwanda. A quarter-century after a genocide tore the already poor East African country apart, Rwanda is a case study in what’s possible. Led by physician Agnes Binagwaho, the nation’s former health minister, and others, Rwanda has steadily invested in health infrastructure, primary care, massive childhood vaccination, and maternal health.”
Read the full article here: https://fortune.com/longform/bill-melinda-gates-worlds-greatest-leaders/
Phil’s Speech at the Inauguration of the Ambulatory Cancer Center Inauguration of Butaro
July 12, 2018
Phil Garrity joined the Partners In Health staff in Boston in 2011 after volunteering with PIH’s sister organization in Peru. As program coordinator on the Monitoring, Evaluation, and Quality team, he helps to measure and evaluate PIH programs to demonstrate the success of the PIH model and improve quality of care. Last August, Phil was unexpectedly diagnosed with osteosarcoma, a rare and aggressive bone cancer, and began a nine-month treatment program that included chemotherapy and surgery at Dana Farber Cancer Institute and the Brigham and Women’s Hospital. His experience as both a patient and provider, one that has taken him from world-class hospitals to rural Africa, sheds light on the invaluable worth of promoting life, no matter the cost.
I’d like to express my gratitude for being here and for the invitation to participate in the inauguration of such a beautiful and urgently needed facility. It’s humbling to be standing up here for many reasons, but I’ll share one: I’m often at a loss when I wonder what gives me much of any legitimacy in sharing my story. Granted, I’m careful not to downplay the very real challenge I faced this past year—for I can imagine few trials more physically, mentally, emotionally, and spiritually demanding than cancer treatment, of laying waste to one’s own body in the hope of saving it—but it’s important to give context to my battle, especially as I reflect on it from a place far different than Boston.It says something that within two weeks of presenting with some minor joint pain last August, I received an MRI, a CT scan, a biopsy, a diagnosis, a treatment plan, and chemotherapy, all in a few 5-star hotels known as the Dana Farber Cancer Institute and the Brigham and Women’s Hospital. It is no exaggeration to say that these institutions have cancer care down to a science, and not just in a technical sense. To think of the myriad comforts and conveniences of such state-of-the-art hospitals, and to weigh that against the brutality of my own treatment, leaves me rather speechless as I stand here today in the midst of patients and providers who wage this battle every day in a setting far less forgiving.And while it’s difficult to compare my experience with those of the remarkable patients and survivors here at Butaro Hospital, I believe I can relate on a very basic level: I know what it means to be sick, and gravely so. A professor of liberation theology at Boston College, Roberto Goizueta, recently told me that he understands poverty to be more than a matter of material privation; the poor, he says, are those who simply cannot take life for granted. And the sick, very often, are among them. Illness experiences offer us a chance to see life through the lens of poverty, to illuminate our vulnerability as well as our interdependence with others and the world. Through these experiences, our humanity is revealed as a continual act of letting go, if only of our sense of entitlement to a life over which we so desperately claim ownership, a life that we so often take for granted. And at the very least, I know that this experience has made it more difficult for me to do that. I know that there is something worse than receiving a cancer diagnosis at twenty-four: chemotherapy. (I can assure you, even now, it makes me a little nauseated to look at that beautiful infusion center). But what is worse than that? Getting a cancer diagnosis and not getting chemotherapy. And even worse, even more humiliating, than that? Not getting a cancer diagnosis. This last scenario is, sadly, the fate for countless millions in our world, a world in which people are relegated to die, like their diseases, in anonymity. I can say without hesitation that I am lucky to have been given my diagnosis, to have had 18 rounds of toxins pumped into my body, to have lost 30 pounds and all of my hair, to have had much of my leg replaced with metal. I am lucky to have had the chance to nearly die so that I might live.I think there’s a very profound metaphor here. Cancer treatment shows us what we as humans are willing to do to protect and promote life. It shows us to what extraordinary lengths we will go, what incredible sacrifices we will make, in order to honor and venerate the life given to us. The simple (or not so simple) act of defying conventional wisdom and bringing world-class cancer care to rural Africa is a testament to this deep respect and radical commitment. To the naysayers, the pragmatists, the “reasonable” ones, we ask: Who are you to say this shouldn’t or can’t be done? That it is too costly, too difficult, too bold? As we’ve seen, and as we are beginning to show the world, it’s not only fair, it’s feasible.I am incredibly proud to be part of a global community of courageous, compassionate people who spend their lives committed to the humbling yet ennobling work of living out our reverence for life. I thank all of you for advancing this life-saving work, for giving my life back to me in so many ways, and for allowing me to give my story back to you.
GCSP Hosts the event “One Health One Planet. Environment and Health in the Human Security Agenda.”
Published by Geneva Center for Security Policy on May 31 2018
“On 22 May 2018, the Geneva Centre for Security Policy (GCSP), in partnership with the University of Global Health Equity (Rwanda), organized an event under the title: ‘One Health, One Planet. Environment and Health in the Human Security Agenda’.
The panel was moderated by Mr Bruno Jochum, former director of Médecins sans Frontières (MSF) and an Executive-in-Residence within the GCSP. The panelists included Dr Stephane de la Rocque, Head of the One Health Team in the Health Emergency program of WHO, Dr Desiree Montecillo-Narvaez, Programme Officer in UN Environment Programme (UNEP) as well as Dr Agnes Binagwaho, Vice Chancellor of the University of Global Health Equity, former Minister of Health of Rwanda.”
Landmark Studies in Rwanda, Madagascar Show Success for Universal Care Model
Published by Partners in Health on May 16, 2018
“BOSTON (May 16, 2018): Deaths of children under 5 have dropped by nearly 20 percent in just two years in a poor, rural district in Madagascar—despite the island nation’s lowest health spending in the world. This transformation echoes the strength of results charted across the last decade in rural Rwanda, where under 5 mortality dropped 60 percent between 2005 and 2010 in Southern Kayonza and Kirehe districts. Both sets of results were products of a grassroots health system movement founded on principles of public partnership, data science, and universal access to care for all. … Professor Agnes Binagwaho is senior author on the Rwanda study, having served as the Rwanda Minister of Health from 2011 through 2016. “Through Rwanda’s commitment to a universal right to health, we have continued to witness transformation that has rendered our country’s health system an example for not only Africa, but for the world,” she said. “We embrace the shared vision and work of our partners in Madagascar. Together, we can pave the way to inclusive health systems that advance equity and health for all people.” Prof. Binagwaho is currently on the faculties of both Harvard and Dartmouth Medical Schools, and is the Vice Chancellor of the University of Global Health Equity, a new Rwanda-based university that trains global health professionals from across the globe.”
Read the full article here: https://www.pih.org/press/landmark-studies-rwanda-madagascar-show-success-universal-care-model
New management training for immunization leaders launches in Rwanda
Published by Yale News on May 15, 2018
“This is an unprecedented opportunity,” said Erika Linnander, director of the Yale Global Health Initiative (GHLI), during her opening remarks at the recent launch in Kigali, Rwanda of a new immunization program. “I see such an exceptionally diverse group here today to help support this program — nurses, managers, policymakers, government officials, development partners, physicians, and educators. This coming together in support of improved management and leadership is fundamental to the achievement of global health targets.” …
“Thoughtful leadership and effective management practices are necessary to strategically and equitably improve health systems, including making sure vaccines reach children in every corner of the world,” said UGHE Vice Chancellor Dr. Agnes Binagwaho. “By hosting this forum in Rwanda, participants will train in an environment that prepares them to both address delivery challenges, as well as inspire them to improve access to high quality care.”
Read the full article here: https://news.yale.edu/2018/05/15/new-management-training-immunization-leaders-launches-rwanda
Words of Wisdom from African Women Moving the World Forward
Published by MasterCard Foundation on April 9, 2018
By Shona Bezanson
“When African women come together to discuss transformative leadership, one can’t help but feel amazed, inspired and energized. TheAfrican Women’s Leadership Conference recently hosted by Wellesley College provided seasoned African women leaders with an opportunity to share their leadership journeys with the continent’s emerging young women leaders….
Dr. Agnes Binagwaho, a pioneer and activist in the global public health sector shone a light on gender inequity at all levels of global health. She also shared her newest project — the University of Global Health Equity, in Rwanda — a revolutionary model of health care provision that puts equity at the center. She told us: ‘find your passion. Fight for it. Be ready to die for it. It gives you life.’”
Read the full article here: http://www.mastercardfdn.org/words-of-wisdom-from-african-women-moving-the-world-forward/
African Women on Top
Published by Project Syndicate on March 8, 2018
By Shona Bezanson and Peter Materu
“TORONTO – Africa has a long history of female leadership. Yet leadership can be a challenging aspiration for the continent’s young women, owing to enduring barriers to success. If African countries – and Africa’s women – are to meet their potential, this must change… Former Rwandan Minister of Health Agnes Binagwaho has dedicated her career to achieving equitable access to health care in her country and beyond.”
Rwanda has Universal Health Care – and it’s Working
Published by BLKHLTH on February 28, 2018
By Paulah Wheeler
“‘It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,’ said Dr. Agnes Binagwaho, the former Minister of Health who turned health in Rwanda around with her belief that health care is a human right for all. ‘It gives you psychological stability so you can concentrate on something else. The money can be used for other things – this is very important in trying to stimulate economic development.’”
Read the full article here: https://www.blkhlth.com/blog/2018/2/28/defining-moments-and-figures-in-the-history-of-black-health
2017: The Year in Quotes
Published by Partners In Health on Dec 18, 2017
“Inspiration in a sentence—that’s what we were looking for as we sifted through our stories about Partners In Health in 2017. Like any round-up, this collection of quotes falls short of conveying the breadth and depth of all that was accomplished this year. PIH staff saw 1.5 million patients in clinics and hospitals, never mind the hundreds of thousands consulted in their homes. But hopefully these few quotes, chosen for their pithiness, hint at one important aspect of the work: our deep gratitude for the chance to serve such amazing people.…‘The more our students are spread across the world to serve vulnerable populations, the more we will be able to change the world.’—Dr. Agnes Binagwaho, vice chancellor of PIH’s University of Global Health Equity in Rwanda, on her hope for graduates”
Read the full article here: https://www.pih.org/article/2017-year-quotes
Vice Chancellor Agnes Binagwaho Inducted to the National Academy of Medicine
Published by the University of Global Health Equity on October 19, 2017
“Washington, D.C. (October 14, 2017) — Vice Chancellor of the University of Global Health Equity (UGHE), former Minister of Health of Rwanda and global health champion Agnes Binagwaho, MD, M(Ped), PhD has been inducted to the National Academy of Medicine (NAM), an esteemed society of over two thousand distinguished contributors to the advancement of health and medicine.”
Read more here: https://ughe.org/national-academy-medicine/
Bending the Arc, Partners in Health Documentary
October 6, 2017
This is a documentary that I was a part of along with Paul Farmer, Ophelia Dahl and Jim Kim Yong which talks about the work of Partners in Health, using Rwanda as an example and looking at the progress that has been made in health.Directed by: Kief Davidson and Pedro KosProduced by: Cori Shepherd Stern, Executive Producers – Matt Damon and Ben AffleckScreened at: Sundance Film Festival, Miami International Film Festival and San Francisco Film FestivalAwards: Best Documentary Feature Film at the Greenwich International Film Festival (2017)
Watch the trailer here: https://www.youtube.com/watch?v=OjJmWZrmpcE
Find screening Information here: http://bendingthearcfilm.com/screenings/
University of Global Health Equity’s Contribution to the Reduction of Education and Health Services Rationing
Published by International Journal of Health Policy and Management on July 9, 2017
This is a video summary made by the International Journal of Health Policy and Management (IJHPM) in which I explain what the University of Global Health Equity brings to health education and how we aim to help the poor and those living in rural areas.
Read the full article here: http://www.ijhpm.com/article_3371.html
Watch the full video here: https://www.youtube.com/watch?v=Yq1ngoa0zUE
Dr. Agnes Binagwaho Appointed Commissioner for the Task Force on Global Advantage
Published by the University of Global Health Equity on June 30, 2017
“Over the last decade, Rwanda has seen significant advances in economic growth and population health. Developments in mobile health technology, household-administered rapid diagnostic tests, and support systems that integrate information and communications technology (ICT) are transforming not just how care is delivered – but where. By delivering high-quality health care and social services in some of the country’s poorest communities, Rwanda has developed a strong brand in global health delivery.”
Read more here: https://ughe.org/task-force-on-global-advantage/
Training the next generation of global health leaders in Africa
Published by Devex on May 31, 2017
By Catherine Cheney
“At this time of year, students around the world are putting on their caps and gowns for graduation ceremonies. Among them are 23 students from Rwanda and one from the U.S. who graduated as the first class of the University of Global Health Equity in Kigali, Rwanda, on Saturday.
Agnes Binagwaho, vice chancellor of the university and a former minister of health in Rwanda, calls UGHE ‘both exceedingly ambitious and urgently needed.’”
Dr. Agnes Binagwaho at Skoll World Forum on Ebola mitigation
Published by Devex on April 24, 2017
Watch the video here: https://www.youtube.com/watch?v=2pvivsmNRMk
Learn more about this discussion: https://www.devex.com/news/a-call-for-implementation-science-and-systems-innovation-in-global-health-89872
Former Rwandan Minister of Health to Lead Partners In Health’s Groundbreaking University
Published by the University of Global Health Equity on March 31, 2017
“Kigali, Rwanda (March 31, 2017)—The University of Global Health Equity (UGHE) announces the appointment of Professor Agnes Binagwaho, MD, M(Ped), PhD, former Rwandan Minister of Health and a champion for health equity, as its new Vice Chancellor.”
The Heart of Africa’s New Medical School
Published by Project Syndicate on February 1, 2017
By Michael Fairbanks
“SAN FRANCISCO – Rwanda has achieved some of the most dramatic gains in health and poverty-reduction in the world. This small, landlocked African country (the size of Massachusetts, but with twice the population) has developed a primary health-care system with near-universal access to clinical care and insurance. Rwanda has reduced both economic and health-care inequality, and demonstrates how ‘health equity’ helps to build strong societies.
In 2015, the government of Rwanda and the Boston-based Partners In Health (PIH), with the help of the Bill & Melinda Gates Foundation and the Cummings Foundation, established the private, not-for-profit University of Global Health Equity (UGHE). The university is founded on the principle that every member of a community deserves the same care and opportunity, and focuses on the delivery of quality health care to those who need it most. Agnes Binagwaho, a co-founder of UGHE who is a former minister of health and an adjunct professor at Harvard Medical School, once said to me, ‘Why would I want to raise my children in a nation where all children don’t get the same medical care as they do?’”
Published by the University of Utah on January 26, 2017
I was invited to speak with students and staff from the College of Social Work, School of Medicine, and the College of Architecture and Planning at the University of Utah.
Read more here: https://thc.utah.edu/lectures-programs/talks-at-the-tanner/
Construction on UGHE Paves Way For The Next Generation of Leaders
Published by the University of Global Health Equity on December 11, 2016
“Kigali, Rwanda – The University of Global Health Equity (UGHE) will break ground on its Butaro campus, initiating the first phase of construction on a facility that will support over 1,000 students and faculty and convene the world’s leading minds in health care delivery.
‘More than a shift in higher education, UGHE represents a shift in opportunity,’ says Dr. Agnes Binagwaho, Professor of the Practice of Global Health Delivery at UGHE. ‘The university will serve as an intellectual hub for the world’s best and brightest; many of whom will come from Rwanda and, as graduates, drive the success of our health system.’”