When Help Hurts: Medical Exploitation and Distrust in East Africa
Medical mistrust is a lack of confidence in healthcare systems, professionals, and research, often rooted in fear that these systems may not act in a person’s best interest. This mistrust arises from real experiences of discrimination, neglect, and unethical practices. While the U.S. Tuskegee Syphilis Study is a well-known example, East Africa also faces its own history of medical exploitation. Colonial abuses, exclusion from healthcare decisions, and violations of consent have deepened scepticism. Systemic inequality and marginalisation have made communities cautious of health interventions and foreign-funded programs, leading to resistance, hesitancy, and worse health outcomes. It raises a vital question: What events have caused this deep mistrust in East Africa, and how can trust be restored?
Dependency, Donors, and Distrust: The Western Grip on East African Health Systems
One of the main reasons behind continuous medical exploitation is the significant influence that Western political powers hold over East African countries. In healthcare, specifically, a large portion of funding comes from foreign organizations, such as USAID and the Bill & Melinda Gates Foundation. Among these, the U.S. PEPFAR (President’s Emergency Plan for AIDS Relief) has been a consistent source of aid. For example, USAID provided approximately $6.5 billion in humanitarian assistance to sub-Saharan Africa in 2024, covering health, education, and economic development programs.
Additionally, USAID Global Health Supply Chain Program (GHSC-PSM) has procured over $3.58 billion in HIV/AIDS commodities during the project’s lifespan, delivering over $101 million in a single fiscal quarter. This continued reliance on Western donors and researchers often involves extractive research practices that prioritise foreign interests. For instance, during Ebola vaccine trials in Uganda, many community members feared they were being used as ‘guinea pigs’ because the trials offered little clear benefit or feedback to local people. Similarly, HPV vaccine campaigns funded by international organisations in Kenya faced suspicion as communities questioned their safety and intentions. Further, Kenyan President Uhuru Kenyatta made negative claims regarding early Coronavirus tests in Kenya. These examples reflect a broader pattern where foreign-led clinical trials and health programs operate with limited local involvement, deepening seated community wariness and mistrust toward healthcare interventions.
Health Inequity as Exploitation
Medical ethics, popularised by Beauchamp and Childress in Principles of Biomedical Ethics, include principles like autonomy, beneficence, non-maleficence, and justice, which guide medical practice and research to ensure patients are treated with respect, fairness, and dignity. Although these standards are universally accepted, healthcare practices in East Africa have often been compromised by exploitative actions driven by Western donors, researchers, and institutions. One of the most glaring examples is Renee Bach, a 20-year-old American missionary who operated an unlicensed clinic in Uganda without any formal medical training. Her actions reportedly led to the deaths of over 100 children. This case illustrates the dangers of the ‘saviour complex’ where foreign individuals believe they are entitled to intervene, ignoring professional ethics and local accountability.
Exploitative research practices are also common. Clinical trials frequently target impoverished participants who are not fully informed or do not receive clear benefits from the research. The HPV vaccine pilot in Kenya faced significant backlash because of poor communication and lack of transparency, which left communities feeling deceived. Additionally, interventions often end abruptly once data collection is complete, leaving vulnerable populations without continued access to beneficial treatments. Rural and refugee communities are especially at risk, often being used for data collection while receiving minimal healthcare support in return. Pharmaceutical companies have also been accused of dumping surplus or experimental drugs into East African markets where regulations are weak and oversight is limited.
A newer form of exploitation has emerged in digital health. Telemedicine platforms and artificial intelligence diagnostic tools increasingly use patient data from African populations without proper data protection or consent frameworks. While companies profit from these innovations, the communities providing the data rarely benefit. Despite the widespread endorsement of medical ethics, these exploitative patterns persist, reinforcing mistrust and deepening the power imbalance in East African healthcare systems.
Everyday Encounters of Powerlessness: How Mistrust Persists in East African Healthcare
The above exploitations have resulted in a deep-seated sense of medical mistrust that has permeated individuals and entire communities. This mistrust not only stems from high-profile cases of exploitation but is also reinforced by the daily experiences of patients who feel powerless within the healthcare system. One significant consequence is the widespread reluctance to access care, even when services are available. In maternal health, for example, many women choose to deliver their babies with traditional birth attendants rather than in hospitals. This choice is often driven by previous encounters with disrespect, verbal abuse, or neglect at healthcare facilities, where women feel dehumanized and their concerns dismissed. During the COVID-19 pandemic, this mistrust was evident in the resistance to vaccination campaigns. In Kenya, suspicion toward Western-led health interventions reignited public fears of being used for experimental purposes. These concerns were not irrational but rather informed by a history of unethical medical practices and a lack of transparent communication from authorities.
The realm of mental health faces similar barriers. Poor public health messaging, combined with the absence of culturally relevant mental health services, leaves many individuals without support. Mental health conditions are frequently misunderstood and stigmatised, and the formal healthcare system often fails to address these cultural nuances, driving people away from professional care. Doctor-patient relations further compound this mistrust. Patients frequently perceive medical professionals as distant and elitist, creating a barrier to open communication. Language differences, hurried consultations, and a general lack of empathy contribute to feelings of alienation. Patients often leave health facilities feeling unheard, their concerns minimised, and their dignity compromised. Medical mistrust in East Africa, therefore, is not merely a legacy of past abuses. It is continually reinforced by everyday encounters that strip patients of agency and respect.
Local Exploiters: The Shadow Beneficiaries of Mistrust
Medical mistrust creates opportunities for exploitation by both foreign actors and local opportunists. As confidence in formal healthcare systems declines, unregulated private clinics often fill the gap. These clinics frequently offer ‘miracle cures’ or overprescribe antibiotics without proper medical oversight, risking patient safety and contributing to broader public health problems like antibiotic resistance. Another effect of mistrust is the rise of medical tourism. Wealthier patients travel abroad, to countries like India and Turkey, seeking treatments perceived as unavailable or unreliable at home. This trend diverts resources and attention toward serving a wealthy few, while most local populations continue to face inadequate healthcare services. Religious leaders also play a significant role in shaping health choices. In many communities, they encourage faith healing over formal medical treatment. While spirituality is an important part of cultural identity, reliance on faith healing often delays critical care, worsening health outcomes and causing preventable deaths, especially in rural areas where formal healthcare access is limited. Thus, mistrust in formal health systems isolates patients and opens doors to exploitation. Unregulated clinics, faith healers, and misinformation thrive in this environment, further fracturing healthcare and deepening the divide between communities and medical institutions.
Rebuilding Trust through Decolonised, Community-Led Healthcare
Rebuilding trust within East Africa’s healthcare systems requires structural change that prioritises ethical responsibility, community participation, and the reclamation of agency by local populations. A critical step is to decolonise the research agenda by promoting African-led research institutions. Control over research priorities must shift to local scholars and practitioners who understand community needs. Ethics reviews should be conducted by local boards, ensuring studies reflect cultural sensitivities and community interests. Community participation must be embedded in every stage of the research cycle, from design to data dissemination. This approach enhances research relevance and fosters ownership and trust. Transparent dialogue between researchers and communities is essential to dismantle the perception of African populations as passive research subjects.
In healthcare delivery, accountability mechanisms are vital. Patient charters outlining rights and responsibilities can empower citizens to demand better care. Legal literacy campaigns should accompany these charters, equipping people to advocate for themselves. Strengthening medical ombudsman offices offers accessible channels to report abuse, neglect, or malpractice, ensuring grievances are addressed. Governments must also support frontline healthcare workers with better pay, safer working conditions, and professional development opportunities. A motivated healthcare workforce is key to delivering equitable care and rebuilding public trust. In the digital realm, all e-health platforms must adhere to transparent data governance policies. Patients have the right to understand how their health data is used, and legal protections must ensure data sovereignty and community privacy.
Conclusion
Restoring trust in East Africa’s healthcare systems requires a holistic approach addressing historical grievances and contemporary challenges. Decolonising research, fostering genuine community participation, ensuring accountability in care delivery, supporting healthcare workers, and safeguarding data rights are all critical pillars. Trust cannot be rebuilt through superficial interventions or isolated programs; it must be earned through consistent, transparent, community-centred actions that affirm the dignity, agency, and rights of every individual in the healthcare system.
