How Rwandan paediatrician Agnes Binagwaho fights racial stereotypes in global health

Agnes Binagwaho first spoke out against racial discrimination in early childhood. When she was seven years old, while attending a Catholic primary school in Belgium, she asked why a religious book showed only white-skinned people. Her white, female teacher promptly punished her in front of the class.

Binagwaho became a paediatrician specializing in treating premature newborns, and in 2014 she earned a PhD in public health from the University of Rwanda College of Medicine and Health Sciences in Kigali.

Binagwaho was Rwanda’s minister of health from 2011 to 2016. At the time, Rwanda was still rebuilding after the devastating 1994 genocide. She and others transformed the country into a global model for building strong health systems in resource-limited settings. During her tenure, the country beat back the Ebola crisis and sharply reduced child and maternal mortality: from 2005 to 2015, mortality rates for children younger than five dropped by around 55%.

In 2015, along with the late global health pioneer Paul Farmer, Binagwaho co-founded the University of Global Health Equity (UGHE) in Butaro, nestled in the hills of the northern district of Burera. She is currently a senior lecturer in the Department of Global Health and Social Medicine at Harvard Medical School in Boston, Massachusetts. Binagwaho combines her experience in building health systems with her passion for training the next generation of African scientists in health equity. She spoke to Nature about her experiences of racism and why she fights for equity in global health partnerships.

What is your great passion that has driven you as a scientist?

Saving lives. This is what propels me to educate myself continuously, to keep up with medical and scientific knowledge. My lifelong mission is to improve the health of my country’s people, especially children and women. But I understand that, alone, you can do nothing — this is not the kind of work for one person.

So, to get more people involved, the country created the UGHE, where students from more than 20 countries in Africa are trained in health equity and equipped with the best scientific knowledge, medical education and managerial and leadership skills. The UGHE launched with financial support from Partners in Health, an international non-profit organization in Boston, among others, and a land grant from the government. The university offers programmes such as a master’s degree in global health delivery and a bachelor’s degree in medicine and surgery. The majority of our students are women. My dream is that our graduates will become changemakers in global health, serving the poorest communities and the world.

Why is antiracism work important to you?

I was born in Rwanda but grew up in Europe in the 1960s. There was a widely held notion there that Africans are racially and intellectually inferior, and that Europeans needed to bring civilization to Africans. In school, I had to prove that this was not true. I never felt that my performance should be linked to where I come from — my father was the first ever Rwandan doctor to earn an MD in Belgium in 1962. He exposed me and my siblings to books and science. I’m Black and I own my African identity.

Today, that notion of racial inferiority still exists, although it’s often more covert. That’s why you have to fight against racism everywhere, including in science. Now, the work of many Africans has shown that disparities between richer countries and Africa are linked to economic inequities, rather than intellectual capacity. The COVID-19 pandemic is a good example of why global health-equity work is important. We have seen the imbalance inherent in the current system, which stems from colonialism and power disparities. Africans must have a say in decisions made by global health institutions to set rules and protocols that are supposed to benefit Africa. We must not accept what is not the best choice for our population.

How have you dealt with issues of racism or discrimination, personally and professionally?

As a Black woman from Africa, I’m not immune to racism and discrimination. When I was minister of health, some Western researchers threatened to kill my career after my team publicly criticized their data-collection methods, which were based on their own point of view and interests without considering Rwandan needs. I replied that I did not care; I’m not going to do anything contrary to my commitment to the people of Rwanda. I am not afraid to be sacked.

Racial stereotypes can be very fragile — but people who agree with them don’t want to be singled out. Racism and discrimination can also be subtle, and even those with good intentions can perpetuate it, so they need to educate themselves. Those of us who experience racism have to speak about it.

What is the biggest misconception or racial stereotype that you’d like to dispel?

Some international development partners that come to Africa have what I call a ‘Western supremacy’ attitude. They often don’t realize that they’re being racist, because racism is more complex than holding simple beliefs, such as “I don’t like Black people,” or “Black people don’t deserve what I have.” Those with a Western-supremacy attitude don’t ‘hate Black people’ — rather, they think that the way things are done in the Western world should be the gold standard in collaborations. They exclude African values and say, “If you want us to help you in your development, you have to follow our set standards.”

We have to fight this type of racism openly, and it’s easy to do because no one in these roles wants to be called out for being racist. Development partners have to follow what Africans want, not make us follow what they want. You’re not going to tell me in my kitchen what colour curtains I have to put up.

What is your best piece of advice to a 20-something researcher in your field?

Understand what your community and country need and learn how you can help to solve their problems. Don’t try to save the world if you cannot improve life around you locally. Also, learn how to manage public funds and keep records. Some health professionals have landed in trouble not because they stole money and resources that were entrusted to them, but because they didn’t maintain the records properly. So, learn how to keep the books.

What single thing would you change about the way science is done?

Funding should be allocated on the basis of scientific evidence and needs. This includes implementation science, which involves developing strategies to ensure that targeted communities adopt evidence-based health interventions. This part of the research is almost always neglected. We need to engage communities and understand the best way to deliver solutions to them.

The University of Global Health Equity was created out of implementation science. In Rwanda, for example, we train community health workers to serve their own communities, empowering people to know and choose which health-care workers to work with, which helps to boost trust and vaccination uptake. In 2011, thanks to our campaign and implementation-science approaches, we vaccinated more than 93% of girls in Rwanda against the cancer-causing human papillomavirus. By 2018, vaccine coverage for girls was 98%.

What do you do to get away from science?

I like to have fun with my community. I go out for picnics with my colleagues and friends; we dance together with our kids, eat Rwandan brochettes (meat skewers that are typically made of beef and chicken, cooked over a charcoal grill) that we prepare ourselves and enjoy good company. It helps to replenish our energy after all the hard work we put in.

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