Current Pharmacogenomics and Personalized Medicine, 2011, 9, 000-000 1 1875-6921/11 $58.00+.00 © 2011 Bentham Science Publishers Letter to the Editors Not So Simple: Situating Postgenomics Personalized Medicine in the Regional Context in Africa for Global and Women’s Health Ida Ngueng-Feze 1, * , Alexander Borda-Rodriguez 2 and Farah Huzair 2 1 Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, Canada; 2 Development, Policy and Practice, The Open University, Milton Keynes, United Kingdom Keywords: Africa, genomics and international development, global health, midwives, public health genomics, postgenomics personalized medicine, regional context, women’s health. TO THE EDITORS We read with great interest the editorial analysis on postgenomics medicine in Africa and ways in which this can benefit global and women’s health [1]. More importantly, the articulation of the triple integration of the biological, social and political determinants of health to ensure equitable global diffusion of genomics innovations in low and middle income countries (LMICs) deserves further elaboration of the African local context. The aim of this Letter to the Editors is to address and ‘explicate’ the local contexts in which health systems and services are delivered in Africa. Without effective understanding, enlisting and cooperation of the key ‘health actors’ in their natural setting and context, we submit that personalized medicine, whether with genomics or other advanced biotechnologies, will not come to fruition. Our discussion below attests to the need for reconciliation of local, regional and global health systems and services in an increasingly interconnected world. TRADITIONAL MEDICINE AND AFRICA The World Health Organization (WHO) has published in its reports that up to 80% of people in many developing countries rely primarily on traditional medicine for their health services [2]. Wherefore, traditional healers and practitioners and this "alternate" health system should be integrated into research parameters if research aims to be comprehensive and fully contextualized. Understanding the patient’s socio-cultural context is part of integrating local advances in larger global objectives. In fact, this approach, referred to as “cultural proficiency”, is an emerging concept, whereby consideration is given to the patient’s culture and perception in order to increase treatment success [3], which is progressively integrated in fields such as pharmaco- genomics and pharmacogenetics. Because of their close and embedded interactions with local communities, traditional practitioners and traditional *Address correspondence to this author at the Centre of Genomics and Policy, Faculty of Medicine, McGill University, 740 Dr. Penfield Avenue, Suite 5200, Montreal, QC, Canada; Tel: (514) 398-8004; Fax: (514) 398-8954; E-mail: inguengf@yahoo.com birth attendants (TBAs) represent both an untapped potential for advancing rational therapeutics as well as a risk if they are not recognized as an important variable on the critical path to personalized medicine in Africa. Indeed, several African countries have started to integrate traditional healers and practitioners in their formal health care systems. For example, in South Africa the “Traditional Health Practitioners Bill,” which came into force in 2006 facilitated the integration of traditional healers in routine healthcare by implementing the development of a pharmacopoeia of traditional medicines [4]. This is particularly relevant to fields such as pharmacogenomics as patients would use healer’s herbal prescriptions in conjunction with doctor’s medications. Several studies have acknowledged the need to integrate practitioners as well as TBAs as they play a crucial role in the provision of health care services. In fact, it was estimated that 60-80% of deliveries in developing countries occurred outside modern health care facilities, with a significant proportion of this overseen by TBAs [5]. Additionally, studies conducted by the WHO, in three different LMICs (Ghana, Mexico, and Bangladesh) to train TBAs, demonstrated that training these health care providers was not only feasible but also resulted in the improvement of healthcare service quality, increased dissemination of health information within the community, as well as the empowerment of stakeholders [6]. Wherefore, if properly trained and integrated, these “health actors” can be valuable especially for many countries with limited resources (few or poor infrastructure, limited funds, lack of qualified personnel) often stretched even further by environmental predicaments (e.g., droughts, infectious epidemics), political turmoil (e.g., political instability, civil war, emigration) or social barriers (e.g., superstitious beliefs, misinformation, lack of education). While many countries in Africa have yet to proceed towards an integrated health system as above, it is important that studies begin to include in research parameters, traditional medicine as part of the cultural context which can both facilitate or hinder the application of new technologies in local contexts. Notably, donors have the ability to facilitate this process by integrating these important components into their terms of reference. This would