Post-COVID-19 – An era of withering dependency?

The late president Robert Mugabe of Zimbabwe, that country’s independence icon, died in a hospital in Singapore in 2019, aged 95.

Ethiopia’s late prime minister Meles Zenawi died in 2012 in Brussels from an undisclosed illness, aged 57.

The late president Levy Mwanawasa of Zambia travelled to France for medical treatment after suffering a stroke. He died at Hospital D'instruction Des Armées Percy in Clamart, France.

In 2014, the late president of this same country Michael Sata died after receiving treatment for an undisclosed illness at the King Edward VII's Hospital in London, aged 77.

The late leader of Guinea-Bissau Malam Bacai Sanhá sought medical treatment in France for advanced diabetes. However, he died there in a hospital in 2012.

The late president Omar Bongo, who ruled Gabon for 42 years, travelled to Barcelona, Spain for treatment of cancer. However, he died there of cardiac arrest in 2009.

Nigeria’s incumbent president Muhammadu Buhari has also been in a European hospital seeking treatment for months.

Many more such leaders died in overseas hospitals beyond their home turf. Hundreds and thousands of high-level officials and wealthy business persons could be included in this list.

When high-profile personalities, including leaders of developed countries, need medical treatment, they often get admitted to major university hospitals. For instance, when former United States president Jimmy Carter needed brain surgery in 2019, he went to Emory University Hospital.

When the late German chancellor Helmut Kohl went for surgery he was admitted at the University Hospital of Heidelberg.

When the former deputy prime minister of the United Kingdom Lord Prescott was diagnosed with pneumonia and needed a ‘high dependency ward’ he was admitted at University College Hospital, London.

Financial implications

According to news reports, the medical tourism industry is valued globally at US$100 billion (and was projected to continue growing at 25% year-on-year until the outbreak of COVID-19).

Nigerians were spending more than US$200 million on medical tourism to India alone. Overall, it is estimated that Africa could be losing up to US$1 billion on imported medical treatment annually, presenting a substantial economic loss to the continent.

As Africa’s middle class is growing, so is the number of people who will be seeking excellent medical treatment. This means that billions more in transportation, accommodation and treatment will continue to flow overseas – until such time that Africa provides comparable services.

If reliable infrastructure and services were strategically built at home, these resources squandered overseas could be effectively spent at home. This, however, requires serious commitment from governments and their officials who are currently enjoying foreign medical services.

Psychological implications

The practice by heads of states, government officials and high-powered individuals seeking medical help overseas publicly reveals their lack of confidence in national medical systems, institutions and personnel.

It also expresses their implicit and explicit dependence on the resources available at such institutions at the expense of their own. Abandoning institutions at home in favour of those overseas has direct and indirect impacts on the psyche of those in the business of caring for their nation’s health. And it may encourage others to look for remedies elsewhere – even when these may be available at home.

By seeking high-end treatment elsewhere, the leaders are implicitly commenting on the incompetence and inferiority of their institutions in the countries which they are supposed to be governing.

Many leaders of these nations – who ferociously fought colonial powers, zealously devoted their lives to anti-colonial struggles, and successfully liberated their countries – astoundingly seek life-saving services and willingly meet their deaths in those same colonial capitals which they often lambast.

It seems that Africa is yet to fully liberate itself from this deplorable dependency in the 21st century. And, no, the blame may not be conveniently laid on unfavourable policies, for example, structural adjustment programmes, foisted upon the continent.

The reasons for seeking medical tourism abound. Key among them are weak domestic healthcare infrastructure and poor standards of healthcare providers. Others include the need for anonymity, secrecy, unacceptable delays for local medical procedures, lack of specialist (complex and luxury) procedures, among others. While it is probably impossible to stop medical tourism from developing countries in its entirety, quite a substantial stride could be made by getting one’s own house in order.

Building excellence – The silver lining

African universities – and the hospitals they run – have great potential to provide world-class services if they are adequately supported and sustainably funded. Establishing new medical facilities and re-invigorating existing facilities need to be seriously considered, particularly now that the COVID-19 pandemic has taken medical tourism out of the picture.

In fact, a pandemic of such biblical proportions as COVID-19, which does not spare anyone, makes it imperative to extricate our nations from dependency upon the resources of other nations whose priorities have now turned towards saving the lives of their citizens.

Some countries have banned repatriating the bodies of their own citizens who have died from COVID-19 for fear of spreading the virus. Bodies are thus buried or disposed of, sometimes against the will and consent of family members and in contravention of their values, beliefs and rituals. While seeking medical care elsewhere may have once been a luxurious alternative, dying at home has become an inevitable reality in the era of COVID-19. And in some cases, dying at home has become a luxury.

According to a New York Times article, 10 African countries (roughly 20% in the continent) do not even have ventilators. South Sudan, a nation of 11 million, has more vice-presidents (five) than ventilators (four), it said. The Central African Republic has three ventilators for its five million people. In Liberia, which is similar in size, there are six working machines – and one of them sits behind the gates of the United States Embassy.

Laying bare the dangers of dependency

The great danger and implications of utter dependency on the resources and infrastructure of others in far-off lands has been dramatically exhibited in the current situation. This is a clarion call to all African leaders, policy-makers and influential personalities to build and sustain high-end (university) hospitals to advance public health as a matter of national security. This needs to be realised through sustainable financial modalities that provide services to all without regard to economic and social status.

This argument is in concert with my position on the need to advance flagship universities and promote differentiated higher education systems in Africa. It is nearly impossible to build ‘elite’ institutions and provide ‘world-class’ services in every institution.

For instance, Ethiopia has until recently embarked upon the establishment of a large number of universities on arguable modalities (along ethnic lines) which has made declaring excellence in selected institutions officially rather tricky. Zimbabwe too was in the throes of establishing a brand new university to honour Mugabe (while he was still alive) – costing billions of dollars – while the rest of the system was struggling.

We are already witnessing some of the national responses to COVID-19: Ghana's President Nana Akufo-Addo, for example, has announced plans to construct more than 90 hospitals to beef up Ghana’s health system in the wake of the outbreak (though critics are questioning how the government intends to pay for its plans). While such effort may be commendable, it is important to consolidate existing (and a few new) ones into ‘world-class’ (university) hospitals.

In the 21st century, where some African countries are already embarking upon ambitious space science initiatives, it is deplorable that their leaders and high-ranking officials continue to seek medical refuge elsewhere, and die in foreign climes.

It is time that leaders lived and perished on their home soil.

Damtew Teferra is professor of higher education at the University of KwaZulu-Natal, South Africa, and founding director of the International Network for Higher Education in Africa. He is convenor and founder of the Higher Education Forum for Africa, Asia and Latin America (HEFAALA). Teferra is founding editor-in-chief of the International Journal of African Higher Education. He steers the Higher Education Cluster of the African Union’s Continental Education Strategy for Africa. He may be reached at teferra@ukzn.ac.za and teferra@bc.edu.