Uganda and Kenya have found what they think is the magic bullet to the problems in their health sectors (strikes, skills) — Cuban doctors.
There is a lot of cynicism, and puzzlement. The Cuban doctors, for example, are being paid far more than their striking East African counterparts are asking for. Why not just pay them half the proposed salaries for the Cubans, and problem solved, they ask.
However, the Cuban doctors also provide us an opportunity to ask some hard questions about our health systems. We are not the first to discover the wonder of Cuban doctors. Countries such as Qatar, which have more money than Cuba can ever dream of, are highly dependent on Cuban doctors.
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The thing with Cuba is that its doctors almost invariably go to help out in countries that are much richer than it or spend more money on health than it does — and get comparatively dismal results.
When West Africa was being hammered by a horrific Ebola outbreak in 2014/2015 and many African countries were rushing to shut their doors to citizens from the affected countries, “poor” Cuba was among the first to rush in to the rescue. We know the stories of universal health in Cuba and its terrific health indicators.
We rarely ask “Why?” Part of is that Cuba has a very enlightened attitude to health. For example, Cuba legalised abortion in 1965, among the first countries. Abortion is still anathema in all the countries importing Cuban doctors — and understandably so. But that alone takes a huge load of dealing with complications related to botched backstreet and bush abortions off the health system in radical ways.
It is the same attitude that invests medical resources in preventative medicine. The thing is that the way politics in East Africa and the rest of the continent is structured, preventative health is unpopular because there is no patronage in it and it doesn’t lend itself to being an electoral tool.
For politicians, a big hospital is something that can be seen, photographed and illustrated dramatically in campaign brochures as an achievement worth a vote.
It certainly works better politically than telling voters that your preventative health measures meant that that 50,000 people did not get sexually transmitted diseases in the past year or that providing more people with clean water cut diarrhoeal diseases by 30 per cent.
And some elements of the medical Establishment doesn’t like it. You need the big hospital with ‘Big Doctor’ in charge, who is entitled to a four-wheel-drive car, a big house and a hefty per diem for his travels. Somebody needs to get the money to buy ambulances, some of which he will divert to his rural farm on the weekend to carry his tomatoes or potatoes to the local market. Who gets to be the medical superintendent is, of course, a political matter, and the job is often doled out as part of the patronage that greases the political wheels.
If you travel around this region, you will from time to time run into small well-run hospitals. They are often unremarkable — they don’t have those tall buildings with lots of glass, the doctors don’t wear bow ties, the nurses don’t have fancy hair or glossy skins and you don’t run into fancy people wearing expensive perfumes in the corridors.
They are mission hospitals, and some have many elderly nuns around and some bent-over gentlemen running things. They have mastered the art of funnelling money into areas that have to do with health, rather than things like real estate.
There is one in northern Uganda, called Lacor, which was almost overwhelmed by the long war in the region. It was reputed to have one of the best in the region for cancer treatment. For long a largely unvisited part of the country, only the sick from all over East Africa went there for the Midas touch.
Not too long ago a dear relative called to announce that he was in Nairobi for eye surgery. I made to go see him before the surgery; of course a plan based on an assumption that he was either in MP Shah, Aga Khan or Nairobi Hospital. He said he was in “Kikuyu Hospital”.
Then fairly young in Nairobi, I had never heard of it, so at first I didn’t catch him, until I asked him to clarify. I got directions, and after getting lost a couple of times, I made it to the place.
The oldest mission hospital in Kenya, it was established in 1908 by Presbyterian missionaries. I was struck by its modest look, the humble folk there — and the unsung goods they delivered. My relative still swears by it.
Our healthcare systems tend to be a Rolls Royce, which we cannot afford, and too focused on the trappings. They need to be as functional as a Toyota Probox — which many people despise.
Mr Onyango-Obbo is the publisher of Africa data journalism site Africapedia.com and explainer Roguechiefs.com. [email protected]