Unveiling the inequalities in our healthcare system

At this point in human history, the inequalities in our healthcare system has never been more glaring. As there is a stark difference between night and day so is the lacuna in the distribution of wealth and health. The developing economies of the world have taken and continue to take loans from the developed economies. The crunching conditions attached to most of these loans are such that the borrowing nations will be in perpetual debt. It is now estimated that China owns more than one-third of Zambia’s debt. The rich nations also owe us the return of our stolen Bronze artifacts but that will be another story. While the rich nations have agreed to token postponements or entire cancellation of some of these debts, they are unequivocal in their decision not to temporarily override their patency laws to give open source for the manufacture of approved vaccines.

The number of deaths caused by the COVID-19 has passed a heart-wrenching milestone of 3 million people. The number is more than the population of the ten, least populated countries in the world. This figure is apart from other deaths that occurred because patients could not seek health care in systems that were overwhelmed by COVID-19 patients. If the rich nations really want to help, then they ought to override patency laws and allow the manufacture of approved vaccines from more countries to increase the production of vaccines and quell the backlog of unvaccinated people leading to increase in the number of people being vaccinated. Failure to do so smirks of selfish interests.

In developed nations, the disproportionate deaths of African Americans when they make up 13-30 percent of the population causes us to pause. In USA, seventy percent of those who have died from the pandemic are African-Americans. A similar picture presents itself in the United Kingdom. Fundamentally, African Americans or people of color have been marginalized. They cannot afford to go to the hospital. They usually have to choose between paying their house rent or electricity bill leaving little room for healthcare. They lack good nutrition and are the ones likely to suffer from obesity, hypertension and diabetes. Recent studies have shown that patients with comorbidities have a poorer coronary disease outcome. They are also the ones more likely to die at the hands of a police officer.

Further, when everyone is asked to stay at home during a pandemic, they are the ones that have the low-paying jobs that are considered essential services; the sanitation workers, trash collectors, hospital cleaners, store clerks, bus drivers, nursing aides and care givers. Their jobs cannot be done remotely. They usually live in multi-generational households and cannot afford to self-isolate when they exhibit symptoms. Entire members of the household get infected. And when they fall sick, they are more likely to succumb to the disease because of the underlying comorbidities.

On a global scale, we can blame leaders of rich nations for the inequities in vaccine distribution and institutional marginalization of Africans abroad but we have our own inequities bequeathed on us by African leaders. In Nigeria, the inequalities in health are usually between the ruling class and the bourgeoisie. We are all Nigerians but some seem to be more Nigerian than others. This lockdown should have been a watershed moment for the ruling class but it has not. Many of our African leaders travel outside their home countries for executive medical treatment. George Orwell wrote his satirical novel; Animal Farm more than 70 years ago but the tale rings true even today.

The tale of Animal Farm saw farm animals overthrow their human masters with a promise to rule with equality for all the animals. They worked on a slogan that, “All Animals are Equal” but soon, Napoleon their leader tweaked the slogan to, “All Animals are Equal, But Some are more Equal than Others”. African leaders seem to have borrowed a page from Animal Farm’s playbook because they treat themselves as more equal than the others they lead.

These selfish African leaders leave the people they swore to protect in abject poverty and misery accruing capital and recurrent costs from their desires to live forever. While they do not live forever, their infamous reputation does. Presidents and elected officials from African countries travel to far flung countries, churning scarce foreign currency to fuel their expensive life styles and medical treatments abroad, not only for themselves but their immediate family members. I am a Public Health Physician, so first off, I think of reducing costs by preventing diseases or in the case of these African leaders, a fraction of the monies they use abroad can be used to build a world class hospital that other countries can actually marvel at. But these leaders like Napoleon of Animal Farm talk as if they believe in equality but their action shows they are more equal than others.

The late leader of Zimbabwe ruled his country for 37 years, first as Prime Minister and then as President. He regularly flew to Singapore for medical treatment and eventually died there although he was no longer ruling at the time of his death. He was one of Africa’s longest serving heads of state. His wife; because of her flamboyancy and penchant for designer wears was known as Gucci Grace; Gucci being a designer brand. Today, one US dollar is equivalent to 362 Zimbabwean dollars. There was a time the Zimbabwean dollar was no longer in use because its value had deteriorated. In 2008, the Zimbabwean $50 billion bill was worth 33 US cents. The former President of Zimbabwe did many good things for his country but all his good deeds seem to pale in comparison to the weakened health care systems of the landlocked country.

Robert Mugabe is not the only African leader to have died abroad while seeking medical treatment. Michael Sata, President of Zambia died in the United Kingdom, Meles Zenawi Asres, Prime Minister of Ethiopia died in Belgium, Malam Bacai Sanhá, President of Guinea Bissau died in Paris, President Omar Bongo of Gabon died in Spain. The leaders of these African countries are just a few examples. All these leaders died in foreign lands while accessing the best of the best in health services and all the while leaving the people they ruled with ruined health care systems. Some of these leaders like Robert Mugabe and Omar Bongo ruled for a combination of 89 years. If they wanted to develop their health care system during their tenures, they could have but they chose not to. They were able to access the types of health care services that the citizens they ruled could only dream of. It ought not be so but this is what happens when leaders rule with selfish interests.

While the African Americans whose forefathers were forcibly taken to the USA are institutionally marginalized, Nigerians who have remained in their Fatherland have been alienated from the riches of the land. Nigerian leaders are not exempted from medical tourism at the expense of the taxpayers. Even in these desperate times, the ruling class is seeking solace in private hospitals abroad deliberately ignoring the masses they rule. Our leaders do not seem capable of understanding the dynamics of the prevention of diseases; a good and balanced health care system especially in these pandemic times.

If there should be a global lock down again in the future not necessarily this pandemic, where will all our African leaders head to when they have deliberately ignored the health care systems in their home countries and instead turned overseas for treatment? While they continue to ignore the elephant in the room; the inequalities in healthcare and the poor in our society, they forget that these are the ones in the supply chain of the agricultural produce they eat. They are the ones who become their security gatemen and drivers. They are the drivers of the motor tricycles and other forms of transport. Having a good health care system is not just for the benefit of the masses but like a boomerang it also helps the leaders in power.

The poor cannot afford to self-isolate. Facemasks and alcohol-based sanitizers are not economically accessible to them. They know how to wash their hands but they do not have access to pipe-borne water to even take a bath. Some cannot even afford to buy soap. While many states were trying to put their educational lessons online using the internet, these people did not have smart phones or laptops to access them.

While the seemingly unsurmountable gulf between the haves and have nots will continue to exist, the chasm can be bridged. It is not too late for the inequalities in our healthcare system to be tackled and the marginalized in our society to be adequately provided for. Nehemiah had a good job but chose to be a leader with a difference. He saw an open wound in his country and he decided to close the wound. By closing the wound, he was not only protecting the needy but he was also protecting himself. Leaving the wound open would have led to insecurity and all the brouhaha that comes with insecure borders. Let African leaders do the right thing!
Obilade, an associate professor of public health is of College of Health Sciences, Nile University, Abuja.