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 like Qatar, which have more money than Cuba can ever dream of, are highly dependent on Cuban doctors.
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 in the world to do so. Abortion is still anathema in all the countries importing Cuban doctors today – and understandably so.
But that alone takes a huge load of dealing related to complications from 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 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 last year.
And the medical Establishment doesn’t like it. You need the big hospital, a Big Doctor in charge, who is entitled to a four-wheel drive car. Someone 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 to the market.
Who gets to be the Medical Superitendant 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 in the corridors. They are mission hospitals, and some have many elderly nuns around.
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. A largely unvisited part of the country, only the sick went there for the Midas touch.
Not too long a dear relative called to announce 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 Aga Khan, or Nairobi Hospital.
He said he was in “Kikuyu Hospital”. Then fairly young in Nairobi, I had never heard of it. I asked for directions, and after getting lost a couple of times, I made it to the place, the oldest mission hospital in Kenya, 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 health care system is a Rolls Royce, that we cannot afford, and too focused on the trappings. It needs to be as functional as a Toyota Probox – which a lot of people despise.