The Corona Chronicles, Bamako

Part three – They know

 

Some years back, during one of those public debates broadcast by French world service radio (RFI) from time to time, I picked up a memorable one-liner from a member of the audience. The location was Lomé, and so he made a reference to the family that had been running his country, Togo, for half a century, primarily as a client state of France.

“When a member of our ruling elites falls ill, he or she takes the next plane to Paris, where hospital treatment is good and readily available. As a consequence, the state of the health care system in Togo is of no interest to them.”

This goes for many a nation. And so, these current headlines are in an odd way rather satisfying…

The late Robert Mugabe had a subscription to hospitals in Singapore, while his subjects died of preventable diseases in hospitals in Harare, Mutare, Bulawayo and Masvingo.

The rhetorically anti-imperialist first president of Guinea, Ahmed Sékou Touré, died of heart failure in a Cleveland hospital.

Muhamandu Buhari, president of Nigeria regularly goes missing because of health scares. If you want to find him, you must go to London.

Paul Biya, the ailing president of Cameroon (in power since 1982) spends most of his time in or near a hospital in Geneva, Switzerland, a visitor to the country he is supposed to govern.

Depending on convenience and religious/ideological bent, you will find heads of state from the African continent occupying hospital beds in Moscow, Brussels, Riyadh, Beijing and sometimes in locations at either end of the continent: usually Rabat and Cape Town.

All this has now come to an end, thanks to Corona, because intercontinental flights have been suspended. Will this mean that the elites develop an interest in how hospitals in their own countries are run? This is not immediately evident. Just like terrorism, this virus is only an issue when they are directly affected. On the other end of the wealth spectrum, ordinary folks initially regarded Corona (which arrived mostly by plane) as a thing that affected “…them up there…nothing to do with us…”.

Not necessarily our problem….we just get on with our work…

But could this be changing?

There is a short-time perspective to this and a longer-term one.

Right now, there is an awareness among the authorities about the (usually poor) state of health care in the face of a looming menace. Whether said elites have developed a sense of their own responsibility in this regard remains to be seen. But they know. They know that things are not good. Years of neglect, devastating wars in some places, coupled with IMF-mandated austerity measures and the expectation that foreign NGOs would be there to pick up the slack have all played their part. Many large hospitals have developed a bad reputation, as places where you don’t go to get healed – but to die. Rural parts frequently lack even the basics.

There are also medical staff up and down this entire region with high levels of professionalism and a keen sense of public duty.  I have met many of them. It’s a fact that tends to be often forgotten, both here and in the global media. They know. They know better than anyone that they are working under extreme circumstances. They know there are not enough intensive care units, ventilators or even hospital beds available to deal with anything major.

And as a result, everybody and everything banks on prevention. Prevention. Prevention. Prevention. Authorities ban large gatherings (well, some of them at least – I’ll come back to this later), close borders, enforce curfews and start campaigns to encourage social distancing (another headache as we have already seen and will see again later)

Live music, Mali’s pride and joy. Banned until further notice. But they’ll be back…

To date, prevention is working remarkably well. Mali has ample experience in this respect, as do Senegal, Nigeria and Côte d’Ivoire. There are at present 87 confirmed cases in Mali, with 7 deaths and 22 recovered patients (according to statistics gathered at John Hopkins University Hospital in Washington), 59 confirmed cases according to the WHO. Here’s hoping it stays that way and that there will be no curve to flatten.

But inevitably there will come the longer-term question: will this outbreak be enough to start changing things around and concentrate elite minds towards creating decent basic services, to wit: water, electricity, health care, education, waste management? This, dear reader, is anybody’s guess. And that, in and of itself, is a deeply unsatisfying answer. But I have, at present, no other.

 

To be continued

An open space

Part 3 – Predation and neglect

Every village has one or several. A makeshift roadblock, usually a branch of a tree set across the road. They are manned by kids. Nearby, on the worst bits of the road, a few are digging up soil and filling up the parts that have been washed away in the rains, reinforcing them with other bits of wood. It’s an unequal fight and the road does not markedly improve but it gets the kids some income. NGO and UN cars can pass but all commercial transport needs to pay for the job being done. Lorries up to 1,000 CFA, about €1,50; motorcycles (these are the fastest here and used for transporting people and merchandise for the weekly markets) pay up to one-fifth of that. Real maintenance has not happened for some ten years and it shows. A distance of, say, one hundred kilometres can easily take five hours…

Pretty much all roads here look like this. Pic: me.

Four chapters in Making Sense of the Central African Republic deal with the fall-out from the concessionary system that France introduced. In essence, the exploitation of a country’s natural resources (in the CAR those have been timber, ivory and diamonds, with uranium and oil waiting patiently in the wings) is farmed out to companies from beyond the country’s border; the companies pay that country’s elites for the privilege.

The book contains one chapter about the diamond business, a sector whose deeply exploitative nature has become law. With ordinary diggers working for head miners, who sell the crop of diamonds to collectors, who in turn take their gemstones to buying offices that furnish the capital to keep the entire operation going. The system has predation written into its DNA and the ones at the bottom are mercilessly exploited. Timber works along similar lines and this business highlights another way in which the state has hacked out its niche in this exploitation system: extreme taxation.

The elites, who are in charge of the CAR’s polity, need to be paid for dishing out the concessionary privileges that those outsiders enjoy but those are, generally, one-off payments. Once these outsiders are in, they need to continue to pay because the elites need to maintain the lifestyle that they are accustomed to. Hence: taxation. Several writers in the book describe the state in the CAR as being “tax obsessed”. This stands to reason, as the number of outsiders who are willing to make use of concessions within the CAR is limited. They are also, quite frequently, of the dodgy variety. Local elites and outside exploiters are equally predatory in their pursuit of wealth. They richly deserve each other. There is of course a group that richly deserves better: the almost 5 million citizens of this country.

Market. Excellent peanut butter on sale there, too. Pic: Femke Dekker.

The principle of subcontracting exploitation has since been expanded to include other spheres of life and now involves organisations that do not come to buy, sell, steal, extract or exploit, but to bring peace, health care, education, development. All matters that you can freely wash your hands off if you can get others to do those things for you, in exchange for a fee. Peacekeeping has been the remit of no fewer than eleven operations, put together by four different actors: the United Nations (currently running MINURCA), France (currently running Sangaris), the neighbours (who had four missions in the country) and the European Union. None of them work, as one chapter in Making Sense of the Central African Republic points out.

In the same spirit, the Ministry of Health is called Medicins Sans Frontières, which has an incredible 2,000 staff here. And since nobody can figure out which part of the country is still in an emergency situation and which part is ripe for “development”, there is the usual alphabet soup of NGOs working on both. And a lot of this work comes at a premium. Take this for an example.

In a rural town, an international groups is refurbishing a hospital. The handicap here is that this particular hospital, in a dreadful state after much neglect, some looting and a fire, is run by someone whose office is not located on the premises, but in the nearby bar. Whenever he gets wind of a foreign presence, he barrels in on his motor and begins looking for loot. For instance: building materials are required for the rehabilitation work and he is very willing to guard some of it. This will enable him to divert it to a much more important project: the construction of his own house. As long as he and too many of his ilk remain in place the citizens (in this case the patients) are hostages to predatory behaviour. And of course, what happens on a small scale here, balloons to the size of the nation elsewhere. All the necessary basic work to keep a nation going is thus parcelled out – and what cannot be parcelled out is left undone. Hence the state of the roads.