NOVEMBER 20, 2014 *Dr Wole Ameyan
The hypothesized setting is a remote village in a remote part of the world. Mr Tuba, a 93 year old man with a known history of terminal cancer sadly succumbs to the disease and dies. He was from a long lineage of longevity. He had been intermittently ill for three years. Luckily, a doctor had been to see him and discuss with his family, extended and nuclear, informing that his was a terminal case. Coupled with his old age, he was unlikely to be alive in another four weeks. The doctor suggests that efforts be made where possible for the last periods of his life to be spent in relative ease and comfort. With 30,000 in cash, Mr Tuba could be managed properly and provided with items that will make him live in modest comfort until he breathes his last.
Mr Tuba is a poor old man with seven children and lived in a community that had taken advantage of his native wisdom in his prime. His community leaders and members are aware of his ill health. They had been aware for the past three years and have now been alerted to the doctor’s recommendation. In his old age, he has had no support and has had to do everything all by himself. Even his children, one of whom a local businessman and has been successful trading in local fabrics, are of no help to him. Occasionally they pop in to say hello to him. When they do, he is often lying in his own faeces, in decrepit conditions. They see this but turn a blind eye. Some community members and friends also come to visit him, but offer no help besides saying hello, some strangely blurting, ‘you seem to be doing well!’ His old acquaintances from other communities are also aware of his poor state. They know of his suffering but have not deemed it fit to do anything. The old man is living his final moments in abject conditions, not fitting for any human. The problem is everyone could see it but have decided to do nothing to help. The glaring inevitable was about to happen.
Mr Tuba finally passes on. He had been gone for five days. A member of the community is passing by his room on the way to a community ceremony and the smell of putrefaction alerts him to Mr Tuba’s passing. Then something strange begins to happen. The sounds of wailing and crying alert other members of the community to Mr Tuba’s death. Before long, hundreds of sympathizers had gathered and are crying and singing in sorrowful tunes. His children have also heard the news, one of whom, a local politician, gives a brief speech to a surging crowd. ‘My father was the most wonderful father in the world.’ ‘I will miss him terribly’. ‘In his prime, he was a worthy servant of the community and therefore I think it is important that the community donate money to give him a befitting burial’.
Huge donations started pouring in. You would not believe this was the same old man rejected by all including his own. Now it is impossible to fathom that this was the same Mr Tuba who had been ill for a very long time, whose condition was known to everyone but ignored. Before long, the donations had come in the millions of cash. Others donated in kind. Indeed, other communities, far and near had begun to pitch in with contributions in order to give Mr Tuba a befitting burial. At the burial, the head of the community delivered a moving speech: ‘It is a sad day not just for our community but the entire human race,’ he began. ‘Our community is in deep mourning over the sudden and unexpected death of Mr Tuba’. ‘He will be sorely missed’. ‘The community town hall shall be named after him’. ‘He is to be given the highest title in the community posthumously’. ‘The biggest market in the community shall be named after him’. ‘The sports complex shall be named after him’…. Already this was the most extravagant burial ceremony in the history of the community. In the end, millions of cash had been spent.
The above metaphor, for me strikes home the current Ebola situation and the response of the affected countries and the international community. Since the outbreak of Ebola, the response of the world has been that of shock and dismay, much like the metaphor above where the old man died a sudden and unexpected death. Without a doubt, the catastrophe that Ebola has visited on Guinea, Liberia and Sierra Leone has been dire and when you witness it directly, you cannot help but be sad and desolate. However, there are many questions which if asked will open a Pandora’s Box of thought-provoking, albeit conflicting ripostes. Did we not know that the health systems of these countries were in dire shape? Did we expect these countries to have been able to deal with an outbreak of such proportions? Or did we just bury our heads in the sand hoping against hope that this will never happen. The Ebola outbreak makes grim discoveries and has revealed a cankerworm of decay in our society. It has revealed that many of the hospitals and clinics in the affected countries and beyond are nothing but glorified infection transmission centres with not even the most basic protective equipment or mechanisms for health workers. Is it acceptable that countries with oodles of natural resources and so called established democracies with years of experience as recipients of foreign aid in cash and expertise cannot provide even the most basic of commodities nor manage the basic health needs of their population?
Now is not the time for giving account, but when this situation dissipates, then will come the time for sober reflection. It will be the time for Africa to come together and ask itself the most salient questions. How come years of donor funds and expertise have not made African countries self-sufficient to the point of managing the basic health needs of their people. What has happened here? The international community has provided millions and millions in aid over many decades to strengthen the health systems of the recipient countries. How has these monies not translated into basic equipment in clinics and hospitals? How come they have not translated into enduring mechanisms on infection prevention and control? How come they have not contributed to local expertise on some of the most common elements in managing public health emergencies?
Foreign aid is needed, for sure; especially for developing even if potentially endowed countries. There is nothing wrong with the more developed and prosperous countries lending a hand and helping other countries. The point is that the help rendered has to be not just in terms of cash but also importantly to help these countries stand on their feet. Unfortunately, the concept and notion of foreign aid has become a parody of sometimes deliberate misconception and outright misinterpretation. It is sad that some forms of foreign aid have led to a substitution of in-country potential, means and resources. A country, after many years of aid, that cannot on its own initiate the most basic of public health protocols cannot be said to be learning useful lessons on foreign aid as a tool for rebirth, revival, regeneration, restoration and recovery.
The most striking evidence of the distortion of the concept of foreign aid has come from comments in the aftermath of the Ebola outbreak on who should shoulder the blame for the epidemic getting out of hand. It has been common to hear otherwise respected and respectable persons and institutions blame the World Health Organisation for the problems. One of the most common terms in the world of health programming is ownership, a concept that seeks to ensure that, in bringing in aid, the host countries lead and have control of the allocation of aid and that programs are planned and implemented according to the needs and necessities of the host countries as directed by the host countries. Since the outbreak began, I have barely heard or seen anyone or organisation lay the responsibility where it truly should lie. The duty of providing security and ensuring the wellbeing of the population is a critical criterion of sovereignty. The international community needs to begin to say it as it is. That is the only way lessons can be learnt. Even Nigeria’s success with curbing the outbreak needs to be put in its proper context. No one is mentioning the reasonable permutation that the health care system in Nigeria is in as dire a state as many others in the sub-region and will also have likely been overwhelmed in the same way as Sierra Leone, Guinea and Liberia have given the same scenarios. The truth is that part of the reasons why the virus has been defeated in Nigeria is because of the almost tailor-made way it was introduced into the country. Had Nigeria shared borders with any of the affected countries and Ebola introduced through any of the remote villages like it happened in Guinea, Sierra Leone and Liberia, there is every chance that the devastation Ebola has wrought will be just as severe as we have had in those three countries now. The country’s health system may not have been able to deal with an outbreak of such proportions. Such is the state of the health system in many a country.
The international community has a critical role to play in mentoring weaker countries to prosperity. Part of this mentorship has to be done through forthright and sometimes blunt and plain speaking; saying it as it is in all ramifications. And not just in health. This forthright assessment and evaluation should include the current haphazard practice and culture of democracy in many countries today. A good electoral system begets good governance which begets accountability. Accountability begets increased availability of resources which then begets good health systems, good roads, and good education. All of these start with free and fair elections. We have seen over the years how elections in many parts of the world have failed to inspire confidence. How can a government serve its people when it has not been properly elected? Unfortunately, we see a situation where even the champions of democracy turn a blind eye to this. Corruption at the ballot box leads to corruption in government. When corruption thrives, there are fewer resources left for the populace to enjoy good infrastructure and there is less available for good roads or well-equipped hospitals. It will be interesting for researchers to come up with methodologies on exploring probable associations between rigged elections on the one hand and good governance, accountability and availability of infrastructure and then the link of all of these to maternal deaths, infant deaths or even road traffic accidents due to bad roads etc. There has to be a link!
Like Mr Tuba in the earlier metaphor, the current Ebola outbreak has revealed a bowl of contradictions. Like Mr Tuba whose community ended up spending so much more for his burial than for his well-being while alive, we may end up spending even so much more to revamp the damage that the Ebola outbreak has caused. Already a lot of the gains made in many of the affected countries over many years are being reversed. It is sad.
Ebola has come; it will go and may likely come again. The time will come for a non-partisan and an all-inclusive discussion about what went wrong and how this has been allowed to happen. When this happens, it is my hope that responsibilities will be laid where they should and that valuable lessons would have been learnt to mitigate the impact of this terrible tragedy and to limit the damage of any future recurrence of the Ebola Virus Disease in our midst.
Dr Wole Ameyan is a medical doctor working in Sierra Leone. email@example.com. +23276704933.