A dream defended: Namibia’s
The country has produced its own physicians but it may take a hundred years to make up for lost time
It took Simon Antindi three hours, two taxis and one jolting ride in the back of an old farm bakkie to reach the state hospital where his father had been admitted — and when he saw it, he was overwhelmed. The hospital, in the far northern Namibian town of Oshakati, was bigger than any the 11-year-old had ever seen before — a huddled mass of low-slung green and blue buildings that trailed off into the horizon in every direction. Every turn led him deeper into a maze of crowded wards and worried visitors. Doctors whispered to each other in languages he didn’t recognise and the whole place smelled vaguely sour, like sickness and cleaning fluid.
And then there was his father. The local primary school principal, this was a man who easily filled a room with his authority and his warmth, a man whose generosity was a longstanding source of local pride.
A few years earlier, when the struggle for independence against South African rule blurred into villages and towns all across this part of what was then South West Africa, his father used to slaughter a goat for each passing band of Swapo guerrillas who trekked through — and often got himself arrested for his trouble.
But at the hospital now, he didn’t look like that man at all. Instead, he was small and shrunken against the blank white bed. For the first time in Simon Antindi’s memory, his father looked utterly helpless.
“At that time, I knew I wanted to be a doctor,” says Antindi, now 31.
But no sooner did the thought enter his mind than he shoved it away. “In my village, in my whole constituency probably, there was no one who became a doctor,” he says.
And as he looked around at the Cubans, Russians and South Africans attending to patients all around his dad, he had a sinking thought.
Maybe Namibians don’t do this work.
Maybe we can’t.
And that was it. As quickly as it had come, the dream fluttered away.
But 700km south, in the capital of Windhoek, many of the country’s top medical minds had nearly the same question. It was the late 1990s, nearly a decade since Namibia’s independence from South Africa, and still the country had no medical school of its own. For generations, all of Namibia’s doctors had been trained abroad — shipped off to places like South Africa, Finland and Russia for a medical education that often translated poorly to local conditions, or else they were foreigners, recruited at great expense from overseas.
“We needed to start training doctors sensitive to local roots, who were prepared to go where the needs were,” says Filemon Amaambo, now the associate dean of the University of Namibia’s (Unam’s) school of medicine — the first in the country — who was then working in government.
Namibia’s problem was not unique. Sub-Saharan Africa carries more than a quarter of the world’s disease burden but is home to only 3.5% of its healthcare workers and just 1.7% of its physicians, according to a 2012 article in the open-access journal Human Resources for Health.
The region’s universities have long struggled to fill that gap. There are 175 medical schools serving a population of about a billion people in subSaharan Africa, compared with 488 medical schools for a population of 743-million people in Europe.
And six African countries — Cape Verde, Djibouti, Equatorial Guinea, Lesotho, São Tomé and Príncipe, and Swaziland — have no medical school at all, according to the World Directory of Medical Schools.
That’s a dangerous gap, because there is a “strong relationship … between medical school density and physician density”, according to research published in the Medical Teacher journal.
In other words, countries with fewer medical schools tend to have fewer doctors too.
For many in Namibia’s public health sector, the absence of a single medical school stung in a way that was deeply personal.
“We knew it was more than imbibing medical knowledge,” says Amaambo, who arrived at the Durban Medical School — then South Africa’s only institution for training “nonwhite” doctors — in 1971.
“For us, medical school was also always about the need to transform society. We saw ourselves as part of the liberation of our country.”
When he finished medical school in Durban, Amaambo returned to South West Africa and moved immediately to the country’s northern border, where he spent the next decade treating gunshot wounds and landmine injuries at hospitals in the heart of the country’s liberation war against Pretoria.
It was an education, he says, at the brutal intersection of medicine and political repression.
“We saw the inequality of care every day,” he explains.
He and other hospital workers listened to the chop-chop-chop of helicopters taking off from the local airport, airlifting injured white soldiers to hospitals in Pretoria and Johannesburg while black civilians were often left to die in understaffed clinics on the frontlines.
One night, he remembers, a young child was rushed into his emergency room, unable to breathe. It was clear to the young doctor that they needed to get him to a bigger hospital or the boy would die. But a strict military curfew meant that, if he sent the ambulance out, everyone inside risked being shot to death by soldiers.
“There was always not just knowledge of anatomy and medicine that we were putting to use,” he says, “but also a broader understanding of why we were doing it.”
So it was no surprise, he says, that, in the years immediately after Namibia’s 1990 independence, academics and government officials there began pushing for an investigation into the feasibility of a medical school. But when the study was finally carried out, it found the project too costly for the young country. It was put on ice.
Even as the debate brewed, a growing health crisis was shaking the country’s health system to its core. By the time Simon Antindi visited his father at the hospital in Oshakati as an 11-year-old, a terrifying new illness was creeping across their village, Ondjamba, and countless others in the region.
“People looked like skeletons,” he says, recalling how friends and neighbours wasted away, swerving sharply from health to death before anyone knew what was wrong.
“As kids, we were really afraid.” Worse still, in a story mirrored across the country and the region, the local hospitals seemed powerless to stop it. People would leave for treatment, Antindi remembers, and then simply come home to die. By the time antiretroviral treatment was rolled out in the early 2000s, HIV was the leading cause of death in Namibia.
For Amaambo, the Aids epidemic underscored the need for the country to train doctors with deep roots in its communities — and particularly in its most remote corners.
“For a long time, we have believed excellence is a privilege — that you deserve the best [care] only if you can afford it,” he says.
But if doctors could be trained locally, he reasoned, maybe Namibia