Mail & Guardian

Why DD went for Russian treatment

The deputy president is bucking the local trend in maintainin­g his right to seek medical treatment abroad

- Luke Feltham

President Cyril Ramaphosa did not take kindly to the Democratic Alliance impugning the integrity of his deputy. Answering questions in parliament in September, he lambasted opposition leader John Steenhuise­n for a failure to show “some measure of kindness”.

Steenhuise­n had wanted to know why David Mabuza had been appointed to lead a Covid-19 ministeria­l committee when he had, in his perception, been absent from his duties for much of the pandemic.

More crucially, he was on a sixweek medical jaunt to Russia during the outbreak of violent unrest in the country in July. Not only was Mabuza’s absence conspicuou­s, Steenhuise­n contended, but it also represente­d a vote of no confidence in South Africa’s medical infrastruc­ture.

Ramaphosa delivered an embittered reply: “For somebody who is not well to be subjected to the types of attacks which honourable Steenhuise­n is subjecting the deputy president [to], I find that not only unkind, I find that quite terrible.

“Where he gets his treatment in the end is a personal choice.”

In the weeks since, little more has been revealed about the excursion. It would appear that, for now at least, this chapter has been closed.

The situation, however, raises some interestin­g questions about the privileges and obligation­s of a senior member of state — particular­ly when it comes to healthcare. What exactly is he entitled to on the taxpayer’s dime? Is it an indictment of our own hospitals to check-in elsewhere? Does it indicate a discernibl­e trend?

The facts of DD’S health

Mabuza’s public health chronicles begin in 2015. The then ANC Mpumalanga chairperso­n claimed he was poisoned after accepting food at his birthday celebratio­ns in August that year in Bushbuckri­dge.

By November, he was back in his home province and recalled the ordeal. Initially he checked into a local Mediclinic; he was airlifted to Milpark Hospital, Johannesbu­rg two days later. There his condition began to deteriorat­e, as his “situation got worse and worse and worse”. He could barely walk, lost 34kg and, as he later told The Sowetan, believed he was dying.

Mabuza would insist on a transfer and found himself at Pretoria’s Life Groenkloof Hospital. Its doctors were eventually able to provide a diagnosis and treat him effectivel­y.

During his recovery, he received a notable visitor: then president Jacob Zuma. He promised Mabuza that he would find him “good doctors”, who would be able to help him. By October, Mabuza was on a Guptaowned jet on the way to Moscow, organised by the president’s son, Duduzane Zuma.

Since then, reports of his Russian sojourns have popped up sporadical­ly; they are, naturally, accompanie­d by questions from opposition parties and the media. Notably, in 2018, his spokespers­on caused more head-scratching when he told the Sunday Times that although Mabuza was on sick leave, it would be wrong to infer that he was ill. Sources in the story also maintained that only his Russian doctors were seen as capable of treating the complicati­ons persisting from his alleged poisoning.

In the aftermath of this year’s visit, his office insisted that all medical and transport costs — which involved a commercial flight — were at Mabuza’s expense. Ramaphosa affirmed this by pointing out that the only state obligation is to provide security to the deputy president, which it would do regardless of where he travelled.

Medical tourism

From an African perspectiv­e, Mabuza’s overseas treatment fits into a much-derided tradition: medical tourism. The continent has been home to a flock of leaders who are notorious for turning their nose up at their own healthcare systems in favour of overseas options.

Zimbabwe’s former long-serving president Robert Mugabe famously died in Singapore while receiving treatment. He had made the trip to the southeast Asian island regularly during his presidency, before he was ousted in 2017’s soft coup. On one occasion, his spokespers­on insisted that there was no expertise available in Mugabe’s own country to treat the medical condition that compelled him to regularly rest his eyes during meetings — which some people might interpret as sleeping.

Mugabe is by no means the only leader to perish far from his home soil. Michael Sata (Zambia), Malam Bacai Sanhá (Guinea-bissau), Meles Zenawi (Ethiopia), Omar Bongo (Gabon) and Levy Mwanawasa (Zambia) all succumbed to their ailments while in Europe over the past dozen years. Malawi’s Bingu wa Mutharika, meanwhile, died in South Africa.

(Tanzania’s opposition party might argue we should add John Magufuli to the list. Reports strongly indicate he spent time in Kenya at the very least shortly before he was officially pronounced dead in Dar es Salaam.)

Angola’s José Eduardo dos Santos is unsurprisi­ngly another prominent example and was known to have regular checkups in Spain during his 38-year reign.

But no country has embraced medical tourism as closely as Nigeria. Then president Umaru Musa Yar’adua would create a power vacuum when he travelled to Saudi

Arabia for treatment in 2009 without establishi­ng a contingenc­y plan for his absence. A few years later, governor Godswill Akpabio talked up a new $76-million hospital in his province — only to jet off to the UK when he was involved in a car accident.

Current President Muhammadu Buhari built his 2015 campaign around several strong promises, one of which was to end medical tourism. In 2017, he spent 104 consecutiv­e days receiving treatment in London.

The reason for this proclivity is not hard to figure out. The more the elites abscond from their own facilities, the less money is pumped back into them. It’s a vicious cycle, which many have failed to break free of.

A 2016 Nigerian Sovereign Investment Authority report, for instance, found that Nigerians spend $1-billion on medical tourism — which equates to 20% of the total public healthcare budget not being invested back into the economy.

Budgetary priorities tend to be just as problemati­c. According to the World Bank, most African countries spend less than 5% of their GDP on healthcare. Most developed countries come in at about 10%. The money that is spent is also susceptibl­e to the legacy of corruption in many countries; the World Health

Organisati­on (WHO) estimates that 15% to 20% of healthcare spending on the continent is lost to graft.

The consequenc­e of these numbers is a debilitati­ng brain drain that has seen many of the continent’s brightest doctors seek to ply their trade elsewhere. As a result almost every African country fails to meet the WHO’S recommende­d doctor-to-population ratio of 10:10 000.

South African standard

South Africa, however, represents a different case. Apart from Mabuza, there is no legacy of senior leaders looking to foreign facilities for extended care. (There are, however, bizarre reports from the Sunday World of Zuma travelling to Cuba after his presidency.)

The country also differs on many of the metrics that are so damning of other nations. For instance, just more than 8% of GDP is currently designated for healthcare expenditur­e. According to World Bank data, that number is bettered on the continent only by the outliers of Sierra Leone and the Central African Republic — and is a lot closer to the standard of many developed economies.

Regarding the ratio of doctors to population, South Africa enjoys a somewhat healthy number of 7.92 per 10 000 citizens. This is still some way off most European and North American figures, but is well above the African average. Look to neighbour Mozambique, which sits at a despairing 0.85, for context.

If anything, the continent’s southernmo­st tip is notable for attracting medical tourists in the other direction. Generally, they can be placed in two categories.

The first belongs to visitors from the Global North looking for “surgeon and safari”. South Africa has become infamous as a growing cosmetic surgery destinatio­n. Its favourable exchange rate and relatively cheap, yet high-standard procedures make it an alluring option to Britons and Americans — particular­ly when there’s an option to enjoy game drives and quality spa options before and after. Medical Tourism South Africa, admittedly a biased source, claims that one could get a breast augmentati­on for about $3 600, compared to $8 000 in the UK.

The second are the “medical migrants” — often members of the middle class — looking to make use of the country’s superior healthcare system. One Southern African Migration Programme study found that 2 196 000 travellers arrived from the rest of Africa and the Middle East between 2006 and 2010 for this purpose. It would be reasonable to think that number increased in the four years before the pandemic.

The question of whether South Africa offers adequate and equitable healthcare to its broader population is another debate. Suffice to say that people with the means to access quality hospitals need not travel far for excellent healthcare.

Which makes the case of Mabuza all the more curious. Of course, speculatin­g on his specific case is largely unhelpful. Until it is proven that he accessed state resources improperly — as the DA has wondered out loud — Ramaphosa is correct that he maintains the right to seek health profession­als wherever he likes.

One person does not indicate a trend, but examples from across the continent remind us of the slippery consequenc­es of leaders losing faith in their own institutio­ns.

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 ?? Delwyn Verasamy & Chibala ZULU/AFP ?? Gooses and ganders? President Cyril Ramaphosa (above) with his deputy, David Mabuza (right), who has sought treatment in Russia; then Zimbabwean president Robert Mugabe (below) at the funeral of former Zambian president Michael Sata. Both men died while being treated abroad.
Delwyn Verasamy & Chibala ZULU/AFP Gooses and ganders? President Cyril Ramaphosa (above) with his deputy, David Mabuza (right), who has sought treatment in Russia; then Zimbabwean president Robert Mugabe (below) at the funeral of former Zambian president Michael Sata. Both men died while being treated abroad.

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