African Hope Or Illusion?

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It would be a remarkable irony if the outpouring of good will that followed the Tsunami disaster extends to Africa. Tony Blair has declared that “Africa is the scar on the conscience of the world�… that in order to facilitate African development, the countries with the world's most powerful economies—referred to as the Group of Eight—forgive the entire debt of poor sub-Saharan African countries

"There can be no excuse, no defense, no justification for the plight of millions of our fellow beings in Africa today," Tony Blair, the British prime minister declared in London recently when he released the report of the International Commission on Africa, a body he established to recommend how to reverse the continent’s malignant poverty.

While I appreciate the sentiment behind Blair’s words, I am quite weary of empty rhetoric. We have heard loud declarations in the past about Marshall Plan-like schemes for Africa, including ones generated from within the continent, such as the Lagos Action Plan and the more recent NEPAD (The NewPartnership for African Development) and the UN-sponsored “Millennium Plan."

Yet, this is perhaps the first time that a leader of a major Western country has staked his own political legacy on the outcome of a program to tackle African poverty and underdevelopment. The U.K. also heads the Group of Eight (G8) and the EU this year so Blair won't have problems getting a public forum for his plan.

It also helps that the Commission includes celebrities such Live Aid activist and musician Bob Geldof, who has bluntly stated that Zimbabwe's Robert Mugabe must pave the way for a successor and that Uganda's increasingly autocratic president Yoweri Museveni not tinker with the countries constitution in order to eliminate the existing presidential term limit. Geldof declared that if African countries don't do their homework by embracing democracy and fighting corruption, the plan won't deliver.

It would be a remarkable—and welcome—irony if the outpouring of good will that followed the Tsunami disaster extends beyond the epicenter in Asia. Blair has declared that “Africa is the scar on the conscience of the world.� The Commission is proposing that in order to facilitate African development, the countries with the world's most powerful economies—referred to as the Group of Eight—forgive the entire debt of poor sub-Saharan African countries to the World Bank, International Monetary Fund and the African Development Bank. Blair is calling for an immediate $25 billion a year increase in international aid. It’s unlikely that the rich countries of the G8, of which the United States is a member, will agree to these bold suggestions.

Nevertheless, as an African-born physician, I can appreciate the sentiment behind the Blair Plan.  It’s been no secret that Africa is the only continent to have grown poorer in the past 25 years Three decades of  what you could describe as mini-Tsunamis –internal armed conflicts, a few genocides, violent regimes change, famines, collapse of agricultural commodity prices, embezzlement of public funds and corruption, the HIV/AIDS pandemic, etc.—have devastated much of the continent. Any sort of international attention directed at Africa is welcome.

As a physician, my biggest concern has been what underdevelopment has done to healthcare throughout Africa. It would be well worth the while of the Commission to examine how all of this debt accrued and  devise a way to ensure it doesn’t recur, should Blair's total debt forgiveness be somehow adopted.

Through Structural Adjustment Programs (SAPs) that were instituted in the 1980’s, the mode by which most of this debt was accrued, the healthcare system in much of Africa crumbled precipitously. Simply put, these programs work by forcing countries to comply with certain economic conditions in order to qualify for loans. Many of these conditions end up being economically disadvantageous but African countries implement the conditions because their so desperate for the monetary infusion.

With about half of the African population living off of less than $1 a day, something that we in the West cannot even fathom, it’s no wonder that life expectancy has dropped in most African countries and that the infant mortality rate is 140 per 1,000 births. Look at the example of Mozambique, considered to be one of the more politically and economically stable African countries; since its institution of IMF-backed SAPs its life expectancy has dropped from 48 years in 1986 to 42 years as of 20001, along with having one doctor per 37,000 (one of the worst doctor per patient ratios in Africa). 

Healthcare systems are so depressed, that emergency medicine physicians like me find it daunting to practice medicine in Africa, especially in my own country of birth, the Democratic Republic of Congo (DRC). In light of borderless issues such as SARS, the EbolaVirus, HIV/AIDS and bioterrorism, the development of stronger healthcare systems should take on a higher global priority in any program to help rescue Africa. This can’t be done without funding. The bulk of the resources will eventually have to be generated by expanding African economies. That's why the Blair Plan – as did the previous African proposed plans – also calls on rich countries to drop trade barriers to lift African exports. I would suggest that African leaders take immediate advantage of this narrow window of opportunity offered by the Blair Plan, and make a collective effort to forge an ideology that will force the Commission to follow through with their goodwill gesture. For starters: ascribe to democratic governance that fit into their own specific frameworks, open political elections, and the end of life presidencies.

Columnist Lumumba-Kasongo is an emergency medicine resident at New York University/Bellevue Hospital and is a Columbia University-trained journalist. For more reports please call (212) 481-7745

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