Will South Sudan be the weakest link in East Africa’s battle against Covid-19?

This post by Professor Jok Madut Jok originally appeared in the Daily Nation.

If ever there were any regional efforts in the East African Community (EAC) in which countries of the region coordinated their measures to fight Covid-19 together, the question of whether or not South Sudan would pull any weight in that effort would undoubtedly present itself.

Though the country was the last in the EAC to report a first case of the Coronavirus, it quickly surpassed all of the others in new daily infections. The sense of casualness that the disease was initially greeted with has now given way to a widespread feeling of anxiety, as the virus spreads, infecting senior government officials, including two vice presidents, their families and several national ministers, and killing prominent individuals in government and in the private sector.

On May 26, for example, the country registered a whopping 188 positive cases, the largest in a single day, out of a total 300 tests conducted on that day. Based on these developments, it would not be surprising if the rest of the region sees South Sudan as a potential exporter of new cases to their territories, even long after these countries have curbed the pandemic within their borders. It is already being seen by some as the weakest link in any joint regional efforts, not only offering very little in any collaboration, but possibly becoming a liability.

XENOPHOBIA
Recently, a local government official in northern Uganda, close to the border with South Sudan, railed in a recorded message, telling the local people not to allow South Sudanese to come into their country and that any Ugandan found hosting South Sudanese would be jailed or fined. While it was probably within the lock down orders, the message was delivered in a way that smacks xenophobia. But such attitudes are common throughout the region. South Sudanese themselves had a similar posture at the start of the pandemic, when their leaders saw the country as virus-free and that it would only get the virus if foreigners were allowed to enter their country. All this may well have been with xenophobic tendencies, but they were also great public health measures that should have been taken up officially and enforced in ways that did not victimise anyone. Because these were not streamlined as national policies, they were bound to be implemented haphazardly, hence ineffective while diminishing the fervor for regional collaboration.

The way Covid-19 is being managed in South Sudan and the speed at which it is spreading, despite the late onset, gives the neighbours chills. Not only does the country lack a well-coordinated response to the pandemic but its health system has also been totally overwhelmed, health personnel frustrated and a big portion of its population is not observing the physical distancing orders. Additionally, the country’s available resources are not being managed properly as to take care of its poor people who are now made all the more vulnerable by the shifting of focus away from services in an attempt to meet the expenses of the public health emergency responses. This situation is not relieved by the realities of South Sudan being both landlocked and imports-dependent, posing such a serious challenge of screening truck drivers and other essential travellers at border crossings, quite possibly wiping out its economy and making the country the last bastion of the pandemic in Eastern Africa.

Does this mean there is no need for a collaborative effort against Covid-19 within the EAC? As South Sudan is the newest member of the EAC, many of its citizens are still riding in the euphoria of their country’s partial admission into the bloc. Whereas many citizens of the older core founding countries, Kenya, Tanzania and Uganda, have seemingly become cynical about the organisation’s capacity to rally its member states for collective action on urgent matters affecting them, South Sudanese are still trusting in the EAC. There is a strong expectation that their country’s partial membership in the regional body bears benefits to them, not just in trade, residence and access to educational and health services they have been buying for years in Kenya and Uganda, but more because there is now a global pandemic that is quickly threatening to inflict a massive damage on the young country’s population, and that requires any assistance it can get from its neighbours.

Without a strong national response plan that has a dedicated political figure to rally troops against the pandemic and becoming the face of that fight, South Sudanese cannot be blamed for looking beyond the borders, to the EAC, to some of the region’s strong leaders who have demonstrated visions and credible plans in the fight for their peoples’ lives. They hold out hope that there is still a chance of coordinated actions between the member states, perhaps to the benefit of all. Even if South Sudan has nothing to contribute to a collaboration, it is in the region’s interest to help South Sudan contain this virus, lest that country remains a vector, to the detriment of the whole region.

COLLABORATIVE RESPONSE
That said, however, despite pronouncements to the effect that the governments of the EAC member states need to work in concert with one another against Covid-19 scourge, the Coronavirus collaborative response has not materialised beyond communication between the heads of state and the public statements that follow their conversations promising joint efforts on screening and quarantining of people who cross borders to provide essential services and to keep the national economies of the region alive.

In his address to the African Union on April 29, Kenya’s president Uhuru Kenyatta declared that “If we are to defeat this enemy, we need to ensure that through our regional economic communities we are able to communicate, work together and able to deal with cross-border issues because unless we fight together, we will lose together.” Rwanda’s Paul Kagame has lamented the willingness of the region’s leaders to allow bureaucratic procedures to get in the way of working together to fight an enemy that is likely to leave a massive health, social, economic and political impact the region.

There is an EAC Covid-19 Response Plan, unveiled on April 30, discussed and supposedly revamped at the virtual summit of four leaders of the bloc on May 12. But to the extent that this can be called cooperation, it has been limited in scope and seriousness at the political level. It does not go beyond the sharing of case reports to the regional bloc’s Headquarters in Arusha, Tanzania. If the pandemic is going to be contained in the whole region, such that no country is left behind to become the source of the next wave of the Coronavirus spread, what’s blocking collective efforts? Weakest link or not, it seems that it is not the suspicion that some countries would have little to bring to the collaboration table. Instead, it’s both national pride and local political dynamics in each country that almost prohibit the leaders to think and act regionally.

 

Covid-19: How do we support the most vulnerable poor?

This post by Prof. Jok Madut Jok originally appeared in the Daily Nation.  

Coronavirus is killing black Americans at six times the rate at which it is killing white Americans. But this is not because there is anything uniquely innate in blacks that makes them less able to withstand the viral assault. Health experts tell us that the reason for this racial disparity in infection and death rates is that “This is an outward manifestation of structural racism where African Americans are at an increased risk,” said Mother Jones magazine about two weeks ago. In other words, a long history of racial discrimination has produced poverty,crumbling of black neighbourhoods in major United States metropolitan cities, police brutality and incarceration of young black men on minor charges and for longer jail terms than Whites. It has also meant that more blacks work odd jobs such as serving fast foods, shelving commodities in groceries, delivering post and serving at gas stations, all of which, in the age of Covid-19 and the physical distancing measures effected by states to fight it, have been considered essential occupations, to keep America running during lock down. But these occupations disproportionally expose them to coronavirus infections.

Above all, this long history of marginalisation, governance deficit and wealth disparities have become more fundamental formations of chronic health conditions in African-Americans, from hypertension to diabetes to lung disease, than anything else. It is these conditions that form a fertile ground for coronavirus to create serious damage to the lungs. It is these circumstances and the history underpinning them that makes the subsequent Acute Respiratory Distress Syndrome (ARDS) more deadly for black Americans. Meanwhile, black people in southern US live in states that have not expanded public health insurance system known as Medicaid, leaving blacks with limited or without coverage at all. And people without insurance in the US are less likely to report to the nearest healthcare centre when they experience Covid-19 symptoms, for they would get hit with a hefty medical bill they would have no capacity to pay.

I report this US situation simply to illustrate how Covid-19 infections and deaths are likely to show similar disparities in many African countries, where socio-economic disparities have become increasingly acute over the past 40 years of the so-called market liberalisation. That opening up of African markets to ‘globalisation’ has seen major foreign corporations, along with their local political and legal facilitators and the local parasitic capitalists, have moved much of Africa’s wealth away from Africans and into the hands of foreign corporations and into the hands of the local petty bourgeoisie class that arranges and expedites this foreign economic onslaught, leaving a gaping hole in the basic services that would have guarded Africans against any health emergencies. In essence, local African corruption and greed have met the global lust for Africa’s natural resources, oil and minerals, land and rivers, cheap labour with a colonised mind to boot, to create a deadly marriage of extraction that has left African landscape laid open to disease.

Wealth and Poverty

This has created gross inequality in Africa’s health-care systems, such that although coronavirus does not discriminate on the basis of class and political power, it will still be the most politically and economically marginalised who will suffer the most should it start spreading its wings in Africa full circle the way global experts are insisting it will. A health system that is gutted of its workforce and the resources necessary for an equitable national response to a health emergency of the Covid-19 magnitude is one that is likely to manifest disparities in infection and death rates that draw a clear line between wealth and poverty. Will the racial disparities that have been seen in the US and the inability of the US healthcare system to respond equitably to a national health crisis manifest itself in Africa due to economic disparities. despite the absence of a racial factor? If such disparity should come to pass, revealing the impact of power and wealth on the one hand and poverty on the other, it will be a classic proof that this disease only sees wealth and poverty in Africa, the same way it only sees the colour of skin in America.

The only caveat that one must add in the case of Africa is that Covid-19 deaths will not just follow wealth disparities, but also the unequal application of the emergency response measures against the virus, as the wealthy elite also wield political power that will most likely grant them preferential treatment in the use of the meagre health resources available, now that there is no way for them to run to foreign hospitals, as they have been doing in normal circumstances. With the infection rates gathering momentum in Africa and the whole world pointing to Africa, predicting that its less effective health systems and Africa being home to a higher burden of underlying health conditions will cause the black continent to be more vulnerable, it is even more worrying to picture poor, post-war and politically fragile African countries like Sudan, Congo, South Sudan or Central African Republic. There, it seems, the landscape lays open to the virus.

Warped System

Overcrowded and unplanned urban settlements that lack basic services and with crumbly hygiene, subsistence industries that just can’t be closed down without risking the lives of people who work in them, poor rural areas without access to healthcare and millions upon millions of refugees and internally displaced persons squeezed together into unworkable spaces, all make Africa seems like the continent has stretched her arms out to welcome Covid-19. And then there is the economy that hardly employs anyone formally, a large and growing gap between a vast impoverished population and a small group of politically-connected who live nicely and get the best healthcare by virtue of the warped system that only looks at how much money people have, not how sick they are.

Looking to the future, the question now is how much longer can Africans go on ignoring or learning to live with these disparities and still expect their countries’ health systems to come to their rescue when emergencies emerge? Do we adhere to these unworkable isolation measures that have been put in place as the only panacea, pretend it is natural that some of us will have access to quality healthcare, should they get afflicted by this disease, and others don’t? Or can we use the inequities to which Covid-19 has exposed to stand together for equitable systems? It is my conviction that anything short of civic solidarity spells death.

What measures can civic activists, public health workers and all people who uphold values of fairness embark upon in readiness to call out these long-established inequities that decide who dies of Covid-19 or the next epidemic or pandemic and who lives?

 

 

 

Will African governments invest more in healthcare after Covid-19?

This post by Professor Jok Madut Jok, Professor of Anthropology, Syracuse University, originally appeared in the Daily Nation.  Link to Prof. Jok Madut Jok’s article in the Daily Nation. 

The fact that the global pandemic, Covid-19, has exposed the deplorable state of health systems in Africa is not surprising at all. Will these systems examine their worth when the emergency has passed? Perhaps in view of the ongoing struggles to contain the virus, this question may not be a priority at this point. But it is an important one nevertheless. With all due recognition of the efforts that African scientists, physicians and other recognition of the efforts that African scientists, physicians and other healthcare workers are putting into the fight against Covid-19 and into caring for the victims of the disease, all under hard working conditions, the obvious question has been whether or not they have a health system that gives them the tools, the weapons and the robust backing that an army at war needs to have. The answer is “no”. What they got is political and bureaucratic bluster. The exceptions to this reality are few and far between.
What Africa’s healthcare workers get are politicised emergency response announcements, lip service to the disease control measures, physical isolation orders that have proven draconian as to be counter-productive, and politicians who speak about the need for patriotism in this combat but then go about their own lives in violation of the very measures they want the rest of their populations to abide by. What the healthcare workers need most and are not getting are honest political decisions. They also need money, along with transparent systems for the public to know how these huge sums are disbursed. Right now, emergency funds have been announced left and right, but there have been no accountability measures to go with these funds.

All across the continent, national budgets show such paltry allocations to healthcare, often justified on the basis of resource dearth. This has meant that much of the financing and staffing of health systems has fallen on the shoulders of donor countries, the United Nations and International non-governmental Organisations; or on private clinics for the few who can afford.

In South Sudan, for example, more than 80 per cent of the country’s health services are covered by these foreign entities. The result is that these services are insufficient, uncoordinated and are not thought out well enough to respond to the country’s healthcare priorities. Instead, the foreign health interventions largely address the problems the NGOs and their donor countries deem as priority. Because the country’s healthcare system is run by foreign organisations, it does not include the development of the country’s healthcare cadres to any meaningful length and standards, beyond the rudimentary “nursing” or “midwifery” skills that are offered on the job. Biomedical research remains singularly in the hands of medical colleges that are housed in woefully underfunded universities, producing far fewer and ill-prepared medical officers than the country requires.

In Kenya, Uganda and Tanzania, the trend is towards privatisation of the health systems. The big public hospitals, from Kenyatta National to Mulago to Muhimbili, these countries’ major referral hospitals and the training grounds for the best healthcare cadres, are left gasping for breath, as they struggle to retain the best physicians, pay their staff decent wages obtain and maintain medical equipment and other supplies, provide quality care that is affordable for the vast low income populations that need their services.

Sadly, there have been no signs that governments of these countries would ever prioritise the health sector, to inject new investments into it or increase its budget by directing some cash away from, say, defence to revamp public hospitals, public health surveillance, sponsor research and stand ready to combat any health emergencies.  The challenge facing healthcare systems in East Africa does not stop at the decay of facilities but extends most importantly to staff morale as they struggle unsupported, unequipped and unclear about the processes of procurement and distribution of medical supplies. This has forced some of the best biomedical minds to seek work in private practices, where wages and working conditions are far better, but where they end up only catering for the small segment of population who can pay. Such private outfits, uncoordinated by any national body, cannot respond meaningfully to a public health emergency. This came to a head when the novel coronavirus showed up in Africa in late February.

This goes beyond the usual claim that attributes this poor investment into healthcare to the weak economies and lack of resources. It is primarily caused by corruption, where even the minimum funding allocated to health is diverted or wasted through mismanagement, much of which is hardly ever accounted for, as oversight institutions, parliaments and ethics commissions are toothless due to their subjugation by and submission to the presidency.

Lack of investment in health can also be attributed to a political leadership that lacks the will to act decisively, with the politicians of most African countries becoming the butts of all jokes, that they do not care about the well-being of their populations, that they abandon the national healthcare systems in preference for seeking their own individual and family medical care in foreign countries at the expense of the public.

In South Sudan, health budget stands at four per cent of the national expenditure in good years, a level of investment that has left physicians in public hospitals unpaid for months on end, forcing them to either flee the public system or reduce themselves to consultants for the NGOs and the United Nations. Meanwhile, 400 members of South Sudan’s parliament were offered cash of $40,000 (Sh4 million) each as car loans in 2019 and $25,000 (Sh2.5 million) as health insurance in 2020. They were also given additional monies outside their salaries, all as a way to buy their loyalty to the executive office. The entire illegitimate expenditure on the lawmakers amounted to a total of $28.1 million (Sh2.81 billion), a sum that could have equipped all the three major teaching hospitals, provide them with constant supply of water and electricity, hire their consultants, provide medications and then have more left to replicate those upgrades in seven other state referral hospitals throughout the country.

Similar echoes can be heard about big medical research institutes in East Africa, which have been drowning in under-funding, chronic maladministration, graft and nepotism. These conditions have rendered them unable to be at the forefront of the fight against outbreaks. Covid-19 pandemic has called their bluff.

The strategy adopted by most of the world’s governments is to “protect the health system” by “flattening the curve” and reserving resources for coronavirus cases. Africans seem to follow suit. But this approach not only has negligible benefits for Africa because there is really no health system to protect, the designers of physical isolation measures have also forgotten that it is near-impossible to achieve the level of isolation necessary to slow down or prevent infections when dealing with populations that are desperately poor, who just can’t stay home without their usual hand-to-mouth livelihood activities. At least not for much longer than this. On the contrary, spending the meagre resources on beating people into isolation diverts these resources from tackling the leading killers of Africans, malaria, complications in childbirth, Hepatitis B, child malnutrition, food insecurity and push back on violence as a public health scourge. How was it that the continent’s research centres could not see this and recommend a more suitable course of action is testament to the quality of health system they undergird?

 

 

 

 

On Taking Action

This post also appears on the  Beyond Intractability website.   The blog is the Constructive Conflict Initiative / COVID-19 Blog and Lou’s essay is at https://www.beyondintractability.org/cci-mbi-cv19-blog1/kriesberg 

We Americans are beset by many awful circumstances in our country and in the world. As analysts and sometimes as activists we examine such developments, analyzing why they are bad and how they have happened. So many bad things are occurring every day, it is hard to fight against any one of them, as new ones distract us. I sketch out an approach to taking actions that have a good chance to be effective and satisfying in overcoming objectionable circumstances.

First, we should select three or four matters that we believe should be bettered. We can each choose those matters that particularly concern us. The matters may or may not be connected and they will vary in magnitude. We should include some local aspects of one or more of the matters that are of concern. We do know that even now, some good things are happening in some cities, some neighborhoods, and some local institutions. They are important, because they have a better chance of being successful, which is encouraging and helps sustain progress. Most bad matters entail contentions, conflicts that embody and sustain them.

Second, we should work with other people to resolve the undesirable matter of concern. It isn’t necessary to build one’s own organization. There are many organizations acting to overcome the bad developments that might concern each of us, which we could join. For example, Indivisible, which functions across the country and was founded soon after Donald Trump’s election, does political action stuff at the local, state, and national level. There also are local union chapters, religious and ethnic organizations, which might be joined or aided. There are also political reform groups and ones working on specific environmental issues. Notably, there are formal official institutions with the charter to manage the undesirable circumstances, which may be joined or aided.

Third, we should reflect on alternative strategies that might ameliorate or overcome the destructive matters of concern. Certainly, one part of any effective strategy is to mobilize support for the possible action to win over the adversaries. The primary objective at this stage is to gather the needed power. There are three sources of power: coercion, persuasion, and positive sanctions, which are combined in many ways in the course of waging a conflict constructively. It would be helpful to hone and apply our persuasive skills in writing and speaking on various platforms; we ought to develop skills to communicate broadly, not only to and for professional colleagues. We should seek to amass resources that can be used as negative sanctions and/or used as positive sanctions. Adversaries should not be dehumanized and their heterogeneity should be recognized so that some cooperative actions might become feasible with some elements of the opposing side.

Finally, we must do something. We should formulate both long term and short-term goals. Long term goals project a vision of a hopeful future. Short term goals should be attainable in some visible way, so a gain can be won. This helps gather more support. In any case, moreover, overreaching should be avoided, since large losses by opponents can provoke them to win great pushbacks. Best of all, opponents may come to see that they have also gained some benefits by the new circumstances.
Acting is a wonderful way of avoiding feeling despair. It can be fun. It keeps hope alive. Having written this, I recognize that I have pursued changing versions of this approach throughout my life.

 

PACE’s Russian restoration will set a dangerous new precedent in Europe

By Mark Temnycky, Freelance Journalist who covers politics and sports in Europe and Ukraine and PARCC Alumni.

Originally posted on the Euractiv.com website on ‎Jul‎y ‎5‎, ‎2019.

Despite its continued meddling in European affairs, Russia has been reinstated in the Council of Europe, with full voting powers. The decision will only encourage Moscow to continue its erratic behaviour on the European continent while others, like Turkey, may follow its example, writes Mark Temnycky.

On 25 June, the Parliamentary Assembly of the Council of Europe (PACE) voted to reinstate Russia as a full voting member within the assembly. The Russian Federation was stripped of its voting power in 2014 after the illegal annexation of Crimea and for supporting the separatist movement in eastern Ukraine.

Fox News’ ‘3 Mexican Countries’ gaffe perfectly sums up Trump’s policies

By Gladys McCormick, Assistant Professor of History, Maxwell School of Citizenship and Public Affairs, Syracuse University

Originally posted on The Hill, April 1, 2019.  

On Sunday morning, an on-screen banner for an episode of “Fox & Friends” displayed “Trump Cuts Aid to 3 Mexican Countries” during a segment on the administration’s cut of hundreds of millions of dollars of promised foreign aid to help Honduras, Guatemala and El Salvador deal with their ongoing security crisis.

Later in the day, Fox News issued an apology and clarified that they knew these nations were part of Central America and not of Mexico. However, the damage was done and the screenshots of the banner had been displayed far and wide among social media circles. Responses ranged from horror to laughter at the geographical mistake. Among Latinos/as, it confirmed that Fox News is not sensitive or knowledgeable of issues important to our community. I am originally from Costa Rica and I laughingly posted on Facebook that little did we know that, as Central Americans, we belonged to Mexico — and to please pass the mescal.

Ukraine’s Athletes Shine Through National Gloom

By Mark Temnycky, Freelance Journalist who covers politics and sports in Europe and Ukraine and PARCC Alumni.

Originally posted on the Atlantic Council website on February 28, 2019.

Five years after the Euromaidan, most analysis of Ukraine is grim. It tends to focus on the patchy reforms that have been put in place, the country’s endemic corruption, the ongoing war in its east, and the current unpredictable presidential election campaign. Hardly any of the coverage is positive.

But that’s not the full picture. Writers and analysts have missed something important: the country has emerged as a leader in sports, uplifting the spirits of Ukrainians in the process. Ukrainian athletes have given their compatriots a renewed sense of pride and optimism during this difficult period.