During 2018 a number of African heads of state have had their share of “medical vacations” — routine medical check-ups and treatments in Europe, Asia and the Middle East for treatment of undisclosed illnesses or “wellness check-ups” as an aid to senescence. And any public concerns about the nature of the medical vacation or the well-being of the first citizen of the nation are met with fervent denials sweetened up with accusations of treason.

There has been an expansion of African scholarly literature critical of “medical tourism”, defined as:

“The set of activities in which a person travels often long distances or across a border, to avail medical services with direct or indirect engagement in leisure, business or other purposes” [Jagyasi, D.P. (2008:10). “Defining medical tourism. Another Approach” – Medical Tourism Magazine. 9-11].

Political scholars have denounced medical tourism as shameful and disgraceful. They advance the following argument: Why is it that post-independence the political elites continue to travel to developed countries to seek medical treatment instead of establishing functioning home-grown health systems and infrastructure. Further, why would a president travel abroad to receive inconsequential medical care for “severe exhaustion” or “dental care” while at the same time he could receive equally effective care in his home country.

In recent times lengthy medical vacations by African heads of state have been accompanied by deceitful diplomatic government statements that they are normally scheduled check-ups. Government spokespeople go to extremes of reassurance, noting that there is nothing to be anxious about. The president is in “excellent health” or “full of energy” and — some of my personal favourites — “in good spirits”, “jovial”, “hale and hearty” or “fit as a fiddle”. Presidential offices continue to lie about the leaders’ health or medical expeditions to foreign countries, costing taxpayers millions.

This lack of transparency — and the dangers for journalists of reporting on it — has given rise to the following questions:

• Should a president’s health be treated as a state security issue? Why is it a crime if journalists report on the state of a president’s health?

• What should be done to avoid conflict as a result of the political uncertainty (power vacuum) during the weeks or months when a president is in a foreign country?

• What are the potential dangers of a lack of transparency in terms of political stability?

• Does this have to do with cultural perspectives on issues of the health of an elderly person?

Recently, Gabonese president Ali Bongo Ondimba spent a month at a hospital in Riyadh, Saudi Arabia, receiving treatment for what the Gabonese presidency initially and diplomatically referred to as “suffering from severe fatigue”.

After a lengthy period of uncertainty and conjecture in Gabon about the whereabouts and well-being of the president, the Gabonese presidency retreated and acknowledged that Ali Bongo was “seriously ill” and had undergone surgery — thus he would be transferred to another hospital in Rabat, the Moroccan capital, to recuperate.

As a result of the deceitful official statements, there were numerous rumours that Bongo was dead. Concern about the president’s health will always be an issue of public interest in Africa because of concerns about their capability of leading the nation.

This is a continent led in the main by senior citizens with an average age of 63 or 64. In 2014, Sudanese-British billionaire Mo Ibrahim, at an event in Rwanda titled “Leadership for the Africa We Want”, highlighted:

“We are the only continent where we have a president at 90 years starting a new term. Are you crazy or not? We see people in wheelchairs, unable to raise hands, standing for elections. This is a joke… Why do bigger countries entrust their economies in the hands of those in their ‘40s? We pick people in the ‘90s to lead us. To lead us where? To the grave?”

The lack of transparency on the illness of a president and the phenomenon of African leaders seeking treatment abroad has ignited the debate on how African governments can guard against “fake news” about the death of a president when a state’s leader is recuperating in a foreign country. One might here interpose an objection: If the public is regularly updated about the president’s health there would not be any gossip fuelling hoax news.

In 2017, Nigerian President Muhammadu Buhari spent more than three months in London battling an unspecified illness and receiving treatment. Buhari’s absence, like Bongo’s, prompted intense conjecture in Nigeria about his health and many reports circulated on social media, falsely saying he had died.

At present, Buhari is repudiating widespread claims that he died during his prolonged medical vacation in London and was replaced by a clone. The Buhari clone jokes underline why l love this continent and its ludicrous humour, which develops into public debate and becomes the subject of global comedy.

Many African countries have provisions for who should take on presidential responsibilities if a head of state is incapable for health reasons, or dies. However, many African presidents suffer from a narcissistic personality disorder — hence they sneak out of their own countries and embark on medical vacations for indeterminate periods without communicating a written declaration that they are not in good health and the necessary process should be undertaken to transfer power to the vice president.

Professor Adekeye Adebajo, director of the Institute for Pan African Thought and Conversation at the University of Johannesburg, who has written extensively on African political affairs, points out that many African presidents do not seem to distinguish between the presidency as a “political institution” which some scholars have described as a “separate branch” and the office-bearer. Adebajo says:

“African leaders often give the impression that the health of their countries is tied to their own personal health, and what is ailing a leader is often treated as a state secret.”

The well-being of the president, as a chief executive or head of state, and that of the institution and the country are inseparable. African presidential politics reveals a subtle tendency to intensely personalise the presidency as an institution and do not disclose their health because they see it as an extension of the wellbeing of the institution and the country. Regardless of the strong checks and balances which have been imposed to ensure that African presidents do not personalise the “branch”, these reforms are unable to prevent African presidents from becoming “too powerful, domineering and overbearing”. [Fombad, C.M., & Nwauche, E.S. (2015). “Africa’s imperial presidents: immunity, impunity and accountability.”] Absolutism means that a leader must represent power, strength, wealth and health.

Analysing the current political milieu in Africa, there are some disturbing themes emerging. Journalists are threatened with arrest, detention, death threats and serious prison sentences when they report on critical issues which deserve more attention, such as the president’s illness, or the true nature of their extravagant “routine” medical vacations.

It is branded as treason of the highest order when the president’s health becomes a public issue. For instance, in 2017, two Zimbabwean journalists were arrested over a newspaper report that described President Robert Mugabe as “in bad shape” when he flew to Singapore for what government officials termed a scheduled medical check-up.

Some traditional pan-African scholars highlight that openness about health issues varies considerably in different cultural contexts. They insist that arguments about transparency are un-African because our culture dictates that the illness of an elderly person is not open for discussion to anyone except to the council of elders of the immediate family.

However, traditional constructs should not be treated as beyond question. I personally think it more to do with socio-cultural constructions of the chief or king or powerful man’s health, as understood as a source of “vulnerability”. Many African leaders behave like kings or chiefs and exercise this right indirectly within the constitutional democratic framework.

In 1971, upon entering the District Office in a remote town in Eastern Cameroon, Peter Geschiere describes how he noticed underneath the president’s portrait the following maxim:

“Be brief, we have to do in decades what Europe achieved over centuries.” [Geschiere, P., Meyer, B., Pels, P. (eds). (2008). ‘Readings in Modernity in Africa.’ Pretoria: UNISA Press]

If African leaders are still serious about achieving in decades what Europeans achieved in years, they have to do away with the idea that “I do not want to be blackmailed into resigning or relinquishing power because I have become terminally ill”. This way of thinking is destructive to our collective effort toward good governance and will not take us anywhere as Africans. The president has to make significant decisions on behalf of the country — and thus he/she has to be physically, mentally, and emotionally competent to do so.

Every African country deserves a fully functioning president, thus citizens must demand full transparency on his health. This should be based on medical records from independent medical doctors, not the presidents’ spokespeople or party political supporters.

If we are to entrust our economies and military in their hands, we are supposed to take their health seriously. They will be involved in meetings with foreign leaders making an important decision and attending multiple events in a day, thus we have to know their capability and it can only be assessed by a series of physical, mental, and emotional capability tests. For a public servant such as a president, his health should be a public interest issue, not a private one, and it should be a national security issue.

Although realistic political scholars initially believed national security referred to military might, at present, it incorporates a wide range of factors, including the president’s health.

My suggestion is that there should be comprehensive health tests for all potential presidents during electoral campaigns. Further, I personally commend journalists in many African countries who continue to report on their presidents’ illnesses, despite being warned that this is a criminal offence punishable by life in prison or death. These are our true heroes. DM

Michael Khorommbi is a researcher on regional integration and peace-building in Africa. He is studying for a Master of Science in Governance and Regional Integration at the Pan-African University Institute for Governance, Humanities and Social Sciences.