Houston, Texas (USA): Unlike dust-blown cities of sub-Saharan Africa, the city of Houston in Texas pumps its blood throughout every vein in and around the medical centre, a 2.1 mile or 5.4 kilometre area strewn with skylines of hospitals, research labs, and health professional schools – it ought to have been named the medical hub.
The men in suits, mostly dark, picked pace and in their strides on the concrete floor was the immeasurable power and authority. The doors flung wide open as they sauntered into a hospital full of children sick with all types of cancer, including that which is malignant as leukaemia (blood cancer). The heavy security escort was about President of Botswana, Mokgweetsi Eric Masisi.
Apart from being told it was a cancer clinic, the beaming faces of these children tell a story totally different from what we are accustomed to in sub-Saharan Africa when patients suffer from debilitating diseases like cancer. Emaciated faces of despair, skin discolouration and skeletal bodies breathing their last are all too common, especially where AIDS and cancer have conspired to set the sun down on Africa’s populations.
The Texas Children’s Hospital has the highest treatment success rate of cancer in the world. In the United States for example, 75 percent of children who are sick from cancer make full recovery, while across sub-Saharan Africa, in every 100, 000 cancer-related illnesses, nearly 90 percent of them succumb.
Research has shown traceable evidence that poor medical facilities to deal with the treatment of the disease that requires expensive state-of-the art equipment, world-class facilities including laboratories for research, as well as the inadequacy of those in the medical field to perform surgical procedures on those suffering from the debilitating conditions, all too often, conspire against the single fighting spirit of the cancer patients in Africa.
In fact, the nation’s best in specialized health care are at Texas Children’s Hospital, for example; Dr Mark Kline – rated the best HIV specialist doctor in the United States and Dr David Poplack, also celebrated as one of top-notch American oncologists. It is worth their mention because these two powerhouses are directly involved in the project that is to be known as the paediatric cancer clinic on the grounds of the University of Botswana, thanks to the gifted donation of $50 million presented by the hand of John Damonti – President of the Brystol-Myers Squibb Foundation, an American pharmaceutical company.
The Foundation is preoccupied with the vision to alleviate pain and suffering brought about by ailments with devastating effects such as AIDS, cancer, diabetes and hepatitis B and C among common diseases in Botswana. They accomplish their objective by capacitating of healthcare workers, integrating medical care and community-based support services as well as mobilizing the communities in the fight against these prevalent diseases.
Over the 15 years since his maiden foray into Botswana’s complex HIV quagmire, Dr Kline saw the set up of the children’s clinic from a mere ward at Princess Marina Hospital named “Bana” to the transformative facility that is today known as “Baylor Children’s Clinic of Excellence”.
Cancer has ramped up in the recent years and has been attributed to the distressing effects of HIV especially among the sexually active populations, where young men present at health centres with skin cancer (Kaposi Sarcoma), while cervical cancer is too common among the young females. The relationship that has existed between Botswana and Texas University has now been taken a notch higher to include cancer with a focus on safeguarding children and securing the future of Botswana.
“This facility will be the best there is in sub-Saharan Africa and a model to emulate by others. Not only will we channel resources to construct state-of-the-art facility, but we commit to making sure that the best in healthcare are sent there to prepare the ground for what will become laser sharp cancer treatment, while strengthening the capacity of your medical officers. We will then pull out and let you run with it,” roared President and CEO of the Texas Children’s Hospital, Mark Wallace who received a standing ovation.
In the words of the Permanent Secretary in the Ministry of Health and Wellness, Dr Morris Sinvula, the partnership is a huge investment for Botswana that must be harnessed especially the facilities belongs to her after they have imparted the much-needed expertise to save children’s lives.
“We should embrace this and run with it as quickly as we can. With their help, we did well in managing HIV and we can tap on their expertise and use their model to manage non-communicable diseases,” stated Sinvula on the sidelines of the reception held in honour of President Masisi.
Dr Kline lauded Botswana as the best model throughout the seven countries where they are present in sub-Saharan Africa because of its exceptional political will expressed at the highest level of government, although rising HIV incidences among the adolescents threaten to reverse the gains thus far made. It is this commitment that Dr Kline is excited to work alongside his colleague; Dr Poplack to significantly bring down the mortality rates among children suffering from cancer.
In response, Masisi said over the recent 74 months – Botswana registered 12, 000 cases of cancer (translating to 162 cases every month) – patients who were referred for specialty care at world-class health facilities, mostly in South Africa at a burdensome cost to the taxpayers.
“I stand here tonight to express deep gratitude on behalf of the nation of Botswana to the continued support we receive from the Texas Children’s Hospital. This is a new front. The mandate has been expanded to include cancer, which is quite prevalent these days in our society, and arguably linked to the HIV incidences. But any country that cares about its posterity does not leave its children behind.
It is because of this reason that my presidency would not be complete if I did not make a visit to this incomparable institution, if I may borrow Mr Wallace’s descriptive qualifier. I can assure you that it will not be my last visit. In 2016, I was there when the cheque donation of $50 million was presented at the site where this new facility will be put up. I was there as the vice president. I was there at the groundbreaking ceremony.
And I am here tonight as the president of the country and making a bold commitment that we have made the resolve as a country to set up a subvention fund every year towards the construction of this facility in addition to the generous contributions from the Brystol-Myers Squibb Foundation. I further commit my government to effectively use your investments for the intended purpose.
I make an appeal not only to the businesses in the health sector, but all others who may see it worthy to partner with Botswana to rid us of the scourge of cancer, especially among children. I assure you that we are a country that prides itself on the rule of law and that means respecting ourselves first, and also respecting those outside our borders. It has meant setting up our immigration protocols to treat those visiting our country or considering us as an investment destination with respect that human beings deserve. You have my word as the country’s president,” he stated amidst cheers.
When responding to Michelle D. Garvin’s question during a roundtable discussion this week, Masisi said while the HIV treatment is second to none in Africa, there is constant drain on the economy and in the ultimate; it would not be sustainable to keep every patient on drugs indefinitely.
“Prevention of new infections is the only solution. It will reduce the cost to government. I need to be advised properly as to the timeliness for my proposed motion before Parliament to criminalise inter-generational sex because the patterns show our young people are getting infected from those with longer sexual experience. I just don’t know if bringing it up now before the elections next year will be ideal. But something like this ought to happen,” he chuckled.
Here is how one Permanent Secretary encapsulates the clear tension between democracy and bureaucracy in Botswana: “President Mokgweetsi Masisi’s Government is behaving like a state surrounded with armed forces in order to capture it or force its surrender. The situation has turned so volatile, for tomorrow is not guaranteed for us top civil servants.
These are the painful results of a personalized civil service in our view as permanent secretaries”. Although his deduction of the situation may be summed as sour grapes because he is one of the ‘victims’ of the reshuffle, he is convinced this is a perfect description of the rationale behind frequent changes and transfers characterising the current civil service.
The result of it all, he said, is that “there is too much instability at managerial and strategic levels of the civil service leading to a noticeable directionless civil service.” He continued: “Changes and transfers are inevitable in the civil service, but to a permissible scale and frequency. Think of soccer team coach who changes and transfers his entire squad every month; you know the consequences?”
The Tsunami has hit hard at critical departments and Ministries leaving a strong wave of uncertainty, many demoralised and some jobless. In traditional approaches to public administration, democracy gives the goals; and bureaucracy delivers the technical efficiency required for implementation. But the recent moves in the civil service are indicative of conflicting imperatives – the notion of separation between politicians and administrators is becoming blurred by the day.
“Look at what happened to Prisons and BDF where second in command were overlooked for outsiders, and these are the people who had sacrificially served for donkey’s years hoping for a seat at the ladder’s end. The frequency of the changes, at times affecting the same Ministry or individual also demonstrates some level of ineptitude, clumsiness and lack of foresight from those in charge,” remarked the PS who added that their view is that the transfers are not related to anything but “settling scores, creating corruption opportunities and pushing out perceived dissident and former president, Ian Khama’s alleged loyalists and most of these transfers are said to be products of intelligence detection.”
Partly blaming Khama for the mess and his unwillingness to let go, the PS dismissed Masisi for falling to the trap and failing to outgrow the destructive tiff. “Khama is here to stay and the sooner Masisi comes to terms with the fact that he (Masisi) is the state President, the better. For a President to still be making these changes and transfers signals signs of a confused man who has not yet started rolling his roadmap, if at all it was ever there. I am saying this because any roadmap comes with key players and policies,” he concluded.
The Ministry of Health and Wellness seems to be the most hard-hit by the transfers, having experienced three Permanent Secretaries changes within a year and a half. Insiders say the changes have everything to do with the Ministry being the centre of COVID-19 tenders and economic opportunities. “The buck stops with the PS and no right-thinking PS can just allow glaring corruption under his watch as an accounting officer. Technocrats are generally law abiding, the pressure comes with politically appointed leaders racing against political terms to loot,” revealed a director in the Ministry preferring anonymity.
The latest transfer of Kabelo Ebineng she says was also motivated by his firm attitude against the President’s blue-eyed Task Team boys. “The Task Team wants to own the COVID-19 pandemic and government interventions and always cry foul when the Ministry reasserts itself as mandated by law,” said the director who added that Masisi who was always caught between the crossfire decided on sacrificing Ebineng to the joy of his team as they (Task Team) were in the habit of threatening to resign citing Ebineng as the problem.
Ebineng joins the Office of the President as a deputy Coordinator (government implementation and coordination office).The incoming PS is the soft-spoken Grace Muzila, known and described by her close associates as a conformist albeit knowledgeable.
One of the losers in the grand scheme is Thato Raphaka who many had seen as the next PSP because of his experience and calm demeanour following a declaration of interest in the Southern African Development Community (SADC) Secretary post by the current PSP, Elias Magosi.
But hardly ten months into his post, Raphaka has been transferred out to the National Strategy Office in what many see as a demotion of some sort. Other notable changes coming into OP are Pearl Ramokoka formerly with the Employment, Labour and Productivity Ministry coming in as a Permanent Secretary and Kgomotso Abi as director of Public Service Reforms.
One of the ousted senior officers in the Office of the President warned that there are no signs that the changes and transfers will stop anytime soon: “If you are observant you would have long noticed that the changes don’t only affect senior officers but government decisions as well. A decision is made today and the government backtracks on it within a week. Not only that, the President says this today, and his deputy denies it the following day in Parliament,” he warned.
Some observers have blamed the turmoil in the civil service partly to lack of accountable presidential advisers or kitchen cabinet properly schooled on matters of statecraft. They point out that politicians or those peripheral to them should refrain from hampering the technical and organizational activities of public managers – or else the party (reshuffling) won’t stop.
In the view expressed by some Permanent Secretaries, Elias Magosi, has not really been himself since joining the civil service; and has cut a picture of indifference in most critical engagements; the most notable been a permanent secretaries platform which he chairs. As things stand there is need to reconcile the imperatives of democracy and democracy in Botswana. Peace will rein only when public value should stand astride the fault that runs between politicians and public managers.
Former Permanent Secretary to the President, Carter Morupisi, is fighting for survival in a matter in which the State has charged him and his wife, Pinnie Morupisi, with corruption and money laundering.
Morupisi has joined a list of prominent figures that served in the previous administration and who have been accused of corruption during their tenure in office. While others have been emerging victorious, Morupisi is yet to find that luck. The High Court recently dismissed his no case to answer application.
United States President, Joe Biden, is faced with a decision to make relating to the Covid-19 vaccine intellectual property after 175 former world leaders and Nobel laurates joined the campaign urging the US to take “urgent action” to suspend intellectual property rights for Covid-19 vaccines to help boost global inoculation rates.
According to the world leaders, doing so would allow developing countries to make their own copies of the vaccines that have been developed by pharmaceutical companies without fear of being sued for intellectual property infringements.
“A WTO waiver is a vital and necessary step to bringing an end to this pandemic. It must be combined with ensuring vaccine know-how and technology is shared openly,” the signatories, comprising more than 100 Nobel prize-winners and over 70 former world leaders, wrote in a letter to US President Joe Biden, according to Financial Times.
A measure to allow countries to temporarily override patent rights for Covid related medical products was proposed at the World Trade Organization by India and South Africa in October, and has since been backed by nearly 60 countries.
Former leaders who signed the letter included Gordon Brown, former UK Prime Minister; François Hollande, former French President; Mikhail Gorbachev, former President of the USSR; and Yves Leterme, former Belgian Prime Minister.
In their official communication, South Africa and India said: “As new diagnostics, therapeutics and vaccines for Covid-19 are developed, there are significant concerns [about] how these will be made available promptly, in sufficient quantities and at affordable prices to meet global demand.”
While developed countries have been able to secure enough vaccine to inoculate their citizens, developing countries such as Botswana are struggling to source enough to swiftly vaccine their citizens, something which world leaders believe it would work against global recovery therefore proving counter-productive.
Since the availability of vaccines, Botswana has been able to secure only 60 000 doses of vaccines, 30 000 as donation as from the Indian government, while the other 30 000 was sourced through COVAX facility. Canada, has pre-ordered vaccines in surplus and it will be able to vaccinate each of its citizens six times over. In the UK and US, it is four vaccines per person; and two each in the EU and Australia.
For vaccines produced in Europe, developing countries are forced to pay double what European countries are paying, making it more expensive for already financially struggling economies. European countries however justify the price of vaccines and that they deserve to buy them cheap since they contributed in their development.
It is evident that vaccines cannot be made available immediately to all countries worldwide with wealthy economies being the only success story in that regard, something that has been referred to as a “catastrophic moral failure”, head of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus.
The challenge facing developing countries is not only the price, but also the capacity of vaccine manufactures to be able to do so to meet global demand within a short time. The proposal for a patent waiver by India and South Africa has been rejected by developed countries, known for hosting the world leading pharmaceutical companies such US, European Union, the United Kingdom, and Switzerland.
According to the Financial Times, US business groups including pharmaceutical industry representatives, have urged Biden to resist supporting a waiver to IP rules at the WTO, arguing that the proposal led by India and South Africa was too “vague” and “broad”.
The individuals who signed the letter, including Nobel laureates in economics as well as from across the arts and sciences, warned that inequitable vaccine access would impact the global economy and prevent it from recovering.
“The world saw unprecedented development of safe and effective vaccines, in major part thanks to US public investment,” the group wrote. “We all welcome that vaccination rollout in the US and many wealthier countries is bringing hope to their citizens.”
“Yet for the majority of the world that same hope is yet to be seen. New waves of suffering are now rising across the globe. Our global economy cannot rebuild if it remains vulnerable to this virus.” The group warned that fully enforcing IP was “self-defeating for the US” as it hindered global vaccination efforts. “Given artificial global supply shortages, the US economy already risks losing $1.3tn in gross domestic product this year.”