This piece first appeared in a shortened version in African Arguments. We repost the piece in its entirety on the CIHA Blog in order to show that countries in the west have in the past, and under COVID-19, also concealed significant aspects of serious health issues suffered by their leaders.
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By Deborah Atobrah (Senior Research Fellow) & Benjamin Kwansa (Research Fellow), Institute of African Studies, University of Ghana
Source: BBC News
The death of former president Jerry John Rawlings on 12 November 2020 incurred a double loss for Ghana. First, the country lost its longest serving president. Second, it lost a huge opportunity for a public health promotion.
Despite massive attention paid to the late president’s death, the Ghanaian people heard hardly any news of his illness or brief hospitalisation beforehand. His passing came as a shock and we still know very little about what killed him.
President Nana Akufo-Addo simply said the 73-year-old had “joined his ancestors…after a short illness”. Some media outlets – including Joy News, GhanaWeb and BBC – reported that Rawlings had contracted COVID-19. Others, such as the late president’s former spokesperson, said he believed the cause of death was malaria.
This meant that Rawlings’ death was shrouded in the same kinds of speculation that have characterised other high-profile deaths on the continent this past year. When President Pierre Nkurunziza died suddenly in June 2020, for instance, the government in Burundi denied he had contracted COVID-19 but did not shed much more light on his supposed condition. Just a week before President John Magufuli died this March, the government in Tanzania insisted he was “healthy and working hard”. When he passed, authorities again denied the cause of death was COVID-19 and pointed to vague heart issues.
Going further back, there are many more instances of African presidents dying suddenly and with little official explanation. This list includes Togo’s Gnassingbé Eyadema, Guinea’s Lasana Conté, Algeria’s Abdulaziz Bouteflika, Zambia’s Levy Mwanawasa, Nigeria’s Umaru Yar’Adua, Ethiopia’s Meles Zenawi, Malawi’s Bingu wa Mutharika and Ghana’s John Evans Atta Mills.
Presidents may not be constitutionally required to report on their health, but the secretive nature of all these deaths robbed countries of timely opportunities for reflection and frank discussions of health and illness.
Until the Covid-19 pandemic, which saw Boris Johnson and Donald Trump initially denying and/or playing down their COVID-19 infections (Reuters, 2 October 2020), many countries have evolved from an era of secrecy to an almost spontaneous declaration of every twist and turn on the health and illness of their leaders. By the late 1940s, such blatant concealment of information regarding the illness of certain national leaders had stirred significant public agitations in other countries. Notable among them were Franklin D. Roosevelt and Woodrow Wilson of the US, James Ramsay MacDonald of the UK, Joseph Stalin of the Soviet Union, and Paul von Hindenburg of Germany (Park 1993). This concealment led to constitutional revisions to promote formal declarations of every twist and turn of illness of leaders in those countries. Although the outcry in such cases was inspired by the negative security and governance imperatives of a chronically sick ruler, health promotion and health policy reforms became an unintended outcome of disclosure.
A useful counter example is Ronald Reagan’s battle with colon cancer in the 1985. In that instance, the US president’s diagnosis and treatment were formally disclosed in detail to the American people, generating widespread media coverage and dispassionate public discussions. Researchers later found that this episode birthed a public discourse on dietary habits and an increase in awareness around the importance of health monitoring. The year after Reagan’s public health problems, the incidence of advanced colon cancer cases declined significantly, likely due to increased early detection.
Eighteen years of researching the lived experiences of people living with HIV/AIDS, cancer and lately, COVID-19, has shown us the high predominance of illness-related stigmatisation and discrimination in Africa. Guilt and shame is more common when conditions are infectious, terminal or are deemed to have some moral or spiritual connotations. In such circumstances, patients generally report to health facilities only when their symptoms are too advanced for any meaningful intervention. These result in poor treatment outcomes, high care burdens and high mortality rates, thereby perpetuating fear. Guilt and shame can be so entrenched as to tarnishthe image of the deceased and that of their family.
This trend likely contributes to why leaders’ deaths are frequently attributed to nothing more than “a short illness”. Secrecy allows figures to avoid the stigma associated with disease and maintain their image as heroic and invincible. Unfortunately, it also reinforces a culture of hiding illnesses and perpetuating the stigma, guilt, disdain, and shame often associated with poor health.
At a vigil for her father, Rawlings’s daughter eulogised: “I recognised and accepted a long time ago that he wasn’t just my father, but the father of many, and we have always shared him.” Indeed, for about 20 years, J.J. Rawlings was the father of Ghanaians, overseeing policies and programmes that affected the lives of people intimately. Would it then have been inappropriate for his children to know what killed their father? As the Ga say, mo ko sane e, moko sane (“one man’s troubles concern another man”).
A country’s citizens don’t need to know about all their leader’s mild maladies, but when their conditions cause death, they ought to be named. This would not only help combat the stigma associated with illness in many places but would provide an invaluable opportunity for people to discuss and learn from the tragic event.
About the Authors
Deborah Atobrah is a Senior Research Fellow at the Institute of African Studies, University of Ghana. She is the treasurer of the African Studies Association of Africa, and serves as Coordinator for the University of Ghana Required Courses. She holds a PhD and an MPhil in African Studies from the Institute of African Studies, University of Ghana, in 2010 and 2003 respectively.
Benjamin Kwansa is a Research Fellow at the Institute of African Studies, University of Ghana. He holds a PhD in Medical Anthropology from the University of Amsterdam, The Netherlands. His research interests are in the areas of construction of masculinities, gender and health, HIV/AIDS, sexual and reproductive health, religion and health, and family, population and development.