Regular screening could reduce noncommunicable disease mortality

PREVENTIVE TREATMENT

The article “What can be done to reduce cancer deaths in Uganda” (DM of June 23, 2017) was a compassionate appeal that must be heeded. The author raised many core issues about the escalation of cancer in Uganda. He left many concepts unexplained.

First, the increasing incidence of cancer and other non-communicable diseases in Uganda should be discussed within the liberal market orientation – the commodification of social spaces, healthcare and rapid consumer cultural transitions. Underneath these are major behavioural changes inspired by the industry that makes available, harmful products such as alcohol, cigarette, ultra-processed foods, etc.

I was recently surprised when I saw four extremely obese kids with their equally super obese parents walking out of a fast food outlet on Kampala Road with four full buckets of deep fried chicken. Many associate fast foods with class and stature.

The increasing propensity among consumers for fast foods in the Fast Foods outlets that litter our streets, illustrate the transformative influence of liberalisation, and its impacts on our cultures and health. Dietary transition, for instance, is a matter of public health, as an indicator of rapid cultural shift among young and middle class people from organic traditional foods to ultra-processed industry foods.

I have until recently, believed in the singular discourse of behavioural explanation of the rise high morbidity and mortality from non-communicable diseases in the so-called emerging markets of the developing countries.

However, after deeply investigating, I now believe that the loss of environmental control is a powerful predictor of such behaviors. Underneath this, are powerful driving forces of multinational corporations. These manufacture, transport, and distribute carcinogenic and harmful products. These corporations are vicious in taking control of our everyday social environment and transforming them into markets, through targeted advertisements, targeted product packaging such as the alcohol sachets, and investing in trade policies that galvanizes their operations. Sachets are designed to attract the poor; sweetened drinks and highly salted foods are targeted at children.

Moreover, certain products such as tobacco, whether over the counter, or counterfeit, most are laced with addictive chemicals.

The claim of sedentary lifestyle as a “causality” in an African settings is questionable as it capitulates upon scrutiny against sound evidence. What is the percentage of Ugandans indulging in sedentary lifestyle, and why? What population are most afflicted by Cancer and Diabetes, and why? When we analyse these questions, and others, with the help of National Health Survey data and from HMIS reports alone, we may discover interesting trends and intersecting patterns between cancer, diabetes, chronic respiratory diseases and heart diseases with poverty, age and gender, and HIV/AIDs status.

The sedentary lifestyle claim in Uganda in that sense is far-fetched given our modest modes of social interactions, poor transportation system, irregular and expensive electricity and television. The increasing use of social media may augment the risk of inactivity given that nearly 19.5 million Ugandans are now on social media. Most of these behaviours are associated with the emerging digital neoliberal economy.

Ugandans are becoming more obese with a bulging belly morphological dilemma. Government must at least make screening services universal and mandatory. In Uganda men tend to resist screening because of reputational masculinity – fear of diagnoses which may alter their social status. This is problematic because most of these conditions, when diagnosed early, are reversible and treatable. Many Ugandans live with hypertension and various conditions unknowingly. The culture of gauging illness by pain or immobility compromises treatment efficacy, and fans mysticism of poisoning, bewitching, etc. Ever heard of an oxymoron where one particular MP is always poisoned and goes for “surgery” in south Africa?

In sum, the liberal market emphasises labor market attachment, production, and productivity. There is little room for being indisposed from the production line. You are responsible for getting sick and expected to get well on your own, perish!  

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Kyadondo East expose FDC’s lack of structure

GRASSROOTS

 One of the challenges of African society is the fortification of elders - those considered of high repute and advanced age - from scrutiny. However, democracy sets aside this cumbersome tradition and demands for transparency as well as accountability in social discourses. For instance, the Kyadondo East by-elections is about to expose a generational fallacy that FDC is building structures!

First, I have doubted the argument that FDC is building grassroot structures. If it is, Kyadondo East would by now be coloUred blue. In reading Hon. Nandala-Mafabi’s interview in the Observer of June 12, 2017 (Refer to: Nandala-Mafabi: FDC shall not work with Mao’s DP), it downed on me that this pep talk of building party structure is hypothetical.  Hon. Nandala-Mafabi confirms that FDC is unable to form and sustain grassroot structures because NRM "invaginates" such a structure with bribery and coercion. Nandala-Mafabi’s explanation speaks against the credential of current FDC Party President, the amiable and respected Gen. Muntu that is cultivated around this building party structures mantra. These days, every Party uses this cliché to sound busy and present at the periphery, whereas they are ensconced in the capital.

At least, Uncle Muniini Mulera, on numerous occasions, praised Gen Muntu for working towards building grassroot structures. This emerging discourse is intended to legitimize  FDC power and brands around gen Muntu. In essence, hasten the alienation of,  and a focus on Dr Besigye.

This “structure” hyperperbole reminds me of the fierce debate in the 90s between Ministry of Agriculture under Hon. Specioza Kazibwe and Parliament. The scandal was about some dams built in the cattle corridor somewhere in Western Uganda. When the MPs went to inspect the Dam, they could not see any. Incidentally, an Agriculture Ministry officials was quoted to have opined that if MPs could not see the dam, at least the cows were able to.

The 2016 Presidential and Parliamentary elections exposed FDC’s lack of grassroot structure.  Therefore, there is legitimacy in entertaining the discussion around the same. However, Gen Muntu was FDC’s Secretary for mobilization prior and he should know better. Without a real structure, winning a 34 years old establisment will require divine providence. The ingeniousness of Dr Kizza Besigye and his minders, with support from the diaspora allowed the P10 matrix system to fill this gap in 2016. FDC cannot therefore remain wishful about structures, or depend on the good will of resentful Ugandans exhausted with the antics of the tyranny.

This, by no means, is anindictment, nor intended to undermine Gen.Muntu’s vision of building party structures. It is only to reiterate that there is a lapse in its realization, as  if the cart is placed before the horse.

In hindset, the Aruu South MP, Hon Odonga Otto once stated on his facebook page that FDC did not have polling agents in nearly 22,000 polling stations around the country, most of them in Western Uganda and Karamoja. This figure is startling, especially to know that these agents were there but coerced, jailed, or compromised.

This fate may be an FDC trademark, which will render its efforts minimalist, even in Kyadondo East. Their inability to read the constituency well may cost the party here. Mr. Kyagulanyi is a man of the people, a grassroot mobilizer who rarely wears shiny suits, or speaks polished “Brexit”, “Donald Trump” and modern English on TV. He speaks the language of the unwashed peri-urban dwellers and employs the people he aspires to represent in Parliament.

The dilamma is that Mr. Kyagulanyi’s nascent support for Dr. Besigye during past hardships endears him to opposition politics. Mr. Kyagulanyi was in courts, visited jail, and at KB’s  home amidst confinement. He paid his dues to the cause when some MPs-elect were denying KB like Peter did to Jesus. Bobi’s star power, organic local support, history of concrete community development initiatives and leadership credentials makes his candidature appealing!

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There is no justification of strongman rule in Africa

STRONGMAN MALAISE

The wisdom of African strongmen rule in Africa is an utter contradiction with no justification whatsoever over 60 years of post-colonial profligacy. Does any nation need a strongman ruler, given the history of their dismal performances thus far?

Consistent evidence show that when dictators establish themselves over their gullible populations, they rule uninterrupted by internal opposing forces. With few exceptions, (eg Ghadafi), all dictators drive their nations to economic downfall and over dependency on foreign aid. By the inherent nature of dictatorship, human suffering follows a steady environmental degradation, low economic productivity, decline in human conditions, unfettered expropriation of resources by foreign interests, and inexorable alienation of citizens from the state. Many unpleasant traits of dictatorships makes strongmen rule in Africa unjustifiable.

Mobutu  of Zaire ruled the vast African country for 31 years.  By the time he was deposed, the entire Zaire had barely 1000 km of road into the countryside with a huge part of the mineral rich countryside inaccessible and isolated. Nearly 92% of Congolese lived under the poverty line of US$2 a day. By not investing in infrastructure, Mobutu perpetuated under-development and the haemorrhaging of Congo’s resources by foreign interests. It took a combination of foreign forces in tow of malignant internal insurgents to kick Mobutu out.

Back home, Idi Amin ruled Uganda with an iron fist and presided over economic collapse and immense human suffering. Like under Mobutu, internal dissent attracted a death sentence under Amin. Only with an external force of arms by Tanzanian People’s Defence Forces were Ugandans able to rid itself of a vicious rule of tyranny and economic collapse in 1979.

Recently, ECOWAs forced out the deranged Gambian dictator, Yahya Jammeh with the combination of diplomacy and potential for external force. There are many strongmen buttressed all over Africa such that to depose them, only an external force may suffice. Internal opposition has proven insufficient to galvanise the critical masses needed for change. Strongmen are vicious, employing corruption, and collaboration with external capitalists to exploit Africa.

Moreover, terrorism charge is strategically employed as a weapon against internal dissent and armed insurrection.

The young Joseph Kabila in DRC, himself a trainee dictator, seems to have graduated given his clutch on power. Soon he will join the regional club of full time dictators armed with strongmen ambitions run their countries down. Nearly every African country where strongmen rule, they have lurked and disabled internal dissent.

The lessons are there for us to draw from in order to realise the potentials of good governance and development.

African scholars should increasingly interpret the terms “good governance” and “development” correctly. These terms exists in situations where western capitalist interests of exploitation are guaranteed. Clearly, good governance and development are interpreted differently for Africa.

Even those who claim to value democracy and good governance as a pretext for development, support the entrenchment of dictatorship in Africa in as far as their interests are guaranteed.

We have to only look at the 2015 report “How the world profit from Africa’s wealth” which highlights the exploitation of Africa. According to the report, African nations received $162 billion in aid, loans, and remittances in 2015. At the same time, Africa lost $203 billion through resource extraction, debt payments, and illegal logging and fishing.

In Uganda’s 2017/18 budget, about 52% was allocated to debt repayment and government is reported to have paid taxes for several investment companies to keep them afloat! Indeed, Strongmen rule is akin to steady decline of Africa.

Nevertheless, not all love is lost with strongmen of Africa. Decisions by Rais Arap Moi of Kenya and Julius Nyerere of Tanzania to relinquish power demonstrated that when strongmen hands over power peacefully, their countries tended to harness the potential of transformation into a form of democracy quite quickly. Further analyses and theorising of this phenomenon may be of scholarly interest to academics.

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