While ostensibly, Beijing has for years been engaging in official health co-operation agreements with African governments to help improve conventional healthcare systems, the private use of Chinese medicine or relying on a Chinese doctor is increasingly becoming the norm in many parts of Africa.
By James Wan for New African Magazine.
Sitting behind his desk in his modest clinic, located on a gently sloping road in the Muyenga neighbourhood of Kampala, Dr Wen pauses for a moment of respite. He checks his phone for messages and his computer for emails before the elderly woman he was treating with acupuncture in the next room − a British NGO worker, he tells me later − pops her head round the door to thank him and arrange her next visit.
We watch out of the window as she climbs a little gingerly into a 4×4 and is whisked off into the city. “She is a very nice lady,” says Dr Wen. “I am happy that she is getting much better and more mobile. She was in a lot of pain before.”
Shortly after that, the doctor’s Ugandan nurse ushers in two more patients, a Somali woman and her young son, and I go out to sit in the waiting room. When they exit the surgery, with the boy clutching a box of Chinese medicine, the nurse gestures to the next patient, an elderly Ugandan man, who greets Dr Wen warmly as he hobbles into the surgery.
“The patients, they like him,” says the nurse. Before long, a Chinese couple pull up outside the clinic and take their seats in the waiting room.
Not every day is necessarily this busy for Dr Wen, an affable man in his 50s, but his clinic, located in a middle-class district of Uganda’s bustling capital, has certainly developed an enviable reputation. Patients from all walks of life turn up at his door, including some referred by surrounding hospitals and some from as far as Gulu in the far north.
“People know I am particularly good for back ache, neck ache, sciatica, skin diseases,” he says. “I am actually specialised in Western medicine, but lots of people come to me for Chinese traditional medicine as well as acupuncture and massage therapy. Chinese medicine is still underdeveloped in Uganda, but its popularity is growing.”
He explains that the majority of his patients come to him via word of mouth. He also suggests that the other appeal of Chinese doctors is their mid-range fees.
“The Western doctors service people who have lots of money. The local doctors treat locals. But I am in the middle so I get both foreigners who don’t want to pay for an expensive Western doctor and locals who don’t want to go to the hospitals.”
Dr Wen is well-placed to make such a judgement. When he set up his clinic in the 1990s after migrating from China, he was one of the very first private Chinese doctors in the country, but more of his compatriots have joined him in the past two decades, working in very literally-named places such as “Chinese Clinic”, “Chinese Clinic Centre” and “Chinese Medical Centre”.
But this uniformity of branding masks the variety between them. For instance some of the clinics employ a handful of staff and have shiny modern premises in well-to-do areas, while others consist of just a couple of sparse rooms nestled in noisy bustling streets. However, they have all become a minor yet significant aspect of Uganda’s healthcare environment, tending to, and filling the gap for patients who have exhausted other healthcare options, or just prefer Chinese treatment.
“I have about ten patients a day with all different kinds of problems,” says another Chinese practitioner, Dr Liu, sitting in his slightly worse-for-wear practice, adorned with Chinese posters and located opposite one of Kampala’s modern malls. “I treat Ugandans, Westerners, Chinese, everyone.
“When it comes to healthcare, Uganda has a fairly long tradition of cooperation with China. Beijing has been sending over Chinese Medical Teams to Uganda since the early 1980s and has been involved in establishing various health departments and hospitals. Most recently and significantly, China built the China-Uganda Friendship Hospital Naguru in Kampala as a gift to the Ugandan government.”
However, as is the case with many aspects of the China-Africa relationship, unplanned, informal and more personal interactions that arise from migration are becoming ever more important.
The most frequently cited estimate is that there are now approximately one million Chinese migrants on the continent, and this number is only likely to grow. As seems to be the case with most Chinese migration across the continent, the history of how Kampala ended up with a dozen or so private Chinese doctors is fragmented and haphazard.
Dr Wen, for example, first arrived as the doctor for a Chinese construction company. He had planned to return home once the project was complete, but some Ugandan friends pleaded with him to stick around.
“I had got to know Uganda well, I had had lots of interactions with patients and locals, and I liked the country a lot,” he recalls, “so when some Ugandan friends said they would help me register and give me financial support, I thought OK, good country, good people, good food, and I stayed.”
Dr Wen set up a private clinic and soon convinced two other Chinese doctors to join him. One of them stayed for nearly 20 years before returning to China, and the other one now runs her own private clinic in the city.
Other Chinese doctors tell their own unique stories, with most either having come over with Chinese companies or having been invited in one capacity or another by Chinese or Ugandan friends. They typically come from various different parts of China, and perhaps unsurprisingly, there is not a great deal of interaction between them. However, one thing that does tend to unite these intrepid doctors is their original motivation for migrating in the first place.
“I wanted to give my son a good education overseas, and on my government wages in China, that would have been impossible,” says Dr Wen. “I don’t want to make big money, but here I knew I could make enough to bring my family over and give them a good future.”
From his clinic located above a shop on a busy commercial street in another distict of Kampala, Dr Lin reveals a similar rationale. “Chinese development is so fast and there are so many educated people there,” he comments. “In China, we could never keep up. Here, we have a better situation and we can make a better living.”
Most Chinese doctors also emphasise a strong duty of care and profess an admiration for Uganda and Ugandans. But as Dr Liu puts it laconically, “the first motivation was money”.
Doctors and quacks
From Uganda’s perspective the presence of more qualified medical professionals can only be a good thing. The country’s healthcare system is largely under-resourced and under-staffed, and many of the Chinese doctors that have set up clinics in Kampala are highly experienced and qualified, and have developed strong reputations for being effective, efficient and affordable.
But this unfortunately cannot be said of all the Chinese doctors. In the same way that many Ugandan herbalists are unregistered and unregulated, not all Chinese practitioners appear to be operating in full accordance with the law either. In a couple of clinics I visited, for example, my requests for an interview were greeted not just with alarm but active hostility, to the extent that I was at one point angrily chased away. At another surgery in the town of Jinja, a couple of hours east of Kampala, I came across a dubious Chinese clinic. Located on a sleepy residential road, the small surgery had a large sign outside that promised Chinese herbal treatments for “diabetes”, “STDs” and “premature ejaculation” amongst two dozen other problems. Inside, the doctor’s surgery − replete with a patient bed and a few shelves stocked with Chinese medicines − was being manned just by a Ugandan “doctor”. He said that the clinic had Chinese owners who also ran a few other businesses and revealed that he had been working there for just a few months and was receiving training “on the job”.
Despite the sign outside, the man was adamant that he only actually dealt with very minor skin problems and insisted that he referred anyone with any more serious complaints to the hospital. However, a little later, when a Ugandan colleague of mine went in pretending to be suffering from sharp stomach pains, he was promptly sold a bottle of herbal drugs for USH30,000 ($11).
Dealing with it
It is perhaps inevitable that while many Chinese doctors are highly qualified and registered, others are taking advantage of Uganda’s weak regulatory environment to set up businesses that attempt to make money through less than honest means. This is, of course, also the case with migrants from anywhere else as well as individuals from Uganda itself, and the country has had several problems in the past with unscrupulous herbal healers.
However, many legitimate doctors are highly concerned that their own reputation is being undermined by quack doctors: “Chinese traditional medicine really works and many of the Chinese doctors in Uganda are extremely well regarded,” says Dr Mugisha, a Ugandan doctor who studied in China and now works at Beijing Clinic in Kampala. “But unless the government can regulate better to make sure doctors are really who they say they are, there will always be dangers.”
Dr Wen feels similarly: “There is a reason we study for 8 years in China to become a doctor. There are some agents, however, using herbal medicines to make money. They are not real doctors at all and they give us a bad name.”
But Dr Wen is hopeful about the future of Chinese medicine and Chinese migrants in Uganda. “If we keep working hard and see medicine not as a business but as a duty, a responsibility, I think we will have a very good relationship.
Chinese, African Leaders call for strengthened partnership
In a new development, the African continent as a whole is Exploring more opportunities for collaboration with China on health care. Chinese and African global health leaders called for strengthened partnership around universal health coverage and access to essential medicines during a conference in China.
More than 350 health leaders from China and Africa — including government officials, academics, and representatives from the private sector and international organizations — convened in Beijing tduring the fourth week of March, 2015 at the 5th International Round-table on China-Africa Health Collaboration. The meeting explored how Chinese and African resources and experiences can be leveraged to mutually support greater health development.
Meeting participants officially published the Beijing Policy Recommendations, a document outlining how intercontinental cooperation can be strengthened to drive sustainable impact, with a focus on the theme, “Contributing to Universal Health Coverage, Expanding Access to Essential Medicines.”
Drawing on decades of joint health efforts, the Policy Recommendations called for deepened dialogue between Chinese, African and international stakeholders, increased investments in health, and alignment with African regional and national strategies. The Recommendations emphasized commitments to a variety of issues including universal health coverage (UHC) and access to safe, high-quality drugs and vaccines, as well as the need for improved government accountability through better monitoring and evaluation.
“China and Africa have a long history of health cooperation going back more than 50 years. Our partnership with Africa is focused on mutually beneficial collaboration that meets the needs of African countries while also contributing to China’s health and development,” said Dr. Ren Minghui, Director General of the Department of International Cooperation at China’s National Health and Family Planning Commission (NHFPC). “China has a unique role to play in supporting Africa’s health progress, thanks to our advances in R&D and production of high-quality, low-cost medicines and vaccines. These lifesaving innovations have tremendous opportunity to make a positive impact in the developing world.”
The Roundtable comes at a crucial time, as China develops its integrated strategy toward other developing countries for the next 5-10 years. The meeting provides a platform for high-level consultation between China and Africa on specific health priorities of mutual interest. China-Africa collaboration on health is an important complement to investments made by African governments and aid from traditional donors, and reflects growing South-South cooperation in a number of sectors.
“More than ever before, African countries and China have the opportunity to work together on issues ranging from infectious disease control to strong, sustainable health systems,” said H.E. Dr. Mustapha Sidiki Kaloko, Commissioner of Social Affairs of the African Union. “As we build on progress made across the continent and work to achieve our post-2015 health goals, international cooperation with countries like China can amplify investments being made by African countries for greater impact.”
Building on commitments made by China and African governments in the 2013 Beijing Declaration, the Roundtable focused new attention on exploring effective tactics to achieve universal health coverage, and ensuring that all people are able to obtain the health services they need without falling into poverty. Participants reflected on innovative policies for UHC in several African countries, as well as China’s domestic health reform, and explored new paths for making universal coverage a reality.
Meeting participants also discussed a cross-section of other issues in which China and African cooperation have unique potential to make an impact. For example, presentations focused on increasing access to health commodities, including through public-private joint ventures and technology transfer agreements. A special session was also held on immunization, recognizing China’s growing role as a worldwide supplier of vaccines and its recent $5 million USD commitment to Gavi, the vaccine alliance. The Ebola outbreak provided context for conversations on health systems and building African health capacity. China provided $120 million USD in Ebola aid and deployed nearly 1,000 medical workers to affected areas.
“China has the experience and capacity to be a key partner in African efforts to expand health access and provide life-saving medicines and vaccines to those in need,” said Mark Suzman, President of Global Policy, Advocacy, and Country Programs for the Bill & Melinda Gates Foundation. “We’re excited to be working closely with China and African countries to identify and invest in health and development solutions that have the potential to improve the lives of millions of people. The Roundtable is an important part of our ongoing efforts to identify shared priorities for collaboration, ensuring that all partners’ needs and capacities are reflected in future policies.”
The Roundtable and the Policy Recommendations will lay the groundwork for the Ministerial Forum of China-Africa Health Development, part of the Forum on China-Africa Cooperation (FOCAC), to be held later this year.
“This meeting is an opportunity for us to share expertise, discuss new forms of cooperation and chart a common course forward. The policy recommendations released today will inform upcoming conversations between health ministers and will help shape the future of China and African countries’ bilateral engagement on health,” said Professor Cheng Feng from the Tsinghua University Research Center for Public Health, who is the co-chair of the Roundtable.
The Roundtable is co-hosted by the Tsinghua University Research Center for Public Health and the China Chamber of Commerce for Import and Export of Medicines and Health Products (CCCMHPIE) under the Ministry of Commerce (MOFCOM).
Planning of the meeting was run by a Task Force that included representation from NHFPC, MOFCOM, the China Alliance for South-South Health Cooperation Research, the Ethiopian and South African Embassies in Beijing, the World Health Organization (WHO), U.N. Children’s Fund (UNICEF), Joint U.N. Programme on HIV/AIDS (UNAIDS), U.N. Population Fund (UNFPA), U.N. Industrial Development Organization (UNIDO), U.K. Department for International Development (DFID), U.S. Agency for International Development (USAID) and the Bill & Melinda Gates Foundation.