In late March 2024, the Nkafu Policy Institute screened a short documentary film about Monique Koumatekel, a young pregnant woman who died together with her twin babies in the precincts of a public hospital in Cameroon [1, 2]. Central to the documentary film is the heartbreaking reality of maternal mortality and a disheartening public healthcare system characterized by neglect and carelessness. Throughout the documentary, the viewer hears the sympathetic voices of experts – a journalist, an insurance expert, and a health economist.
Most captivatingly, Monique’s mother courageously talks us through the event that led to the death of her daughter and grandchildren, interspersing her narration with tears of deep pain. She places a huge blame on the nurses on duty – their meanness, carelessness, and inhumanity. This is however not an isolated incident in the provision of (maternal) health care in Cameroon, where human life does not seem to matter in some cases. This article explores the healthcare system in Cameroon with a focus on maternal mortality and the insidiousness of capitalism and health care provision in the country.
Our Common Trouble: Neglect in Healthcare Institutions
There was something more than the nurses’ apparently inhumanity in Monique’s case. That thing looming in the background which made them negligent in this scenario is that they knew whom they were working for. Their non-intervention was not a random incident. Put differently, this is a systemic issue and something that has developed into a culture of itself, especially in the public sector. Claiming that they know whom they work for is a way of pointing fingers at the public health institutions because the private sector is a little different. Compared to public health institutions, as some patients have noted, the private health facilities are more likely to offer patients the attention they deserve [3]. Paradoxically, some of the negligent healthcare personnel in the public sector also work (assiduously) in the private sector [3]. This, in other words, suggests that some of the public healthcare personnel transform themselves into something else, and display negligence when working in public health facilities.
The documentary about Monique reveals an instance where one of the nurses was manicuring her fingernails, rather than attend to a laboring woman around the corner. Such neglect and inhumanity that were displayed by the nurses, are however not unique to Cameroon. For example, Nancy Scheper-Hughes, an American anthropologist, witnessed a high disregard for human life and uses the phrase ‘useless suffering’ to describe the ‘meaningless (premature) deaths of infants’ in Brazil [4]. The underlying question revolves around the price of human life in the face of such neglect. James Baldwin, a renowned African-American writer of the 20th century talks about ‘our common trouble,’ when referring to the pain and death caused by systemic cruelty, where the power structure does not confront cruel people who have high disregard for human life [5].
Furthermore, Achille Mbembe, the Cameroonian philosopher, would read the neglect and death in public health institutions as another manifestation of necropolitics, which underscores the health institutions’ power to decide who lives and who must die [6]. The decision whether people should live or die exposes the realities of commodified public health delivery system where heart-wrenching reports continue to emerge about desperate Cameroonians denied medical attention because they are unable to pay for such services. In other cases, they are detained and prohibited from leaving the hospital because they cannot settle their bills [7, 8]. This fundamentally begs the question as to why human life is subject to capitalistic principles, under a commodified healthcare system where the high cost of access is necessarily alienating for financially vulnerable people [9]. The increasing cases of mistreatment and neglect in the health sector further question our common belief that human life is of greater value than money.
It may sound unreasonable to suggest that people, especially the vulnerable category such as pregnant women, should get free treatment in public health institutions. Talk less of providing them with free delivery services; they are bringing new members into the society and we should welcome them with joy. This demand that our new members be welcomed with happiness, without the baby’s family worrying about financial payment, seems farfetched until we look at what obtains in other parts of the world. For example, in a country such as Denmark, maternity services are generally free for the indigenes and families do not worry about the cost of hospital bills in the post-birth period [10].
Placing the Human at the Centre of Healthcare
James Baldwin concludes his speech by saying societies suffering oppression need a system overhaul because people cannot deal with the status quo the way it is [5]. On her part, Scheper-Hughes argues that people cannot maintain a moral neutrality in the face of institutionalized pain inflicted on fragile and vulnerable bodies [4]. Society must ask itself critical questions concerning the existence of healthcare institutions. Why do they exist in the first place? It is a moral and ethical necessity to place the human at the center of healthcare systems. It is even more so considering the medical personnel supposedly swear the solemn medical oath to save lives.
One may be compelled to ask why a healthcare system disregards human beings, especially in the neoliberal era. For sure, healthcare institutions are finding it hard to escape from neoliberal principles. In the health sector, neoliberalism often demonstrates an uncaring and dehumanizing tendency when patients cannot afford the health services [11, 12]. Sadly, a commodified healthcare system perceives the human body more as clients not patients needing attention. Additionally, exploitation becomes normalized once people working in such spaces embrace a capitalist mindset. All I am saying here is that under capitalist conditions, human beings may find it convenient to withdraw sentiments towards the patients who are unable to pay for health services.
Such act of withdrawing sentiments in the health sector is learnt; the personnel learn to internalize ideas about those who face difficulties in paying for health services. The nurses working at the time Monique was brought to the hospital may not be monsters; they worked in a milieu where they learnt to withdraw their sentiments once they saw a certain category of patients. One can begin to ask at what point the medical personnel learns to not feel for the lives they should be saving.
Conclusion
Poor health delivery is a collective challenge that can destroy the health of a nation. Nkafu Policy Institute has taken the matter of health and health insurance seriously, often with a call for universal health insurance coverage in Cameroon. The Institute sees healthcare as a fundamental human right [13]. Health care personnel would unlikely reject or ignore a patient at a public health facility when they know the patient has a health insurance coverage. It is also dignifying for people to know that they would not be rejected when they desperately need health services. Beyond a universal health insurance coverage, the state, together with the medical corps, could work out a strategy on how to periodically remind the medical personnel of their responsibility. The many stories (and rumor) of uncaring and insensitive medical practices we hear regularly suggest that some medical personnel ignore or are unaware of the legal implications of their (in)actions.
Dr. Primus M. Tazanu
Dr Primus M. Tazanu is a Research Fellow in Governance at the Nkafu Policy Institute .He is equally a lecturer at the Department of Sociology and Anthropology, University of Buea, Cameroon. Primus holds a PhD in social anthropology from the University of Freiburg, Germany
