Hello. Hi. Welcome back to Conversations
with Stephen Kamugasa. This is the fourth
podcast episode in our Genocide series. Today's
guest is Dr. Helen Epstein, an American professor
of human rights and public health with a
special interest in Uganda and other countries
in East Africa. Helen obtained a PhD in Molecular
Biology from Cambridge University and an
MSc in Public Health in Developing Countries
from the London School of Hygiene and Tropical
Medicine. Since 2010, Helen has been a visiting
professor of Human Rights and Global Public
Health at Bard College in New York. In 1993,
Helen relocated to Uganda, where she worked
on an AIDS vaccine research project and taught
molecular biology in the medical school at
Makerere University in Kampala. A vaccine
against HIV remains elusive even now, and
Helen witnessed firsthand the suffering caused
by AIDS, which was the subject of her 2007
book, The Invisible Cure, why we are losing
the fight against AIDS in Africa. While working
as a consultant in Uganda, Helen realized
that despite massive donor investments in
the health sector, the country's maternal
and infant mortality rates weren't falling
nearly as fast as those in other countries
in the region. The reason wasn't hard to
find. Uganda's institutions and leaderships
were and remain highly corrupt and the international
community has long turned a blind eye to
the problem at the cost of thousands of lives
each year. Ugandan activists and politicians
who have tried to draw attention to corruption
have suffered arrest, torture and worse.
At the center of this troubling story is
Uganda's strategic military partnership with
Washington in the global war on terror, which
Helen describes in her 2017 book, Another
Fine Mess, America, Uganda, and the War on
Terror. In this episode, we discuss the topic,
Uganda in a Multipolar Brave New World Order.
Dr. Helen Epstein, Welcome.
Thanks so much, Stephen.
On page 137 of your book, Another Fine Mess,
you write, and I quote, I was first drawn
to Uganda by its remarkable medical history.
Well before colonial times, the people of
this region had their own gods to distinguish
plague from smallpox and perform cesarean
sections, operations considered too difficult
and dangerous by Europeans of the time. Helen,
please tell us something about your childhood
and education. And how did your early life
experience ignite your curiosity, which subsequently
led to stumbling upon Uganda's remarkable
medical history?
Yeah, thanks so much. I guess I had a pretty
ordinary American childhood. I grew up in
New York in an apartment in the city in the
1960s. I was, but I always had a kind of
wanderlust and my parents had a lot of books
and they had a book about Africa. I think
it was just pictures of animals, but it fascinated
me. And I used to canoe down the Nile on
their Ottoman chair with a vacuum cleaner
pole as as a paddle. So when I found myself
after graduate school working as a lab scientist,
I kind of began to wonder, how did I end
up here? Why am I not in Africa? And those
were the days of the, this was the late 1980s,
early 1990s, the days of the AIDS crisis,
which really hasn't gone away. I mean, the
disease is very much still there, but it's
now being managed much better than it was.
and back then the situation was really very
dire. So I quit my job, which I didn't really
like much anyway, and volunteered to help
set up a little laboratory in Kampala at
the main hospital, Belago, and did some experiments
there. The team I was working for was trying
to develop a prototype AIDS vaccine that
was actually being tested in the United States,
and they were trying to figure out whether
it might work in Uganda too. Unfortunately,
this was a long time ago, but it turned out
the vaccine didn't even work in the United
States, much less much less Uganda. So I
think actually in the last year or so recently,
there is now some sort of, it's not really
a vaccine, but it does, it's a drug that
offers long-term protection against HIV.
And I think it's now being, they're trying
to prepare to distribute it to people across
in many parts of the world now, which is,
which is very exciting. But back then there
really was When I was really in the AIDS
vaccine game, it was really clear that something
else had to be done, and that's how I got
interested in public health. Then within
the topic of public health, I got particularly
interested in the issue of corruption. For
diplomatic reasons, international public
health experts don't talk about it much,
but in Uganda and, of course, other countries,
it's a major reason for the massive loss
of life and particularly of infants' children
and mothers. That's what led me to an interest
in Ugandan politics because really in the
1990s during the Clinton administration and
even more so during the George W. Bush administration
in the early 2000s, the United States was
pouring huge amounts of money into Uganda
for health programs, which was a good thing
in many, many ways. But the ruling elites
were stealing practically every shilling
that wasn't nailed down. And no one outside
Uganda was saying anything about this. So
I thought, let me try to draw some attention
to the problem. And that's how I got interested
in human rights, Ugandan politics, and so
on. So here we are.
On page 138 of your book, you write and I
quote, Ugandan scientists helped pioneer
treatment for childhood cancers and malnutrition
and the mass immunization campaigns that
UNICEF would later promote throughout the
developing world. When Singapore was looking
to reform its own healthcare system in the
1960s, it sent a delegation to Uganda. What
you say, Helen, doesn't align with the perception
that many of us have of modern-day Uganda.
Our listeners must be intrigued. Can you
please say more about these programs?
Well, even before colonial times, as you
read, Uganda had a pretty sophisticated culture.
Most of what we know is is from the historical
record is about Uganda, but there were very
sophisticated cultures throughout the country
too. In Uganda, yeah, I was amazed. They
were doing cesarean sections in the 1870s,
which was pretty remarkable because they
were not routine operations even in Britain
at that time. and they were pretty dangerous
to do and pretty scary. They used banana
wine both as antiseptic and as anesthetic
for the women, but it was pretty rough. For
whatever reason, I think the British, when
they arrived and took over the country, they
actually recognized that there was something.
They recognized the humanity in a sense or
the culture of Ugandans in a way that they
didn't necessarily normally do in their empire
elsewhere. For some reason, they decided
to try to turn Uganda into a kind of intellectual
capital of their African empire. In the early
scramble for Africa years, the late 19th
century, early 20th century, when the British
were first establishing their rule their
officers did do some pretty terrible things
in Uganda. They pitted tribes against each
other. There were terrible massacres and
so on. It was absolutely awful. But when
things settled down around the sort of getting
towards the mid-20th century, in parallel
with, unfortunately, ongoing repression,
the British did build a kind of very sophisticated
medical and also educational system there.
There was a Makerere, which is the main university
in Uganda. It was really the Harvard of Africa
then. The novelists V.S. Naipaul and Paul
Theroux taught there. Attached to it was
a very good hospital, Mulago, that Brits
themselves, British people themselves went
to. Researchers there pioneered these mass
vaccination campaigns. They discovered the
cause of a disease called Burkitt's lymphoma.
They made other discoveries. They actually
figured out how to deliver healthcare in
poor countries. It was really quite remarkable.
But what the British failed to do was create
a culture of democracy, which would sustain
those kinds of services. You really need,
there really is evidence actually that in
order to maintain a public health system,
democracy is the best way of doing that because
everyone, when people don't get the services
they deserve, they actually have a voice
and can say something about it. and politicians
will take notice, which they don't do in
dictatorships. They can ignore the voice
of the people. But the British kind of set
up Ugandan democracy to fail. They tried
to create a parliamentary system that would
manage the various tribal and regional interests
of the people. But Uganda is an extremely
diverse country ethnically. I like to think
that democracy can still work in a place
like that just as I like to think democracy
can still work in the United States despite
the challenges it's now facing. Democracy
is a very, very fragile thing. When the British
left Uganda in the early 1960s, they created
two power centers. First, a prime minister
who was Milton Abote at the time. president,
who at that time was the traditional king
of Uganda, the largest tribe in the country.
And these two men despised each other and
they clashed almost at once. And Uganda subsequently,
one thing led to another and Uganda soon
became a symbol of African dysfunction within
just a few short years. And that's really
where we are. Still, unfortunately, the situation
has not much improved, even since the days
of Idi Amin. We like to think that Idi Amin
was the sort of apotheosis, the worst it
can get as far as African governance goes.
But in fact, the mayhem created under the
current regime actually makes even the regime
of Idi Amin look pretty good, to be honest.
I'm afraid.
Again, on page 138 of your book, you write,
and I quote, today, this system is a shambles.
Bats, snakes, and other wildlife have taken
up residence in once functioning rural clinics.
I have seen fecal material rain down from
crumbling ceilings of operating theaters.
power cuts and water shortages, in hospitals
kill thousands of patients each year, and
emergency operations on pregnant women are
sometimes carried out by the light of torches
made from burning grass. Helen, how important
is leadership to the health of a country?
And is it a reasonable and legitimate expectation
that every person in any given nation state
has a right to a public health infrastructure
that is adequately resourced and operating
properly?
Well, a leadership is obviously crucial,
I think. And as to whether it's reasonable
for people to expect a functioning health
system, well, I think so. I mean, Uganda,
for example, has signed and ratified the
UN Convention on Economic, Social and Cultural
Rights. which among other things, commits
the government to do everything within its
means to improve the health of the people,
especially the health of women and children.
Uganda isn't doing that. It has the resources
to do a much better job. Many of the medicines
that are available in the Ugandan healthcare
system are donated by rich countries when
they aren't stolen by somebody there. But
doctors and other medical staff aren't paid
adequately or on time. Their equipment repairs
aren't done. Buildings aren't maintained.
It's really outrageous, really, and shouldn't
ever happen. So, yeah, it's really a disgrace.
And, you know, I thought things might get
better when I wrote those words, now more
than seven years ago, but it's, my understanding
is things haven't gotten much better.
You write the following on page 218 of your
book regarding something called the Atlantic
Charter, an idealistic agreement signed by
Franklin Roosevelt and Winston Churchill
on the eve of America's entry into World
War II. And I quote, Roosevelt was almost
certainly sincere about the sentiments contained
in the Atlantic Charter. He had expressed
similar views eight months earlier in his
Four Freedoms speech, calling for freedom
of speech and religion and freedom from fear
and want everywhere in the world. It was
this last phrase that worried FDR's advisors.
That covers an awful lot of territory, Mr.
President, speechwriter Harry Popkin said
at the time. I don't know how interested
the American people are going to be in the
people of Java. I'm afraid they will have
to be someday, Harry, the president replied.
The world is getting so small that even the
people in Java are getting to be our neighbors
now. Please talk to us about the Atlantic
Charter and Do the sentiments expressed in
the Atlantic Charter apply equally to black
Africans in a nation state such as Uganda?
Should the American people care?
Yeah. Americans have a lot of problems of
their own right now, especially when it comes
to their own, our own freedoms, actually.
You know, books take a long time to see the
light of day. Another fine mess from which
that passage came was published in 2017,
but it was mostly written in 2015 and 2016
when Barack Obama was still the president
and America was still seen to be the sort
of reigning light of democracy in the world,
or at least it was seen that way by many
people. But I felt that America really hadn't
been doing as good a job, at least since
World War II, as it could have, and really
lived up to its ideals or the ideals expressed
by FDR in the Atlantic Charter and also in
the For Freedom speech. After FDR died, we'd
undermine democracy in Chile and Guatemala
and Iran, participated in coups in all those
countries. We'd messed up, we'd messed up
Vietnam and Laos and Cambodia, Liberia and
Congo. We'd backed the apartheid system in
South Africa for far too long. Then there
was Nicaragua and El Salvador, where we backed
anti-democratic forces in those countries,
and also not to mention Iraq and Afghanistan.
And then, so when I arrived in Uganda and
I realized we were supporting a corrupt dictatorship
there too, it was depressing. Why were we
doing this? FDR really was serious when in
1941, he called for freedom everywhere. And
I still agree with him, although it's kind
of a lonely attitude. But I'm not sure human
beings are capable of it. And I fear greatly
that we, you know, we could destroy ourselves
before we get there. Anyway, the bottom line
is that Americans right now are preoccupied
with their own problems, which of course
have to do with our own democratic future,
which seems to be in some peril. And I think
the lesson is really that our leaders have
never really believed in it. And if they
can so easily undermine democracy elsewhere
in other countries like Uganda, why not here
too? In a way, we shouldn't be surprised
by what's happening to us now, given what
we've done overseas. And unfortunately, I
don't think many Americans are caring much
about Uganda, except a few of us here. But
as long as we maintain a donor relationship
with the country and partner with its military,
we really have to care. I mean, as long as
the Museveni regime is our ally, it's our
responsibility too. That's my concern.
Your book, Another Fine Mess, applies a scalpel
to a festering wound, cutting deep to the
very bone, as it were. In a chapter entitled
Murder in Uganda, you write on page 182 the
following, and I quote, since 2006, Irish,
French, Italian, American, and Chinese companies
had been scrambling for a foothold in what
was estimated to be a 400 billion petroleum
reserve in Western Uganda near the Congo
border. In Africa, the discovery of oil typically
amplifies corruption by swelling the rivers
of patronage that keep leaders in power.
There was every reason to believe Uganda
would be no exception. Farther down in the
chapter, you write on page 187, thus, and
I quote, Alice had spoken to Cerinah earlier.
She had seemed fine, but the man insisted
she was at a hospital in a neighborhood called
Nsambya. Because of the traffic, Alice couldn't
get there quickly, so she called Cerinah's
stepfather, who wove through the traffic
on a hired motorcycle taxi. By the time he
arrived, Cerinah was dead. Now, 400 billion
in US dollars is a significant number. But
Helen, are dead black Africans the price
of doing business in the new world order,
where great powers are vying against each
other for access to natural resources on
the African continent? And Helen, where does
fighting climate change fit into the complicated
balance of developing a poor African country,
such as Uganda, while at the same time protecting
her rich biodiversity?
Thanks for that. Well, this is really the
greatest challenge in that region of Africa
right now. At the moment, Uganda is forging
ahead with the East African crude oil pipeline,
which will funnel oil from the west of Uganda
and eventually from Eastern Congo and South
Sudan as well via Tanzania to the coast.
And in the process, it will destroy precious
ecosystems, kill off wildlife, displace thousands
of people. There's a war in Eastern Congo
right now that few people know about, but
a lot of people there are being killed in
it. And it's partly about oil, which Uganda
is trying to control. All that oil is also
going to release tons and tons of carbon
dioxide into the atmosphere, which will accelerate
global warming and create more hurricanes,
wildfires, deadly tornadoes and droughts
and raise sea levels. There's a really inspiring
campaign to stop the East African crude oil
pipeline. and to target particularly the
companies involved with it, including the
multinational Total Energies, which is an
American-French, Franco-American, largely
multinational company, the Chinese National
Overseas Oil Company, the Standard Bank of
South Africa, the Industrial and Commercial
Bank of China, and Sumitomo Mitsui Bank of
Japan. Everyone needs to join the movement
against that against that pipeline, not just
to save Uganda, but to save the world. And
also regarding the case of Cerinah Nebanda,
the passage you read was about the young
member of parliament, only 24 years old,
who was a fearless campaigner against corruption,
particularly in the oil sector in Uganda.
She was only one of many prominent Ugandans
who have died or been severely disabled,
almost certainly at the hands of the Ugandan
regime in recent years. Of course, there
have been no transparent, independent investigations,
but it's very dangerous to be an activist
in Uganda. And that's why people from the
outside world really need to step in and
help out. especially regarding this very
dangerous pipeline, which will not only destroy
the world, but will also very much empower
further the regime at the moment that's existing
there.
The title of our podcast is Uganda in a Multipolar
Brave New World Order. On November 25th,
2020, you published a powerful piece in the
New York Review of Books entitled In Uganda,
another Museveni crackdown in which you concluded
thus, and I quote, of course, the diplomats
see what's going on, but they must operate
within a cruel system of foreign aid and
subaltern military relationships in which
rich countries hire poor armies to do their
dirty work. Call it Cold War realpolitik
or the global war on terror It amounts to
a modern form of colonialism, even if Washington
now terms it partnership. The donor cynicism
boils down to the same kind of racism that
prevailed in colonial times, born of vastly
unequal power relations. In order to stuff
a dictator's pockets so his forces will fight
their wars, it is necessary to regard the
lives of African people as expendable. Helen,
given our podcast theme and the coming dark
age of global lawlessness, is access to natural
resources in Africa a critical national security
concern for the US that supersedes all other
considerations such as freedom, democracy,
and the rule of law? And how, Helen, would
you advise a little insignificant nobody
like myself to help me influence the United
States of America to reevaluate a foreign
policy in the Great Lakes region of Africa?
It's a tough one. It's a tough one. I think
we all feel very small at the moment, given
what's going on in the world. So I don't
know, but keep doing what you're doing, talking
to people and trying to get different viewpoints
out there. Really, everyone must help where
they can and do what they can. I think joining
a campaign like Stop ECOP, or the East African
Crude Oil Pipeline, would be a great place
to start. Anyone can do that. Anyone. There
are demonstrations going on all the time.
Sign a petition. Join a demonstration. Become
informed. Try to convince the people around
you to care about the issue, too. It's something
that affects everyone, especially the people
of the future, wherever they live. It's really
an existential problem. It's absolutely crucial.
So I guess, yeah, that's the best advice
I can think of.
And finally, Helen, please advise our listeners
where they may find your book, Another Fine
Mess.
Thanks so much. My book is available through
Amazon.com and other online booksellers,
or you can ask your local bookshop to order
it.
Dr. Helen Epstein, thank you very much for
being a guest on this podcast.
Many thanks for having me, Stephen.
This podcast was brought to you by the Kamugasa
Challenge in partnership with Democracy in
Africa. Democracy in Africa is a platform
dedicated to building a bridge between academics,
policymakers, practitioners, and citizens.
The fifth episode in the series is entitled,
How Critical is Democracy in a Multipolar
World? An interview with Professor Nick Cheeseman,
a political scientist and Professor of Democracy
and International Development at the University
of Birmingham, specialising in democracy,
elections and African politics. The podcast
will go live on October 14th, 2024. If you
enjoyed this podcast, please support us by
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Thank you very much for taking the time to
listen to this podcast. Until next time,
goodbye.