First published in ITIJ 136, May 2012
A catastrophic decline in the number of tourists to Senegal provides little incentive for the private healthcare sector to expand and improve the facilities it offers foreign visitors and insurance companies. Robin Gauldie reports
Senegal has long been rated by outside observers as one of Africa’s more stable and honest states, but its former President Abdoulaye Wade was criticised for tinkering with the constitution to consolidate presidential power during his 12-year reign and there were concerns that he might not willingly concede defeat in elections scheduled for February.
The Senegal Constitutional Court’s decision in January 2012 to allow the president to stand for a third term in elections to be held in February triggered violent demonstrations in the capital and several other towns. There was further unrest in the run-up to and during the presidential election, which led to a run-off between Wade and rival presidential candidate Macky Sall. However, in March voters awarded Sall a convincing win and the 85-year-old Wade stood down relatively gracefully, preserving Senegal’s reputation as Africa’s oldest democracy.
Wade’s election in 2000 brought an end to 40 years of Socialist Party rule in the former French colony, which became an independent republic in 1962. Like his predecessors, he kept Senegal aligned with the West, luring aid and investment from the former colonial power, the US and other developed countries, including China. He also pursued a policy of privatising or part-privatising many public sector enterprises, and has aimed to develop public-private partnerships (PPPs). Macky is unlikely to reverse many of these policies, and his appointment of musician Youssou Ndour, probably the best known Senegalese figure on the international scene, as culture tourism minister will raise the country’s profile as a destination.
From a high of almost one million visitors in 2008, Senegal slumped to only 500,000 visitors in 2010
Whether Macky can launch a peace process to end the niggling problem of a low scale conflict in the Casamance region in the south of the country, where insurgents seek an independent state, remains to be seen.
The conflict, which broke out recently in neighbouring Mali where rebel forces seemed close to ousting the government, could also have some impact on Senegal, though the conflict zones are remote from Dakar and Senegeal’s main tourism zones.
Senegal retains strong economic and cultural links with France, and the majority of its political, professional and business class, including most doctors, surgeons and other medical staff, are French educated.
French is the official language, although around 43 per cent of the population of 13 million are from the Wolof language group, and 94 per cent of Senegalese are Muslim.
France is also, by far, the country’s biggest tourism source market, and tourism has for some decades been Senegal’s second-largest foreign exchange earner, contributing up to seven per cent of gross domestic product, second only to fishing, which accounts for 22 per cent of exports.
But both of these key economic sectors are in decline. Fishing suffers from over-exploitation of stocks and European Union (EU) restrictions on imports, while the holiday business has been hit by factors ranging from civil unrest in the Casamance region of southern Senegal to underinvestment in the hotel infrastructure and bad publicity that highlighted the alleged growth of an unsavoury sex tourism industry, notably in the resort area of the ‘Petite Cote’ south of Dakar. From a high of almost one million visitors in 2008, Senegal slumped to only 500,000 visitors in 2010 and preliminary results indicated a total of only 350,000 for 2011 – a figure that falls lamentably short of the 1.5 million target declared by President Wade in 2002.
Senegal’s climate is its major selling point. Temperatures average 26°C to 30°C year round with uninterrupted sunshine from November to May. The country experiences a short rainy season from June to October, with occasional showers on most days, but no heavy downpours. The country has around 320 hotels rated as ‘tourist class’, but the Senegal tourism employers’ organisation COPITS claims that most are two decades old, run down, and do not meet international standards. COPITS has also cited the price advantage of rival destinations such as Egypt, Tunisia and Morocco as a contributing factor in the ‘catastrophic’ decline in visitor numbers.
Things may look up when Senegal’s new Blaise Diagne International Airport opens later this year (2012) at Diass, 47 km from Dakar, replacing the existing international airport and providing a new home for the country’s flag carrier Air Senegal, which launched a year ago as a partnership between the government and UAE-based Emirates. The new airport should make Dakar a more attractive regional and intercontinental hub, opening up potential new markets from the UAE to the US, Turkey, South Africa and Brazil.
The government is also said to be in talks with a Chinese development company over upgrading and expanding 15 airports throughout Senegal, facilitating the expansion of new domestic carrier Air Teranga, a joint Senegalese-Chinese venture. Senegal currently has 10 airports with surfaced runways, plus 10 more unpaved airstrips that can be used for fixed-wing and helicopter air ambulances.
Senegal allows limited hunting of big and small game, and attracts hunters, mainly from France, but also from the US and Germany
The sharp decline in popularity of Egypt and Tunisia as holiday destinations for European visitors due to the violent events of last year’s ‘Arab Spring’ might present an opportunity for Senegal to present itself as an alternative destination and recoup its lost numbers, but the country’s tourism authorities have shown little initiative, either in actively marketing the destination in its traditional main source market, France, in developing new markets, or in providing incentives for international hotel companies and tour operators.
France contributes some 50 per cent of visitor numbers, making Senegal very vulnerable to fluctuations in the French market. A trickle of British tourists come to Senegal, usually on holidays that combine Senegal’s main cultural and eco-tourism destinations with the beaches of Gambia, the tiny former British colony that forms a narrow enclave on the banks of the Gambia River and is surrounded on three sides by Senegal. Italy and Germany are also significant source markets.
Since the advent of international tourism in the mid-1970s, the country’s portfolio has diversified. Winter sun and sandy beaches are still key, but eco-tourism and cultural tourism have also become significant. Goreé Island, once an infamous centre of the slave trade, is now a World Heritage Site that attracts many visitors. The dilapidated ex-colonial town of St Louis, on an offshore island, has yet to fulfil its heritage potential, but eco-tourism looks more hopeful, with wildlife-rich areas such as the Sine-Saloum and Senegal River deltas attracting growing numbers of visitors. Unlike many African countries, Senegal allows limited hunting of big and small game, and attracts hunters, mainly from France, but also from the US and Germany – a small, but high-spending market segment that poses specific challenges for insurers in terms of providing cover for very expensive items (a high-end big-game rifle can cost $25,000 or more), legal liability and the unique risks that hunting entails.
Club Med’s enclave at Cap Skirring is still Senegal’s highest-profile international resort, but the company has divested its second property, at Dakar’s seaside suburb, Les Almadies. Other international hotel brands present in Senegal include Le Méridien and Radisson Blu, both with hotels in the capital and targeted primarily at the business travel sector.
Business travel from other African countries, attracted by Senegal’s relatively strong economy, is a resilient sector, and there is also a significant expat population, mainly in the capital Dakar and employed by French companies and international non-governmental organisations.
The 14,000-kilometre road network includes around 4,100 km of surfaced roads, as well as a few hundred kilometers of major highways.
Endemic infectious diseases with a high degree of risk include hepatitis A, typhoid, hemorrhagic fever, dengue, malaria, Rift Valley fever, yellow fever, schistosomiasis, and meningococcal meningitis. With fewer than one physician per 10,000 people and fewer than one hospital bed for every thousand, Senegal’s public health infrastructure is undoubtedly under-equipped and under-staffed, especially beyond the capital, Dakar.
In Dakar, however, the public Hopital Principal meets adequate standards, and is used by international assistance organisations, although its facilities are limited.
“The level of care is very low in the whole country, including St Louis, Ziginchor, Thies, Tombacouda and elsewhere” says Dr Hervé Raffin, of the French assistance company Medic’Air. “Patients need swift transfer to Dakar by reliable intensive care equipped ambulance.”
Several private hospitals – notably the Clinique du Cap, Clinique de la Madeleine and Clinique Casahous – offer international standards of treatment and care. Most private hospital staff at all levels are fluent in French, while other European languages, including English and German, are not widely spoken.
All the private hospitals operate modern emergency road ambulance fleets. The Hopital Principal has its own ambulance service, which like those operated by the private sector must be paid for, sometimes in cash.
Credit cards are widely accepted in major hotels, restaurants and larger shops in tourist areas, but the US State Department warns that credit card theft is prevalent and using credit cards should be avoided where possible.
Senegal’s main private emergency healthcare and medical evacuation operator is SOS Médecins Senegal, based in Dakar with a team of 22 mainly French-educated physicians, including emergency doctors, cardiologists and anaesthesiologists. SOS Médecins also operates emergency-capable land ambulances with emergency doctors and/or paramedics, and claims that it has international medevac aircraft ready to take off 45 minutes after the initial contact.
Dakar, where the country’s best state and private hospitals are located, perches at the very western tip of the African continent, but nowhere within Senegal is more than 700km flying distance from the capital.
“Most of our trauma cases go to the Hopital Principal in Dakar,” says Hervé Raffin. “Medical cases go to the private clinics: La Madeleine, Le Cap or Les Mamelles.” However, the level of care even in Dakar is also limited, Raffin says. “There is no angioplasty available for MI (myocardial infarction) cases and monitoring in intensive care is not constant during the night.”
Working with commercial airlines such as Air France and Brussels Airlines to carry stretcher cases, as well as with SOS Médecins for air ambulance cases, Medic’Air evacuates its patients within 24 hours of admission to hospital in Senegal.
France, around 4,000 km from Dakar, is understandably the preferred destination for assistance companies repatriating severe cases, whether by scheduled airline or air ambulance, but patients can be repatriated to most European destinations.
Raffin cites the case history of a Belgian client who was repatriated by the company from Dakar: “In his hotel in Dakar, he was woken at 5.00 a.m. (local time) by chest pain. The hotel reception called SOS Médecins, which arrived shortly with an ICU ambulance. At the same time, the assistance company in Belgium was informed. “Medic’Air’s duty doctor in Paris had the first medical contact at 11.00 a.m., with the emergency physician in the ambulance on the way to a laboratory downtown to confirm diagnosis by blood test. “Regarding the clinical status and the major signs of MI, an immediate evacuation to an intervention coronary unit in Belgium was agreed between SOS Assistance and the patient. At 1.00 p.m., [the] troponine test was positive and the local physician began fribrinolytic treatment (Metalyse) in the ambulance on the way to the Clinique La Madeleine, to wait for the medevac.”
Taking off at 3.00 p.m., an air ambulance Falcon 50 with its duty Medic’Air crew took off for Paris from Dakar for a non-stop flight of six hours. Refuelling in Paris with the patient under monitoring and IV treatment, the aircraft took off again in less than an hour. “After an uneventful flight, the patient was admitted to the St Luc University Hospital in Brussels for an immediate angioplasty for his marginal coronary at 4.00 a.m., less than 24 hours after the onset of the pain.”
Senegal’s public health infrastructure is undoubtedly under-equipped and under-staffed
So, despite Senegal’s low level of infrastructure when compared with some competing destinations, assistance companies can operate quite smoothly when medical evacuation is called for. But if President Wade wins a third term and makes good on his pledge to boost visitor numbers to 1.5 million year, the country will need to expand and improve its medical infrastructure.
Perhaps the Chinese can help. The People’s Republic is already a big spender in Senegal. In 2009 China promised to build a new children’s hospital as part of a further US$11.5 million investment, and last year China’s vice president Hui Liangyu, visiting Senegal last year, underlined Chinese interest in helping to develop hospitals along with other aspects of Senegal’s infrastructure. Such development will play a major part in the development of Senegal’s tourism industry, and its economy as a whole.