By Asha George, Michelle de Jong
Paperwork is a part of the lived experience of those of us from low- and middle-income countries (LMICs). Numerous certificates and documents attest to our eligibility for various purposes. In South Africa, we are frequently at the police station having copies of birth certificates, passport, work permit, marriage certificate, employment contract certified, never mind the usual utility bill as proof of residence for various transactions with officialdom. The difference between this and applying for visas is that, as part of a professional elite, going to the police station to get documents certified is not an intimidating process – someone is always there with the official stamp, it usually takes less than 5 minutes, and everyone has to go through it at some point or another.
Applying for visas is, in comparison, a huge waste of valuable time. It’s not unusual to lose at least two days while filing out the application, booking an appointment, assembling all the required documentation, travelling to the interview, etc. Time that should be spent mentoring students, finishing papers, writing grants, contributing to management decisions, etc.
If you travel frequently, not only are you regularly wasting your time on visas, but you must carefully orchestrate applications sometimes months ahead of time in between trips, given that some embassies can hold your passport hostage for uncertain periods of time. While some people can make travel decisions within 1-2 weeks, this is an impossibility for many of us. It is not uncommon to decline invitations because they are unrealistic in terms of visa processes.
Apart from the waste of time and inconvenience, it is the indignity of the process. Why must I show my high school diploma if I have three university degrees and am a professor at a university? How can I possibly remember every international trip made in the past 10 years? Visa officers zealously bureaucratically tick off every little detail and you are reminded several times that despite coughing up huge amounts of money and wasting so much time, the visa may or may not materialise. You are confirmed a supplicant at the mercy of these faceless bureaucrats and left wondering whether you really want to go at all.
And as it is increasingly becoming recognised, people do get declined: people who are on the frontlines of global health and who best know ground realities; the very people who are needed to keep global health a valid enterprise. There is an inverse principle: those most able to fly to Geneva, New York and London to participate in premier global health events, are at times the least needed people there. The costs in terms of blocking the sharing and learning that are at the heart of effective research and policy have been listed by many.
So visas are, in effect, a tax applied to middle class LMIC applicants on behalf of wealthy governments. But the patterns are not uniform as shown by the spidergrams below contrasting the Welcoming Country Index with the Henley Passport Index, i.e. how many countries does a nation allow in without visas, or with visas on arrival or electronic visas vs. how many countries can a citizen travel to without prior visas. In general, many LMIC countries are much more welcoming of others while often being very limited in terms of where their citizens can travel freely, with the opposite often applies in Europe and other high income countries. But there are exceptions, and some LMIC countries are not especially welcoming to other nations and are also not welcome everywhere.
We at Health Systems Global are committed to equity and inclusiveness as core values of our professional society. Decision making on where to hold symposia can be complex, deliberated and sometimes taken with unintended consequences. This piece is one part of a broader analysis that aims to highlight the complexities involved in these choices, while acknowledging the injustices as well.