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The problem with presidential medical travel

There's still a lot of confusion surrounding the death of Malawian President Bingu wa Mutharika from a heart attack yesterday, but from what Reuters is reporting, it seems that his country's shoddy infrastructure and medical system may have played a role:

The 78-year-old was rushed to hospital in Lilongwe on Thursday after collapsing but was dead on arrival, the sources said. State media said he had been flown to South Africa for treatment although his immediate whereabouts remained unclear.

Medical sources said the former World Bank economist had been flown out because a power and energy crisis in the nation of 13 million was so severe the Lilongwe state hospital would have been unable to carry out a proper autopsy or even keep his body refrigerated.

Many Malawians blamed Mutharika personally for the economic woes, which stemmed ultimately from a diplomatic spat with former colonial power Britain a year ago.

"We know he is dead and unfortunately he died at a local, poor hospital which he never cared about - no drugs, no power," said Chimwemwe Phiri, a Lilongwe businessman waiting in a snaking line of cars for fuel at a petrol station.

It's impossible to say if Mutharika would be alive today if he could have made it to a properly supplied hospital, but as BBC Kampala correspondent Joshua Mmali put it on Twitter last night, "Lessons outta 4 : You can't go to the UK or Germany to treat a heart attack. Improve your health systems"

It has indeed become a depressingly common occurence for leaders to head abroad for major medical treatment -- an option Mutharika didn't have. In recent years, we've seen Venezuela's Hugo Chavez travel to Cuba for cancer treatment, Saudi King Abdullah come to New York for tests, Yemeni President Ali Abdullah Saleh travel to Saudi Arabia to treat injuries sustained in an attack, Pakistani President Asif Ali Zardari go to Dubai for undisclosed medical treatment, and Iraqi President Jalal Talabani head to Jordan for treatment of exhaustion and dehydration. There are plenty of other examples from Algerian President Abdelaziz Bouteflika to New Guinea Prime Minister Michael Somare.

It's always a bit surprising that this isn't more politically embarrassing. If there isn't even one hospital in a leader's country where he feels confortable getting treated -- presumably by that country's best doctors and the most advanced equipment available -- that would seem to be a pretty damning indictment of his leadership. 

ALEXANDER JOE/AFP/Getty Images

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The Election 2012 Weekly Report: The General begins

The Presumptive Nominee

After pulling off a hat trick on Tuesday night, winning the primaries in the District of Columbia, Maryland, and Wisconsin, Mitt Romney now boasts an unassailable lead in delegates. Barring major unforeseen circumstances, he seems virtually guaranteed to be the Republican candidate in November. (Though second-place contender Rick Santorum -- not to mention Newt Gingrich and Ron Paul -- has given little indication that he plans to drop out.)

His new position as the presumptive nominee may give Romney more latitude to broaden his pitch to moderates and independents and focus his attacks more directly on President Barack Obama. The president certainly assumes that Romney is the opponent he will face in the fall, taking time during a speech this week to mock the former governor's support for a GOP budget he described as right-wing "social Darwinism."

Obama's hidden agenda

The Romney campaign has continued to take advantage of Obama's "hot mic" moment during a conversation with Russian President Dmitry Medvedev. Last Friday, spokesperson Andrea Saul suggested that the president "should release the notes and transcripts of all his meetings with world leaders so the American people can be satisfied that he's not promising to sell out the country's interests after the election is over."

The notion that the president has a hidden agenda on foreign policy may emerge as a central campaign talking point. In a speech Wednesday to the Newspaper Association of America, Romney suggested that the incident "raises all kinds of serious questions: What exactly does President Obama intend to do differently once he is no longer accountable to the voters? Why does ‘flexibility' with foreign leaders require less accountability to the American people? And on what other issues will he state his true position only after the election is over?"

Release the Biden

Vice President Joe Biden has been relatively quiet during this primary season. But in an appearance on Face The Nation last Sunday, the VP came out swinging, questioning Romney's qualifications on foreign policy. Referring to Romney's description of Russia as America's No. 1 geopolitical foe, Biden said, "He just seems to be uninformed or stuck in a Cold War mentality." He went on to say that Russia is "united with us on Iran."

The Romney campaign responded: "Vice President Biden appears to have forgotten the Russian government's opposition to crippling sanctions on Iran, its obstructionism on Syria, and its own backsliding into authoritarianism."

Good for the Jews?

Heading into Passover weekend, a new poll shows that fears that Obama's tensions with the Israeli government would erode his support among Jewish voters may be unfounded. The poll, by the Public Religion Research Institute, showed 62 percent of Jews supporting Obama's reelection, with little evidence of change in support for the president since 2008. While Jews tend to hold more hawkish views on Iran than other American voters, according to the poll only 2 percent listed it as their top voting priority. Just 4 percent listed Israel.

In a Passover message this week, Obama referred to the recent anti-Semitic killings in France, saying that the Exodus story was a reminder that "Throughout our history, there are those who have targeted the Jewish people for harm, a fact we were so painfully reminded of just a few weeks ago in Toulouse."

Trump roast

Guess who's back? In an appearance on Laura Ingraham's radio show on Tuesday, real estate mogul, reality-show star, and onetime primary candidate Donald Trump suggested that Obama will start a war with Iran to bolster his reelection chances. "If you remember Bush, Bush was unbeatable for about two months, and then all of the sudden the world set in when he attacked Iraq. And he went from very popular to not popular at all. But I think that Obama will start in some form a war with Iran, and I think that will make him very popular for a short period of time. That will make him hard to beat also."

The comment was somewhat overshadowed the next day when the Donald offered to show his genitals to attorney Gloria Allred.

What to watch for:

Obama's week will be heavy in Latin America, with Brazilian President Dilma Rousseff visiting the White House on Monday and the Summit of the Americas in Cartagena, Colombia, beginning April 14.

There are no primaries this week, but Romney is looking ahead to the April 24 contest in Pennsylvania, trying to put the final nail in Santorum's coffin by winning his home state.

The latest from FP:

Joshua Keating lists 7 foreign-policy flip-flops Romney needs to make now.

Heleen Mees says Fed Chairman Ben Bernanke might be the greatest obstacle to Obama's reelection.

Uri Friedman looks at the foreign-policy views of Rep. Paul Ryan, whose buzz as a possible VP contender has been growing.

Daniel Drezner asks readers to take the Trump Foreign Policy Challenge.

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