By Joel Brinkley | San Francisco Chronicle

Meles Zenawi, Ethiopia’s dictator, died last month – in a Brussels hospital. Why didn’t he get medical care at home? Look at the state of his people’s health, and you’ll understand.

The government provides vaccinations for only 5 percent of the children. Fewer still receive antibiotics when they contract pneumonia. Only 20 percent of teenage girls are educated about AIDS. Is it any wonder that Ethiopia’s average life expectancy is 56 – among the world’s lowest?

Eleven years ago, 53 African nations signed a pledge to spend at least 15 percent of their national budgets on health care. Almost no nation has lived up to that. Right now, Ethiopia dedicates 3.6 percent of its budget to health. So no one was surprised when the president went abroad for care.

In fact, across the developing world, whenever a president or potentate gets sick, he travels to a more developed state for care. That boldly displays the heedless view these leaders have of their own people. Perhaps if they were required to use their own hospitals, they might be more inclined to improve them.

Many of these reprobates find they can’t step on the plane as blithely as Zenawi did. To get away often requires stealth and deceit.

Not long ago, Asif Ali Zardari, Pakistan’s president, wanted to go abroad for an unspecified, apparently minor health issue. So he directed doctors at a Karachi hospital to forge a report saying he had a more significant illness: prostate cancer. Dr. Ghayur Ayub, a former national director general of health, had a look at the lab results and on his blog declared the diagnosis “ludicrous.” Zardari left anyway.

Last year, he decided to spend some time in Dubai. His spokesmen said he’d gone to visit his children. But that was proved to be a lie after he entered a hospital. The rambunctious Pakistani press declared that he was being treated for a host of different problems: a heart attack, a clot in his neck, a dangerous reaction to medicine.

After he’d been away two weeks, the news media began writing about the political message Zardari was sending. Pulse International, Pakistan’s most prominent medical journal, wrote that Zardari’s trip demonstrated a “lack of trust and confidence in Pakistani healthcare professionals and healthcare institutions.” It turned out he’d had a minor stroke.

Zardari is hardly alone. Since Hugo Chavez, the Venezuelan strongman, took office in 1999, he has bragged ceaselessly about improving health care for his people. But when he contracted cancer, he flew off to Cuba – twice. That’s a telling statement about Venezuelan medicine. Cuban doctors say they earn about $24 a month.

In Venezuela, rumors are rife that Chavez’s cancer is terminal, though he denies that. Is he lying? You decide. Chavez suddenly decided to build a $140 million mausoleum for Simon Bolivar, the 19th century political and military leader Chavez reveres. The Venezuelan press notes that the building has room for at least one more resident.

Hun Sen, Cambodia’s prime minister, visited constituents a while back and noted that he had a minor wound needing treatment. He insisted that only when “doctors in Cambodia say they cannot deal with it will I go to a hospital abroad.” He failed to note that a few years earlier he had traveled to Tokyo for what the government said was a two-day “checkup.” Cambodian doctors aren’t capable of even that? Like the other leaders who travel abroad, health and welfare conditions in his country are no better than those in Ethiopia.

But in Saudi Arabia, an exceedingly wealthy state, Prince Nayef said he was traveling abroad for “medical tests” last spring. He was gone a month and said he’d been in a Cleveland hospital but provided no other details. He died in June – in a Geneva hospital.

Dictators always seem to be traveling abroad for simple tests or checkups. Nursultan Nazarbayev, Kazakhstan’s president, insisted he was in a German hospital for a “checkup” last year – though he had issued a press release saying, “I suggest everyone have routine checkups here in Kazakhstan.” A German paper reported that he was treated for prostate cancer.

This spring, a South African newspaper reported that government leaders from Malawi, Gabon, Togo, Nigeria and Tanzania all had died in foreign hospitals. The paper then made a note of a fact that every one of those leaders’ constituents ought to stand up and shout about: These heads of state “prefer to pour taxpayers’ money into overseas medical facilities rather than spending it on improving health care at home.”

Joel Brinkley, a professor of journalism at Stanford University, is a Pulitzer Prize-winning former foreign correspondent for the New York Times.