DAKAR, Senegal (AP) — The rumors started to swirl around Ghana in June: President John Atta Mills was ill, maybe too sick to seek re-election, and he was going abroad to seek medical treatment. Some radio stations went so far as to prematurely report his death.
Eager to deny the speculation, Atta Mills jogged at the airport upon his return in a display of his vigor. The following month, though, the 68-year-old was dead. Many lined up in the capital, Accra, where his body was laid in a casket draped in the national colors of red, yellow and green on Wednesday to pay their respects before his burial Friday.
In a part of the world where presidents traditionally have ruled for life, Atta Mills is only the latest West African leader to show that "routine checkup" can be the code word for much graver troubles.
Many longtime rulers in the region have feared coups or power grabs if they were perceived as vulnerable. Though even in a mature democracy like Ghana, those around Atta Mills still tried to protect his image of strength until the very end.
"I think it's a little bit about power — when you taste it and you really don't want to give it up whether you're sick or healthy," says Kwame Tufour, 36, who owns an energy company in Ghana. "I think it kind of got to his head."
Political calculation certainly plays a part in an election year, as there can be repercussions if a party's standard bearer is seen as weak, said J. Peter Pham, director of the Africa program at the Washington-based Atlantic Council.
While Ghana is an exception as a stable democracy, Pham said earlier strongmen in the region tended to concentrate power in their own hands until their deaths.
"You didn't vote for a party with a platform if you voted at all," he said. "Leadership was viewed and functioned as the figure that you followed."
Speculation on leaders' health isn't unique to West Africa — 88-year-old Zimbabwean President Robert Mugabe insists he's "fit as a fiddle" despite reports he's battling prostate cancer. Few regions, though, can cite as many examples.
Only hours before the death of Gabon President Omar Bongo — at one time the world's longest-serving president — his prime minister described him as "alive and well."
And Nigeria's late President Umaru Yar'Adua grew so weak while in office he once had to be carried off a runway by a soldier during a state visit to Togo, according to a book by his former spokesman. The military officer assigned to Yar'Adua apparently draped traditional robes over his arm to conceal what was happening.
State-run television was told to only film one side of his face when the other side was swollen, according to the book by Olusegun Adeniyi.
The National Assembly ultimately voted extra-constitutionally to empower then-Vice President Goodluck Jonathan to serve as acting president for Nigeria.
The health and undisclosed illness of late Guinean strongman Lansana Conte also was a topic of national debate for years before his 2008 death. Rumors of his death surfaced periodically, including in 2003 when he was forced to go on TV to deny them.
The week before he died, the editor of a local paper was arrested after publishing a picture of the frail leader struggling to stand up. A spokesman for the president went on TV to assure the nation that Conte was not ill.
The newspaper was ordered to print a photograph of Conte, showing him in good health.
In Ghana, opposition newspapers in the weeks before Atta Mills' death had started questioning whether the president was healthy enough to seek a second term in December.
The late Ghanaian leader was apparently in a coma for at least a day — possibly two — before he died, said a government official in neighboring Ivory Coast who spoke on condition of anonymity because of the sensitivity of the matter.
The official said the Ghanaians did such a good job hiding it that even the intelligence services of Ghana's closest allies were not aware of his state of health.
Eugene Oppong, 40, a driving instructor, said Ghanaians had started to notice recently that Atta Mills had grown lean, spoke with a raspy voice, and frequently took sips of water while giving speeches.
Still, Oppong said Atta Mills was right to stay in office until his death, and he called speculation about the president's health before his death disrespectful.
"So far as you still have your power and you're alive, you don't need to give your power to someone else," he said.
Associated Press writers Rukmini Callimachi in Dakar, Senegal and Laura Burke in Accra, Ghana contributed to this report.