Thursday, December 18, 2008

Petition for Kenyan MPs to Pay Tax

Dear Kenyans,
The time is coming when EVERYONE will have to take a stand on issues of national importance. I don't know about you, but for me the time arrived when our presumably progressive government decided that it was an offence to wear a black T-shirt with inscription exhorting our MPs to pay tax, and asking for implementation of the Waki report on Post-election violence.
As a first step in dealing with this slide into authoritarianism and collusion between most of the important organs of government- the Executive, the Legislature (and maybe even the judiciary- judges too do not pay tax!), I think it is important for all Kenyans to demonstrate solidarity with on Michael Otieno who has filed a suit in the High court against the Kenya Revenue Authority asking that MPs' salaries and allowances be taxed to the fullest extent of the applicable tax laws.
You can get involved by going to and getting enjoined in the suit.
You can also get a black T-shirt and stand ready for a Million-Person Black T-shirt March on Parliament, State House and the High Court whenever the opportunity presents itself.
You can also contact me with your ideas on what you think needs to be done on
Let us 'Be the Change we want to see in our country'!

Monday, December 15, 2008

Their dream died at independence

Daily Nation Friday, December 12, 2008, Page 11

Today, Kenyans are celebrating the day when Kenya officially became independent under majority rule. Prior to this date 45 years ago, the country had been under white minority rule for 69 years.

History tells us that before the 19th century Scramble for Africa, the territory now known as Kenya was populated by various ethnic communities under different forms of rule, from monarchies to councils of elders.

Prior to the advent of independence in 1963, there was a decade and a half of an armed insurrection culminating in the declaration of a state of emergency in 1952. Thousands of freedom fighters were killed in the struggle, and many more were incarcerated in concentration camps all over the country.

Hundreds of thousands were compulsorily ‘‘villagised’’ in an attempt by the colonial government to control movement and crush the rebellion.

Two years ago, we carried out a study that found out that almost a third of the survivors of those concentration camps suffer from post-traumatic stress disorder and a large proportion suffer from other psychological problems, including depression and anxiety disorders.

Many of the veterans interviewed were bitter that the freedom they sacrificed for had been ‘‘grabbed’’ by those that stood by and collaborated with the ‘‘enemy’’.

Many colonial administrators — chiefs, district officers and junior police officers — at independence became senior government officers with power to allocate resources to the burgeoning middle class. Freedom fighters were shunted aside or advised to band together, purchase land, and start their lives afresh.

In Nairobi and other urban centres, one will today find groups of demoralised old men and women with multiple physical and psychological scars of the freedom struggle. They are now grandparents and great grandparents many times over, but they still eke out a living in conditions of near absolute poverty.

Their children have fanned out across the country and try to make a living from hawking and doing other businesses. They in turn started their own families and in the cycle of poverty they live in, shared stories of how their parents lost everything during the ‘‘Mau Mau’’ war and had nothing to show for it under successive governments.

The grandchildren of the freedom veterans, disillusioned with a hopeless existence and condemned to a life that is Hobbesian — solitary, poor, nasty, brutish, and short — were seduced by the hopeful religion of liberation by facing back to the past. Thus, Mungiki was born.

Current urban thuggery can thus, at least partially, be traced to a Government policy that deliberately ignored the past and sought to build a future based on a spineless vision of ‘‘forgive and forget’’.

If this nation is built on the foundations of the freedom-struggle narrative, then it is a shaky foundation indeed, given the sense of betrayal one sees in the tired eyes of these men and women and their offspring.

In developed societies, there are dedicated veterans’ administrations to cater for the needs of the men and women who take up arms in defence of the state.

As part of our acknowledgement of our past errors, we must start thinking of setting up a similar structure to serve, not only the veterans, but all the soldiers who have fought for this country and now live in humble retirement, suffering nightmares due to their war experience.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Thursday, December 11, 2008

Jamhuri Day in Kenya

Jamhuri day refers to the day Kenya became a 'self-governing' 'free' republic, December 12 1964. The country had just attained 'independence' the previous year on the same date after more than a decade of armed struggle mostly in Nairobi, Mount Kenya Region and parts of the Rift Valley.
Every year we pretend to celebrate the 'independence', before packing our travelling bags and making a beeline for Paris, London, New York and Washington DC with our begging bowls in place and our hats in our hands...
Independence indeed! We are unable to feed our population and are now labouring under two prices for the maize meal staple, one for the 'rich' and one for the 'poor'. The government has finally accepted poverty as an ineradicable reality in this country and has moved to institutionalise it.
Soon we should start seeing schools for the rich and poor, segregation in hospitals, public offices, electoral booths, roads and even churches. For there are only two tribes in this country, as the cliche goes: the haves, and the have-nots.
This is just too tiring to think about! And to imagine that 'we' aspire to be a 'middle income' (sort of ) industrialised country by 2030, I have no breath left in me after the bout of laughter....
This is Kenya.

Monday, December 1, 2008

Reality check on the Waki report

Sunday Nation, November 30 2008 Page 22

Ongoing debate over the report of the Commission of Inquiry into Post-election Violence (CIPEV) has taken a familiar Kenyan trajectory.

Many commentators are seeing it purely through tribal or partisan lenses, and if this continues, it is inevitable that the International Criminal Court at the Hague will be involved.

At the beginning of this year, I spent several days at the Moi Teaching and Referral Hospital Mortuary, organising mental health and psychosocial services for the mourners coming to identify the bodies of loved ones killed during the violence.

At the peak of the violence, 50 to 100 bodies were arriving each day with bizarre injuries that tested even veteran morticians at the mortuary.

Bodies burnt beyond recognition, torsos without heads, dismembered limbs and bodies were the order of the day.

Bodies picked up several days after being killed and dumped in farms and trenches were brought in badly decomposed. Some are still awaiting identification through DNA technology.


According to the Waki report, 1,133 people were killed between December 27, 2007 and February 29, 2008. I think the deaths are being considerably underestimated.

Many people died during flight and were buried in mass graves or abandoned at roadsides, and these could not have been counted as victims identified by the police or public hospitals.

It is important that anyone deigning to comment on the Waki report reflects on these facts before cheapening the lives of those that were killed during this dark period of our history.

It is important also to remember that both government and civilians hold responsibility for the deaths. About a third of the recorded deaths are attributed to the police while the rest are attributed to civilians.

For those insisting on seeing things through ethnic prisms or in orange and blue, the following statistics in the Waki report should help clarify things somewhat.

Roughly equal numbers of Kikuyu (268) and Luo (278) were killed, and significant numbers of Luhya (163) and Kalenjin (158) lost their lives, among others.

It is macabre for politicians to harp about how “their” people were the only victims, while minimising the losses purportedly suffered by “others”.

Weeps and prays

Every time someone denigrates the contents of the Waki report, a Kenyan somewhere weeps and prays for strength to face the next day without a loved one.

It must be understood that the deepest and most painful scars suffered by the vast majority of Kenyans as a result of the violence were not physical.

Most people underwent some degree of psychological anguish, and indeed the bitter fruits of that experience are only just beginning to be felt.

Many Kenyans are seeking help in health facilities for problems to do with sleep, forgetfulness, poor concentration, nightmares and being easily startled.

These symptoms are often accompanied by chronic bodily aches and pains that are difficult to treat with pills. These are actually some of the symptoms of the psychological effects of traumatic experiences many were exposed to earlier this year.

Long after physical wounds have healed, many Kenyans will continue suffering mental anguish, and it will be difficult to mobilise them politically towards any national goal.

Unless this psychological suffering is addressed enduringly, this country should brace itself for major challenges in its quest to achieve the Millennium Development Goals or Vision 2030.

First step

The first step in addressing this problem will have to involve some form of closure. This will be in the form of a sense that justice has been done one way or the other, and that some degree of restitution has been achieved.

Whether through a local tribunal or at the Hague, this need for a just outcome will just not be wished away, and the sooner our politicians understand this, the better for all of us.

This should be followed by a process of reconciliation, involving our coming together as a nation and re-examining our national values vis a vis the violent activities characterising our history since independence.

The Truth, Justice and Reconciliation process may not go far enough in achieving this goal. We must embark on a national project of healing that goes beyond cyclical political upheaval.

The end-product must include a national vision that is coherent and shared by all who identify themselves as Kenyan.

Political and constitutional reforms not anchored in a national morality and vision will only serve as a template for the next generation’s conflict.

The Waki report offers us the opportunity to finally exorcise the ghosts of our bloody past, and failure to do so will leave us exposed to the harsh judgment of history.

Dr Atwoli is a consultant psychiatrist and a lecturer at the Moi University School of Medicine.

Wednesday, November 26, 2008

Mushrooming campuses alarming


Daily Nation Tuesday, November 25 2008 Page 11

EXPANDING UNIVERSITY EDUCATION and taking higher education closer to the people in need of it is an important prerequisite for any country aspiring for industrial development.

It seems clear that our local universities have taken on this role with gusto, and are engaged in voracious expansion and creation of satellite campuses, colleges and collaborations with private institutions.

Over the past decade, there has been apparent competition between the universities on which one will have the largest number of satellite campuses in the most far-flung corners of our republic.

However, this has been done with the same degree of preparation as goes into an improvised kindergartners’ dance. University bigwigs just declare that we shall have a campus in such and such an area and voila! The deed is done.

In many cases, no thought is given to the staffing and infrastructure necessary to make the campus an ideal learning environment, and often students are called to these campuses before the teaching staff are identified.

Indeed, in many cases, the only consideration is that the location should be near the home of one of the senior university administrators.

This is leading to a situation where our universities are beginning to appear like glorified secondary schools, competing with all sorts of middle-level colleges for students.

Highly educated professors are being dispatched to head up these colleges and campuses and end up being under-employed and playing the same role as headmasters and principals of high schools!

It is time our universities sat back and rethought this whole expansion strategy.

Failure to involve all those affected in siting satellite campuses will result in a situation where it will become increasingly difficult for teaching staff to divide their attention between the main campuses and these satellite campuses.

INDEED, A CRISIS IS LOOMING IN some of the universities as teaching staff are beginning to raise complaints about inadequate remuneration and provision of facilities to make it easier for them to reach these far-flung campuses.

The Privately Sponsored Students’ Programme (PSSP) was initiated as an income-generating activity to enable our public universities to improve their infrastructure and to better remunerate lecturers without compromising the quality of education.

As it is currently, the income-generation objective seems to be the only one being met, and going by the complaints from many dons, it would appear that little is being done to meet the other goals.

Education standards are being compromised in the name of taking higher education to the masses.

Most of these universities have very little to show in terms of infrastructure improvements since the programme was started, and even the little money lecturers have been getting through the program is at risk.

The question must therefore be asked: Where have the funds accruing from this PSSP been going? Can any of our public universities fully account for these funds?

Satisfactory answers to these questions will be the exception rather than the rule. Indeed many university administrators will be hard pressed to show that there has not been any corruption in the use of these funds.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine, Eldoret.

Friday, November 14, 2008

Mathari: What is in a name

Daily Nation, Thursday November 13 2008 Page 11

A few weeks ago, the World Mental Health Day was marked. The event is commemorated on October 10, but in Kenya, this was changed to the last Friday of October due to the Moi Day holiday.

Every year, there are calls for the reduction of stigma against mental illness by changing the name of the premier mental health institution in this region, Mathari Hospital.

A former minister of health once suggested a change from Mathari Hospital to ‘‘New Muthaiga Hospital’’ or some other more glamorous name. Ironically, despite having the power to effect the change of name, the minister never went beyond the suggestion.

This year, the matter was rehashed at the ceremony marking the day at Mathari Hospital on October 31. It is likely that nothing will be done about this since the ceremony was given a wide berth by senior officials at the Health ministries.

There is stigma directed towards the mental health community, not only in Kenya, but all over the world. Those with mental illnesses are often shunned or hidden away from public view.

Many languages contain derogatory references to the mentally ill, all suggesting that the illness fundamentally changes one into something less than fully human.

The stigma is not limited to those with mental illness. Their families are often targets of snide remarks, and people are afraid to associate with them.

Stigma is often a product of ignorance and prejudice. It is then manifested in discriminatory behaviour. Tackling ignorance, prejudice and discrimination would, therefore, be a more comprehensive method of dealing with stigma than seeking to whitewash it with a mere change of name.

A strategy incorporating an increase in the general population’s knowledge on mental illness and mental health would be the beginning of an anti-stigma campaign.

Huge amounts of money have been channelled towards increasing knowledge on HIV and Aids over the last two decades, and today it is estimated that over 95 per cent of the adult population knows all there is to know about it.

If only a fraction of this money were used in a mental health awareness campaign, a huge dent in the stigma directed at the mentally ill would be made.

Prejudice may be tackled by demonstrating the ubiquitous nature of mental problems in our society, and highlighting helpful attitudes towards them. Investment in the facilities for treatment of mental illness would go a long way in improving the quality of life for the mentally ill, and for the general population at large.

Discrimination must be tackled from the very top. The Mental Health Act of 1989 takes the first step by outlawing discrimination in health insurance coverage for mental illnesses. This must be taken further to deal with discrimination at the workplace, in social places, hospitals and other public services.

Failure to fundamentally address the problem of stigma towards mental illness is responsible for many social ills in society.

The violent crises in our politics and in the education sector are an indictment on the mental health of our nation, and unless steps are taken to improve the situation, we can predict with utter certainty the recurrence of worse eruptions in future.

Dr Atwoli is a consultant psychiatrist and lecturer at Moi University School of Medicine, Eldoret. (

Monday, September 29, 2008


Edited version Published Daily Nation Monday 29 September 2008.

By Lukoye Atwoli

The entry of ‘youthful’ politicians onto the national stage excited many in the early days after the elections. People gleefully pointed out the ‘old guard’ who had been thrown out and replaced by young leaders who would presumably inject new ideas and vigour into our national politics. Many thought, barring the fiasco that was the presidential election that ignited ethnic fires across the country, that the new leaders would introduce a new paradigm of leadership devoid of the tribal tint the pre-independence generation were captive to.
In the recent past many of these youthful leaders have moved to swiftly disabuse Kenyans of any notion of ‘newness’ in the way they do business. They have been heard saying ridiculous things like ‘the Rift Valley has given up too much; we will fight for the rights of our region’ and similar tripe. Others are heard stridently repeating the tired cliché: ‘It is our turn to eat- the national cake must be shared equitably’.
Despite being relatively young, these leaders have embraced the same old tired way of doing things, electing to follow the wind instead of forming the essential bulwark against national disintegration. The hopes many had placed in them must now be reevaluated, and the nation must wait another generation for the emergence of true leadership.
Political commentators like Tom Mshindi (Daily Nation, Friday 12 September 2008) in attempting to correct this wayward brood, only end up perpetuating the same tribal nonsense they set out to demolish. Mshindi, for instance, peppered his contribution with messages to tribal leaderships to ‘take advantage of the numerical strength at the national level’. He even refers to the ‘notion of tribal coalition as popular! There can be no clearer indication of intellectual bankruptcy than this.
What Kenya needs is a generation of leaders who stand up for something much more significant than what Justice Johann Kriegler so eloquently referred to as their ‘grandfathers’ surnames’. We need leaders who can see further than their own political noses into a future in which their own roles will be diminished and the reins of leadership will be in different hands.
When youthful leaders make political threats meant to perpetuate environmental degradation, it displays a great degree of incurable myopia that puts to shame all those who have trust in youth and generational change. The older leaders’ stake in the future of Kenya is limited, since many of them have lived long enough to see their grandchildren and great-grandchildren. It is the younger leaders with children still in diapers who need to keep an eye on the future, laying plans for a better life for the next generation.
Allowing themselves to be drawn into the old politics of ‘my people, their people’ only lowers their claim to greater responsibility and power, for it betrays a hunger, greed or thirst with the potential of outdoing the Goldenberg and Anglo-leasing generation of leaders. All our political thieves do so in the name of their people, even when the so-called ‘people’ do not extend beyond the perimeter walls of their palatial mansions.
As our leaders dither, the rest of the world is moving on, and nations are confronting their own demons. For the first time in history, the United States of America is confronting its twin bogeymen of race and gender discrimination. One candidate is an ethnic minority in the truest sense of the word, being the son of a one-time visitor to the US without the race memory of White supremacy or Black enslavement. The other candidate has chosen a woman for a running mate in a country still populated with women who in their youth did not have voting rights!
Our country needs a similar political re-engineering to come up with a non-tribal system where one campaigns on a platform of issues that matter in the lives of common citizens. Campaigns should be built on issues like healthcare, education, infrastructure development, trade and foreign policy, and not on moronic subjects like ‘this tribe has ruled for too long and needs to be taught a lesson’, or ‘ this community cannot lead this country because they do not circumcise their men’!
Believe it or not, these two were major themes in our campaigns last year, and their animal appeal played a significant part in the eruption of violence after the disputed results. In electing a new generation of leaders, we had hoped to change our political discourse into something more enlightened, and not more of the same.
Clearly we only managed to pour new wine into old wineskins, and now as the Good Book warns us, the new wine has ‘burst the skins and will be spilled, and the skins will be destroyed’.

Dr Lukoye Atwoli is a Consultant Psychiatrist and Lecturer, Moi University School of Medicine

Monday, September 15, 2008

MPs' baffling display of mediocrity

Daily Nation
Publication date: September 15 2008

Our MPs never cease to amaze. Recently, some of them used the floor of Parliament to concoct a theory that a non-alcoholic beverage actually contained alcohol and that the brewer was using it to corrupt the morals of our children.
The proof offered by the parliamentarian was the riots that rocked schools during the ‘mock’ exams season, and an alleged experiment by some pupils that is said to have demonstrated alcohol in one of the drinks!
Despite assurances by the Kenya Bureau of Standards and the responsible ministry, these MPs insisted on using tax-payers’ money to go and verify the claims that the drink contains alcohol.
This mediocrity of thought and behaviour was magnified several times over when the index ranking constituencies by poverty levels was released.
Many MPs went to town with claims that the index was doctored to show that their constituencies had become richer than they were five years ago! So loud was the noise that the minister suspended the index pending investigations.
Whether the index was doctored or not cannot be ascertained in these columns. What is of interest, however, is the knee-jerk reaction of MPs who indicate that it would be better if their constituencies are forever ranked as the poorest.
The reason given is that the poorest constituencies receive more handouts in the form of constituency development funds than the richer ones.
In the extremely suspicion-laden political environment our country currently finds itself in, many may find justification in the claims of interference with statistics.
Indeed any official document released by the Government will first be viewed with suspicion and intensely criticised before being accepted reluctantly, if at all.
What is baffling is the speed at which our representatives rushed to criticise the index without looking at the methodology, basing their rejection of the ranking purely on the perceived improvement of poverty levels in their constituencies.
This tells us what their plans are for their people — maintain them in the poorest possible state, dependent on State largesse, which they can then claim as their own.
It is instructive that in five years, these MPs will be falling all over themselves to show how they have improved the lot of their constituents and asking for another five years ‘to complete the development projects they will have started’.
By dismissing the poverty ranking index, they are sending out a clear message that they will not abide any method of evaluating their performance.
The goal of the index should include evaluating the effectiveness of the CDF that is disbursed regularly to the constituencies.
In an ideal situation, if an audit uncovers inefficiencies in the administration of the fund, changes would be instituted to address these weaknesses and make the fund more useful to the people.
Indeed, if the fund is found to be harmful and counterproductive, it would be better to scrap it and think up more meaningful uses to put our money to.
Politicians have perfected the art of empty rhetoric and populist outbursts to the point that they have stopped paying attention to the content of their speech.
This they do with the active connivance of Kenyans who look on and applaud every farcical statement they make.
In the middle of all this, the poverty levels continue to rise, inflation eats away at the savings of the common man, commodity prices climb remorselessly and incomes continue to dwindle.
No politician is displaying the kind of vision needed to raise this country out of the dark hole it is digging itself into. Instead they are either peering into crystal balls trying to figure out if they will be alive in 2012, or making useless noises in defence of their ‘principals’.
As demonstrated in our recent history, this country is suffering from an acute crisis of leadership.

Dr Atwoli is a consultant psychiatrist and lecturer at the Moi University School of Medicine.

Wednesday, August 27, 2008

Local talk-show presenters promoting dangerous quacks

A LOT OF PROGRAMMES ON television have started a very disturbing trend. Segments with religious content and special programmes especially on health issues are commonly presented on weekend breakfast shows, and some of the messages being propagated are deeply troubling.

This past weekend, for instance, one religious leader presented a man said to be suffering from HIV/Aids to his congregation.

The preacher indicated that the man was in ‘‘end-stage disease’’ from his own examination and evaluation. After a session of vociferous and boisterous prayer, the man was declared ‘‘healed’’ of Aids.

His activities raise serious questions about the role of religious bodies in health promotion and prevention of disease. This was not the first time this was occurring on this programme, nor was it the only instance that someone was ‘‘healing’’ serious illnesses on TV.

MANY KENYANS HAVE DEEP RESPECT for their religious leaders and will follow whatever prescriptions are decreed in the name of God. One shudders to imagine what this ‘‘newly healed’’ individual may do with his new-found status.

Another related phenomenon on other TV stations is the practice of inviting a particular expert on traditional medicine to pontificate on the ability of his special preparations to treat a myriad ailments.

This ‘‘expert’’ even proffers a theory of HIV/Aids that is completely at odds with the prevailing scientific opinion as to the causation of HIV and Aids.

He claims that a certain parasite, Paragonimus, is responsible for this global pandemic, and he prescribes an herbal concoction to clear this parasite and free one from the scourge.

This has been going on for quite some time now, and it is surprising the responsible authorities, including those in charge of the war on HIV and Aids, have done very little to directly counter the claims being made by these individuals who can be characterised as charlatans.

The responsible TV stations are also to blame for encouraging these people to continue making these claims to millions of unsuspecting viewers without presenting credible opposing opinions from experts in various health fields.

At a time when the war on HIV/Aids appears to be stagnating, it is dangerous to allow people to peddle falsehoods to patients desperate for good news.

Other well-publicised claims have emanated from a medical professor who over the years has made repeated claims to having ‘‘discovered’’ the cure for HIV.

Every new ‘‘discovery’’ is greeted with fanfare, but there is never follow-up to check if anyone has been put on the concoction and been cured.

As a scientist, the professor knows very well the rigorous burden of proof that is placed on any new pharmacological agents before they are even tested on humans. His claims, therefore, place him in the same category as charlatans who claim to cure every ailment on earth.

The people making these claims are doing a lot of harm to both their clients and their chosen ‘‘professions’’. Genuine traditional healers and religious leaders suffer a crisis of credibility due to the activities of these individuals, and it is time everyone started speaking out against this dangerous practice.

The truth must start being told loud and clear to counter these misleading claims. Left unchecked, our country will decline to the same level of ignominy that has become the fate of South Africa’s Jacob Zuma, who holds that a good shower after unprotected sex will help prevent HIV!

TO DATE, THERE IS NO KNOWN CURE for the disease caused by HIV. What are available are medications to reduce the viral load and to combat opportunistic infections and thus improve the individual’s quality of life.

Nutritional, psychological and behavioural interventions work hand in hand with these medications to help people with HIV/Aids to live as near-normal lives as possible. To purport to have a cure for HIV without subjecting it to rigorous testing and proof is therefore putting the lives of millions at risk.

To declare someone ‘‘healed’’ of HIV is tantamount to hastening their demise and exposing others to infection. Those doing this should be subjected to the full force of the law to discourage others from perpetuating the same fallacies.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine, Eldoret (

Friday, July 11, 2008

Medical doctors need to eat too


Publication Date: 7/9/2008

It is open season on doctors again! It is increasingly becoming fashionable to attack doctors for engaging in ‘‘private practice’’.

A recent media interest in the issue seems to have sparked a passionate commentary by one Mary Okello (DN, July 4), who seems to have a particular gripe with doctors providing radiation oncology services at Kenyatta National Hospital and has now generalised it to all doctors in public service who engage in private practice.

Several allegations made in the article cry out for immediate clarification to make the debate better informed. The writer asserts that all doctors in public hospitals engage in private practice, and that this is poorly regulated, resulting in patients without money dying ‘‘while waiting to access services, while their richer counterparts are fast-tracked into treatment’’.

Another serious allegation of an ethical (and even criminal nature) is that doctors refer patients requiring ‘‘specialised treatment… to their own clinics or to their colleagues’ private clinics’’.

The writer also suggests that private practice is inherently unethical since most doctors in public service ‘‘went through medical school courtesy of loans made possible by taxpayers’’.

She closes by asserting that the ‘‘current position is heavily skewed in favour of doctors’’, and is creating discontent among other health cadres who feel overburdened and underpaid.

Not all doctors engage in private practice. Issuance of private practice licences by the Medical Practitioners and Dentists’ Board is tightly regulated, and there are clear guidelines on who is entitled to engage in private practice and who is not.

Even highly-qualified specialists are required to work under supervision of senior colleagues.

Doctors do not see their private clients at the expense of hospital patients. Any doctor who does this flouts the terms of his or her employment.

The question of referal is vexed. Doctors are trained to deal with a host of common problems during their basic training.

However, some undergo further training in specialised areas to provide expertise in dealing with more serious and less common problems that would be difficult for a doctor with basic training alone.

In medical practice, it is expected that a doctor will only deal with conditions that he or she is competent in.

When a doctor comes into contact with a condition that requires more expertise, the practice is to refer to a specialist in that area, or to a colleague with more experience with the condition.

It should therefore not surprise anyone that they get referred from one doctor to another. Would it be prudent for the doctor to insist on treating conditions he or she is unqualified to handle? It would be unethical and even criminal for a doctor to do so.

Private practice is encouraged by hospitals since some clients demand to be seen privately by highly-skilled consultants who are few and sparsely distributed.

To serve such clients, many hospitals have private wings where their consultants can continue to offer private services within the hospital.

The doctors are offering an important service, and anyone who has problems with how this is organised needs to give suggestions about administrative measures instead of launching an attack on the service provider.

The Government appreciates that lack of appreciation of professionalism and commensurate remuneration is the major factor in brain-drain affecting the health sector.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Scam a test for the Grand Coalition


Publication Date: 7/7/2008

WHEN THE GRAND COALITION Government was sworn in a couple of months ago, they promised Kenyans that despite the bloated size of the Cabinet, they would do the right thing to bring the country back on its feet economically and in other spheres.

They promised to rein in corruption and improve the business environment to achieve huge levels of economic growth. Kenyans were promised that any public official on whom even the mere suspicion of corruption was directed would be relieved of his or her duties.

Given the nature of the recent scandals and the personalities involved, it must be reasonably expected that in the coming days we will have a new Finance minister, governor of the Central Bank and other senior civil servants at the Treasury.

This is the big test for the grand coalition. If it fails in this, all its members will lose legitimacy in the eyes of the common citizen, and all talk about vanquishing corruption will be rightfully dismissed for the hot air it is.

It is not enough, or even exculpatory, for a minister to purport to ‘‘blow the whistle’’ on a Cabinet colleague. It is worse than tragic for the fellow on whom the whistle has been blown to go to the press to ‘‘praise’’ the whistle-blower while in the same breath defending the illegal sale of public property.

It betrays a view of the common citizen as a blundering fool who will accept anything from those in Government despite the contrary evidence.

Why was it necessary to complete the Grand Regency deal with such haste and secrecy? Why the apparent lies about the buyers and the amount paid for it? Why the use of force and threats to public servants in order to register the sale and transfer of ownership?

FOR GOVERNMENT TO BE SEEN TO be working, these issues must be resolved at Cabinet level, the culprits identified and punished, and the entire Cabinet speak the same language about corruption and good governance.

That being the case, Mr Kimunya will find it increasingly difficult to explain away the sale of the Grand Regency.

The minister is still grappling with public discontent over the handling of the Safaricom IPO and the refund process, and another scandal concerning printing of currency lurks in the shadows. There is no way he can remain in Government while these issues remain unresolved.

Whether there are others involved in these scams or not, he must be the first casualty. If this does not happen, then any other minister who shares a Cabinet meeting with him must be deemed to be guilty by association. None of them will retain any moral authority with which to rant and rave about official corruption or poor governance.

An argument that is beginning to gain currency is that these scandals in the financial sector are all machinations aimed at burying the debate over taxation of MPs’ allowances by deflecting attention to other matters that will keep the minister busy.

That may well be the case, but we must, in the Prime Minister’s words, be able to chew gum and ascend a flight of stairs at the same time. We can keep an eye on the MPs to ensure they pay their taxes while at the same time ensuring those that insult the taxpayer by selling our property for a pittance are held responsible.

Dr Atwoli is a consultant psychiatrist and lecturer at Moi University School of Medicine.

Friday, June 27, 2008

Tax: MPs must try better excuses


Publication Date: 6/24/2008

KENYANS ARE ONCE AGAIN having to contend with avarice, double-speak and outright insults from those they have elected to be their representatives.

The question of whether or not our MPs should pay taxes on their generous allowances is not new in our national discourse. Neither are the justifications they use to deny the Exchequer what rightfully belongs there.

Outside of Parliament, when they are busily campaigning for the title “Honourable”, they argue that MPs earn way too much and their pay should be reduced and subjected to tax.

Once they get in, they metamorphose into avaricious creatures that would do anything to line their own pockets.

To be fair, some MPs have spoken out in favour of paying taxes on their allowances. Most, however, are adamant that the move is unacceptable to them and they are preparing to shoot it down.

Words used to describe the measure include “populist politics… nonsense… punishment” among others. It is difficult to gauge the amount of time our MPs have spent thinking about this matter, but their output suggests that theirs’ are knee-jerk reactions to the proposal.

The words they use to describe the proposal are indeed instructive. It is ‘‘nonsense’’, a measure meant to punish the targeted taxpayer and reduce his or her standing in society.

The interesting thing is that some of these fellows sit on important parliamentary committees that vet public expenditure and pass levies to be charged on the common citizenry.

Even as they complain about paying tax, they have already presented proposals to buy new cars for themselves (including a convoy for Mr Speaker) among other perks they already enjoy. Some have even threatened to increase their allowances if the tax measure passes.

One reason they are using to reject the tax on allowances is that they spend most of their pay on their constituents. This is a very lame excuse, especially in view of the Constituency Development Fund (run by MPs!) and other funds meant to take over the functions of harambee and out-of-pocket expenditure for MPs.

THAT THEY SPEND THEIR MONEY on their voters is therefore a personal decision, and nobody forces them to do so. Many Kenyans out of Parliament are doing exactly the same thing, yet they pay taxes on their income.

We are educating members of our extended families, feeding those too poor to afford a meal, forking out money for neighbourhood security, paying bills for our friends and neighbours and even organising weddings and funerals for these MPs’ constituents, yet we also faithfully pay our taxes and fill out our annual tax returns to avoid paying huge penalties. What makes MPs’ expenses more important than those of the common citizen?

Another reason they are giving is that they travel frequently to their constituencies and spend a lot of money on their fuel-guzzlers, and therefore they need tax breaks to deal with this. Others claim they work for 24 hours and have no weekends, and therefore their tax-free allowances are fair compensation.

These are all ludicrous arguments that would not stand close examination. Common citizens also toil endlessly in order to afford a single meal in a day, and as for the cost of fuel and travel, all Kenyans have been hard hit.

It is ridiculous in the extreme that Kenyans earning less than a quarter of what our MPs earn end up paying the same amount of tax as the MPs! It is time those MPs who care about the future of this country stood up to be counted.

Let them pay tax so that they can feel the pain the common citizen feels when the Kenya Revenue Authority milks them dry. This may inspire them to find ways of reducing taxes and using the money collected more efficiently.

But that is a very long shot indeed!

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Monday, June 16, 2008

Kenyan politicians not really ready for true democracy


Publication Date: 6/12/2008 Daily Nation Page 11

IN A RARE MOMENT OF CANDOUR, a senior figure in the Grand Coalition revealed the true motivation for the Kenyan politician.

Speaking at a campaign rally in Kilgoris, Assistant minister, Joseph Nkaissery was quoted as saying that parties are of no importance in Kenyan politics, and that he held the interests of his tribe above those of his party.

He was justifying his refusal to campaign for a candidate from his political party and preference for a candidate from an opposing party.

His only consideration was the ethnicity of his preferred candidate, and not the policies he espoused or his commitment to the welfare of his constituents.

The scenario above represents the mind of the average politician, and has been replicated countless times in relatively cosmopolitan constituencies.

People elected on various party platforms turn around and threaten to leave their respective parties unless the interests of their ‘‘community’’ are taken into account.

The meaning of ‘‘community’’ in this context is often narrowed down to what the so-called leader feels is in his or her personal interest.

STATEMENTS LIKE ‘‘KENYANS WILL not accept ABC’’ or ‘‘Kenyans are demanding XYZ’’ are common during thunderous rallies and news conferences, while in reality the Kenyans being referred to would not fill a room in one of the mansions occupied by our leaders.

On the authority of this politician, we now know the truth about all those shouting themselves hoarse about ‘‘we in ODM’’ or ‘‘we in PNU’; they have no interest in the welfare of Kenyans, and are just looking out for their own interests.

Many young people have been involved as foot soldiers in political campaigns on behalf of these politicians, and many have paid the ultimate price – their lives.

Hundreds of them are languishing in police cells facing various charges mostly involving violent acts on behalf of these two-faced politicians.

These young people engaged in these acts probably believing that they were serving a just cause, that they were righteous warriors (pardon the metaphor) in the interests of their community, political party or country.

What a lie!

When the politicians sat together across the mediation table, they agreed to prosecute all perpetrators of violence, which was described as bordering on war crimes and crimes against humanity.

They then went ahead and shared posts in Government and started planning ‘‘home-coming’’ parties, forgetting that the soldiers for freedom and defenders of the community were wallowing in poverty all over the country.

The tragicomic show on ‘‘amnesty’ is just another false front being opened by politicians to hoodwink their followers that they are fighting for their rights.

The truth is that politicians on both sides are saying the same thing but emphasising different aspects of the argument.

One side is amplifying the need for certain perpetrators of violence to be punished and turning a blind eye to others, while the other side is emphasising the need to punish all purported wrong-doers instead of doing it selectively.

Both sides seem agreed on the need to deal expeditiously with all those in custody – releasing those whose rights have already been violated through inordinately long incarceration, releasing petty offenders arrested for blocking traffic and shouting slogans, and taking those who committed heinous crimes through the due process of the law.

What is the future of our fledgling democracy then?

It is clear that as long as we continue along the path of deceit and double-speak, we shall continue suffering pain and bloodshed as experienced at the beginning of this year.

WE ARE NOT LIVING IN A DEMOCRacy, and we should stop deluding ourselves that we are. What we have is a hodgepodge of nation-states practically at war with each other, and at every election, we put up our best warlords to vie against the best from other groups.

Until we start thinking about ourselves as Kenyans first and use values and principles in making political decisions, we shall continue falling prey to duplicitous politicians who pretend to be one thing when campaigning and become another in other settings.

Kenyans will only demonstrate their commitment to democracy when they transcend the comfort zone of their tribes and define themselves by other values. Until then, one can only conclude that we are not yet ready for democracy.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Wednesday, May 28, 2008

We can’t just decide to go back to business as usual


Publication Date: 5/27/2008

REPORTS THAT THE RECONCILIATION talks are hitting a deadlock due to absenteeism do not come as a surprise to many who now understand the psyche of the Kenyan leader. To most of them, the crisis is over, and once the internally displaced go back ‘‘home’’, it will be business as usual.

In the same vein, it is rather too optimistic to expect that anything positive will come out of the Truth, Justice and Reconciliation Commission set to be established soon.

The Kriegler Commission, too, may also hit a dead end, and even if they do a sterling job, the political will to implement their findings may be lacking.

My pessimism is informed on the failure of successive regimes to implement findings of similar commissions despite their potential to forestall just the sort of conflagration we experienced following the December elections.

The Parliamentary Select Committee reports on the killings of J.M. Kariuki, Robert Ouko and others; the Goldenberg Commission of inquiry; the Ndung’u Land Commission; the Akiwumi Commission of inquiry into ethnic clashes – the list is endless.

IT APPEARS THAT SINCE INDEPENDENCE, Kenyans have been going about their lives wearing heavy veils and unable to see each other’s true faces. These veils are once in a while lifted by events that threaten to destroy the nation, but we soon go back to life as usual.

As soon as the genie is conveniently stuffed back into the bottle Kenyans go back to some semblance of ‘‘normalcy’’ and continue with their pretended civility and hidden hatreds and resentments.

After the eruptions earlier this year, many had hoped that we would be collectively stunned as a nation into action that puts the tragedy behind us.

Indeed, many celebrated a new beginning upon the signing of the deal between President Kibaki and Prime Minister Raila Odinga. Soon enough, however, our leaders’ true natures came through and the fighting began in earnest.

When they are not engaging each other over primacy, they are arguing about the need for a “Grand Opposition” or whether or not to resettle IDPs or give amnesty to those arrested in connection with those anarchic times.

The focus on the future has been lost, and the only future our leaders are discussing is their own – who will occupy what position come 2012. In case they have forgotten, there are issues that must be confronted.

First among them is constitutional reform to formalise the compromises struck and take them further to include the creation of secure institutions that can hold the State together even when politicians disagree.

Disengagement from personality-cult politics and reorganisation of our political landscape will go a long way in reducing the risks of further violent eruptions during election years.

Secondly, we must find a way of dealing with the question of impunity. Thieves of public resources and beneficiaries of corruption must never find their way into public office to continue their nefarious ways.

Similarly, perpetrators of illegal acts of whatever nature must face commensurate punishments, however big or small. Kenyans must stop viewing thieves and killers through the ethnic prism and instead recognise them for what they really are – vile criminals standing by for an excuse to commit crime.

Thirdly, employment creation and fair remuneration must be made an urgent priority. Giving Kenyans a stake in the economy will reduce their propensity to go on destructive orgies every time they feel slighted.

Gainfully employed people are less likely to rush to destroy such infrastructure as roads and railways as well as public utilities.

FINALLY, DISTRIBUTION OF RESOURCES must not be perceived to be concentrating on only certain regions from which key national leaders hail. Efforts must be made to ensure that all citizens feel they owe allegiance to one nation and not to sub-nations or even foreign countries as is the case presently.

The current perceived inequities in national development only serves to entrench the perception that development only comes to those whose leader is nearest to State House, resulting in the zero-sum political contests every five years in our country.

These are only some of the ‘‘burning’’ issues that our leaders need to be trying to solve, instead of falling back on to our favourite national pastime – bickering.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine.

Wednesday, April 30, 2008

Bickering over primacy adds little value to governance


Publication Date: 4/30/2008

THE PAST FEW DAYS HAVE seen Kenyans being treated to an unsavoury manifestation of the power-play that is at the very root of this country’s recent dalliance with disintegration.

Politicians, academics and common citizens have exercised their minds on who between Prime Minister Raila Odinga and Vice-President Kalonzo Musyoka is more powerful than the other.

The feud has been prosecuted in the full glare of publicity and has even come in the way of the Government’s own efforts at reconciliation.

The issue has become so emotive that it has become the proving ground for idle loyalists still stuck in the pre-election campaign mode.

Every politician is seeking to prove just how loyal he or she is by shouting loudest about their man being the closest to the seat of power.

THE TRAGEDY IS THAT THESE people are all supposed to be serving in the same government and working towards better service delivery for Kenyans.

Their two ‘‘Principals’’ signed an agreement, which the MPs then endorsed in Parliament and entrenched in the Constitution. The continuing wrangles over who is the most powerful between the PM and the VP, therefore, exposes the politicians’ ignorance over the contents of the Bills they passed at the height of the crisis.

After passage of the political agreement, Parliament was supposed to turn its attention to the more pressing matter of long-term solutions, including a review of the Constitution, land reforms and institutional reforms to fashion Kenya into a modern state with clear guidelines on what is acceptable and what is not.

Parliamentarians were supposed to take the lead role in reconciling our warring communities and creating a framework for lasting peace through truth, justice and reconciliation.

Instead, they spend their waking hours wondering how to prove their might to the ‘‘other’’ side. Even straightforward issues such as resettlement of internally displaced persons have become mired in the petty political squabbles and mistrust that pervades our political space.

When the National Accord was signed late February, it was argued in these columns that the hard work was only just beginning. It was pointed out that the celebrations were all premature. These arguments are now being clearly borne out by the petulant chest-thumping our politicians are now displaying.

It can now be surmised that for the politicians, it is back to business as usual. In their minds, Kenyans cannot have enough of politics, and every day is another day on the campaign platform, seeking to out-perform the political or ethnic ‘‘other’’.

The clamour for a new Constitution has been abandoned for the next big thing, in this case the row over primacy between the PM and the VP.

Dealing with the food crisis can wait, so that the President can clarify who is second to him. Our discredited electoral system can wait until one of the men is confirmed in no uncertain terms to be the most important.

What is emerging is that as long as we put our hopes in the current crop of politicians (or indeed any politician) we are doomed to keep repeating the mistakes of the past.

Like the proverbial lunatic, we will keep doing the same thing over and over, and expecting a different result with each repetition. These ‘‘leaders’’ are failures even before they begin doing whatever it is they are supposed to be doing for their electors.

KENYANS ARE THEREFORE CALLED upon to begin searching for a new leadership paradigm that does not include excellence in politics or astuteness at accumulating wealth by stealing from the poor.

Today, our public service is on the verge of collapse due to the sheer weight of incompetence and lack of vision that chokes the entire governance system.

The poorest carry the weight of the rich, and when they grumble, they are told to wait a while longer while their terms are being looked into.

The true leader stands at the head of the column, not at the rear. Our leaders must stop these childish games and face up to the challenge of leadership.

This demand for leadership is even more urgent at the top than anywhere else in this country. Our very survival as a nation depends on it.

Wednesday, April 2, 2008

We should not make ECK a scapegoat for our failures


Publication Date: 4/2/2008

IN RECENT DAYS, THE CLAMOUR for the Electoral Commissioners to either resign or be sacked has reached fever pitch.

ECK chairman, Samuel Kivuitu, has even had to suffer the indignity of being booed and jostled in the streets of Mombasa.

And it seems clear that the public mood is such that he may not be safe anywhere else in this country.

The other commissioners are not safe either, and their existence has been reduced to a level below that of common criminals.

All this indignation and finger-pointing begs the question: What is it that the ECK did, that makes it more culpable than the ‘‘ordinary’’ Kenyan who used all sorts of weapons to kill and maim others for daring to be different in one way or the other?

Is Mr Kivuitu more responsible for the breakdown in law and order than the politicians with their inciting utterances, the warlords with their planned aggression, the police with their skewed response, and the common citizen with his machetes, projectiles and petrol bombs?

Examining the entire hullabaloo with a clearer eye unblinded by the ‘‘civil society’’ noise and rabble-rousing, one gets the impression that the ECK has been turned into a convenient scapegoat for most of the ills that are facing our society today.

From an independent stand-point, it is clear the ECK mishandled the elections on a huge scale, and this mishandling may have served to worsen the conflict, that was simmering below the surface amongst many members of the Kenyan society.

The ECK’s perceived malfeasance, therefore, only served to remove the veil of civility that has covered our social interactions since independence, and exposed us for the very uncivilised creatures that we are.

It may be right then to condemn the ECK commissioners for whatever role they played in the post-election fiasco, but the vilification must be tempered with the reality that the most heinous eruptions since the election were the handiwork of criminals in other spheres of society.

Politicians, media workers, opinion leaders, religious leaders and others must also be examined for the roles they played in the violence, together with the officials of the ECK.

For as long as we continue hankering after quick solutions to our problems, hoping that a few resignations and mea culpas will wash away our sins and help us start afresh, we shall continue brewing new subterranean hostilities which periodically erupt into barbarism.

The lasting solution will not be found at the door of Mr Kivuitu or the other ECK commissioners, but in the hearts of each and every Kenyan.

A COMMON STATEMENT IS THAT ‘‘Kenyans only fulfilled their roles in electing their leaders, and now they are living in camps as a result of leadership failure’’.

This refrain is repeated by all, including the politicians themselves. One is then constrained to ask, whom, therefore, is responsible for the appalling atrocities that continue to be meted out against fellow Kenyans?

Is it some foreign malignant force that has been unleashed to destroy our ‘‘island of peace’’?

At the height of the violence, a claim which has since fizzled out was made that Ugandan soldiers were used to quell riots in some parts of the country.

This only goes to illustrate further our search for convenient scapegoats, targets that can absorb all the blame and leave the rest of the country almost entirely blameless!

President Yoweri Museveni’s quick act to congratulate President Kibaki made him an instant villain among many politicians, further serving to confirm his culpability in our problems.

One question Kenyans need to ponder is this: Isn’t it just possible that the ECK did us all a favour (whatever it is they did!) by triggering a process through which we were forced to discard our masks and show our real selves?

The undercurrents of ethnic animosity they exposed may now be comprehensively dealt with through the formation of an Ethnic Relations Commission and the Truth, Justice and Reconciliation process.

The inordinate importance we place on individuals and not institutions has also been uncovered, and we now have the opportunity to create strong institutions that will outlive their occupants.

The weak base of our economy has been thrust under the examining glass, and we may yet learn some lessons in how to diversify our investments instead of depending on only one factor of production.

If the ECK is found to have committed any crimes by the Independent Review Commission, the commissioners must face the full face of the law.

But the same standard must be applied across the board to all Kenyans (and even foreigners!) who may have had a hand in the sad events that occurred around the December election.

Only then can we talk about justice and equity!

Dr Atwoli is a consultant psychiatrist operating in Eldoret

Friday, March 14, 2008

Enough of Jubilation; now the hard work must begin

Publication Date: Daily Nation 3/14/2008

MANY KENYANS ARE STILL celebrating the signing of the political agreement between President Kibaki and Mr Raila Odinga. But amid all the celebration and back-slapping, I would like to be the voice of reason, or the wet blanket, depending on where one stands on this issue.

Just before World War II, British Prime Minister Neville Chamberlain signed a deal with Adolf Hitler that was hailed as one that would bring ‘‘peace in our time’’. A few months later, Hitler’s forces were pounding the rest of Europe, and the British Isles were not spared.

It is said that those who do not heed the lessons of history are doomed to repeat the mistakes. Soon after our elections last year, the country erupted into cataclysms of killing and plunder that were neither foreseen nor anticipated.

Unless we want to believe that the key culprits, the forces behind the killings, were President Kibaki and Mr Odinga, then the status quo ante still obtains.

THE TWO PRINCIPALS MAY HAVE suddenly become chummy, but the bitterness that drove someone to slash his neighbour and burn his property has not been wiped away by their handshakes.

The anger and despair occasioned by the losses suffered by the survivors has not been assuaged by the agreement signed in Nairobi by people who are, for all intents and purposes, strangers to them.

Even as we celebrate the political agreements and move forward with the creation of positions and rewarding of cronies, we must not lose sight of the key issues that need to be addressed as part of a lasting solution to our crisis.

We must let the political developments to continue parallel to other peace-building and conflict resolution processes.

A key issue is the creation of an environment that enables the displaced persons to find a place to settle, whether it is their original home or elsewhere.

Dialogue between communities and leaders must begin in earnest if this is to happen quickly, and edicts from Nairobi directing people to return to their homes will just not do.

Concrete steps must be taken to prepare both the displaced and their erstwhile tormentors for peaceful coexistence if this process is to succeed.

People returning to their homes will find most of them ransacked and destroyed, and they will need assistance to start afresh.

Their needs must be assessed and efforts made to address them if we are to avoid creating new refugee camps in the areas of return.

In the meantime, it may be necessary to either continue serving the displaced within the current camps or create new ‘‘transit’’ camps to temporarily host people returning to their dwellings while they organise their affairs.

Many of those displaced have suffered great physical and psychological distress, and steps must be taken to address their psychosocial needs even as their material needs are taken care of.

Special attention must be paid to children and young adults, since their attitudes and lessons will form the basis of their future interactions with the rest of society.

If their psychological needs are neglected, we will only have created a time-bomb that will explode again in the near future.

Part of the people’s psychological needs will be met in the process of truth, justice and reconciliation, and it is important that mental health professionals be involved in this process.

They can offer invaluable advice on what needs to be said, in what circumstances and by whom, to facilitate healing.

The process itself does not need to wait for politicians to satisfy their power-sharing needs, it must start sooner rather than later.

IT MUST TRICKLE DOWN TO EVERY village, instead of becoming the travelling circus many commissions have become.

The Rwandese Gacaca courts, with all their imperfections, provide a poignant lesson on how to deal with local atrocities, and we may need to borrow a leaf from them.

Finally, a reconstruction package that includes development of infrastructure, youth employment opportunities, and expansion of the education system must be implemented.

Areas perceived to be underdeveloped must be given priority to prevent resentments that can grow into another conflagration in future.

If these steps are taken, we will have ensured peace, not just for our time, but for all eternity.

Dr Atwoli is a consultant psychiatrist working in Eldoret

Tuesday, February 12, 2008

Redirect anger to restore sanity

Publication Date: 2/12/2008

I READ PROF WILLIAM OCHIENG’S commentary on February 4 with profound dismay. From a man who has studied and taught history for as long as he has, I expected a reasoned and less emotional dissection of our place in history and what the future holds.

Instead, he bombards us with a depressing diatribe, railing against fellow man and expressing disillusionment with systems, individuals and almost the entire body of humanity.

The good professor pledged never to vote again, joining the bandwagon of Kenyans who, having lost faith in present institutions, now condemn their progeny to a life of uncertainty and pessimism.

Those that have a stake in the future of this country must stand up and be counted. They must speak up and say that though they feel wronged this time by those whose hold on the future is tenuous at most, they shall rise up, and like the proverbial phoenix, rebuild a beautiful land out of the ashes.

Those that have little stake in Kenya’s future have lit the fires that rage across the land, and are moving only sluggishly and reluctantly to douse the flames long after lives and livelihoods have been reduced to ashes. Even as they do this, more fires are being lit, literally and figuratively, in many parts of the country.

I want to be the first to say that for the sake of my children and their progeny, I shall not give up. I will keep my voter’s card as a reminder of the power of the ballot, a power that can build and a power that can destroy. I will definitely use it again in future, to elect true leaders who care about the struggles I go through daily to earn a living.

If there are enough people out there who believe in the beauty of this vision, then we shall triumph and the country will be the richer for it. If, on the other hand, we are in the minority, it is a minority to which I am proud to belong.

The Electoral Commission, the Judiciary, the Executive, all these shall pass on and give way to others, but the power of the ballot shall remain.

Prof Ochieng’s article, however, raises many issues worthy of consideration. The issue of the perpetrators of violence and whether they are expressing any political opinions by wielding machetes, rocks and even guns has been revisited by many commentators.

THE VERDICT APPEARS TO BE THAT they are criminals who would use any opportunity to commit crime, especially if it is covered by the term ‘‘political violence’’ or some such other convenient tag.

That man can kill and loot does not make humanity as a whole killers and looters. Stories abound in these chaotic times of people who sheltered their neighbours, even risking their lives to protect vulnerable people from ‘‘wrong’’ ethnic groups or political persuasions.

The need for firm and consistent application of the law to discourage acts of lawlessness is also self-evident.

The role of the middle class, and by extension, their brothers and sisters in the Diaspora, has also become an issue that cannot be avoided in this debate. Many in these classes have felt safe enough to continue bandying about ethnic stereotypes and insults knowing that they may never be victims when riots break out.

Those outside the country persist in these prejudices from a safe distance, knowing that should the country collapse, they are safe with their green cards and foreign citizenships. Those in Kenya, particularly in Nairobi, live in neighbourhoods that have remained untouched by the violence, and can therefore talk about a ‘‘sense of normalcy’’ returning.

The middle class seems to be unaware of the power it wields to provide solutions in this crisis. They must examine themselves and see that their common interests supersede their ethnic loyalties or even political leanings. They need each other regardless of ethnic affiliation or political inclination.

To the powers that be, expanding the middle class by providing more jobs and better incomes will reduce the number of people willing to destroy all in the name of misdirected anger.

Friday, February 8, 2008

Kenyans need to unite and help in healing the nation

Letter by Dr Lukoye Atwoli DN 06 February 2008

Our politicians have developed the propensity of playing politics with the lives of Kenyans.

Every ‘enemy’ death is celebrated almost like a goal in a ball game, while every supporter’s death is held up as evidence of injustice by the ‘other’ side. Politicians are counting the lives of the dead and injured and comparing them the way people compare scores in a game.

There has been talk of genocide and crimes against humanity, and possible prosecutions to be pursued through the international justice system.

Observing these trends, one is then constrained to ask: Are these leaders of the whole Kenyan nation, or are they leaders only of their communities and regions? Are some lives more precious than others? Is one form of wrongful death more justifiable than the other?

It is instructive that one of the people who tried to be ‘objective’ depending on which side of the divide one is, Mr Maina Kiai of the Kenya National Commission for Human Rights, was pigeon-holed and judged by his previous comments and activities and chased out of a displaced people’s camp in Eldoret. This was an illustration of the kind of chasm that has now been dug by our ‘leaders’ on both sides. A member of ‘our’ community who chooses to listen to both sides is labelled a traitor and rewarded with threats to his or her life.

As the international mediators go about their business, they must realise they face a much deeper problem than just disputed election results. They face a country at war with itself, struggling to define its very identity and riven with deep ethnic divisions.

This is now a country where we can justify the shooting of a protester in the streets and describe televised footage of the same as a ‘Rambo’ movie.

It is a land where the violent mass eviction of members of one community by another, going as far as burning down churches and schools, is justified in the heat of political debate.

For a while now, many Kenyans have believed that the solution to the current crisis lies in dialogue between the president and his main rival, Raila Odinga. Perhaps it is now time we came out of our sheltered ignorance and acknowledged that the solution may need to go further than that.

The first step should be for both groups to visit all the areas affected by the violence, and offer sincere condolences to all those who have lost loved ones as well as property and livelihoods.

Some sort of compensation package for all those affected will have to be worked out without acrimony. An agreement must be reached on what to do with the identified perpetrators on both sides.

An attempt will have to be made to re-conceptualise the problem from a ‘them’ versus ‘us’ situation to one where all Kenyans stand against all those who do not respect their lives and property.

Our own basic humanity must be used as a starting point towards agreeing to coexist with each other peacefully.

Additionally, there is a need to create and strengthen the institutions that hold together the fabric of State, institutions that have been taken for granted and ignored since independence. The Judiciary, the electoral system and the architecture of the Executive need to be re-examined and improved in order to better serve the people.


Thursday, January 31, 2008

EAYPT Press Release on the Ongoing Violence in Kenya

Mental health professionals in our country have been working hard over the past one month to try and preserve and maintain our nation’s mental health under very difficult circumstances. The losses in lives and livelihoods are great, and the wound to the national psyche is greater still. It will take many years to heal the damage that has been wrought by the physical and emotional violence in Kenya.

We have taken care of people who have become mentally unwell due the on-going conflict; we have taken care of others who have had mental illness for a long time but the conflict has made it worse and disrupted their usual care channels; we are also working against all odds to help many others to deal with their current difficulties in order to avoid future psychological difficulties.

Our plea to our fellow citizens is simple: Please stop the violence. The damage goes deeper than the current issues and disagreements. Many years into the future our children will still bear physical and psychological scars as a result of our actions today. Let us all begin working together to build a truly united nation that cares about the future of its children.

To our politicians: Please sit down and talk in all sincerity, and come up with a solution that will save Kenya, not just one that will satisfy your needs and desires. Stop the posturing and the threats to one another, if you truly have the interests of all Kenyans at heart. Visit the victims of the violence together, encourage peaceful co-existence, and help initiate a process of national healing and reconciliation.

To our law-enforcers: Please exercise professionalism in carrying out your duties. This is the time your services are in greatest need, and you must provide security for all, not least our contending politicians, in order to give them the opportunity to sort out the crisis. Do not let other considerations come in the way of carrying out your duties. Live up to your motto: Utumishi Kwa Wote.

Finally, we express our solidarity with all those who have lost their relatives, friends and property. We are in this together, and we shall come out of it together. We are available to continue offering you support in this your hour of need.

Consultant Psychiatrist

Tuesday, January 22, 2008

Suggested Disaster Mental Health Interventions in Kenya

The current crisis in Kenya, involving killings occasioned both by agents of state and the citizenry, has exposed how woefully inadequate our disaster mental health services are. We were ill prepared to deal with a disaster of this (or any) magnitude.
Subsequently I have put together some suggestions for the running of a disaster mental health service at least at this emergent phase. More detailed guidelines will come out after discussions of this and other drafts.
My Suggestions are available here.

Friday, January 18, 2008

Let's Free our Children from Bondage of Ethnic Bigotry

Publication Date: 1/18/2008 Daily Nation Page 11

A 10-year old boy with an arm sling stares at all visitors at the Moi Teaching and Referral Hospital Accident and Emergency Department.
Asked what happened to his arm, he replies after some hesitation that members of a neighbouring tribe attacked those of his tribe and they had to escape. He describes his escape without emotion: ‘‘They threw stones at the roof of the church so that we do not try to run out. They blocked all the entrances and set the church on fire. I jumped out through the window and ran into the bush. They hit my arm as I ran, and that is how it broke.’’
IN KISUMU, A 15-YEAR-OLD BOY WAS shot in the leg by a policeman responding to a riot. He says: ‘‘All the policemen were speaking with the accent of members of another tribe. They used live bullets to disperse the crowd. I was shot as I tried to salvage some iron sheets from a burnt stall.’’
All around the country, little children are witnessing heightened tribal animosity. Some people are stridently repeating that this conflict is political and not tribal. They need to take some time off and visit with the children who have witnessed the atrocities. Politics is the dress our national ogre, tribalism, is wearing this time round. Next time, it will be land or business rivalry, or even disagreement over resource allocation. But at the very core of the issues is tribe.
Children who have only now grown old enough to speak a few words are repeating disturbing ethnic stereotypes with such ease, one wonders how entrenched they are in their psyche.
They have internalised our communal hates and prejudices and made these their values. They now calmly accept the fact that in some parts of this country, they are ‘foreigners’ always at risk of eviction.
These children have now learnt that nothing is sacred in the struggle for what belongs to ‘us’. Looting, murder, arson and rape are all legitimate ways of getting justice. They cannot now be convinced that stealing is all evil either.
It is said that love is natural, while hate is learnt. We are slowly but surely
incubating a hateful future for Kenya, where certain parts of the country will be inhabitable for some tribes. We have accomplished the difficult task of teaching our children to unlearn the natural love and trust they have for everyone, and have replaced that with hate and bigotry based on such a transient feature as one’s ethnic origin.
The above scenario paints a gloomy picture for the future of our nation. It promises that what is happening in Kenya today will happen again in 15 or 20 years’ time. When these children are strong enough to wield machetes, clubs or even guns, they will settle their differences the very same way they have learnt from their parents. They will loot, they will kill and they will rape in pursuit of what is rightfully theirs. They will make anyone who comes from a different community a target for their anger whenever they feel aggrieved.
All hope is not lost, though. When all has been said and done by the politicians, and agreements have been reached and deals brokered, we will have to examine the effect these eruptions have had on our children and by extension, on the fabric of the nation.
At the individual level, mental health professionals are involved in a crisis response that involves helping the survivors to integrate the traumatic events into a coherent, liveable worldview and reduce psychological distress.
The same process will have to be carried out at the national level, aiming at healing the nation’s wounds and creating a national vision that is coherent and liveable for all our people.
THE TASK OF HEALING THE NATION will fall on all of us, but must be led by individuals who have gained the trust and confidence of the nation, in much the same way that a doctor must inspire confidence in her patient for the therapy to work. A national healing and reconciliation process, by whatever name, must be instituted to embark on the difficult journey of helping Kenyans find themselves.
At the personal level, it will be important for us to make certain rules of etiquette when dealing with each other. For instance, use of ethnic stereotypes must be deemed taboo whether in public or in private. Use of insulting language targeting whole communities must be discouraged whether on the campaign platform or in the privacy of our homes.
Our children should be taught to appreciate the culture of others and not to hold one group to be superior to others simply because they belong to it.
The time to act is now.

Dr Atwoli is a consultant psychiatrist
© 2005 NationMediaGroup All Rights Reserved

Wednesday, January 16, 2008

More Mental Health Resources

I will be making available more mental health resources on this blog.
One can access the American Psychiatric Association Journals (Free for many developing countries.
The Royal College of Psychiatrists' Publications are also available here.
Psychological first aid collated materials shall be made available from time to time as they become available.
Request for more material in your comments and we shall try to come through.

Monday, January 14, 2008

Disaster Mental Health Services in Kenya

During this current crisis in Kenya, Mental Health professionals need to know that they have a major role to play in preventing psychological distress from developing into later mental problems among the affected population. Another role is in helping people come to terms with what happened and to process it, coming up with a coherent world view that is not informed by anger and hate.
These goals can be achieved relatively easily through a proces of psychological first aid, and a manual is available here (the Psychological First Aid Field Operations Guide, 2nd Edition). Other useful material can be obtained in the Disaster Mental Health Guidebook for Clinicians all available on the ncptsd website.
Earlier, Critical Incident Stress Debriefing was a popular intervention in disasters to help mitigate the effects of trauma. More recent studies have either shown no effect or even hamful effects with debriefing, necessitating a reevaluation of disaster mental health responses toward a psychological first aid framework.
Responders to most disasters in Japan, the US, Australia and other parts of the world are now embracing Psychological First Aid as the initial intervention of choice, followed by other more individualised approaches with the passage of time.
Debriefing, however, may still be useful for the responders themselves, given that they are more psychologically aware, and may be more willing to verbalise their experiences in order to avoid vicarious traumatisation.
Research Continues.

Friday, January 11, 2008

There's Nothing like 'political' violence; it's all sheer envy

Publication Date: 12/14/2007

IN NORMAL CIRCUMSTANCES, when a person hacks a neighbour to death, he is arrested, charged with murder, and if convicted, sentenced to death under the law. If one burns a neighbour’s house, he is charged with arson and is sentenced appropriately.
Clearly, we are not living under normal circumstances today. All around the country, crazed mobs are running around armed with all sorts of simple and sophisticated weapons maiming and killing fellow citizens with abandon.
All this is ostensibly in the name of political activity. No election campaign is complete without supporters of one candidate attacking those of his opponent. Criminal acts have been labelled ‘‘political violence’’ and blame has been laid squarely at the feet of our political class. Politicians are being accused of inciting people and paying for the violence.
THE QUESTION THAT BEGS AN answer is this: Which politician has held a gun to someone’s head and forced them to hack their neighbour with machetes and burn their houses? Is there a politician out there who has threatened a group of people with death if they do not go out and attack his opponents?
Using terms such as ‘‘political violence’’, ‘‘politically instigated violence’’ or ‘‘incitement’’ only legitimises crime and allows people to carry out barbaric actswithout fearing the repercussions.
Murder, arson, armed robbery, carjacking and all sorts of heinous crime attain a sacrosanct status, and the perpetrators cannot be brought to book because their ‘‘political’’ godfathers will raise hell!
The truth is that there is no such thing as ‘‘political violence’’. It appears that many Kenyans live in a state of perpetual envy of their neighbours’ property and perceived success and only need an excuse to dispossess them, even if it means taking their lives. People make personal decisions to harm their neighbour, and then they find a comfortable cover for doing so. The ‘‘political violence’’ tag doesthe job perfectly.
No amount of incitement would otherwise cause a right-thinking man to suddenly attack his neighbour of many years without any provocation. No amount of money would convert a God-fearing upright citizen into one of the monsters we see on TV shouting death threats at people who hold contrary views.
One columnist recently stated that all it would take for the violence to end is for the politicians to say ‘No’. This could not have been further from the truth!
Politicians are under the control of their supporters, not the other way round. They will do whatever is necessary to get them elected. They will happily say no to election violence but complain bitterly when their supporters are arrested and charged with committing the same crimes. However many politicians say ‘No’ to violence, it will not stop as long as Kenyans are still happy when members opposing camps or tribes are attacked and killed during campaigns.
Poverty has often been cited as a reason why people are easily ‘‘incited’’ into committing violent crimes during campaigns. But poverty does not convert one into a mindless automaton that obeys orders from the highest bidder.
Criminals do not reform when they get rich. Nor do good people become criminals when they encounter poverty. Poverty and politics are, therefore, excuses that people use to commit crime and escape punishment.
THE MAJORITY OF POLITICIANS ARE representatives, not leaders, and are incapable of inciting us to do what we are unwilling to do. They cannot come up with any values alien to what their supporters hold deeply themselves. It would seem that the politicians are pawns in this complex game of politics, fulfilling the wishes of those they represent.
Strict, impartial and severe application of the law might be a starting point in dealing with these crimes. Killers must be held personally responsible for their crimes. Arsonists must be punished for their crimes. Once these criminals realise that they have no protection from the law, they may become less willing to accept inducements from politicians to commit ‘‘political violence’’.

Dr Atwoli is a consultant psychiatrist operating in Eldoret
© 2005 NationMediaGroup All Rights Reserved