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

Thursday, January 10, 2008

We're on the Brink of Becoming one of Africa's Failed States

Publication Date: 1/3/2008

AFTER PROTRACTED TALLYing following the December 27 General Election, the Electoral Commission finally pronounced a winner in the closest presidential race in Kenya’s history. Opinion polls preceding the vote had predicted a tight race, but not even the pollsters could predict just how close it would be. Predictably, there are protests by those claiming the poll was rigged in favour of the incumbent, and people are spilling into the streets to express disappointment. The merits or demerits of these allegations cannot be fully examined in this article.
A more worrying development, however, is the widespread violence, looting and destruction of property across the country. As the American ambassador said in an interview, violence has no place in a democratic society. After an election, however flawed, the winners must be magnanimous and reach out to those who have not won, while the losers must be measured in expressing their disagreement with the result.
HARMING OTHERS AND DAMAGING property does not change the outcome of an election, and it does very little to further the cause of the protesters. All legitimate avenues of protest must be explored and pursued to their logical conclusion.
It has always been clear that the perpetrators of violence are common criminals looking for an opportunity to loot and get away with it. The looters seen on national TV carrying away cookers, TV sets and carpets from a supermarket could not have been expressing any political opinions through their acts.
As we digest the implications of the election result and the resultant reactions, we must seek to understand the issues that threaten to tear apart the fabric of our republic if left unattended. These issues include negative ethnicity, paucity of leadership, and enduring dishonesty among key segments of our population.
The spectre of negative ethnicity has been illuminated through statements and opinions expressed by many Kenyans, politicians and common citizens. Some questioned the legitimacy of leaders elected with the support of only one tribe, while others questioned the credentials of some leaders on the basis of their ethnic origins and traditions. Ethnic stereotyping took on monstrous proportions, and to a large extent, became a key issue in deciding the election.
As the country impatiently waited for the results to be released, a great opportunity existed for the emergence of leaders who would appeal to the people’s best instincts and encourage patience and peaceful coexistence.
Sadly, this opportunity went begging. Our ‘‘leaders’’, instead, chose to engage in accusations and counter-accusations in the full glare of the media, thus inflaming passions among their supporters and tacitly encouraging them to seek alternative outlets for their frustrations.
As the violence spread, politicians appealed for peace with their mouths but projected belligerence with their body language. Key politicians remained silent, as though nothing was happening.
A final problem with our society is the dishonesty with which we handle important matters in our national life. We have refused to acknowledge and deal with serious historical and current crises in our country. We chatter in bars, marketplaces and street corners and then go home and perpetuate the same vices we decry. We have refused to deal with issues, and preferred to link our destiny to individuals. We have refused to build enduring institutions, instead leaving the affairs of state to the whims of those that represent our ‘‘community’’ interests.
EVERYONE KEEPS TALKING ABOUT equitable sharing of the ‘‘national cake’’, as though the nation is separate from us and our ethnic communities. Our fixation with free things is symptomatic of our national psyche. We demand free education, free healthcare and even cash handouts for the unemployed. The amounts of money involved in the collapsed pyramid schemes illustrate our collective propensity for ‘‘free’’ material gains. We don’t understand that building a nation is hard work: Sweat, tears and even blood such as that shed in the struggle for independence.
The country stands on the brink of a precipice. The choice is ours: Do we jump off and become yet another statistic in the crowded galaxy of failed African states?
Or do we take a deep searching look at the consequences of our actions and speech, and turn back to the more important business of building some semblance of nationhood?

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

Stop the Killings!

The nation lies wounded, bleeding at your feet. The blood of innocents flows torrentially into the Great Rift Valley lakes and rivers. Lake victoria threatens to turn crimson with the blood of people whose only crime was to (presumably) vote differently from us.
Ethnic cleansing is rife in most parts of our beautiful country.
While this continues, we fan the flames by distributing evil emails, sms and messages, unaware that we are initiating yet another chain of bloodletting by inflaming passions one way or the other.
The nation stands on the brink of a precipice. The decision is in our hands- we can jump and join Somalia and other African countries that bloat the pantheon of failed states. Or we can, by our individual efforts, move to stem the bloodshed, by refusing to engage in negative thought, emotions and acts. We can stop our fathers, brothers and sons from wielding those machetes; we can stop them from burning women and children in churches and other sanctuaries.
We can stop and help injured neighbours; we can provide food and shelter to those displaced. We can call our friends and acquaintances and pass on a positive message.
We can believe in the dream of a safer future, free of ethnic jingoism, where everyone is given the opportunity to strive for a better life.

Tuesday, January 1, 2008

The Kenyan Politician

Society, they say, gets the leaders it deserves. It may be wise for Kenyans to reflect on this saying especially during this election season. In Kenya, leaders are defined as councillors, MPs, Presidents and aspirants for those positions. We can therefore paraphrase the above aphorism- we get the politicians we deserve.
Some people would say that democracies propel the best in a society into leadership positions. Many more would aver that a democratic process produces what represents the average view of the majority, that leaders in a democracy would reflect the average situation in a society.
I disagree with both positions, especially on the Kenyan political scene. Judging from our political history, it would appear that our democratic process tends to throw up individuals who will not fit into any other area of our social life. Thus many unsuccessful businesspeople turn to politics, as do unsuccessful lawyers, doctors, teachers, professors etc. Politics has turned into a playground for failures and retirees, and it is no wonder that the people into whose hands we leave the affairs of state many times have no idea what to do with the power we hand them.
I also disagree with the earlier assertions partly from a selfish point of view: I believe I am an average Kenyan, and very few of our ‘representatives’ represent what I believe in. If I was to agree that they represent either the best or the average among Kenyans, I would have to agree that the average Kenyan has many obnoxious attributes, a few of which I will enumerate.
Laziness would be the first attribute I would give the average Kenyan based on the behaviour of his representative. They work the fewest hours and waste no opportunity to avoid their responsibilities, but they expect their regular pay check at the end of the month. They perfect the art of procrastination, waiting until the last minute to begin doing what they must do, taking the maximum allowed time, and them asking for more.
Greed and hankering after quick wealth would have to compete for honours with laziness. For our politicians, leadership positions are opportunities to enrich oneself, their family and friends. They will steal, blackmail, grab, and use all means at their disposal to become as rich as possible in the shortest possible time.
Dishonesty would follow as a key attribute of the average Kenyan. Our representatives have no compunction singing the praises of one individual or idea today and without batting an eyelid change their tune the next day. This change would not be motivated by any amount of deep soul-searching, but would result from some such personal misfortune as defeat in nominations, or the offer or promise of a position in government, or even an exchange of some sum of money or property. Our ‘leaders’ will paint each other as monsters in daylight, while dining together in the evening and laughing at their daytime theatrics.
A final attribute I would reluctantly bestow on the average Kenyan would be either low intelligence or plain ignorance. People who sprout profound wisdom when not in politics suddenly start saying the most ridiculous things in public and expecting everyone to believe them. The tragedy is not that they say such things, but that a large segment of the population actually believes them and takes them seriously.
Because I am reluctant to accept that the average Kenyan possesses the attributes enumerated above, I disagree with the precept that our politicians represent the attributes of the best or the average Kenyan. I think we take politicians far too seriously in our country, and end up expecting too much from them. Politics and elections are a matter of life and death to politicians, for that is where they earn their living from. But they are not, and must not be made matters of life and death for the average Kenyan.
This is why it puzzles me that we are quick to take up machetes and hack our neighbours to death during election seasons, and then turn and blame politicians for inciting us. We run into streets and brave police bullets while stoning strangers on behalf of politicians who wouldn’t care less if we live or die.
If we agree that politicians do not represent the best, or even the ‘average’ among us, then we must behave a bit more responsibly and put politicians squarely in their place. We must treat them with the indulgence we would give a person who cannot take responsibility for his actions. We should give them very little responsibility, watch them carefully every step of the way and refrain from blaming them for ruining things, for that is what is expected of them.
The alternative would be to accept that we are all like our politicians, God forbid!